HomeMy WebLinkAboutP2021-0536 - PermitsCity of Newport Beach - Building Division 111111III 11111p11111p1111111111111111111p1111111111
o r, 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 2 1 0 5 3 6
Permit Counter Phone (949).644-3288'
Job Address: 532 FULLERTON AVE Bldg: 1 Floor: Suite:
Description of Work: PLUMB/GAS LINE TO BBQ
Inspector Area: 3 Code Edit 2019
Legal Description: FIRST ADD TO NEWPORT HEIGHTS BLK 39 LOT 9
Owner: CONSTANTINER MICHAEL/LAURA
Contractor:
Compensation Insurance -
Address: 532 FULLERTON AVE
Address:
28241 CROWN VALLEY PKWY, F293
NEWPORT BEACH, CA 92663
LAGUNA NIGUEL CA 92677
Phone:
Phone:
949-363-7932
Con State Lic:831378
Issued Date:11/3012021
Lic Expire:
0212812022
Bus Lic:
BT30060506
Processed By:
Lic Exp Date:
09/30/2022
PLUMBING Permit: P2021-0536
Project No : 2796-2021
Inspection Requests Phone (949)644-3255
OUTDOOR CONCEPTS
Carrier: BENCHMARK INS CO
Policy No:CST5021783
Expire : 06/18/2022
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ri-INorker's
J0p
.
FEES
Bathroom Fixtures
Kitchen Fixtures
Misc.
Misc.
Other
Toilet:
0
$0.00
Kitchen Sink:
0
$0.00
Water Piping:
0
$0.00
Roof Drain: 0
$0.00
$0.00
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:
0
$0.00
Grease Interceptor:0
$0.00
Bath Tub:
0
$0.00
Vegetable Sink:
0
$0.00
Gas up to 4 outlets:
1
$8.00
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:O
$0.00
Lndry/Trap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
$38.00
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:
$46.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance : $46.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Monday- Friday 7:6u a.m. to 6:30 p.m. aYd Saturday. -ram 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 items)
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the 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 Iicensure 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 U 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
improvements are 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).
❑ 1, as owner of the 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).
❑ 1 am exempt from Iicensure under the Contractors' State License Law for the following reason:
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legally
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profe�signs Code, and my license is in full force
and effect C I
License Class License No Dat '�?� Contractor SignattlGe�c
COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDTHOUSAND DOLLARS ($100,000), IN ADDITION TO THE
:DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
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
Tpence of the work for which this permit is issued. Policy No.
and will . Intain workers' compensation nsurine, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
carrier kdolicy numb ar : '
is of Agent v v
certify that, in the performan of the ork for which
if I should become jCbje to a work pen!
lature of AODlican 1 �
Date
permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and ag
isions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
n --_si `/ / .?,-)
hereby affirm under penaltytf pgfjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ender's Name �� Lender's Address
y my signature below, I certlTf to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and countyprdmanc and state laws relating to building construction.
I authorize representatives of this city or county,Io j(nte e a ove-ide{Itified property for inspection purposes.
L�� l
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE
77
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