HomeMy WebLinkAboutS2022-0096 - Permits`4gwrr}; City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Job Address: 34 DUNES BLUFF Floor: Suite: Bldg: 1
Description of Work:SFR POOL REMODEL & REPLASTER WI DRAINAGE
Inspector Area: 5
Legal Description:
111111111111111111111111111111111111111111111111111111 POOLPermit : S2022-0096
Project No : 1099-2022
Inspection Requests Phone (949)644-3255
Plan Check No: 1099-2022
Code Edit: 2019
Owner:
HARPEN SHAWN
Contractor:
MIRAGE LANDSCAPE
Address:
34 DUNES BLUFF
Address:
61 THREE VINES CT
NEWPORT BEACH, CA 92657
LADERA RANCH CA 92694
Phone:
Phone:
949-293-2800
Applicant: ELLISON PAUL
Con State Lic:
B06651
Address:
24642 VIA RA7A
Lic Expire:
0413012022
LAKE FROEST, CA 92630
Bus Lic:
BT30068406
Phone:
949-683-9861
Lic Exp Date:
0813112022
Building Rear:
Setbacks: Front:
Left:
Right:
Construction Valuation: $17,500.00
Building Permit Fee : $385.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$1.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$334.95
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE : $1,162.95
PROCESSED BY:
ZONING APPRONJ
Worker's Compensation Insurance
Carrier: EXEMPT
Policy No:
Expiration:
FEES
Architect:
Address:
Phone
Engineer: LACHER TODD
Address: 1201 N TUSTIN AVE
ANAHEIM CA 92807
Phone: 714-630-6100
Special Conditions:
Issued Date: 0412512022
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State Lic: a a
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State Lic:C-067656
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Record Management:
$6.00
Water Quality ---
$0.00
Building Dept Inspection Fee:
Drainage Permit Fee :
$237.00
Water Quality Dept Insp Fee:
$0.00
Drainage Plan Check:
$199.00
Building Dept WQ Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Additional Fee :
$0.00
$0.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance
: $1,162.95
PLAN CHECKED BY::
APPROVALTOISSUE'
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 Law for the reason(s) indicated below by the checkmark(s) I 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 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). 1201 N TUSTIN AVE
1, as owner of the property, or my employees with wages as their sole compensation, will do U 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 cf'ho 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).
I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature bi.low 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 legall,
^ell 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.htmi.
Signature of PrbpertyOwner or Authorized Agent Date
,I LICENSED CONTRACTOR'S DECLARATION
III hereby affirm ur,de, penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 0) Dip ion 3 of the Business and Prof n ode, d my i ense is in full force
(land effect. Livens Class License No Date ZS Z Contractor Signature
IIWORKERS' COMPENSATION DECLARATION
I'WP FNING: FAILURE TO SE.:URE 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 $706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
ha, ebd affirm under penalty of perjury one of the following declarations:
I have and u:1 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
performance of the 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' compensatio
nsura ce carrier and policy number are:
Ca r Policy Number Expiration Date
e of Agent Phone #
certify at, in the performance the fo7h1chis isissued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
at, 1 1 should become bj t to e w ers' ot' n ovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant DateflCode).
DECLARATION REGA ING C ION DING AGENCY
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, I
_ender's Name Lender's Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act an the pPoo'behI have read this application and the information I havrt.I agree to comply with all applicable city and county otat ws rI g to building construction.?�I authorize representatives of this city or county t entified p Sty for inspection purposes. �,/ [
Signature of Property Owner or Authorized Agent rint Property Owner's or Authorized Agent's Nam a Vt'�-y Dat
ACTION DATE BY VECCtATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED ISUBMITTE;I-A ESTOS NOTIFICATION TO
PERMITEXFENDED 1v AC&D
POOLALARMS / EWOUFTIC
ION IS NOT APPLICABLE TO
INSTALLED �j171C �` ROPOlSIGNAT
PERMITFINAL Ili l