HomeMy WebLinkAboutS2021-0157 - PermitsCity of Newport Beach - Building Division 1111pIII111111N1111p111111111111111111(9)
100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 1 0 1 5 7
Permit Counter Phone (949)644-,3288
Job Address: 515 EL MODENA AVE Floor: Suite: Bldg: 1
Description of Work:SFR UNDERGROUND NEW PREFAB SPA
Inspector Area: 3 Plan Check No: 1623-2021
Code Edit: 2019
Legal Description: FIRST ADD TO NEWPORT HEIGHTS ELK 36 LOT 21
Owner:
RAKESTRAW THOMAS E
Contractor:
OWNER/BLDR
Architect:
Address:
515 EL MODENA AVE
Address:
RAKESTRAW THOMAS
Address:
NEWPORT BEACH, CA 92663
O/B AUTHORIATION ATTACHED
Phone:
Phone:
Phone:
Applicant: RAKESTRAW THOMAS E
Con State Lic:
O/B
Engineer:
Address:
515 EL MODENA AVE
Lic Expire:
Address:
NEWPORT BEACH, CA 92663
Bus Lic:
Phone:
714-865-2833
Lic Exp Date:
Phone:
POOLPermit : S2021-0157
Project No: 1523-2021
Inspection Requests Phone (949)644-3255
RAKESTRAW THOMAS �
515 EL MODENA AVENUE
NEWPORT BEACH CA 92663
949/474-5353 State Lic:C019790
THOMPSON DOUGLAS SEVIER
21084 BAKE PARKWAY #100
LAKE FOREST CA 92630
949-599-0320 State Lic:S-002578
Building Rear: Worker's Compensation Insurance Special Conditions:
Setbacks: Front: Carrier:
Left: Policy No: ,
Right: Expiration: Issued Date: 08/18/2021 '
Construction Type
FEES
Construction Valuation: $15,000.00 '
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 Delp Plan Check:
$396.00
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE: $853.00
PROCESSED BY:
ZONING
Record Management:
$16.00
Water Quality --
Building Dept Inspection Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Drainage Plan Check:
$0.00
Building Dept WQ Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Additional Fee :
$0.00
$0.00
Plan Check Fee : $396.00
PLAN CHECKED BY::
APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at Permit Issuance :
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) 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, ; hor tc its issuance, also requires the applicant for
the 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
Professions 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
not more than five hundred dollars ($500). 21084 BAKE PARKWAY #100
❑ 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, 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 i proved for the purpose of sale).
XI, 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).
YSl I am exempt from licensure under the Contractors' State License Law for the following reason:
X OW N EIS �N 1 L I� GtZ 8 H l2r PI�6FP_ zji10 N9 ti Sufi Cuu'�IeAtiO*y 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 ¢as not een 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 reques when this app Kati submitted or at the following Web
site:http://www.leginfo.ca.gov/calaw.htm1. Signature of Property Owner or Authorized Agent -
Date LICENSED CONTRACTOR'S DECLA
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (comm 'in
with Section 7000) of Division 3 of the Business and
Professions Code, and my license is in full force and effect. License Class License No Date Contractor
Sinnalure
WORKERS' COMPENSATION DECLARATION
I'ARN!NG: 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
CCST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm uri penalty of perjury one of the following declarations:
❑ I 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 thi
aei ormarl of tire work for which this permit is issued. Policy No.
I 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'
su,ance carrier and policy number are:
Policy Number
of Agent
Date
certify that, in +he 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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant Date_
CLARATION REGARDING 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).
ider'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 to enter the Eve-i led property for inspection purposes, y
nature of Pi Owner or Authorized ADent %q % Print Pi Owner's or Authorized ADent's Name 1'<_PoYti'L4g RAID
ACTION DATE BY �( Df[?LARATIO(S.OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
((EGULATIONS PART 61 OF TITLE 40 AND AQI RULE
PERMIT EXPIRED
LU I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
UEPA
PERMIT EXTENDED
OAQMD
POOL ALARMS
INSTALLED
LJASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERMITFINAL
M