HomeMy WebLinkAboutP2015-0299 - PermitsCity of Newport Beach - Building Division 111p1III IIIIIp11111p1111111111p111111111111111111
�4 G 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 5 0 2 9 9
Permit Counter Phone (949)644-3288
0
Job Address: 90 SIDRA COVE Bldg: 0 Floor: Suite:
Description of Work: PLUM - REPLACE WATER HEATER
Inspector Area: 6 Code Edit 2013
Legal Description:
Owner: LANDOLPH AL
Contractor:
GREENSTAR HOME SVCS INC
Address: 90 SIDRA COVE
Address:
1951 N MAIN ST
NEWPORT COAST CA 92657
ORANGE CA 92865
Phone:
Phone:
949-885-0102
Con State Lic:965527
Issued Date:06/23/2015
Lic Expire:
09/3012015
pp
Bus Lic:
BT30036969
Processed By: !/ . i
Lic Exp Date:
01/31/2016
PLUMBING Permit: P2015-0
Project No :
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : EMPLOYEE SVC GROUP
Policy No:434987
Expire : 07/01/2015
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:
1
$15.00
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:
$35.00
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: $50.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $50.00
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) 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 (_) 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
improvemems are `,tot 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).
J 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 �3 an owrer of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
v am exemptlfrom licensure under the Contractors' State License Law for the following reason:
By my eignatumbe:o v 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 legall
sell a structl ire thPt 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
Frufessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Cigneture of Rope.ty Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
' her^.by affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and Affect X
�,u,Ist Class License No Dat , a3-t S Contractor Signature
NORKERS' CUMPCNSATION DECLARATION
NARNING: FAILURE .0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUB.IECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
:DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
1 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 th
mance of the work for which this permit is issued. Policy No.
ave 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' compensatiol
nce carrier and policy number are:
Policy Number Expiration Date
of Agent
certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
'signature of Applicant
IECLARATION REGA D G CONSTRUCTION LE CY
\S
hereby affirm under penalty of perjury that there is aCoRafruction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code)
Ender's 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 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 %,Ate laws relating to building construction.
I authorize representatives of this city or county toenter o -� ntifie,Uroperty for inspection purposes. T _n
of Property Owner or Authorized
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ 1 SUBMITTED ASBESTOS NODFICATION TO:
❑ EPA
❑ AQMD
PERMIT CA NCELLED
PERMIT EXTENDED
PROPOSED DEMOLITION. STOS iION 15 NOT APPLICABLE TO
PERMIT FINAL
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