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Home My WebLink AboutS2019-0153 - Permits, � City of Newport Beach - Building Division II III IIIIIIIIIIIIIIIIII III IIIIIIIIIIIIIIIII II PQOLPermit : S2019-0153 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 1 9 0 1 5 3 Project NO : 2012-2019 r- :; Permit Counter Phone (949)644-3288 '.. fir. "!ttiu'k... Inspection Requests Phone (949)644-3255 Job Address: 2141 INDIAN SPRING LN Floor: Suite: Bldg: 1 Record Management: $12.00 Water Quality --- Description of Work:SFR NEW POOL/SPA 606 SF W/DRAINAGE $0.00 Building Dept Inspection Fee: $269.00 Inspector Area: 3 $0.00 Plan Check No: 2012-2019 Water Quality Dept Insp Fee: e Building Green Fee: $3.00 Code Edit: 2016 Building Dept WQ Plan Check: i ��® Plan Dept Plan Check: Legal Description: N TR 6689 LOT 1 Grading Consultant Fee : $1,298.00 Others Building Dep Plan Check: $373.00 Owner: CHASON CLIFTON Contractor: SWAN POOLS OF SOUTHERN CA Architect: Building PC Investigation : e Additional Fee : Address: 2141 INDIAN SPRING LN Address: 24512 BRIDGER ROAD Address: $0.00 e ece°oc NEWPORT BEACH, CA 92660 LAKE FOREST CA 92630 0.0 ° Phone: Phone: 949-859-8466 Phone: $716.00 Fee Due at Permit Issuance : $2,177.00 e State Lic: Applicant: ELLISON PAUL Con State Lic: 440333 Engineer: LACHER TODD Address: 24512 BRIDGER RD Lic Expire: 03/31/2020 Address: 1201 N TUSTIN AVE LAKE FOREST CA 92630 Bus Lic: BT96008994 ANAHEIM CA 92807 ° e � Phone: 949-859.8466 Lic Ezp Date: 07/31/2020 Phone: 714.630-6100 0000e State LicC-067656 ° e IC u Building Rear: 20 Worker's Compensation Insurance Special Conditions: Setbacks: Front: 6 Carrier: STATE FUND ° Left: 6 Policy No: 9228545 Right: 6 g Expiration: p 04/01/2020 Issued Date: 11/08/2019 °c0000 Construction Type: FEES Construction Valuation: $66,000.00 Building Permit Fee : $418.00 Record Management: $12.00 Water Quality --- Permit Issuing Fee: $0.00 Building Dept Inspection Fee: $269.00 Investigation Fee: $0.00 Drainage Permit Fee: $0.00 Water Quality Dept Insp Fee: $119.00 Building Green Fee: $3.00 Drainage Plan Check: $0.00 Building Dept WQ Plan Check: $0.00 Plan Dept Plan Check: $0.00 Grading Consultant Fee : $1,298.00 Others Building Dep Plan Check: $373.00 $0.00 Building PC Investigation : $0.00 Additional Fee : $412.00 $0.00 Plan check Ext. Fee: $0.00 WQ Compliance Insp Fee, 0.0 TOTAL F $2,893.00 Plan Check Fee : $716.00 Fee Due at Permit Issuance : $2,177.00 C14 LJ PROCESSED B PLAN C CKED BY:: ZONING APPROIV APPROVAL PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID • e•� e o• e• 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). 1201 N TUSTIN AVE ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) 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). ❑ 1, 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 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://www. leginfo.ca.gov/calaw.html. Signature*& 159operty Owner or Authorized Agent Date I IFENSEQ COkITRACTOR'S DECLARATION I hereby affRrfi"(er penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7002213 of the Business and ProfeSe is orce Bpd effect. License Class License No Datessi R od y Ii Contractor Signature IYaRKER$',(;QMPENSATION DECLARATION NARNING: FAIIl��Uj�JJB 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 OAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. Aereby affjl&T►dnder penalty of perjury one of the following declarations: e •• i have an jj 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 ante of the work for which this permit is issued. Policy No. AI ve A VArllaintain 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' compensatioi enr`car•rii r aqd policy number are: 7rierar • • • Policy Number _ Expiration Date Name of Agent Phone # :11 certify that, in the performs oft a work for w ' this per it is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alifornia, and agre :hat, if I should become subj t to th ers' s i provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant - Dat )ECLARATION REGA G CONSTRUCTION LENDING AGENCY hereby affirm under pr of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). -ender's Name Lender's Address 3y my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county divan as d e s rel ' to building construction. I authorize representatives of this city or county t enter th ab -i ifie perty for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owners or Authorized A ent's Name ACTION DATE BY V DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMITEXPIRED LIISUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED EPA NSOALLARMS PROPOSEDDEMOLITION.ASBESTOS NOTIFICATION IFICAION IS NOT APPLICABLE TO