HomeMy WebLinkAboutS2023-0021 - Permits�aEWPO/�ar
City of Newport Beach
@
Community Development Department- Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone: (949) 644-3288
Inspection Requests Phone: (949) 644-3255
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newportbeachca.gov/inspections
Combination Type - SFP
Work Class - Alteration
111111III �111111111111111111111111111111111111111111 II Pool Permit : S2023-0021
Plan Check No : PC2023-0193
Issued Date : 0112712023
Inspection Area : 3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 1133 SOMERSET LN Legal Desc : N TR 3032 BLK LOT 7
Description: SFR - REPLASTER POOL & SPA, SPLIT MAIN DRAINS, NEW DRAIN COVERS
Owner: DANIEL BLACKWELL
Contractor :
Architect
Address : 1133 SOMERSET LN
Address :
Address
NEWPORT BEACH, CA 92660
Phone: (949)241-9175
Phone:
Phone: ,
Con State Lie :
State Lie
Lie Expire
Applicant : DANIEL BLACKWELL
Bus Lie:
Engineer:
Address : 1133 SOMERSET LN
Bus Lie Expire :
Address
NEWPORT BEACH, CA 92660
Phone : (949) 241-9175
Phone
Workers' Compensation Insurance
Carrier :
Owner/Builder: DANIEL BLACKWELL
Policy No:
Designer
Address : 1133 SOMERSET LN
W. C. Expire:
Address
NEWPORT BEACH, CA 92660
Phone : (949) 241-9175
Phone:
Code Edition : 2022
Fire Sprinklers : NO
Construction Valuation : $24,000.00
Type of Construction :
Fire Hazard Zone : NO
Added/New/TI sq. ft. Bldg : 0
Occupancy Groups : U
No of Units :
Alteration sq. ft. Bldg :
Bldg Height:
No of Stories:
Added/New sq. ft. Garage: 0
Building Setbacks : Front: 20, Side: 6, Side: 6, Rear: 6
Flood Zone : X
Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates minimum lot area)
PROCESSED BY:
SPECIAL CONDITIONS:a.-
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 tops Issuance, also requires the applicant for
to 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
'rofessions 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 fora permit subjects the applicant t0 a civil penalty of
of more than five hundred dollars ($500).
31, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or C) portions of the work, and the structure is not Intended or offered for sale (Section 7044,
tusinses and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through emplayees' or personal effort, builds or improves the property, provided that the
nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
n roved for the purpose of sale).
as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and. Professions Code: The Contractors' Stale License Law does not
poly to an owner of properly who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law),
I I am exempt from licensors under the Contractors' State License Law for the following reason:
ly my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the Improvements covered by this permit, I cannot legal]!
ell a structure that I have built as an owner -builder if It has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and
rofessions Code, is available upon request when this n I$ submitted or at the following Web site:http:llwww.leginfo.ca.govicalavr.htmL
lignature of Property Owner or Authorized Agent t! `--• I...it 1 Date�-I c�3
.10ENSED 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 Code, and my license is In full force
no effect. License Class License No Date Contractor Signature
VORKERS' COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 13 UNLAWFUL, AND $HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (3/DO,000), IN ADDITION TO THE
DST OF COMPENSATION, DAMAGES As PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
hereby affirm under penalty of perjury one of the following declarations:
I I have and will nalnts:n a certiNcete 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 lh
errormance of the work to: whi611.1s permit is issued. Policy No.
have 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'
ranee carrier and policy number are.
Policy Number Expiratic
of Agent Phone
Date
certify that, in the performance 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
if I should become su"'ect to the wnrkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
(nature of Applicant Dale—,_
CLARATION REt-AROrMG CPNSTR'ICTION LENDING AGENCY
sreby affirm under penalty of perjury thatthere is a construction lending agency for the performance of the workfor which this permit is issued (Section 3097, Civil Coda).
7der's Name Lenders 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 and state laws relating to building construction.
I authorize representatives of this city or county t°I ester the ablove-identified property for inspection purposes.
nature of Prooertv Owner or Authorized. Y'�--' �-�-I Print Prooenv Owner's or Authorized Aaent's Name k lv--1 R or
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART Fl OP TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED REPA IV All required alarms, latches gates and fences which serve as part of a pool/spa barrier, shall
PERMIT EXTENDED Mp be to place prior to approval tofill pool/spa & shall remain in place & be maintained for the
PERMIT FINAL -g�3 SBESTOS NOTIFICATION IS NOT APPLICABLE TO life of the pool.
CERTIFICATE OF PROPOSED DEMO tON 1
OCCUPANCY ISSUED 'SIGNATURE: V✓1
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