HomeMy WebLinkAboutS2021-0052 - Permits�w City of Newport Beach - Building DivisionIIIIII�IIIIIIIIIIIIIIIIIII�IIIIIIII�IIIII II POOLPermit : S2021-0052
100 Civic Center Drive, Newport Beach, CA 92660 S 2 8 2 1 �' Project No : 0387-2021
`- Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Phone
Applicant: DORN RICK
Address: PO BOX 10047
WESTMINSTERCA 92685
Phone: 714-585-7322
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $24,000.00
Building Permit Fee :
$484.00
Permit Issuing Fee:
$0.00
Investigation Fee:
CTOR
Job Address: 1407 SANTIAGO DR Floor: Suite:
Bldg: 1
Plan Dept Plan Check:
$0.00
N4
E
Description of Work:POOL REMODEL & ADD SPA 49 SF
$0.
Plan check Ext. Fee:
00
Inspector Area: 3
$0.00
Plan Check No:
0387.2021
Lie Exp Date:
02128/2022
Code Edit:
2019
Legal Description: N TR 3851 LOT 53
-- -
Owner: WHEELER SHARI
Contractor:
RICK DORN CONST
Architect:
Address: 1407 SANTIAGO DR
Address:
P O BOX 10047
Address:
NEWPORT BEACH, CA 92660
WESTMINSTER CA 92685
Policy No:
Phone
Applicant: DORN RICK
Address: PO BOX 10047
WESTMINSTERCA 92685
Phone: 714-585-7322
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $24,000.00
Building Permit Fee :
$484.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$1.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$421.08
Building PC Investigation :
$0.
Plan check Ext. Fee:
00
WO Compliance Insp F
$0.00
TOTAL FEE :l $912.08
PROCESSED BY:
ZONING APPRO\,
Phone:
714.585.7322
Phone: State Lie:
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Con State Lie:
357535
Engineer:
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Lie Expire:
05131/2021
Address:
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Bus Lie:
BT30074323
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Lie Exp Date:
02128/2022
Phone: State Lic:
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Worker's Compensation Insurance
Special Conditions:
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Carrier:
WC EXEMPT
Policy No:
(NO EMPLOYEES)
Expiration:
Issued Date: 02119/2021
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Record Management:
$6.00
Water Quality ---
Building Dept Inspection Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Drainage Plan Check:
$0.00
Building Dept WQ Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Additional Fee:
$0.00
$0.00
Plan Check Fee :
PLAN CHECKED
APPROVAL TO II
V
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at Permit Issuance
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)'6f 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 pgnalty of
not more than five hundred dollars ($500). ❑
1, 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).
IJ 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 Iegailt
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:hltp://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm VIM pgnalty of perjury that I am licensed under provisions of Chapter 9 (commencing with SectionX000) 9 .I Io 3 f the Business and Professions Cod ud+mg-lipense is in full force
and effect. LiceR"Slass License No Date ; Z"-' 1 Contractor Signature
�VCK4RS' C�ONw'Pf1SATION DECLARATION ��
NIIRNRT: FAILURE f0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU RED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
C ST O COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3703 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
Pher€by affirm under penalty of perjury one of the following declarations:
• ••••.
q JJgo•mafit
e and will ain 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
performance of the work for which this permit is issued. Policy No.
3 .. • . •
.W% and wig nl*tain 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' compensation.
NBUrgore carrier and policy number are:
Policy Number
Date
that,ili /heVerformance of the work for which th' ssu d, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
ould become s ct to the workers'/coffin �sat�ion prowslons action 3700 of the Labor Code, I shall forthwith comply with those provisions.
of Applicant
areby affirm under penalty of perjury ththere 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 ordinances &15lVe ws relating to building construction.
I authorize representatives of this city or counnt g) terve-Id led property for inspection purposes.
.,�r,,.e ..r D...,.ea„ n,.,nor..r A„rnndeen A,.entT Print Pronedv Owners or Authorized Acent's Name
ACTION
DATE
BY
121MIXIIATION OF COMPLIANCE WITH CODE OF FEDERAL
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
FOR OFFICE USE ONLY
All required slarms, latches
& fenees
PERMITEXPIRED
U,l SUBMITTED ASBESTOS NOTIFICATION TO
gates
which serve
as part of a pool / spa
barrier, shall be in place
prior to approval to fill
pool/spa & shall remain in
place F be maintained for
PERMIT CANCELLED
LIEPA
PERMITEXTENDED
UAQMD
POOL ALARMS
INSTALLED [,�'/,i'
// l
/ JA I
ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
PROPOSED DEMOLITION.
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