HomeMy WebLinkAboutS2022-0034 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 2 0 0 3 4
Permit Counter Phone (949)644-3288
,lob Address: 526 RIVERSIDE AVE Floor: Suite: Bldg: 1
Description of Work:SFR NEW POOL & SPA 126 SF W1 DRAINAGE
Inspector Area: 3
Plan Check No:
0278-2022
Cade Edit:
2019
Legal Description: FIRST ADD TO NEWPORT HEIGHTS LOT 7 BILK 35
Owner: SAMEN EDWARD
Contractor: OWNER/BLDR
Architect:
Address: 526 RIVERSIDE AVE
Address: SAMEN MICHAEL
Address:
NEWPORT BEACH, CA 92660
Phone: 949-629-8263
Phone:
Phone:
Applicant: SAMEN EDWARD
Address: 526 RIVERSIDE AVE
NEWPORT BEACH, CA 92660
Phone: 949-629-8263
Building Rear:
Setbacks: Front:
Left:
Right:
Construction Tvoe :
Construction Valuation: $25,000.00
Building Permit Fee : $440.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$1.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$396.00
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WO Compliance Insp Fee:
$0.00
TOTAL FEE:
PROCESSED BY:,
ZONING
Con State Lic: Ole
Lic Expire:
Bus Lic:
Lic Exp Date:
Worker's Compensation Insurance
Carrier:
Policy No:
Expiration:
POOLPermit : S2022-0034
Project No : 0278-2022
Inspection Requests Phone (949)644-3255
State Lip:
Engineer: THOMPSON MATTHEW
Address: 12021 N TUSTIN AVE
ANAHEIM CA 92807
Phone: 714.630-6100 State Lic:C-086051
Special Conditions:
Issued Date: 0410712022
FEES
tr,
Record Management:
$6.00
Jr
Water Quality--- ai_ ° ;
Fee:.I
$0.00
Building Dept Inspection
+'-"'
Drainage Permit Fee :
$237.00
Water Quality Dept Insp Fee:
$152.00
Drainage Plan Check:
$199.00
Building Dept WO Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Additional Fee :
$0.00
$0.00
Plan Check Fee : $595.00
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at Permit Issuance : $836.00
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 items)
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
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 for a permit subjects the applicant to a civil penalty of
of more than five hundred dollars ($500). 12021 N TUSTIN AVE
1 I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure.is not intended or offered for sale (Section 7044,
lusiness 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
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).
I, as o er 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
ppl n 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).
I m exempt from licensure under the Contractors' State License Law for the following reason:
Iy nnsignature 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 lega11,
ell structure that I have built as an owner -builder if it has/K15Pbeepconstructed in its ant" y licensed contractors. I understand that a copy of the applicable law, Section 7044 of t.e Bu iness and
essions Code, is available upon request when thy ap Io s ubmitted at t www. egln o.ca.gov/calaw.html.
Iignature of Property Owner or Authorized Agent ` Date _� �Z
.ICENSED 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
nd effect. License Class License No Date Contractor Signature
NORKERS' COMPENSATION DECLARATION
NARNING: 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
: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:
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 th
)erfomlance of the work for which this permit is issued. Policy No.
:3I 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' compensatioi
nsurance carrier and policy number are:
ter Policy Number Expiration Date
Jame ant Phone #
certi that, in the performance oft Mrk for which this permit is issu I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
at, if I ould become subject
/to th w e compensation Shall
9;Z99-ef the ' Rbor Code, I shall forthwith comply with those provisions. 1 7
Signature of Applicant X722-'bey !- �9�9 — Date.Y
DECLARATION REGARDI NSTRUCTION L�G AGENCY Y`�'
hereby 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).
-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 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 or nces and state laws rel ' o building construction.
authorize representatives of this city or county to h above-ide ad ses. S' �^
Signature of Property Owner or Authorized Agent rint Property Owner's or Authorized Agent's Name ,/��ti7l ate
ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED LJ I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED EPA
PERMIT EXTENDED QMD
POOLALARMS ASBESTOS NOTIFICATION IS NOTAPPLIC.BLE TO
INSTALLED PROPOSED DEMOLITION.
SIGNATURE:
PERMITFINAL