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Home My WebLink AboutS2019-0023 - Permitsr�wlra� City of Newpurt2eaoh- Building Division 100 Civic Center Dive, Newport @each. CA 92600 Permit Counter Phsree (9d§)644-32Fi8 V c'{sxrn4ek u 6 L c crr e Job Address: 1106 SEA LN Floor: Suite: Bldg`:1 Description of Work:NEW SPA 49 SF Inspector Area: &/ Legal Description: N TR 2202 LOT 9¢ Owner: KEISSELBACH MARK Address: 1106 SEA LN CDM CA 92625 Phone: Applicant: ELLISON PAUL/BLACK MTN Address: 39695 REDONDO MESA MURRIETA CA 92562 Phone: 949-337-3831 P-4, Building Rear: Setbacks: Front: Construction Valuation:\$' Building Permit Fee Permit Issuing Fee: Investigation Fee: Building Green Fee: Plan Dept Plan Check: Building Dep Plan Check: Building PC Investigation Plan check Ext. Fee : WQ Compliance Insp Fee: TOTALFEE: PROCESSED BY: ZONING 111111111111111111111111111111111p11111111111111111POOLPermit : S2019-0023 S 2 0 1 9 '0 0 2 3\ Project No : 0325-2019 Inspection Requests Phone (949)644-3255 r_ce \k ��iRan Check N 0325-2019 O� Cod OF6it: 2016 �"� C� MOUNTA�� OLS Architect: REDONDINESA Address: POO Con State Lic: 822100 S Lic Expire: 07131/2019IM Bus Lic: BT300579 %' ` Lic Exp Date: 0212 01 e e7�s Compensation -Insurance Phone: J Engine e L Addrel 1 `\\\\)))) ODD tlFYiER 1 N TUSTINSTIN EIM CA 5 nN�Conditions \5' �� \ a er STATE COMP Policy No<'�` 1891732 `�i�XD: \� Expiration: 12/0112019 0 \ Issu�' 08/2019 kao e�^ FEES +DDrainage ord Management:11 $4.00nage Permit ® '��a $0.00 ��- $0.0 Grading t Fe'S A 0 $0.0 Building Dept Inspection Fee: $0.00 Water Quality Dept Insp Fee: $0.00 Building Dept WQ Plan Check: - $0.00 $0.00 $0.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $815.00 PLAN CHECKED BY:: A APPROVALTO 60 D 4� PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION OWNER -BUILDER DECLARATION \\ I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License L or the reason(s) In.d�'lr�a{dd i ction 7031.5, Business and Professions Code: Any city or county that requires a permit to c Fact, alter, improvelolish, or permit to file a signed statement that he or she is licensed pursuant to the provisions of Contractors' Start a Law (Ch fessions Code) or that he or she is exempt from licensure and the basis for the alleg xemptiah.®,hy viola of Section 7 more than five hundred dollars ($500). , yea ^ 1 N T J I, as owner of the property, or my employees with wages as their sole t usiness and Professions Code: The Contractors' State License Law does iprovements are not intended or offered for sale. If, however, the build' iproved for the purpose of sale). ] I, as owner of the property, am exclusively contracting with li sed Cc oply to an owner of property who builds or improves thereon d who cor ] I am exempt from licensure under the Contractors' S License L 1 y my signature below I acknowledge that, except for personal r dent -11 a structure that I have built as an owner -build it has In t b n const rofessions Code, is available upon request this app' on is sul ignature of Property Owner or Authorized ant ICENSED CONTRACTOR'S DE RATION oy the chs&mark;s) I hHve.placed next to the applicable items) ail anysrrucflre, prior to ;ts issuance, also requires the applicant for 9 (commencing with Section 7000) of Division 3 of the Business and ry` py applicant for a permit subjects the applicant to a civil penalty of all q%py(_) portions he work, and the p® erty who, tbpeflgh employees',or per JVithin one yepwKof completion, the O:v:ier //`�\-p- i ctors to corlstfuct them&(Section 7044, Business and P IS for the projects w!"'licensed Contractor pursuant to the is fogwing reasgQ 1hi6h i must have resided for at least one year prior to corn A in its entirety by licensed contractors. I understand thiii or at thefollowing Web site:http://www.leginfo.ca.gov/. hereby affirm under penalty of pi a ii; need under provisions of Chapter 9 (Command wit nd effect. License Class License No VORKERS' COMPc ON DECK ATION' IARNING: FAILURE TO SEC WORKERS' PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER DST OF COMPENS, AMAGEe ASP VIDED F„f'IFTIN SECTION 3706 OF THE LABOR CODE, INTEREST, ANO ATTORNEYS hereby affirm DO of to of Agent _ certify that, in if I should be y on r,! the following declarations: N,*,f 0� Cate of consent to self insure for workers' compensation, sue the\C ector of s permit is issued. Policy No reorkers' compensation insurance, as required by Section 3700 of the Labor Code, for t pe number are: �p�` Policy Number . ej " i signature of Applicant IECLARATION REGAII U nder olu hCTI hereby affirm upenal at there tinder's Name ",Fi• A Iy my signature below, I certify to - ' 1t o\elol,I am the property owner or author d, I have read this application and the' I agree to comply with all applicable c I authorize representatives of this city o cur Pre property owner's I have-povided ispd ore i.: not 'imAnded-cr offered for sale (Section 7044, eff)rt, ,bLildc or improves qhe property, provided that the jr wiir have the burden of proving that it was not built or Contractors' State License Law does not ense Law). covered by this permit, I cannot ection 7044 of the Business and i 3,X the Business Pn f 0 5, an y tic a is in full force Contractor g t' CIVIL FIN PTO ON UN D THOUSAND DOLLARS (E100,000), IN ADDITION TO THE is[ I ion provided for by Section 3700 of the Labor Code, for th Py ce a work for which this permit is issued. My workers' compensatioi _Expiration Date Phone # employ any oeison in al yam er so as to become subject to the workers' compensation Is s of California, and agre of the L r Code, a 1 rthwith comply with those provisions. Da 2 e perfor n the work for which this permit is issued (Section 3097il Code). building construction. inspection purposes. Print Prooertv Owner's or Authorized ACTION DATE.; BY I REl3l)RTI 'COMPLIANCE 610 TTE 40 AND AQMD RULE AL PERMIT EXPIRED -13/-2 EXAft— 1 L3,i SUBMITTED A513ESTOS NOTIFICATION TO PERMITCANCELLED DEPA PERMIT EXTENDED QMD POOLALARMS INSTALLED L1 ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: FOR OFFICE USE ONLY