HomeMy WebLinkAboutS2021-0280 - PermitsCity of Newport Beach - Building Division 1111111111111111111111111111111111111111111111 POOLPermit : S2021-0280
!.� 100 Civic Center Drive, Newport Beach, CA 92660 s 2 0 2 1 0 2 6 0 Project NO :2949-2021
ry n Permit Counter Phone (949)644-3288
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+ Inspection Requests Phone (949)644-3255
Job Address: 420 SERRA DR Floor: Suite: Bldg: 1
Description of Work:SFR RE -PLASTER (E) POOL, INSTALL NEW BAJA BENCH
Inspector Area: 5
Plan Check No:
2949-2021
Code Edit:
2019
Legal Description: N TR 1237 LOT 26
Owner: ASSID JOHN
Contractor:
SMITH ALAN POOL PLASTERING
Architect:
C)
Address: 3612 OCEAN BLVD
Address:
227 W CARLETON AVE
Address:
CORONA DEL MAR, CA 92625
ORANGE CA 92867
VJ
Phone:
Phone:
714-628-9494
Phone: State Lic:
S
-°�
Applicant: JAI M E/ALAN SMITH POOLS
Con State Lic:
571196
Engineer: THOMPSON MATTHEW
!�
64.
Address: 227 W CARLETON AVE
Lic Expire:
06/3012023
Address: 12021 N TUSTIN AVE
ORANGE CA 92867
Bus Lic:
BT00012422
ANAHEIM CA 92807
Phone: 714-448-0537
Lic Exp Date:
08/31/2022
Phone: 714-630-6100 State Lic:C-086051
e,®
Building Rear:
Worker's Compensation
Insurance
Special Conditions:
Setbacks: Front:
Carrier:
ARCH INS. CO.
Left:
Policy No:
ZAWC12545402
Right:
Expiration:
04/01/2022
Issued Date: 1211612021
Construction Type : VB
FEES
Construction Valuation: $48,865.00
Building Permit Fee : $798.00
Record Management:
$10.00 Water Quality ---
$0.00
Permit Issuing Fee: $0.00
Building Dept Inspection Fee:
$0.00
Investigation Fee: $0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Building Green Fee: $2.00
Drainage Plan Check:
$0.00
Building Dept WQ Plan Check:
Plan Dept Plan Check: $52.00
Grading Consultant Fee :
$0.00 Others
$0.00
Building Dep Plan Check: $894.26
$0.00
Building PC Investigation : $0,00
Additional Fee :
$0.00
Plan check Ext. Fee : $0.00
WQ Compliance Insp Fee: $0.00
TOTAL FEE: $1,556.26
Plan Check Fee : $0.00
Fee Due at Permit Issuance
: $1,556.26
PROCESSED BY:
ZONING
PLAN CHECKcJ Bl :.
f,PPROVAL T7 ISS'J5
PERMIT EXPIRES 180 DAYS AFTER ISSUANC_ OR LAST VFLII11NSf? G.TION
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) 1 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 m 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). 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 (_) 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
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 i o Division 3 of the Business and Profes�gas-Code, and license is in full force
and effect. License Class License No Date Contractor Signature �
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO 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
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNErS FEES.
I 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
perymance of the work for which this permit is issued. Policy No.
rhave 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' compensatior
urance carrier and po bar are: N
m
mer Pot im ey Expiration Date
me of Agent r J Phone #
I certify that, in the performance of the work fo 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 agre,
t, if I should becomes ject rkers' c pensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant I Dat /12or
CLARATION REGOADMG CONSTRUCTION LENDING AGENCY -
:reby affirm under penalty 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).
order'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 and state laws relating to building construction.
I authorize representatives of this city or county t9 entpxtrl'labove-i4ntifed property for inspection purposes. t _ ,y
ACTION
DATE
BY '
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY (" '
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
All required aiarms,latches
1403
PERMITEXPIRED
_
LJ I SUBMITT':D ASBESTOS PIOTIFICATION TO
E EPA
as part of a pool / spa
barrier, shall be in place
prior to approval to fill
pool/spa & shall remain in iS
place & be maintained for
PERMITCANCELLED
PERMIT EMENDED
_
qMD
POOL ALARMS
INSTALLED
11ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
PROPOSED DEMGUT,C N.
the life of the pool/S a
SIGNATURE:
— — _ — — —
X AW �-
PERMIT FINAL
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