HomeMy WebLinkAboutP2022-0159 - Permits(9)
City of Newport Beach -Building Division 11�1111 1111111111111111111111111111111111111111111 111111
100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 2 2 0 1 5 9
Permit Counter Phone (949)644-3288
Job Address: 1950 GALAXY DR Bldg: 1 Floor:
Description of Work: GAS LINE TO BBQ
Inspector Area: 3 Code Edit 2019
Legal Description: N TR 4224 LOT 17
Owner: ZMIJEWSKI JEANETTE
Address: 1950 GALAXY DR
NEWPORT BEACH, CA 92660
Phone:
Issued Date:07105/2022
Processed By: MA
Suite:
Contractor: WATERWORX POOLS INC
Address: 202 FASHION LN STE 219
TUSTIN, CA 92780
Phone:
714-714.0424
Con State Lic:1059336
Lic Expire:
10/31/2023
Bus Lic:
BT30074831
Lic Exp Date:
03/31/2023
PLUMBING Permit: P2022-0159
Project No : 2889-2021
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : CAROLINA CASUALTY
Policy No:BNUWC0154761
Expire : 08/02/2022
rr ,
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.
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason (a) 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
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 licensure 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 legall
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://w .leginfo.ca.gov/calaw, html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
hereby 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 an Is in f o
and effect. b Z Z
License Class License No Date 2 Contractor Signature41
WORKERS' 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 ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
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 the
pe mance of the work for which this permit is issued. Policy No.
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'
carrier and policy number are:
arrier Policy Number
ame of Agent
�I certify that, in the performance of thew r which this permit is is �I s — not employ
at, if I should become subject to the s' C ens n pro ' ns of ton 3700 of the I
ignature of Applicant I/ ,�e
hereby affirm under penalty ofperjury that there is a construction lending agency for the performance of
Ender'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.
agree to comply with all applicable city and county ordinances t aws r ling to build
I authorize representatives of this city or county to enter t entifie operty for' ion p
ignature of Property Owner or Authorized Agent IC Goo ii irlwtxr"��
Date
manner so as to become subject to the workers' compensation laws of California, and
forthwith comply with those provisions.
work for which this permit is issued (Section 3097,
-+",
ACTION
DATE
BY
DECLARATIONOF COMPLIANCE IMTH CODEOF
FOR OFFICE USE ONLY
FEDERIL REGUL 4TICIPS PART fit OF TITLE 40 AND
AOh^D RULE f4G3.
PERMIT EXPfREO
D /Sti3MI. IED) SCESTCS NOTIFICATfON TO:
❑ EPA
❑ AOMD
PERMIT CANCELLED
PERMIT EXTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROF=ED DEMOJTIOA'.
PERMIT FINAL
CERTIFICATE OF
SIGNATURE:.
OCCUPANCYtSSUED