HomeMy WebLinkAboutP2019-0165 - PermitsCity of Newport Beach - Butiding Division100 Civic Center II II �IIIIIIIIIIIIII IIIII�IIIIII IIIIIIII II
Counter Phone (949)644-3288 Drive,
Beach, CA 92660 P 2 0 t 9 0 7 6 5
Permit
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Job Address: 422 VISTA GRANDE Bldg: 1 Floor: Suite:
Description of Work: PLUM -SEWER CLEAN OUT
Inspector Area: 8 Code Edit 2016
Legal Description: TR 6230 (L.L.84-214033) PAR 10
Owner: THE BLUFFS HOA
Contractor:
ROTO ROOTER SERV
Address: 2141 VISTA DEL ORO
Address:
23311 MADERO
NEWPORT BEACH, CA 92660
MISSION VIEJO CA 92691
Phone:
Phone:
949-380-4161
Con State Lic:1016021
Issued Date:05/30/2019
ic Expire:
Luc
07/31/2020
us Lic:
BT30057895
Processed By:
Exp Date:
01/31/2020
PLUMBING Permit: P2019-0165
Project No :
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier: FEDERAL INS
Policy No:54309480
Expire: 08/01/2019 • - -
0
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:
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
Backftow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
$0.00
Hydro -Mass Tub:O
$0.00
LndrylTrap:
0
$0.00
Backftow overt":
0
$0.00
Sewer Alter/Repair:l
$35.00
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:
$70.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance : $70.00
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, 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 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 legalll
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.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm urder Penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se ion 7000) of Division 3 of the Business and Profe lions Code, and my license is in full force
and -fact. / /l
license Class License No Dat, u 1 l 4 Contractor Signature a
COMPENSATION DECLARATION
'ARNING: 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
OFT OF OMPENSPTICN, DOMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
herehy affirm under penalty of perjury one of the following declarations:
7 I have and will mair,:ain 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
c�canence 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 pd;;cy number are:
is of Agent __--,
certify that, in the pl
. if I should become
Policy Number
Date
of the work 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
heiworkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. y
Signature of Applicant/ Late-, � I J -1
DECLARATION REGAR G 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 correct.
I agree to comply with all applicable city and county o Ina nd state laws relating to building construction.�Av�c./n
I authorize representatives of this city or coun ent64�er the abo -identified property for inspection purposes. // d
Signature of Property Owner or Authorized Agen - Pdnt Property Owner's or Authorized Agent's Name e
AC 1ON
DATE
BY
DECLARATION OF COMPLIANCE tMTNCODEOF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OFTITLE40AND
AQMO RULE 1403.
PERMIT EXPIRED
❑ i SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERMIT EXTENDED
0 ASBESTOS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERNRTFINAL
05/31/19
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CERTIFICATEOF
OCCUPANCYISSUED