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Home My WebLink AboutP2019-0171 - PermitsZ: City of Newport Beach -Building Division `P2019-0171' PLUMBING Permit: P2019-0171 a y- 100 Civic Center Drive, Newport Beach, CA 92660 Project No Permit Counter Phone (949)644-3288 c��c�rLw;n' Inspection Requests Phone (949)644-3255 Job Address: 6 CROOKED STICK DR Bldg: 1 Floor: Suite: Description of Work: PLUMBING -WATER HEATER CHANGEOUT Inspector Area: 8 Code Edit 2016 Legal Description: N TR 15391 LOT 64 Owner: BAILEY WILBUR ROBINSON TR Contractor: GREENSTAR HOME SERVICES Worker's Compensation Insurance - Address: 6 CROOKED STICK DR Address: 1951 N MAIN ST Carrier : LIBERTY INS NEWPORT BEACH, CA 92660 ORANGE CA 92865 Policy No:WA763D508631018 Phone: Phone: 949-885-0102 Expire : 10/0112019 Con State Lic:795556 Issued Date :Q5181120 9 Lic Expire: 0212912020 . Bus Lic: BT30056111 Processed By: % Lic Exp Date: 08/31/2019 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: 1 $16.00 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 LndrylTrap: 0 $0.00 Backflow over 2": 0 $0.00 Sewer Alter/Repair:0 $0.00 Issuance: $35.00 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: $51.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $51.00 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 items) (Section 7031.5, 3i^iness 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 -sipped 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 Frofessions 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 hindrad dollars ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, 3usi.i-,ss 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 impruveo for the parpoae of sale). ❑ I Psowner or fn= 9roperty, 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). n I am exempt from licensure 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 legall sell a structure that I `lave 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 Protessions Cede, isavailable 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 70 0) of Division 3 of the Business and Profess y Ice s-'hrfull force and effect. License Class License No Dat Contractor rai WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS 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. 1 hereby affirm under penalty of perjury one of the following declarations: 111 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 tf pe ormance of the work for which this permit is issued. Policy No. 5 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' compensatic insl0lance carrier and policy number are: ter Policy Number ie of Agent certify that, in the performance of the work for which this permit is . if I should become subje ompensa Ion pr0yi—SW of Date I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre( ction 3700 of the Labor Code, I shall forthwith comply with those provisions. Date CLARATION REGARd1NGe®1119TRUCTION LENDING AGENCY 3reby affirm under penalty of'peyuryrthat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). 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 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 county ordinances and state law relating to building construction. ` I authorize representatives of this city or count t ant „-,a - - n le P Y fI cl - " T 3moses. Tim pmPetLY..f �..�.,o� ..,,T. ��oo��GGG�LLL mature of Property Owner or Authorized Agent �� Print Propert Owner s or Authorized Agent's Name Y DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ACTION DATE FEDERAL REGULATIONS PART 61 OF TTTLE40AND AQMD RULE 1403. ❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD ❑ ASBESTOS N07IFICATION75 NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMfT€XPIRED P€RMITCANCELLED PERMITEXTENDED PERMITRNAL CERTIFICATEOF OCCUPANCY/SSUEO