HomeMy WebLinkAboutP2017-0427 - Permitss��Nrokr� City of Centeric Drive, ofNewport Bea Beach, Building
Division Il�lP�l� � 01l� 7�u�lll0�lll4lll� lull II
F' Permit Counter Phone (949)644-3288
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Job Address: 2136 BALBOA BLVD E Bldg: 1 Floor: Suite:
Description of Work: GASLINE TO 33' HIGH BBQ
Inspector Area: 1 Code Edit 2016
Legal Description: TR 756 LOT 37(AND NWLY1/2 LOT 38
Owner: SMITH VINCENT Contractor: I BUILD CONSTRUCTION
Address: 2136 E BALBOA BLVD Address: 27795 SAGEBRUSH ROAD
NEWPORT BEACH CA 92660 SUN CITY CA
Phone: 949-768-4394 Phone:
Con State Lic:931796
Issued Date:09/25/2017 Lie Expire:' 04/30/2011
Bus Lice BT30060618
Processed By: 04-� Lie Exp Date: 09130/2018
PLUMBING Permit: P2017-0427
Project No : 3042-2013
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance
Carrier: NORGUARD
Policy No:JAWC870398
Expire : 04/27/2018
s_.
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
$6.00
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
BackOow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
$0.00
Hydro -Mass Tub:0
$0.00
LndryfTrap:
0
$0.00
BackBow over 2":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
$33.00
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:
$39.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance : $39.00
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
1 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 U all of or U 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).
111, 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 owna,if 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 exempi irui n licensure under the Contractors' State License Law for the following reason:
3,- 7,y signature !)flow -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 Iega11'
sell a structum -hFt I have 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 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.gov/calaw.html.
Sigr.E:ure of Property Owner or Authorized Agent D
LICENSED CONTRACTOR'S DECLARATION
I hemby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing wit Section 7000) of Division 3 of the Busines and my license is in full force
and effect.
License Class - License No Date ^29r! Contractor Signature
WORKERS' COMPENSATION DECLARATION
V.ARAING: FAILURE fO SEni IRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPL YER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE D THOUSAND DOLLARS ($t00,000), IN ADDITION TO THE
COST OF COMPENSATION, C-IMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
nereoy 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 Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for
ormance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
Policy Number
IS of Agent
Date
]I certify that, in the pert irmance o e ork for which this permit is issued, I shall not employ any person in any manner so as to become subject to the rkers' compensation laws of California, and
rat, if I should become. sLbj am saticn prove of Section 3700 of the Labor Code, I shall forthwith comply with those provisions�y Y
ignatu re of Applicant/ Date ! �2S '-2�! -
iECLARATION REGARDING STRUCTION LENDING AGENCY
hereby affirm unde penalty o erjury that there is a construction lending agency for the performance of the work for which this permit is issued ( ection 3097, Civil Code)
Ender's Name it Lender's Address
y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property
I have read this application and the information I have provi
I agree to comply with all applicable city and counW ordi ni
I authorize representatives of this city or c
AC77ON I DATE
PERMITEXTENDED
lb h_3
BY
and state laws relating to building construction.
d property for inspection purposes.
Print Property Ownei
FEDERAL REGULATIONS PART 61 OFTITLE40AND
AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
OCCUPANCYISSUED