HomeMy WebLinkAboutP2018-0299 - Permits (2)City of Newport Beach - Building
Division 'P2018-0299* PLUMBING Permit: P2018-029
100 Civic Center Drive, Newport Beach, C
92660/ / rOJ2C
Permit Counter Phone (949)644-3288
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Inspec o eques s (949)644-3255
❑ 80% or ❑ 100% refund I
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Suit% . t N� " %mof Cm ALm to Whom: r
Job Address: 441 SEAWARD RD Bldg: 1 Floor:
Description of Work: SFR WATER HEATER C/O
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Inspector Area: 5 Code Edit 2016
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Legal Description: N TR 1237 LOT 8
Owner. GILCHRIST MARY ALYS Contract
r: LDR °L mpensationInsurance- 8
Address: 441 SEAWARD RD Address
Carrier: f
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CORONA DEL MAR, CA 92625
Policy No:
Phone: 949-726-1878 Phone:
r. nir�
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CcExpi
Issued Date:08/31/2018 Lic Expi
L_ �' y:�peJE-4I i.a ceha•1k
Bus Lic:
(Work Started) no work started)
Processed By: LicExp
ate:
Note:
_ FEES Ins inn ials:
Bathroom Fixtures Kitchen Fixtures Misc. Misc. Other
Toilet: 0 $0.00 Kitchen Sink: 0$0.00� Water Piping: 0ram:
Bidet 0 $0.00 Garbage Disp: 0 $0.00 Water Softener: 0 $0.00 Grease Trap: 0 $0.00 $0.00
Urinal 0 $0.00 Bar Sink: 0 $0.00 Water Heater: 1 $15.00 Grease Interceptor:0 $0.00
Bath Tub: 0 $0.00 Vegetable Sink: 0 $0.00 Gas up to 4 outlets: 0 $0.00 P-Trap: 0 $0.00 Record Mgmt Fee: $0.00
Shower Stall: 0 $0.00 Ice Maker: 0 $0.00 Gas over 4 outlets: 0 $0.00 Sewer Investigation: $0.00
Wash Basin: 0 $0.00 Dishwasher: 0 $0,00 Backflow up to 2": 0 $0.00 Sewer: 0 $0.00 Plan Check: $0.00
Hydro -Mass Tub:0 $0.00 Lndrylfrap: 0 $0.00 Backflow over 2": 0 $0.00 Sewer Alter/Repair:0 $0.00 Issuance: $33.00
Floor Sink: 0 $0.00 Regulator: 0 $0.00 Hose Bibb: 0 $0.00 Sewer Abandon: 0 $0.00 Supplemental Fee: $0.00
Floor Drain: 0 $0.00 Lawn Sprinkler: 0 $0.00 Drinking Fountain: 0 $0.00 Additional Fee : $0.00
TOTAL: $48.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $48.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE'OR LAST VALID INSPECTION��
Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s)
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, priorto its issuance, also requires th^applicant for
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
improverr.ents ara not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
improved for`the purpose of sale).
❑• I. as owcerrof tha property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
nI am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below I acknowledge that, except form personal residence in which I must have resided for at least one year prior to completion of the improvements covered b this permit, I cannot legal)
sc•II a strtcturehat I have built as an owner -builder " it has not been cons�wcted in its entir ty by licensed contractors. I understand that a copy of the applicable law, Sectio 044 of the Business and
Professions Coda, is available upon request wh is appl' a is s b itt o at of ling Web site:http://www.leginfo.ca.gov/calaw.html.
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Signature o} NiopeCy Owner or Authorized Agent Dat
LICENSED CONT T LA T
I hs.aby affirm and=r penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions ode, and my license is in full force
and effect.
I.IOPrse Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued. Policy No.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
rance carrier and policy number are:
ier Policy Number Expiration Date
1e of Agent Phone #
certify that, in the pert rmance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to
if I should become bjec�t to theppp rkers' co,[�`n \ns o ovissio(nss of Section 3700 of the Labor Code, I shall forthwith comply with those provisip
lature of Applicant\`�.A� Ali \ Dat4'/
.reby affirm underoenalty of perjury that there is a construction lending agency for the performance of the work for which this permit is
Ider's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the p operty owner's behalf.
I have read this application and the information I h e provided is correct.
I agree to comply with all applicable city and cou ordinances and state laws relating to building construction.
I authorize representatives of this city or county #,pterftabryvq,id n' le property for inspection purposes.
of Prooertv Owner or Authorized
ACTION
DATE / I BY
I PERMITCANC€LL€D I I I
I PERMITEXTENDED I_ I I
OCCUPANCYlSSUED
AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NORfICATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
workers' compensation laws of California, and
3097, Civil Code).
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