HomeMy WebLinkAboutP2022-0089 - Permits�� .rk� City of Newport Beach - Building Division 1pil11111111111111111111111111111111111111111111p PLUMBING Permit: P2022-0089
''� 100 Civic Center Drive, Newport Beach, CA 92660 Project No : 1155-2022
Permit Counter Phone (949)644-3288
v ra a �� Inspection Requests Phone (949)644-3255
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Job Address: 1615 LINCOLN LN Bldg: 1 Floor: Suite:
Description of Work: SFR GASLINE TO BBQ
Inspector Area: 3 Code Edit 2019 ,
Legal Description: N TR 3702 LOT 1
Owner: KOSICH WALTER Contractor: INSTANT POOLS LLC Worker's Compensation Insurance -
Address: 1615 LINCOLN Address: 116 SENCILLO PL Carrier: WC EXEMPT
NEWPORT BEACH, CA 92660 RANCHO MISSION VIEJO CA 92694 Policy No:(NO EMPLOYEES)
Phone: Phone: 949-795-0648 Expire
Con State Lie:1009644
Issued Date:05/02/2022 Lie Expire: 07/31/2023
B Lie: BT30053469 .
Processed By: _Lie Exp Date: 12/31/2022
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 pf 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 eiv%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 (_) 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).
I am exempt from lice nsure under the Contractors' State License Law for the following reason:
3y my �:gnature 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 perml
sell , structure chat 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
Professions Coda, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Siynat-re of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereky affirm nnder'penalty of perjury that I am licensed under provisions of Chapter 9 (commenci g w h Section 7000) of Division 3 of the Business an ]loan!
and effect. Z �l,.Z_
L;oa,i.,e Class- License No Dat Contractor Signat
NUr2RERS' COMPENSATION DECLARATION
is in full force
VAkNING: 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 COMPENSATInN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hergh,, affirm uhoer penalty of perjury one of the following declarations:
Ihave and will roLintain 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 thi
lerformance 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 the performance of the work for which this permit is issued. My workers'
,ante carrier and oolicv number are:
bTtify that, in the performance
if I should become subject to I
Policy Number
permit is issued, I shall not
nature of Appcant
El
CLARATION RGA IN STRUCTIO DING AGENCY
Ireby affirm under pena of perjury tha re is a constr en
Ider's Name
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 ordina nd state Is
I authorize representatives of this city or coup to en a abov—a�-r+r
Date
any person in any manner so as to become subject to the workers' compensation laws of California, and
Labor Code, I shall forthwith comply with those provisions. 7
I .Ai/ � � C- — Z Z
the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Address
for inspection purposes.
Print Property Owner's or Authorized
S= Z -ZZ
ACTION
DATE
RY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 51 OF TITLE40AND
AQMO RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERMIT EXTENDED
ElASBESTOS NOTIFICA TION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL-ZTj
' Z
CERTIFICATF OF
SIGNATURE:
OCCUPANCYISSUED