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Home My WebLink AboutS2022-0061 - PermitsCity of Newport Beach - Building Division 111111111111111111111111111111111111111111111111111111 4' 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 Job Address: 609 DONALD PL Floor: Suite: Description of Work:SFR NEW SPA W/DRAINAGE 80 SF Inspector Area: 3 Legal Description: N TR 10156 LOT 1 Owner: MILLER ROBERT Address: 609 DONALD PL NEWPORT BEACH, CA 92663 Phone: Applicant: DORN RICK Address: P.O. BOX 10047 WESTMINSTER CA 92685 Phone: 7141585-7322 Building Rear: Setbacks: Front: Left: Right: Construction Valuation: $56,000.00 Bldg: 1 Plan Check No: 0654-2022 Code Edit: 2019 Contractor: RICK DORN CONST Address: P O BOX 10047 WESTMINSTER CA 92685 Phone: 714-585-7322 Con State Lic: 357535 Lic Expire: 0513112023 Bus Lic: BT30074323 Lic Exp Date: 02128/2023 Worker's Compensation Insurance Carrier: STATE COMP INS. Policy No: CWC00207000 Expiration: 09/2812022 FEES Architect: Address: Phone POOL -Permit: S2022-0061 Project No : 0654-2022 Inspection Requests Phone (949)644-3255 Engineer: THOMPSON MATTHEW Address: 12021 N TUSTIN AVE ANAHEIM CA 92807 Phone: 714-630-6100 Special Conditions: Issued Date: 04/0512022 ••m• State Lic: •m°• °°®• • State Lic:C-086051 .... ° • • ° o •° momm• °• • •m°°•° 0 0 ° • • Building Permit Fee: $440.00 Record Management: $8.00 Water Quality --- Permit Issuing Fee: $0.00 Building Dept Inspection Fee: $0.00 Investigation Fee: $0.00 Drainage Permit Fee : $237.00 Water Quality Dept Insp Fee: $0.00 Building Green Fee: $3.00 Drainage Plan Check: $199.00 Building Dept WQ Plan Check: $0.00 Plan Dept Plan Check: $0.00 Grading Consultant Fee : $0.00 Others Building Dep Plan Check: $396.00 $0.00 Building PC Investigation : $0.00 Additional Fee : $0.00 $0.00 Plan check Ext. Fee: $0.00 WO Compliance Insp Fee: $0.00 TOTAL FEE: Plan Check Fee : PROCESSED BY: PLAN CHECKED ZONING APPROVAL: APPROVAL TO I PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Fee Due at Permit Issuance : $688.00 OWNER -BUILDER DECLARATION I` 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 Kamm ction 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 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 fessions 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 more than five hundred dollars ($500). 1 12021 N TUSTIN AVE I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions ainess and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throu( )rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of cc )roved for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 70, )ly to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contra( I am exempt from licensure under the Contractors' State License Law for the following reason: my signature below I acknowledge that, except for my personal residence in which I must have resided for at least or a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I (fessions Code. jS Vallable upon request when this application is submitted or at the following Web site:http://www.le nature of Pr ftq); gt✓ner or Authorized Agent rfA$ED CQUTJ ACTOR'S DECLARATION 3rebyeffirm under -penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section hoO d effect. License'Ila'ss License No Date DECLARATION FAILURBTO SECNRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL !OMPENSATR)R,'OAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. affirm LTel fr penalty of perjury one of the following declarations: Le -and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Dire Wce of the Work for which this permit is issued. Policy No. • • •. and �� ainiein workers' compensation insurance, as rpeuired by Section 3700 of the Labor Code, for e carri and uollicv number a'fe: i n y I .� ie of Agent r certify that, in er ormance of the work for which this it is issued, I shall not employ any person in any if I should become subject to orkers' corm o ovisions of Section 3700 of the Labor Code, I shall hereby affirm under penalty othat there is a construction lending agency for the performance of the work for Ender's Name Lender's Address the work, and the structure is not intended or offered for sale (Section 7044, employees' or personal effort, builds or improves the property, provided that the pletion, the Owner -Builder will have the burden of proving that it was not built or Business and Professions Code: The Contractors' State License Law does not pursuant to the Contractors' State License Law). year prior to completion of the improvements covered by this permit, I cannot iderstand that a copy of the applicable law, Section 7044 of the Business and ifo.ca.qov/calaw.html. Date the Business and Prdfesg'erfs Code, my lic nse is in full force OO Contractor Signature AND CIVIL FINES UP TO ONE HUNDRED THOUSA D DOLLARS ($100,000), IN ADDITION TO THE of Industrial Relations as provided for by Section 3700 of the Labor Code, for performance of the work for which this permit is issued. My workers' Date so as to become subject to the workers' compensation laws of California, and agre h comply with those provisions. D te_ i this permit is issued (Section 3097, Civil Code). By 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 a ws relating to building construction. I authorize representatives of this city or coun to r the abo tified property for inspection purposes. �_ Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's a '�'= D t tiZ ACTION DATE BY ATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY Alf required alarms,latches REGULATIONS PART 61 OF TITLE 40 AND ACMD RULE gates & fences which Serve 1403 as Dart of a nnnl r PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO Darner, shall be In place prior to approval to fill pool/spa & shall remain in place & b-_ Inaintaine'c i:)r the II- Of the n - . X I(�4'a ----- ___ PERMIT CANCELLED LIEPA PERMIT EXTENDED UAQMD POOL ALARMS INSTALLED ASBESTOS NOTIFICATION IS NOT APPLICABLE TO OPOSED DEMOLITION. SIGNATURE: PERMIT FINAL