HomeMy WebLinkAboutS2022-0053 - PermitsCity of Newport Beach - Building Division "S2022-0053'
100 Civic Center Drive, Newport Beach, CA 92660 - It
H Permit Counter Phone (949)644-3288
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Job Address: 4515 ORRINGTON RD Floor:
Description of Work:SFR NEW POOL & SPA 260 SF
Inspector Area: 5
Legal Description: N TR 3357 LOT 76
Owner: ZIEMBA FAMILY TRUST
Address: 4515 ORRINGTON RD
CORONA DEL MAR, CA 92625
Phone:
Applicant: ELLISON PAUL
Address: 24642 VIA RAZA
LAKE FOREST CA 92630
Phone: 949.683-9861
Building Rear:
Setbacks: Front: 6130
Left: 6
Right: 6
Construction Tvoe :
Construction Valuation: $50,000.00
Building Permit Fee :
$440.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$2.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$396.00
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
Suite: Bldg:1
Plan Check No: 0543-2022
Code Edit: 2019
Contractor: STEELE BRETISTEELE POOLS
Address:
4921 E LEEDS
ORANGE CA 92867
Phone:
714-496-1427
Con State Lic:
923975
Lic Expire:
10/31/2022
Bus Lic:
BT30042152
Lic Exp Date:
0212812023
Worker's Compensation Insurance
Carrier: WC EXEMPT
Policy No: NO EMPLOYEES
Expiration:
Record Management: $20.00
Drainage Permit Fee :
$0.00
Drainage Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Additional Fee :
$65.25
FEES
Architect:
Address:
POOLPermit : S2022-0053
Project No : 0543-2022
Inspection Requests Phone (949)644-3255
Phone: State Lic:
Engineer: BIEDENBACH CHRISTOPHER
Address: 1201 N TUSTIN
ANAHEIM CA 92807 „
Phone: 714-630-6100 State Lic:C-074003
Special Conditions:
Issued Date: 03/14/2022
Water Quality- --
Building Dept Inspection Fee:
$0.00
Water Quality Dept Insp Fee:
$152.00
Building Dept WQ Plan Check:
$aco
Others:
$0.00
$0.00
II TOTAL FEE : $1 075.25 Plan Check Fee : $461.25
PROCESSED BY: 1
75T PLAN CHECKED BY::.
ZONING APPROVAL: 3 APPROVAL TO ISSUE
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at Permit Issuance : $614.0o
SR G
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
I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) 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 Lf the P; operty, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
^poly town 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).
n I am exemp: fwm licensure under the Contractors' State License Law for the following reason:
By my sign Stu re 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 legal
cell 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 a%ailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Sigl latura of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under nPnalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of ivi oni oof the Business and Profes ion od and li a is in full force
ana efrect. License Class License No Date 2 Contractor Signature
'.YORK�:RS' CnMPFNSATION DECLARATION
DARNING: FAILURE Tn 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
JL1 GF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LLraSy affirm rode- 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
'ormance of the work for which this permit is issued. Policy No.
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' compensa
Trance carrier and policy number are:
Date
of Agent
I c rtify that, in the perfor an of a rk f whi t S permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensat on la s of California, and agre
t t, I should become subj ct t wo ers' omp n till provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. `%
Signature of Applicant Date t C_
DECLARATION REGA DIN ST kdCTIONk&HAG AGENCY
I hereby affirm under penalty o rt t th is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Name Lender's Address
By my signature below, I certify to each of the following:
am the property owner or authorized to act on the owner's beh
have read this application and the information ve prove ed is corr t.
agree to comply with all applicable city and coun y ordin sand ate ws re ing to building construction.
I authorize representatives of this city or county tc me above d If p rty for inspection purposes. Y� /
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name Data
_A
ACTION DATE BY DE N dFre6IMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED LJ I SUBMITTED ASBESTOS NOTIFICATION TO
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