HomeMy WebLinkAboutP2021-0158 - Permits (2)wwr�� City of Newport Beach - Building Division 11111111111111111111111111111111111IN 1111111
zG 100 Civic Center Drive, Newport Beach, CA 92660
r Permit Counter Phone (949)644-3288
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Job Address: 1331 ANTIGUA WAY Bldg: 1 Floor: Suite:
Description of Work: PLUMB/BBQ AREA GAS LINE & SINK
Inspector Area: 1 Code Edit 2019
Legal Description: N TR 3852 LOT 16
Owner: 1331 ANTIGUA NEWPORT BEACH Contractor:
Compensation Insurance -
Address: 1331 ANTIGUA WAY
Address: WILLIAM YANG
NEWPORT BEACH CA 92660
Phone: 949-395-5055
Phone: 949-395-5055
Con State Lic:O/B
Issued Date:05/18/2021
Lic Expire:
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Bus Lic:
�/ Processed By: tl V
Lic Exp Date:
PLUMBING Permit: P2021-0158
Project No : 2315-2019
Inspection Requests Phone (949)644-3255
OWNER/BLDR t iVorker's
Carrier :
Policy No:
Expire :
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:
0
$0.00
Grease Interceptor:0
$0.00
Bath Tub:
0
$0.00
Vegetable Sink:
0
$0.00
Gas up to 4 outlets:
1
$7.00
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:
$37.00
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:
$44.00
Plan Check Fee:
$44.00
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, priorto its issuance, also rectuires 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 an(
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 o'
not more than five hundred dollars ($500).
LJ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U portior
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, tl
improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year
improved for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Cor
❑ I 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
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contrac
Professions Code, is available upon request when this application is submitted or at the following Web site:http://v
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section
and effect.
License Class License No Date
COMPENSATION DECLARATION
of the work, and the structure is not intended or offered for sale (Section 7044,
ough employees' or personal effort, builds or improves the property, provided that the
' completion, the Owner -Builder will have the burden of proving that it was not built or
Business and Professions Code: The Contractors' State License Law does not
)r pursuant to the Contractors' State License Law).
year prior to completion of the improvements covered by this permi
I understand that a copy of the applicable law, Section 7044 of the
Date
of Division 3 of the Business and Professions Code, and my license is in full force
Contractor Signatu
IARNING: 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
DST 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:
I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Dire
ormance 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
rance carrier and policy number are: -
"ier Policy Number
ie of Agent
certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any m
, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fl
of Industrial Relations as provided for by Section 3700 of the Labor Code, for
performance of the work for which this permit is issued. My workers'
Date
so as to become subject to the workers' compensation laws of California, and
1 comply with those provisions.
nature of Applicant I Date
CLARATION REGARDING CONSTRUCTION LENDING AGENCY
areby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for hich this permit is issued (Section 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 owner's 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 county to enter the above -identified property for inspection purposes.
mature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name
Date
ACTION
DATE
BY
DECLARATION OFCOMPLIANCE k19TN CODEOF
FOR OFFICE USE ONLY
FEDERAL REGULATIONSPART 61 OF TIME40AND
AQMD RULE 1403.
PERMITEXPIRED
❑ I SUBMITTED ASBESTOS N07TFICATIOM TO:
❑ EPA
❑ AQMDASBESTOS
PERMIT CANCELLED
PERMITEXTENDED
N077FICA NOT APPLICABLE TO
PERMITFINAL
i
PROPOSED DEMOLITIOMDON1fS
CERTIFICATEOF
SIGNATURE:
OCCUPANCYfSSUED