HomeMy WebLinkAboutS2022-0003 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) /�
11 OFFSHORE, NEWPORT BEACH 92657 C(n Gt �U4
LEGAL DESCRIPTION
LOT 52 BLOCK TRACT 15918
2. DESCRIPTION OF WORK POOL/SPA, (16) CAISSONS
SWIMMING POOL
Check Appropriate box for Applicant
ESTIMATED $ VALUATION 125,000
POOL FENCING ❑ DRAINAGE ❑
❑ 3.
OWNER'S NAME
LAST
FIRST
STUPIN
ANDREW
ADDRESS
OWNER'S E-MAIL ADDRESS
11 OFFSHORE
CITY
STATE
ZIP
PHONE NO.
NEWPORT BEACH
CA
92657
949.370.9576
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
PMA ENGINEERING
PETROV
PLAMEN
SE-66947
ADDRESS
ENGINEER'S E-MAIL ADDRESS
28161 CASITAS CT.
P.PETROV@PMA-BG.COM
CITY
STATE
ZIP
PHONE NO.
LAGUNA NIGUEL
CA
92677
714.717.7542
5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
DEVORE POOLS & SPAS
BT97026761
No.401549 ClassC-53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
PO BOX 828
DEVOREPOOLS COX.NET
CITY
STATE
ZIP
PHONE NO.
SAN JUAN CAPISTRANO
CA
92693
949.370-9576
OFFICE USE ONLY
2�A
PERMIT N0.
PLAN CHECK NO. 1
POOL P/C FEE $ 1c] e' 1
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION x r r't ,i f
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
11 OFFSHORE, NEWPORT BEACH 92657
LEGAL DESCRIPTION
LOT 52 BLOCK TRACT 15918
2. DESCRIPTION OF WORK POOL/SPA, ( 16 ) CAISSONS
ESTIMATED $ VALUATION 125,000
SWIMMING POOL ® SPA ® POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for ADolicant
❑ 3. OWNER'S NAME
LAST
FIRST
STUPIN
ANDREW
ADDRESS
OWNER'S E-MAIL ADDRESS
11 OFFSHORE
CITY
STATE
ZIP
PHONE NO.
NEWPORT BEACH
CA
92657
949.370.9576
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
PMA ENGINEERING
PETROV
PLAMEN
SE-66947
ADDRESS
ENGINEER'S E-MAIL ADDRESS
28161 CASITAS CT.
P.PETROV@PMA-BG.COM
CITY
STATE
ZIP
PHONE NO.
LAGUNA NIGUEL
CA
92677
714.717.7542
Fj 5. NTR CT R' N j�E
BUSINESS LICENSE
STATE LICENSE
1
No. ClassC-53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
28
ET
CITY
STATE
ZIPS
PHONE NO.
S�,N_JtVA-k LCAP
9-2693
1942�,- 76
' OFFICE USE ONLY �f ��IJ`� Well)
PERMIT NO. (320 C' '� �7 � liy71--
PLAN CHECK NO.
POOL PIC FEE $ 19
DRAINAGE PIC FEE $
Forms\Pool spa appl (rev3-04).xls
r
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION J�/��
PLEASE PRINT OR TYPE VOW)
�{�1 1 )
1. PROJECT ADDRESS (NOT MAILING ADDRESS) "
11 OFFSHORE, NEWPORT BEACH 92657
LEGAL DESCRIPTION
LOT 52 BLOCK TRACT 15918
2. DESCRIPTION OF WORK POOL/SPA, ( 16) CAISSONS
SWIMMING POOL ® SPA
Check Appropriate box for Applicant
ESTIMATED $ VALUATION 125.000
POOL FENCING ❑
DRAINAGE ❑
3.
OWNER'S NAME
LAST
FIRST
STUPIN
ANDREW
ADDRESS
OWNER'S E-MAIL ADDRESS
11 OFFSHORE
CITY
STATE
ZIP
PHONE NO.
NEWPORT BEACH
CA
92657
949.370.9576
4.
ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
PMA ENGINEERING
PETROV
PLAMEN
SE-66947
ADDRESS
ENGINEER'S E-MAIL ADDRESS
28161 CASITAS CT.
P.PETROV@PMA-BG.COM
CITY
STATE
ZIP
PHONE NO.
LAGUNA NIGUEL
CA
92677
714.717.7542
® 5.
CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
DEVORE POOLS & SPAS
BT97026761
No.401549 ClassC-53
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
PO BOX 828
DEVOREPOOLS COX.NET
CITY
STATE
ZIP
PHONE NO.
SAN JUAN CAPISTRANO
CA
92693
949.370-9576
OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
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Forms\Pool spa appl (rev3-04).xls