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Home My WebLink AboutP2018-0208 - PermitsCity of `r for � �d�t� vl�_ Ill/ lllllllll llllllllllllllll�llllll llllllll lllllf applicable: PLUMBING Per it: P2018-0208 100 -�+N Project No Permit Cou P ne (949)644-3288 ❑ 80% or ❑ 100% refund �i NCELto Inspection Requests Ph a (949)644-3255 whom: Job Address: 1900 EERY N Bld Description of Work: PLUM tF IR ;) KITC N S LI€ r,rt , Inspector Area: 3tjd Edit P I R &MR Legal Description: N TR 18061LQT 9 Y r; Owner: DABOLT JOYCEL0 C ractor: RESCUEROOTER Worker's Compensation Insurance - ✓ /� Address: 221 ROSE LN A� N 3 � c lit o:l 31L COSTA MESA CA Q2 7 k Phone: ie'' Pho e: 714-7 , Expire : � 1/2018 CoA 6ic J (no Worii Stc^fe.�'� Issued Date:06/12/2018 Lie Expire: 07/31/2018 • Bus Lie: BT30046061 Processed By: -""' -tiC'@RpSatB-0212 w insp. initials: 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 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:l $33.00 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 Additional Fee : $0.00 TOTAL: $66.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $66.00 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 tl •D• DI• 4tD Q 0 D b D D 8 4 D 0 p D D Y G f6 D OP B• 4 4f O 4 4 6 [ 4 et C tlU CV oma DDn Do v o DDo Dm4 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 d0 `) all of or L) 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). ❑ 1, 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 legall, 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/ca[aw.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 Professions Code/,, and my license is in full force and effect. ` /ld 1��/,X✓ik License Class License No DateX � 1�_ 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 ATTORNEY'S FEES. hereby affirm under penally 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 th Derfo ance of the work for which this permit is issued. Policy No. have and will ppIn�� tain 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' compensatiol nsurance carrier\ p licy number ar ^. ardor \ I .,, 1 P,K v Ngm-I& Expiration Date is of Agent t vnone g 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 if I should become su 'ect tg the � rkI/e�s' corrtpenlsaation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 1 lature of Applicant 1 Clyon°,`",' / /l�ll`t%xV' L_U CLARATION REG"DING CONSTRUCTION LENDING AGENCY - )reby 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). Ider's Name Lender's Address my signature below, 1 certify to each of the following: I am the property owner or authorized to act on the property owners 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 laws relating to building construction. I authorize representatives of this city or cou�nty/5� ter the abo/v`(y')�identified property for inspection purposes. nature of Property Owner or Authorized Agent_ G�r1 L1 f� Id t� Print Property Owner's or Authorized Agent's Name ' 1L Date ACTION DATE BY DECLARATION OF COMPLIANCE MTH CODE OF FOR OFFICE USE ONLY FEDERALREGULATIQNy PA.QT61OPNTEE40AND •. .' AQMDRULE 1403. . • • . . . PERMITEXPIRED ❑ iSUBMITTEDASaST0.%VO.II4C4T10VJ& •; ❑ EPA • • • •• ❑ AQMD ❑ ASBESTOS NOTIFICATIONIS NOTAPPLICABL.E TO PROPOSED DEMOUTIQM • •; , • • • ° • • • , • • " • ` PERMI€CANCELLED PERMITTEXTENDED PERMIT FINAL CERTIFICATE OF SIGNATURE: ; ; '; ; • ', ', OCCOPANCYISSOEO • • • .. • • • • . e •