HomeMy WebLinkAboutP2022-0075 - Permits�4*A'flofs,.. City of Newport Beach - Building Division 111p1III 11111p11111p11111111111111111111111p111111 PLUMBING Permit: P2022-0075
o'k s ,- 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 2 2 0 0 7 5
Project No : 2684-2021
Permit Counter Phone (949)644-3288
t%,, +� Inspection Requests Phone (949)644-3255
Job Address: 2411 BAMBOO ST Bldg: 1 Floor: Suite:
Description of Work: PLUMB/BBQ
Inspector Area: 4 Code Edit 2019
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Legal Description: N TR 4893 LOT 48
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Owner: LA21A LLC
Contractor:
T J C HOME BUILDERS LLC
Worker's Compensation Insurance -
Address: 26880 ALISO VIEJO PKWY #100
Address:
26880 ALISO VIEJO PKWY #100
Carrier: NATIONAL FIRE & MARINE INS CO
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ALISO VIEJO CA 92656
ALISO VIEJO, CA 92656
Policy No:42HB615046601
Phone:
Phone:
(949) 481-7026
Expire : 12/31/2023
Con State Lie:1025507
Issued Date:0411212022
Lie Expire:
04/30/2023
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Cy"y
Bus Lie:
BT30059037
Processed By:
Lic Exp Date:
05131/2022
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
$8.00
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: $46.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance : $46.00
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 Iicensure 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 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).
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).
❑ 1 am exempt from Iicensure 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 one year prior to completion of the improvements covered by this permit, I cannot legally
sell a structure that 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,htm].
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se tion 7 00) of Division 3 of the Business and P fes ion de, and -li nse 's'in full force
and effect. jj
License Class License No Date I� Contractor Signatur
NORKERS' COMPENSATION DECLARATION
NARNING: 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 ($100,0 0(, IN ADDITION TO THE
COST 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:
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
e of the work for which this permit is issued. Policy No.
have and vo-79aintain 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'
of Agen
ertify the ,' he performance
if I should become subjectle-
iture of Applicant
Date
permit is issued, I shall not employ any person in any manner so as to become subject to the
prPvisic`s of Section 3700 of the Labor Code, I shall forthwith comply with those vi ' ns.
hereby affirm under penalty of perjury that there is a construction Ding agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Enders Name Lender's Address
ly my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have provided is correct..
I agree to comply with all applicable city and county o ances atq )p
I authorize representatives of this city or county t - terr[nabo I ent' i
of Property Owner or Authorized Agent
building construction.
inspection purposes.
_ Print Property Owner's or
laws of California, and
ACTION
DATE
BY
DECLARATION OFCOMPIIANCEMTHCODEOF
FOB OFFICE SE ONLY
FEDERAI RFGIIIATIONS DAPT£1 OF'ITLE4GAND
AQMDRULE7403.
PERMIT EXPfRED
❑ ISUeMITTEDAS3E�TOSNJTIF;CaAt)NTO'
❑ EPA _
❑ AQMD
PERMIT CANCELLED
PERMITEXTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED 9FM)"TION.
PERMIT FINAL
j
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED