HomeMy WebLinkAboutP2021-0217 - Permits4��waf�A�x
City of Newport Beach - Building Division *P2021-0217*
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Job Address: 880 IRVINE AVE Bldg: 1 Floor: Suite:
Description of Work: MFR -"BLDG M" CHANGE OUT (2) WATER HEATERS
Inspector Area: 3 Code Edit 2019
Legal Description: P BK 15 PG 36 PAR 1
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Owner: UDR NEWPORT BEACH NORTH L
Contractor:
Compensation Insurance -
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Address: PO BOX 06408
Address:
2510 N GRAND STE 110
CHICAGO, IL
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SANTA ANA CA 92705
Phone: 0
Phone:
714-315-5607
.
Con State Lic:556812
Issued Date:
Lic Expire:
02/28/2023
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Bus Lic:
BT30073028
Processed By:
Lic Exp Date:
09/3012021
PLUMBING Permit: P2021-0217
Project No :
Inspection Requests Phone (949)644-3255
SERVICE FIRST
Carrier: STATE NATL INS CO
Policy No:AMX0820021004
Expire : 10/01/2021
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Bathroom Fixtures
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Toilet:
0
G§ 4'
Kitchen Sink:
0
$0.00
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$0.00
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$0.00
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Ob 0
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Garbage Disp:
0
b0
Water Softener:
0
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0
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0
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
$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:
2
$62.00
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:0
$0.00
Issuance:
$38.00
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:
$100.00
Plan Check Fee :
$100.00
Fee Due at Permit Issuance : $0.00
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 L) 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).
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).
. ..
I am exempt rom.'icensure under the Contractors' State License Law for the following reason:
By my signature 6AM 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 ermit, I Cannot legal],
941%struchre IM thave 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 704 of the Business and
• ProfessionsOode, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signalwe of Property Owner or Authorized Agent ate
LICENSED CONTRACTOR'S DECLARATION
, Pber4hy affimf grAr (lenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business an Pr es Co a and my license is in full force
and effect.
License Class • �. •. License No Date ��% Contractor Signature
WORKP RS' COMPENSATION DECLARATION
3Rr�fIJ� FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE Is UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOO UNDRED THOUSA1f DOLLARS ($100,000), IN ADDITION TO THE
OST OF,OMPEN,ATIV, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. /'
WEV tyy affirm uMbr pBnalty of perjury one of the following declarations:
••1"ve and"110, amtain 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
performance 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' compensatiol
sur nce carrier and policy number are: /
Policy Number
of Agent
Date
I certify that, in the performan o t rk 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 agree
It, if I should beco bjec o r rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
[nature of Applicant Dater Q1C�,
iCLARATION REG T CTION LENDING AGENCY
Breby affirm unde nalty of perj that there is a construction lending agency for the performance of the work for which this permit is issued (Sectio)v. 3097, Civil Code).
ider's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property n is a f.
I have read this application and the information I have prov' ed' r t. yyy
I agree to comply with all applicable city and county ordi nce t e laws relating to building construction.
I authorize representatives of this city or county ante th v Ida tified property for inspection purposes. ,y`
[nature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's NamEE \/,((.e.. 1 Dat
AC77Diy DAA 4, g
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART61 OF TITLE40AIVD
AQMDRULE 1467.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATIONTO:.
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERMIT EXTENDED
ASBEOS
P❑ROPOSED DEMOLITION, RON IS NOT APPLICABLE TO
PERMIT FINAL 'j d, �Z
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED