HomeMy WebLinkAboutP2016-0216 - PermitsCity of Newport Beach - Building Division 111111III 111�1p1111111111111111111111111p11111111111
off` 100 Civic Center Drive, Newport Beach, CA 92660 P 2 0 1 6 0 2 1 6
Permit Counter Phone (949)644-3288
n'l�IIORT-
Job Address: 1723 TERRAPIN WAY Bldg: 1 Floor: Suite:
Description of Work: PLUMB/INSTALL SEWER CLEAN -OUT
Inspector Area: 3 Code Edit 2013
Legal Description: N TR 3097 LOT 26
Owner: EITEL JOSEPH
Contractor:
DRILL SUB INC
Address: 1723 TERRAPIN WAY
Address:
4805 5TH STREET STE 210
NEWPORT BEACH, CA 92660
RAINBOW, CA
Phone:
Phone:
888-782-9110
Con State Lic:937432
Issued Date:05/09/2016
Lic Expire:
09/30/2016
Bus Lic:
BT30047532
Processed By:
Lic Exp Date:
10/28/2016
PLUMBING Permit: P2016-0216
Project No : 1879-2015
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : STATE COMP FUND
Policy No:9040882
Expire : 12/0112016
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:
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/-rrap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:l
$32.00
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:
$64.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance : $64.00
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 Iicensure 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 L) 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).
❑ 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 year prior to completion of the improvements covered by this permit, I cannot legally
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://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION p
I 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 I fessions Code, and my license is in full force
and effect.
License Class License No Date S '—LI—� J� Contractor Signatur .
NORKERS' 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 HUND D THOUSAND DOLLARS ($100,000), IN ITION TO THE
COST 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 the
Jerfprmance of the work for which this permit is issued. Policy No.
have and will mai al 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'
,ance carrier and pdlljcyumber are: .n
ie of Agent
certify that, in the pi
, if I should become
lature of ADDlicant '
Date
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
the workers' compensation Mvisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �•
✓i/ n.,.e/[ C — C? — / ICJ
!reby affirm under penalty perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code)
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 provided is correct.
I agree to comply with all applicable city and county o inances and state laws relating to building construction.
I authorize representatives of this city or county to a the above-' .fified-property-for-inspection purposes.
nature of Property Owner or Authorized Agent PTint-Pjoperty Owner's or Authorized Agent's Nam
ACTION
DATE
BY
ON OF COMPLIANCE WITH CODE OF
FOR OFFICE
FEDERAL REGULATMS PAPT b7 uF TTR--JO AYD
AQMD RULE 1403.
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PERMIT EXPIRED
❑ I SUBWTTEDASBE'STOS NO719CAT'Ot-TO:
❑ EPA
PERMtTCANCELLED
❑ AQMD
PERMITEXTENDED
PROPOSED TDEMO T N OS nOM lS NOT APPLICABLE TO
PERMIT FINAL
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CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED