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�rr,.wlq,4 City of Newport Beach - Building Division 'S2022-0007* POOLPermit : S2022-0007
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100 Civic Center Drive, Newport Beach, CA 92660 Project No : 0055-2022
+ Permit Counter Phone (949)644-3288
INS;D �
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r��S4vR�� Inspection Requests Phone (949)644-3255
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Job Address:. 2015 SABRINA TER Floor: Suite: Bldg: 1 } �aQ ®(
Description of Work:SFR REMODEL POOL & ADD 54 SF SPA & BAJA S -LF X n"oOiC
Inspector Area: 2 w� aV Plan o: 0055-2022
1 I C dit: 2019
Legal Description: N TR 2813 LOT 128 �0
Owner: FOX PETER ntractor B Architect:
Address: 2015 SABRINA TER Address 4 Address:
CDM CA 92625 W> «sr p•"�a
Phone:
Applicant: ISLAS RJ
Address: 1806 W 9TH
UPLAND
.40
Phone: 909- 151u N!y�,
RSP ,
Construction Valuation: 0,000V
Building Permit Fee :,-
$ .00
Permit Issuing Fee:
$ 00
Investigation Fee::
$0.
Building Green Fee:
$2.0
Plan Dept Plan Check:
$52.00
Building Dep Plan Check:
$704.70
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WO Compliance Insp Fee:
$0.00
TOTAL FEE : $1,736.70
PROCESSED BY:
ZONING APPROb
.Phone: •-219111��-'w.. Phone:
ARCHER TODD
Con State Lic.O/B�'+� En
ur Lic Expire -es Ads���JJJJ••" 01 N TDSTIN
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Bus Lic e�AHEIM CA
OMI Lic Exp Date Pfion§i 1' 714-630-61
Worker's Compensation Insurance ,,.�+. i .Special Conditi ygej•
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Carrier: 1,�Q \�\t\a'O/B,�
Policy Na: \\
Expiration: Is d DD®j�,Q• 01/26
R 7d�'a
q0h
r ' ee PN@r YQ`Fee
rainagk Check:
rading Consultant Fe
Additional Fee
�V
FEES
> e ater Quality --
Building Dept Inspection Fee: $0.00
$0.00 Water Quality Dept Insp Fee: $152.00
$ . 0 Building Dept WQ Plan Check: $0.00
$0 - Others
$0.00
$0.00 $0.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance : $1,736.70
PLAN CHECKED BY::
APPROVAL TO ISSUI
\tateic:
,,-State Lic:C-067656
ATTACHED•
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 rea (s) indicated
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alte prove, demolist
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contract State License Law I
Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemptio ny violation of Sectio Z
by the checkmark(s) I have placed next to the applicable item(s)
r air any structure, prior to its issuance, also requires the applicant for
)pt 9 (commencing with Section 7000) of Division 3 of the Business and
.5 by y applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars ($500). 1 I 1 N TUSTI rN
I, as owner of the property, or my employees with wages as their soZccmpensatlon,ion, w' o U all og ) po� QbQ thework,a heBusiness and Professions Code: The Contractors' State License Law do owner f rty w d,�htoughemply rpeimprovements are not intended or offered for sale. If, however, the builment is sq��lthin oryy rofcompleti the Owneimproved for the purpose of sale).\\t� ��' `I, asowner of the property, am exclusively contracting with licensedo condtruct t g�rj�ct (Section 4,Business and Pr
a�Eoan owner of property who builds or improves thereon, an he proje�i a license f tractor pursuant to the I
I am exempt from licensure under the Contractors' State
ly my signature oclow I acknowledge that, except for my pe
ell a structure th.a::::ave built. as an owner -builder if it has�r
!�c'ess'ons Cod^, is available upon request when t plir
lig natty e of Prupeny Gwner or Authorized Agent
:,LENSED CONTRACTOR'S DECLA O
heruLy affirm under penalty of perjury t am li n
Ed effect. Li=se bass ,
is not intended or offered for sale (Section 7044,
it, builds or improves the property, provided that the
riO have the burden of proving that it was not built or
ust have residWfor at least one year prior to completion of the
Iirety by Iik9sed contractors. I understand that a copy of the al
Illowing;Web site:http://www.leginfo.ca.gov/calaw.html..soa
The Contractors' State License Law does not
6 License Law).
provisions of Chapter (commencing with Section 7000) of Division 3 of the'BTSiness and Pro
.nse No Date Contractor Signature
YVf \CRJ I.VIYIr mn' I u 4y AR IUD`
_r,N. : FAILUR_' TO SEC JRE RKERS' C P ATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL.F.IN�S UP TO ONE
EST OF COMPENd 1`1oN, D GES AS PROM FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm and enalty of perju one of thI declarations:
4.
I have and �t{II 'na c�Nan:a certificate of consents -to self -insure for workers' compensation issued by the Director ottridustrial Rea s ase�aC¢
PrferMince of thli�worK for which this permit Is Issued. Policy No, ++�.�Q� ��tt��`q`�'
I Lave and will nalrtaln workers the compensation Insurance, as required by Section 3700 of Labor.Code fatthe perform a of�tph eWork&fol
Isurance carrier and policy number are:
_Policy Number
me of Agent
I certify that, in the performance of tl
It. if I should became 4ulaiect tc thes°i
Inature of Applican
hereby affirm under penalty of pe ju that there is a cc
ender's Name rxa
ly my signature below, I certify to each the f
am the property owner or authorized act
I have read this application and the infor anon hay
I agree to comply with all applicable city a county
I authorize representatives of this city or co ty t; e
ACTION
PERMIT EXPI RED
PERMIT CANCELLEL
PERMITEXTENDED
POOL ALARMS
INSTALLED
PERMIT FINAL
DATE I BY
Date
Section 7044 of
and my license is in full force
IE100,0001, IN ADDITION TO THE
Section 3700 of the Labor Code, for
this permit is issued. My workers'
permit is issued employ any person in y manner a become subject to the workers' compensation laws of Ca'fornia, and ogre
t provisions of ct 700 of the Labor Cod shall fo ply with those provisions. v/ 2 �
Date CF
AGEN -
iaS�io,(Zle ding's for the p rmance a for which this permit is issued (Section 3097, Civil C de).
Le is Addr
:tt 0 r behalf
o disc IT .
1 n es a to law let o building construction.
t a a = miffor inspection purposes.
�i Print Property Owners or Authorized Agent's Name Da i !�
IAT10 F PLIANCE ITH CODE OF FEDERAL FOR OFFICE USE ONLY
NS.P9AT 61 OF TITLE 40 AND AQMD RULE
'1'6MITTED ASBESTOS NOTIFICATION TO
EPA
AQMD
SESTOS NOTIFI IS NOTAP II (ABLE TO