HomeMy WebLinkAboutP2010-0015 - PermitsJob Address: 2781
City of Newport Beach
Building Department
PLUMBING Permit No: P2010-0015
PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255
VISTA UMBROSA Bldg: 1 Floor: Suite:
Inspector Area: I # 3 Code Edit 2007
Legal Description: N TR 6905 LOT 44
Owner: DOMBROW FAMILY TRUST
Address: 23132 SOMERSET CIR
MONARCH BEACH CA 92629
Phone:
Issued Oate:01/12P1010
Processed
Contractor: ORANGE INSTALLERS
Address: 905 E CHALYNN AVE
ORANGE CA 92866
Phone:
714-532-4857
Con State Lic:511971
Lic Expire:
06/30/2011
Bus Lic:
BT30026564
Lic Exp Date:
01/31/2010
Description of Work: PLUM/WATER HEATER C/O
Worker's Compensation Insurance -
Carrier: DELOS INS CO
Policy No:01 DKRM12006530
Expire: 04/27/2010
�IVSP�CTar?
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
$14.65
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:
$1.05
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
Lndry/Trap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
$33.10
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:
$48.80
Plan Check Fee :
$0.00
Fee Due at Permit Issuance : $48.80
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
BY:
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 PERMIT EXPIRED
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 PERMIT CANCELLED
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 ( ) 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 employVees' or personal effort, builds or improves the PERMIT EXTENDED
property, provided that the improvements are not intended or offered for sale. IT., however, the building or improvement Is sold
f I h Ow B Id ill have the burden of rovin that It was not built or improved for the
within one year o comp etli ivon, t e ner- uer wp
�rposeofsale). PERMIT FINAL 06/ZS/Io
L l I, as owner of the propert , am exclusively contracting with licensed Contractors to construct the project (Section 7044, l rG r� qj
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 CERTIFICATE OF
Law).
❑ I am exempt from licensure under the Contractors' State License Law for the following reason: OCCUPANCY ISSUED
3y myy signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year
Nlor to completion of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -
wilder 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
ollowing Web site:hftplAwm.leginfo.ca.gov/caiaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under provisions of Chapter 9 (commencing with Section 7000)
of Division 3 of the Business and Professions Code, and my license is I grce an ffect.
ktense Class ` License No. 1
Bate (— 1�- t> ��ntractor Signature G
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 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
❑ I 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
Name of Agent _
❑ I certify that,
so as to become
workers' compenl
Signature of Appli
will maintain workers' compensation insurance, as required, by, Section 3700 of the Labor Code, for the
e work for which this permit is issued. My w rke s' compensation insurance carrier and policy number are:
wl Policy2bUQ;5' Expiration Date_( JZ- 16
Phone #
of the work for which this permit is issued, I shall not employ any person in any manner
ers' comppensation laws of California, and agree that if r should become subject to the
Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
I hereby affirm, under enalty of perjury that there is a construction lending agency for the performance of the work for
which this permit is Issued Section 30p7, 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 propert read this application and the information have vi correct.
I agree to comply with all applicable city and county i and sta aw elating to
I authorize representatives of this city or county to the Crove-1 pe
'gnature of Property Owner or Authorized Agent
:Pjint Property Owners or Authorized Agent's Name:
FOR OFFICE USE ONLY
0110112009