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HomeMy WebLinkAboutP2016-0346 - Permits0wI City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II PLUMBING Permit: P2016-0346 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 6 0 3 4 6 Project No Permit Counter Phone (949)644-3288 't'T�Gt,y '�4 ,' Inspection Requests Phone (949)644-3255 Job Address: 543 VISTA FLORA Bldg: 1 Floor: Suite: Description of Work: PLUM - SEWER CLEAN OUT Inspector Area: 3 Code Edit 2.n+ C.-TOZ Legal Description: TR 5740 (L.L.84-214028) PAR 30 t,,. / % eemm mmoe°o Owner: ALBRIGHTCHARLES QaFi�ot 4'orketls'CetaA1QitionInsurance - °m Address: 729 W. 16TH ST Address: 23311 MADERO ST ET Carrier: ZURICH AMERICAN INS m • e ° mm o COSTA MESA, CA92627 NV OC 2 1 ;�:; � ;�(ylc)/r_N®YV�017�WQ rL^-ffJl;r �m® •m ° oc o c`o Phone: hone: 4.4 -3 " Expire :07/13/2016 on St Lic: 06 m 0 mmmco Issued Date:06/2212016 00 0 Ia whom:-, m ommoo Bus Lic: BT00000858 e 0000eo Processed By: e:"OPI6 � ° omem0o 0 , 0 oommoe oomo 0 ,; o m m oom0 ®.,-.- . - - w.anw 0 0 0 Bathroom Fixtures Kitche Fixtures Misc. Misc. Other Toilet: 0 $0.00 Kitche ' Sin 00 Water Piping: $O.0 o f DrElin: 0 $0 00 $0.00 Bidet 0 $0.00 Garba Di9-taftarkino 0 $0.0 Gr s r y" 0 $0.00 Urinal 0 $0.00 Bar Si 0 $0.0 ri 6 OOp / Bath Tub: 0 $0.00 Vegeta Is Sink: 0 $ OO Gas 4 outlets: 0 $0.00 P-Tr 0 0. Record Mgmt Fee: $0.00 Shower Stall: 0 $0.00 Ice Ma er: 0 $9-A S(9@9� outlets: 0 $0.00 Sj6b wort( karf8c� Investigation: $0.00 Wash Basin: 0 $0.00 Dishw her: 0 $0.00 Backflow up to 2": 0 $0.00 Sewer: 0 $0.00 Plan Check: $0.00 Hydro -Mass Tub:O $0.00 Lndryrallote0 $0.00 Backflow over 2": 0 $0.00 Sewer Alter/Repair:l $32.00 Issuance: $32.00 Floor Sink: 0 $0.00 Regul or: 0 ggQ.pDpp ental Fee: $0.00 Floor Drain: 0 $0.00 Lawn rinkler: 0 $0.00 Drinking Fountain: 0 $0.00 Additional Fee insp. i(1g&IS: TOTAL: $64. -- ^`eek -- Pn ^^ d ^- -` desk amce : $64.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 m`yee`'C MotttfrerPse@io�will•do•(_}-all of or L) portions,aG,theewetkrdatre.-AtcU.gture Is ooLn(erLded or offered for sale (Section 7044, Business and Professions Code: T e 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 ffere 4 . 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 p improved for the purpose of sale). — If applicable: ❑ I, as owner olI roperty, am a clusively contracting with licensed Contractors to construct the project (Section 7044et, aBausiness and Professions Code: The Contractors' State License Law does not apply to an owner o property who ti0ilds3ontract hereo who tract or t pro' wit . s Contra L__I p�t tp t�g-qogtrlacffpr I Stake_(-icgpge Law). .� I am exempt fror� licensure un&r th Sta Lice se r th o aso .�yin`ysignature ire%w.l acknowledge that y p onal si u have rea ast one year prior to completion of the improvements covered by this permit, cannot legall! seqa structure tfSJt I have built a an o f it h e con d i e ors}�uq>�<;tgnfllthat a copy of the applicable law, Section 7044 of the Business and •Professions Code, is available uRon requis application is submi a or a e fo mg e 1 egin"i%��. c��agddJJfcahaw:Mmh----- `Signature of Property Owner or Aut oriz d Agent Date `.•` : LICE ED TO I I hcf4y affirm undecpenalty of pe uryt t. Ii sed rov s o ha r (RaEllo 00) of Division 3 of the Business and P ions Code, and my license is in full force CoOemSa Class a No Contractor Signatur. � �--�. �h.RK1 RS' CQMPEJJSATION , ECLARATION I06 (iOMPENSATION, DAMAGES AS WW%ffirm upBgTpanalty of Pe I have and will maintain ace brmance of the work for which 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 )VIDEO FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hav and will maintain workers compensation Ir ce carrier and policy numbeitare: :wBBBBBBe sation, issue by t Q u F�el ti s head`for by Section 3700 of the Labor Code, for 3 0�w"4�'''"' ection 3700 of the Labor Code, Jr1Q WGF11{L 1%taf}1ed)rk for which this permit is issued. My workers' compensa ier 2Ii Policy Number le of Agent certify that, in the performance. f t_he work for which this permit is issued, I shall not employ any person in any manner so if I should become�biect' o the orkers compensa f-Sectiorr3T00-ef- the -I=abeF GO 0,-1_shalLfodhwith-c nature of Applica \' / � CLARATION RE RDING 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 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 owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city andt ordinances and state laws relating to building construction. I authorize representatives of this city or cpyl0 toen r the above -identified property for inspection purposes. nature of PmnertV Owner or Authorized A 7 Print Property Owner's or Authorized Agent'sL ACTION DATE BY r/ ULAt nvrry vr wmrunrvu rrr fn �yr FEDERAL REGULATIONS PART 61 OFTDLE40AND XPIRED (O S ©� SUBMITTEDASSESTOS NOTIFICATION TO: ANCELLED © EPA VENDED 0 AOMD 0 ASBESTOS N077RCA710NIS NOT APPLICABLE TO INAL PROPOSED DEMOLITION. CERTIFICATEOF I SIGNATURE. OCCUPANCYISSUED Date .ct to the workers' compensation laws of California, and agre, )6isions. '.. 4 Z ._22-(` ecfron 3097, Civil Code). rz�� QU/l��ur��� DaYa� FOR OFFICE USE ONLY