HomeMy WebLinkAboutP2018-0187 - PermitsCity of Newport Beach - Building Division 1111111111111111111111111111111111111111111111111111111 Jill
a$ °. 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 8 0 1 8 7
w - s Permit Counter Phone (949)644-3288
Job Address: 1812 ANTIGUA CIR Bldg: 1 Floor: Suite:
Description of Work: PLUMB SEWER CLEAN OUT
Inspector Area: 3 Code Edit 2016
Legal Description: N TR 3764 LOT 24
Owner: MCBRIEN SUZANNE
Contractor:
DIAMOND MIKE
Address: 1812 ANTIGUA CIR
Address:
3801 LENAWEE AVE
NEWPORT BEACH, CA 92660
FEES
CULVER CITY CA 90232
Phone:
Phone:
310-838-0406
Con State Lic:765436
Issued Date:O 30/201
Lie Expire:
07/31/2019
Bus Lic:
BT00014957
Processed B : r
Lic Exp Date:
10/31/2018
PLUMBING Permit: P2018-0187
Project No :
Inspection Requests Phone (949)644-3255
N `40, " I CTO- R
Worker's Compensation Insurance -
Carrier: REDWOOD INS
Policy No:MIWC916676
Expire : 01/01/2019
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.
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
Bidet
0
$0.00
Garbage Disp:
0
$0.00
Water Softener:
0
$0.00
Grease Trap: 0
$0.00
°
sTod
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:
$6.00
Shower Stall:
0
$0.00
Ice Maker:
0
$0.00
Gas over 4 outlets:
0
$0.00
Sewer
Investigation:
° $U.0®
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:O
$0.00
Lndrylfrap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:1
$33.00
Issuance:°f:f:
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...
o °
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.
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).
❑ 1, 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 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 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 @.copy-athe ap' p II'�caV Iaw-Se tion 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.g lc3faw.html.
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 S ion 700 of vi�on 3 of the4Biness a ns Code, and m license is in full force
and effect. / License Class License No Contractore
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
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
:11 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
2e,rformance of the work for which this permit is issued. Policy No.
ylift Whin workers' compensation insurance, as required by Section 3700 of tI/�e Labor Code, for the performance of the work for which this permit issued. My workers' compen
yol'c mer are: �t I11�I ��1 �. Expiration
N� Policy Number �J�,� 111 �; p ation D
Agent• • • Phone
y t .in the -pe, ormance of the wo f which t permit is issued, I shall not employ any person in any manner so as to bacon) subject to the workers' compensation laws of lifornia, and
ould. Lau13jeCtto tIAwQrkers grgpens ' ; mrovisions of Section 3700 of the Labor Code, I shall forthwith comply with ti provisions.
tATION.51F9ARDING CONSTRUCTION LEtVDING AGENCY ✓
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).
Name ' Lender's Address
. •loam the propertybwner or1ltirized to act on the property ow behalf.
ic(i&K and the information I
• •I agreert dbn"y wiithatlI appl cable city and cou tyvordinanced is costate laws relating to building construction.
I authorize representativ this city or county toabove-ide ' prepertyfor inspection purposes.
i nature of Property Owner or oTlze t— Print Property Owner's or Authorized gent'
AC77ON DATE BY DECLARATION OF COMPLIANCEt40TN CODE ur
FEDERAL REGULATIONS PART 61 OFT17LE40AND
PERflt(TEXPIRED, AQMD RULE 1403.
I SUBMfTTEDASBESTOS NOTIFICATION TO:
PERM(TCANCELLED ❑ EPA
PERA41TEXTENDED ❑ AQMD
❑ ASBESTOS N077FICA170MIS NOT APPLICABLE TO
PERNIITFINAL PROPOSED DEMOLITION.
CER77FICATEOF
OCCUPANCYiSSUED SIGNATURE: