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Home My WebLink AboutX2021-1893 - PermitsCity of Newport Beach - Building Division COMB Permit: X2021-1893 .'+ 100 Civic Center Drive, Newport Beach, CA 92660 Project No: 1401-2021 Permit Counter Phone (949)644-3288 y.. i Inspection Requests Phone (949)644-3255 Issued Date : 07/20/2021 "'frrv,vx.> Combination Type - BLDG Inspection Area : 4 PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION. PROJECTS MUST BE COMPLETED BY 07/20/2024 OR PERMIT WILL BE INVALID Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Ho�l"C�ys Job Address: 23 PINEHURST LN NB �(JJ�i(1 Description: ADDITION OF HOLDING TANK FOR POOL AND SPA S2021-0144 Legal Desc.: N TR 7223 LOT 52 Owner: SEAHORSE HOLDINGS LLC Contractor: RICK DORN CONST Architect: Address: 2601 MAIN ST STE1200 Address: P O BOX 10047 A IRVINE92685 , CA 92614 Phone: hone: 714-585-7322 Phone � . State Lic: if a plicable: r Applicant: RICK DORN CONST Date. -- AEr>�i6ear: LACHERTODD Address: P O BOX 10047 Lic Ex re: 05/3112023 r I StTJN AVE "R, or'12 �A WESTMINSTER CA u �j �p}�, Phone: 714-585-7322 Code Edit : 2019 Type of Construction: Occupancy Group: U Added /New sq.ft. Bldg: 0 Added /New sq. ft. Garage: 0 No of Stories: 0 No of Units : 0 Bldg Height: 0 Bldg Sprinklers: Construction Building Permit Fee: $280.00 Plan Check Fee: $243.60 Overtime Plan Ck: $0.00 Investigation Fee: $0.00 Record Management : $0.00 Energy Compliance: $0.00 CA Seismic Safety: $0.00 Disabled Access: $0.0c Hazardous Mat $0.0c Building Green Fee : $1.0c PROCESSED BY: j3us Lic .. BT�9074322:, 0 H '' ,- ` 91 Phone: 714-630-6100 State Lic:C-067656 - 'Lic Exp Date. '02128/2022 Worker's Compensation Insurance E L topwhei-I: --- - + Lem Carrier. STATE COMP INS. Address: Policy No: 9269144 ' Expire. 0211512022 Phone: a�or— =?�> Bwlding Setbacks Rear / - Special Conditions: Front 1 Right: / e,..,, n Fire Hazard Zone : N t o OGra a,�,�, c,ar p r y yy PIT a $timiedt i ment A�on $D.00 i Plan c eck F e 0 Fire Inspection $0.00 dc� �pr� s ¢¢eea�rr}} \ $0.00 Fair.Share. �n0 work Shia$ d Fire Plan Rev $0.00 Grad}n onr5lianCe� I $0.00 SJH Trans : $0.00 Demolition Fee Grading Permit Fee: $0.00 In -lieu Housing Fee : $0.00 Buildin pt ad i $0.00 ♦ Grading PC Fee: $0.00 Public Works De a - e 3 $0.00 Note: ark Dedication : $0.00t $0.00 PAN Plan Check: $o.pgsp, i nitlalS:G r $0.00 Me f LJ Mechani $0.00 ° � $0.00 lumbina %: $0.00 TOTAL FEE: $524.60 ZONING APPROVAL: GRADING APPROVAL: Check Fee : $0.00 Fee Due at Permit Issuance : $524.60 PUBLIC WORKS APPROVAL: PLAN CHECK BY: APPROVAL TO ISSUE: 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) 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 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 more than five hundred dollars ($500). as owner of the property, or my employees with wages as their sole compensation, will do U all of or `) eon ass and Professions Code: The Contractors' State License Law does not apply to an owner of pro. ert +ements are not intended o - & ,n one ear improved for the purpose of Sal 111, as owner of the property, apply to an owner of property w ❑ I am exempt from Iicensure By my signature below I ackrim sell a structure that I have built Professions Code, .3 available I Ficra"rr^. of Property Owner or LICENSED CON 'i RACTOR I,h'zreby.. affirm under penalty of and e.fact. License Class iARNN6: FAILURE TO SECURE WORKE; = qr COMPENP 4TION, D 4MAGES AS hi,e4r, affirm under penalty of pe Y s of the work, and the structure is not intended or offered for sale (Section 7044, n Pmnl^•^ ^. _^..,^ al =ffort, oves the property, provided that the completion, the Owner -Builder will have the burctn of proving that it was not built or the project Section 7U44 i 69a�ih1l@fofessions Code: The with a licensed Contractor pursuant to the Contractors' State Lic :r the Contractors' Stalb License Law for the following r�on [ eo% nr I � uuU ,,o rerl.lna e that, except for my p resitl'dike iri'wNAN mds 'have resiefed'forat least one year prior to completion of the improvemen I owner builder if it has not en constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, request when this application is submitted or at the following Web site: http://w .lGL"fW f)q3".law.html. that I am licensed under provisions of Chapter 9 (commencing with Section 7000 of Division 3 of the Business and Profe eense No Data, 'z-( Contractor Signature _ ION 71 � E N COVERAGE IS UNL FUL, AND SHALL SI{BJECT AN eMPLQYEK TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED ECTION ABO0.' d5E, INTEREST, AND ATtORNFft EES 0 o e followina declarations: + , ,iave and will maintain a cei ficate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relati ns as ovided for by �tformznce of the v:orC for which is permit issued Policy No.YO V1 �! �� ant al nave and will main+ain worker co p on _hisgtr�n a �equirep r.>N 00 of the L bon de, 1!P` E f wo o d!/FfII�I}It1111s pe swance Carrie, ai,o policy numbe are: V V iA i 9 �./ gorier (Odl*n � (no work st@49) n Date ame of Agent Phone # ]I certify that, in the performance f thew or w ich this permit is issued, I shall not employ any person in any manner so as to become subject at, if I should become subject to t e r@ co ensation r v comp y with those provisio ignature of Applicant Insn. initials:._ areby affirm under penalty o(perjtry that there is a construction le d no nn,nl;"g rti^ - --- -- tder'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 agree to comply with all applicable city and county ordina sand slat laws relating to building construction. I authorize representatives of this city c coun'fty to ent a ova -id tified property for inspection purposes. nature of Property Owner or Authorized Age�Fr Print Prooertv Owner )rs' State License Law does not I). vaned by this permit, I cannot legall, ,ion 7044 of the Business and to 0 my I��nse is in full force DOLLARS ($100,000), IN ADDITION TO THE ADDITION TO THE n 3700 of the Labor Code, for thI issued. My workers' compensatioi risation laws of California, and agree - Zp— 24 Civil Code). ACTION DATE �BY I�f-[L4frTION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMIT EXPIRED 7 30 09 I SUBMITTED ASBESTOS NOTIFICATION TO PERMIT CANCELLED LIEPA PERMIT EXTENDED QMD PERMITFINAL U ASBESTOS NOTIFICATION IS NOT APPLICABLE TO CERTIFICATE OF PROPOSED DEMOLITION OCCUPANCY ISSUED SIGNATURE: