The URL can be used to link to this page

Home My WebLink AboutS2019-0188 - PermitsCity of Newport Beach - Building Division 11111111111111p111111111111111111p11111p11111111111 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 1 9 0 1 8 8 F:, �� •� n Permit Counter Phone (949)644-3288 4' )r Job Address: 4531 CAMDEN DR Floor: Suite: Description of Work:SFR NEW POOL/SPA 369 SF Inspector Area: 5 Legal Description: N TR 3357 LOT 136 Owner: WILLIAM APPLEBEE TRUST OF 1995 Address: 4531 CAMDEN DR CORONA DEL MAR, CA 92625 Phone Applicant: ADAMSON MARK Address: 1416 UXBRIDGE ST WESTMINSTER, CA 92683 Phone: 714-376-6301 Building Rear: Setbacks: Front: Left: Right: Construction Type : Construction Valuation: $75,000.00 Building Permit Fee : $418.00 Permit Issuing Fee: $0.00 Investigation Fee: $0.00 Building Green Fee: $3.00 Plan Dept Plan Check: $0.00 Building Delp Plan Check: $373.00 Building PC Investigation : $0.00 Plan check Ext. Fee: $0.00 WQ Compliance Insp Fee: $0.00 Bldg: 1 Plan Check No: 2650-2019 Code Edit: 2016 Contractor: ADAMSON MARK Address: 14196 UXBRIDGE ST WESTMINSTER, CA 92683 Phone: 714-376-6301 Con State Lic: 590874 'Lic Expire: 02/29/2020 Bus Lic: BT30057889 Lic Exp Date: 01/3112020 Worker's Compensation Insurance Carrier: STATE FUND Policy No: 9225662 Expiration: 02102/2020 Architect Address: POOL -Permit: S2019-0188 Project No: 2660-2019 Inspection Requests Phone (949)644-3255 Phone: State Lic Engineer: PASOL DAWN Address: 1411 N BATAVIA STE 208 ORANGE CA 92867 Phone: 714.363-3585 State Lic:C-061163 Special Conditions: DRAINAGE W/ X2019.0057 Issued Date: 1210512019 FEES I Record Management: $2.00 Water Quality - Building Dept Inspection Fee: $aoo 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 : $118.00 Others $0.00 Additional Fee: $412.00 $0.00 II TOTAL FEE : -$1,315.00 Plan Check Fee : $656.00 PROCESSED BY: v ` _ PLAN CHECKED BY: ZONING APPROVAL: _ _ _ _ APPROVAL TO ISSU PERMIT EXPRLS .8L DAY.,i AFTER ISSUANCE OR LAST VALID INSPECTION Fee Due at Permit Issuance : $659.00 -.r lAl(— 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 :he 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). 1411 N BATAVIA STE 206 ❑ I, 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 im roved for the purpose of sale). I, 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). ❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason: By 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 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:hftp://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent e LICENSED CONTRACTOR'S DECLARATION j I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) f Di isio f the Business and Profe i o and my license is in full force and effect. License Class License No Date Contractor Signature WORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT S AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under 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 th pe rmance of the work for which this permit is issued. Policy No. ❑I ve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which th' permit is issued. My workers' compensatiol Sur nce carrier and policy number ar C r Policy Number Expiration Date Z,P_ Name of gent [[ Phone # ❑l certify that, in the performanc o e wor Lfor which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compen ation laws of California, and agre that, if I should become subject rk compensatio -visions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant Date 6115 DECLARATION REGARDING RU ION LENDING AGENCY 1 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, Ci I 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 own s behalf. I have read this application and the information I ha a vi ad s orrect. I agree to comply with all applicable city and coun or i a a d state la g to building construction. I authorize representatives of this city or cou to n th a v = I ad property for inspection purposes. Nay �-� f{-rq}��'. Date Signature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Name ACTION DATE BY ATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED POOL ALARMS INSTALLED �A V�+ PERMITFINAL 1. 7id�ln I SUBMITTED ASBESTOS NOTIFICATION UASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: