HomeMy WebLinkAboutP2016-0046 - Permits00Ewl•„uq,--�I�
City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIII II
100 Civie Center Drive, Newport Beach, CA92660 P 2 B 1 6 0 0 4 6
Permit Counter Phone (949)644-3288
Job Address: 17 SARACENO Bldg: 1 Floor: Suite:
Description of Work: PLUM -WATER FILTER SYSTEM
Inspector Area: 6 Code Edit 2013
Legal Description:
Owner: TAGNOLI JOHN
Contractor:
PROSERV PLUM & DRAIN
Address: 17 SARACENO
Address:
3012 ENTERPRISE ST #F
NEWPORT COAST CA 92657
COSTA MESA CA 92626
Phone: 310-497-5319
Phone:
714-540-8400
Con State Lic:798615
Issued Date:01/29/2016
Lie Expire:
08/31/2017
Bus Lic:
BT01100443
Processed By: iii -Lie
Exp Date:
08/31/2016
PLUMBING Permit: P2016-0046
Project No :
Inspection Requests Phone (949)644-3255
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Worker's Compensation Insurance - '
Carrier: LIBERTY INS CORP
Policy No:WC7631508631
Expire : 10/01/2016
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:
1
$6.00
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:
0
$0.00
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:
$32.00
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:
$38.00
Plan Check Fee :
$0.00
Fee Due at Permit Issuance: $38.00
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) inch
(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 licensure 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 Prutessions Code: The Contractors' State License Law does not apply to an owner of property who, through
improvement:, d,a not intended or offered for sale. If, however, the building or improvement is sold within one year of corY
Improved for the purpose of sale).
Q I, a3 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 Contracto
11 1 tm exempt, f,cm licensure under the Contractors' State License Law for the following reason:
oy my signaturea:elow I acknowledge that, except for my personal residence in which I must have resided for at least one y
sal; a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I
Pr7fessione Cooe. -s available upon request when this application is submitted or at the following Web site:http://www.le
Sigrature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm rde• penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000)
al,d .effect.
License Class _ License No Date
COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL'
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 Director of
rmance of the work for which this permit is issued. Policy No.
IL h ve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pe
Isur nce carrier and policy number are:
arrier Policy Number
ame of Agent
]I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner:
let, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
ignature of Applicant �1-34 "
ECI )INSTRUCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which
Bnder's Name 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 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 county4t err the abovg:jfjentified property for inspection purposes.
of Property Owner or Authorized
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 permit, I cannot
that a copy of the applicable law, Section 7044 of the Business
/calaw.html.
Date
Division 3 of the Business and Professions Code, and my license is in full force
Contractor Signature
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
Relations as provided for by Section 3700 of the Labor Code, for
of the work for which this permit is issued. My workers'
Date
as to become subject to the workers' compensation laws of California, and
)mply with those provisions.
- ;9 4O /%
permit is issued (Section 3097, Civil Code).
Name J__ARWf r�D /✓�/�7
ACTION
DATE
BY
DECLARATION OF COMPLIANCE MTh
FEDERAL REGULATIONS PART 61 OF
AQMDRULE 1403.
❑ I SUSMFTTEDASBESTOS NOTIFIC
❑ EPA
❑ AQMD
❑ ASBESTOS N017RCA77ONIS NOT
PROPOSED DEMOLITION,
SIGNATURE:
CODE OF
77LE40AND
TIONTO:
APPLICABLE TO
FOR OFFICE USE ONLY
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMITFINAL
D,�L- ADA- '7
CERTIFICATEOF
OCCUPANCYISSUED