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Home My WebLink AboutP2011-0449 - Permits(4) City of Newport Beach Building Division PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 PLUMBING Permit No: P2011-0449 Inspection Requests/Telephone (949)644-3255. INSpFCToR Job Address: 2765 VISTA UMBROSA Bldg: 1 Floor: Suite: Description of Work: PLUM/C/O WATER HEATER SAME LOCATION "LIKE FOR LIKE" Inspector Area: 3 Code Edit 2010 Legal Description: N TR 6905 LOT 40 Owner: GRIGORIAN ARMEN A Contractor: ORANGE INSTALLERS Worker's Compensation Insurance - Address: 2765 VISTA UMBROSA Address: 905 E CHALYNN AVE Carrier: EVEREST NATIONAL INS NEWPORT BEACH, CA 92660 ORANGE CA 92866 Policy No:7600007247111 Phone: 949-294-1128 Phone: 714-532-4857 Expire : 04/27/2012 Con State Lic:511971 Issued Date: 1.1101/2011 Lic Expire: 06/3012013 • Bus Lic: BT30026564 - - - - - Processed By: o Lic Exp Date: 01/31/2012 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 $C.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. n;.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 over2": 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 TOTAL: $49.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $49.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION JI ,(�,qV 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, 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 Cade) 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 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). - ❑ I, 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 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 Iegall 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.govlmlaw.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 Professio od an my license is in full force and effect. '_icense Class License No Date I( (( Contractor Signature WORKERS' COMPENSATION DECLARATION ARANG: FAILURE T J 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 r 061 OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. �ieleoy affirm under penalty of perjury one of the following declarations: I have and w;:I mai,itain 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 IN LN*FRaice of thn -vo,k for which this permit is issued. Policy No. a e 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' compensatio ir.su>rlcL carrier and policy number are: Carrier_ _ _ _ _ Policy Number Expiration Date Na na cf Agent V Phone # I certify that, ir.:hz ps.lormance of the wo for which this 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 agre that, if I should become subject to the r rs' ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ``�^1 p Signature of Applicant N � DECLARATION REGA7RDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By 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 orreG: I agree to comply with all applicable city and county ordma nd ate relating to building construction. I authorize representatives of this city or county to enter t b v - en property for inspection purposes. Signature of Property Owner or Authorized Agent _. Print Property Owner's or Authorized Agent's Nam 11611 Date ACRON POZ/Z7/iZ BY DECLARATION OF COMPLIANCE IMTH CODE OF fOR OFR[E USE ONLY FEDERAL REGULATIONS PART 61 OFTITLE 40 AND AOMD RULE 1403. ❑ ISUBMITTED ASBESTOS N071FICATfONTO: [3 EPA [IAQMD PERM17IXP1RED PERMITCANCELLED PERMIT EXTENDED ❑ ASBESTOS NOTfRCATIONIS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMIT FINAL ❑' Wl qc c^ CERTIFICATEOF � H OCCUPANCYISSUED