HomeMy WebLinkAboutP2018-0024 - Permits0--tw.'O,
City of Newport Beach - Building Division100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 8 0 0 2 4
Permit Counter Phone (949)644-3288
Job Address: 206 29TH ST Bldg: 1 Floor: Suite:
Description of Work: MFR SEPARATE UTILITY ENTRANCES (SEWER & WATER)
Inspector Area: 1 Code Edit 2016
Legal Description: LAKE TR BILK 128 LOT 4
Owner: SHIRLEY BRYAN/DUNE
Contractor: OWNER/BLDR
Address: 206 29TH ST
Address: JUNE SHIRLEY
NEWPORT BEACH CA 92663
Phone: 267-463-7898
Phone:
Con State Llc:O/B
Issued Date:03/16/2018
Lic Expire:
Bus Lic:
Processed By:
Lic Exp Date:
PLUMBING Permit: P2018-0024
Project No: 0188-2018
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier :
Policy No:
Expire :
FEES
Bathroom Fixtures
Kitchen Fixtures
Misc.
Misc.
Other
Toilet:
0
$0.00
Kitchen Sink:
0
$0.00
Water Piping:
1
$6.00
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
Backflow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
$62.64
Hydra -Mass Tub:0
$0.00
Lndry/Trap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:2
$66.00
Issuance:
$0.00
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:
$113.50
TOTAL:
$248.14
Plan Check Fee:
$176.14
Fee Due at Permit Issuance: $72.00
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.
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OWNER -BUILDER DECLARATION
1 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'"',_m(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 L) 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 employees' or personal effort, builds or improves the property, provided that the
rovemenIs 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
fi� ro ed for the purpose of sale).
I61 I, s 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
y 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).
LJ 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 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 w n sp lication is sub m' t or at the Ilowin W e:http://www.leginfo.ca.gov/calaw.html. //� ate/ y
Signature of Property Owner or.Authorized Agent D2%\ '��ai-!!L f
LICENSED CONT C S DECLARATION
1 hereby affirm under penalty of perjury that I am lice a under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class License No Date Contractor Signature
NORKERS' COMPENSATION DECLARATION
NARNING: 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 ATTORNETS FEES.
hereby affirm under penalty of perjury one of the following declarations:
1 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
rerformance of the work for which this permit is issued. Policy No.
:1I 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' compensation,
nsurance carrier and policy number are:
carrier Policy Number Expiration Date
Vame of Agent Phone #
kI certify that, in the performance 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 agre
ha if I should becom 'ect to the workers' compensati'Ti provisions ction 3700 of the Labor Code, I shall forthwith comply with those provisions.
e�/A- /
Signature of Applicant Dates l���i�.— /(1 aZE%�d
)ECLARATION REG G CONSTRU TION LENDING AGENCY
hereby affirm under a Ity 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).
-ender's Name Lender's Address
3y my signature be ow, I certify to each of the following:
1 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 coun ordinances and state laws relating to building construction.
I authorize representatives of this city, or county ter the abov -id ntified pr any f ' spection purposes.
signature of Property Owner or Authorized Agent ' t Property Owner's or Authorized Agents Nam u to
ACTION DATE BY DECLARATION OF COMPLIANCE KgTNCODEOF FOR OFFICE USE ONLY
FEDERALR GUATIONSPART61OF71TLE40AMD
PERMITEXPIRED A4MQRU 'I d.: ` ••• •
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PERMIT'CANCELLED ❑ t• ` • • ` • ` i
PERMLT EXTENDED A?MD
SBESTDS NOTIAC4TIONIS NOT APPLICABLE TO
PERMITF1NAL OSED O•fJJJO%. • • �••
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OCCUPANCYISSUED
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