HomeMy WebLinkAboutP2021-0246 - Permits,Yakr City of Newport Beach - Building Division J 11111111 III IIIIIpIII111111111111111p1111111111111111 il
V G 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 2 1 0 2 4 6
Permit Counter Phone (949)644-3288
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Job Address: 28 POINT LOMA DR Bldg: 1 Floor: Suite:
Description of Work: DELTA 3, CHANGE OUT WATER HEATER
Inspector Area: 6 Code Edit 2019
Legal Description: N TR 7432 LOT 43
Owner: BROEDLOW THEODORE
Contractor:
DOCTOR REMODEL
Address: 28 POINT LOMA
Address:
27171 SOLEDAD
CORONA DEL MAR, CA 92625
MISSION VIEJO CA 92691
Phone:
Phone:
949-584-5919
Con State Lic:406279
Issued Date:07/26/2021
Lic Expire:
03/31/2023
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Bus Lic:
BT30034884
Processed By:
✓
Lic Exp Date:
03/31/2022
PLUMBING Permit: P2021-0246
Project No : 1371-2020
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : WC EXEMPT
Policy No:(NO EMPLOYEES)
Expire :
FEES
Bathroom Fixtures
Kitchen Fixtures
Misc.
0
$0.00
Misc.
Roof Drain: 0
$0.00
Other
$0.00
Toilet:
0
0
$0.00
$0.00
Kitchen Sink:
Garbage Disp:
0
0
$0.00
$0.00
Water Piping:
Water Softener:
0
$0.00
Grease Trap: 0
$0.00
$0.00
Bidet
Urinal
0
$0.00
Bar Sink:
0
$0.00
Water Heater:
1
$31.00
Grease Interceptor:0
0
$0.00
$0.00
Record Mgmt Fee:
$0.00
Bath Tub:
0
$0.00
Vegetable Sink:
0
$0.00
Gas up to 4 outlets:
0
0
$0.00
$0.00
P-Trap:
Sewer
Investigation:
$0.00
Shower Stall:
0
$0.00
Ice Maker:
0
0
$0.00
$0.00
Gas over 4 outlets:
Backflow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
$0.00
Wash Basin:
Hydro -Mass Tub:O
0
$0.00
$0.00
Dishwasher:
Lndry/Trap:
0
$0.00
Backflow overt":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
$38.00
$0.00
Floor Sink:
0
$0.00
Regulator:
0
$0.00
Hose Bibb:
0
$0.00
Sewer Abandon: 0
$0.00
Supplemental Fee:
Floor Drain:
0
$0.00
Lawn Sprinkler:
0
$0.00
Drinking Fountain:
0
$0.00
Additional Fee :
$0.00
TOTAL:
$69.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance : $69.00
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) ind
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, dE
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License
Professions Code) or that he or she is exempt from Iicensure and the basis for the alleged exemption. Any violation of Sec
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 L) portions of t
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throug
improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of col
improved for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contract(
❑ 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
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors.
Professions Code, is available upon request when this application is submitted or at the following Web site: http://www.IE
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 7000)
and effect.
License Class License No Date Y t�
COMPENSATION DECLARATION
d below by the checkmark(s) I have placed next to the applicable item(s)
sh, or repair any structure, prior to its issuance, also requires the applicant for
(Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
work, and the structure is not intended or offered for sale (Section 7044,
employees' or personal effort, builds or improves the property, provided that the
letion, the Owner -Builder will have the burden of proving that it was not built or
usiness and Professions Code: The Contractors' State License Law does not
pursuant to the Contractors' State License Law).
:ompletion of the improvements covered by this permi
that a copy of the applicable law, Section 7044 of the
Division 3 of the Business
Contractor
Date
Code, *pd my INeRe is in full force
'DST OF: FAILURE TI SECURE WORKERS' COMPENSATION COVERAGE Is UNLAWFUL, CO SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI SAND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,0001, 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:
J I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of
erformance of the work for which this permit is issued. Policy No.
11 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pe
isurance carrier and policy number are:
arrier Policy Number
ayfe of Agent
certify that, in the performance pf the work for which
, if I should become SulYieot tot vArkers' comoen,
nature of ApplicanZN ]-!
CLARATION RE ARDING C—ONSYRUCTION LENDING A
Relations as provided for by Section 3700 of the Labor Code, for
of the work for which this permit is issued. My workers'
Date
I shall not employ any person in any manner s as to become subject to the workers' compensation laws of California, and
action 3700 of the Labor Code, I shall forthwith omply with those provi6ionS.
CY
)reby affirm under penalty of perjury that there is a constructI lending agency for the performance of the work for which
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 pr vided is correct.
I agree to comply with all applicable city and count yyy ppprdi nc and st laws
a
ngto buildingconstruction.
I authorize representatives of this city or count y-tol
er
art ove-ide ' d
for inspection purposes.
nature of Property Owner or Authorized Agen 1
Print Property Owner's or Autl
permit is issued (Section 3097, Civil Code).
tlih �3J Lo� D O ^ Z�o
ACTION
DATE
BY"
DECLARATIONOF COMPLIANCE AgTH
FEDFRAL REGULATIONS PART fit OF I
AQ.ACRULE 7403.
' SUF3MI7 TED ASBESTOS NORRC
n E,oA
❑ AQMD
❑ ASBESTOS N077FICATION IS NOT
PROPOSED DEMOLITION,
5'tGN1711R1-:
ODE OF
ITLE40 AND
TION TO:
PLICABLE TO
FOR OFFICE USE ONLY
PERMIT EXPIRED
— —
PERMIT CANCELLED
PERA41T EXTENDED
PERMIT FINAL
CERTIRCATEOF
OCCUPANCYISSUED