HomeMy WebLinkAboutM2019-0029 - Permitsoea eo ao o m oco 00
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00 Ci °fe6e AporN wpo Meh.`;92 60g Division IIIIuIIIIIIIIIII�IIIIIIIIIIIIIII�IIIIiIIIIIIIIIIIIIIIIIII HARBOR Permit M2019-0029
Permit Counter Phone (949)644-3288 Project No: 0886-2019
0 0 0 0 m u c o c c
Inspection Requests Phone (949)644-3255
Job Address: 619 36TH ST Floor: Suite: Bldg: -0
Description of Work: R/R 262 SF FLOATING DOCK SYSTEM.
Inspector Area: 1
Legal Description: CANAL SECTION BILK 636 LOT 10
Owner: KRUSE DANIEL Contractor: SWIFT SLIP DOCK/PIER BUILDERS Engineer: PETROV PLAMEN }
Address: 319 36TH ST Address: 6351 INDUSTRY WAY
NEWPORT BEACH CA 92663 Address: 28161 CASITAS CT
Phone: WESTMINSTER CA 92683 LAGUNA NIGUEL CP�7 i
Phone: 949-631-3121 Phone: 714-717-7542
State Lic: C-066947
Applicant: CHUNG JACQUELYN Con State Lic:797052
Address: 6351 INDUSTRY WY Lic Expire: 07/31/2019 Designer.
WESTMINSTER CA 92683 Bus Lic: BT01122734 Address:
Phone: 949-631-3121 Lic Exp Date: 11/30/2019
Phone:
Special Cond:
Issued Date 06/13/2019
Valuation:
$30,000.00
Inspection Fee:
$287.00
Plan Check Fee
$302.00
OT Plan Check Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee :
$2.00
TOTAL FEE: $595.00
PROCESSED BY:
PLAN CHECK BY:
Longshoremen's and Harbor Workers' Compensation Declaration -
Carrier: AMERICAN LONGSHOR
Policy No: ALMA01662-01
Fire Inspection Fee:
$0.00
Fire Plan Check Fee:
Records Mangement
$0.00
Plan Dep -Counter Review :
$0.00
$0.00
Harbor Plan Check Fee:
$4.00
$0.00
Plan Dep - Zoning Plan Check:
Plan Dep - OverTime Plan Check:
$0.00
Plan Check Fee: $302.00
HARBOR RESOURCES:
APPROVAL TO ISSUE:
OTHER DEPARTMENTS:
FINAL INSPECTION: _
PERMITEXPIRES 180 DAYSAFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at permit Issuance: $293.00
....
NER-BUILDER D RATION reas ndc ate
I hereby affirm u r penale I
ty of perjury that I_ am An cit mortfrom Icounty he thal�ntractsra peamit to construct,te License Law falteheimpro e( demolish, m epairby;
anyhstmcture, ptrios)to�itsV ss renes, aesoxt trequires the applicanttotem
:tion 7031 .5, Bu 'ass and Professions Co Y YIS L - rm sub a the applicant to a civil penalty o
permit to file a signed sand Professions
that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business am
'essions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by an..applira� t :or aAe 1 qj$. • P
more than five hundred dollars ($500). ortions of the work, and the sfLucture :s pot iDtendecho �ofered for sale (lon that4thl
I, as owner of the property, or my employees with wages as their sole compensation, will ro (_) all of or (_) p
iness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or pArtoIT212ffort, milds, orimproues tha property, provided
rovements 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 e
roved for the purpose of sale).sios Code: The
.Iv t1, as owner of the property, am o an owner of property who buildsorimproves thereon, lndlwho contracts for the projects withicensed Contractors to construct ha licensed Contractor acto� pusuant to the Cont acto sn State Li cense Law).dors' State License Law does no
7 I am exempt from licensure under the Contractors' State License Law for the following reason:
y 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 im
A a structure that I have built as an owner -builder if it has not been constructed in its entirely by licensed contractors. I understand that a copy of the
rofessions Code, is available upon request when this application is submitted or at the following Web site:http:llwww.leginfo.ca.gov/calaw.htmi.
ignature of Property Owner or Authorized Agent
.ICENSED CONTRACTOR'S DECLARATION p(com� Kj j1Division 3
hereby affirm under penalty of perjury that I am licensed under rovisions of Chapter 9Date m nc h S f 00) of Contractor S'gnau r iness al
nd effect. License Class License No.
.ONGSHOREMEN'S & HARBOR WORKERS' COMPENSATION DECLARATION
IARNING: FAIL RE TO SECURE LONGSHOREMEN'S 8 HARBOR WORKERS'CO COVERAGE I5 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES!
6700,0 ), INV: DDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby i
ar s
I have and will maintain Longshoremen's and Harbor workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
ssu d. My workers' compensation insurance carrier Pnl cv Numbpolicy number are:
and
covered by this permit, I cannot lei
law, Section 7044 of the Business
Date
is in full
5 UP TO ONE HUNDRED THOUSAND
penalty of perjury one of the
Expiration
lone # _
ane of Agent
so as to become subject to the workers' compensation lawsf California. an
1 certify that, in the performance of the w for w is is permit is issued, I shall not employ any person in any manner
t of S Ion 3700 of the Labor Code, I shall forthwith comply with those provisions.
gree that, if I should become subject to the wor ers' com e provisions
Date:
lignature of Applicant:
)ECLARATION REGARDING CONSTRU TIO ENDIN GENCY
erfothe work for which this permit is issued (Section 3097, Civil Code).
for th performance
1 hereby affirm under penalt of perjury that th re is a co truction lending
agency
Lenderemanceof
Lender's Name
By my signature below, I cern to each of the of Ing:
I am the property owner or ' ed to act on the property owner's behalf.
I I have provided is correct.
I have read this applic n and e I ormation
I agree to comply wi all applic ble cit nd county ordinances and state laws relating to building construction.
I authorize repress atives of t a ci or unty to enter th above -identified property for inspection purposes.
Signature:
Print Name:
DECLARA IONOFCOMPLUNCEtMT CODED FOR OFFICE USE ONLY
ACTION DATE RY
FEDERAL REGULATIONS PART 61OFTITLE40AND
AQMO RULE 1403.
❑ f SUBMITTED ASBESTOS NOTIFICATION TO:
PERMITEXPIRED
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PERMtTCANCELLED
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PERMITEXTENDED
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PROPOSEDDEMOIITIOM
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CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED
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