HomeMy WebLinkAboutS2021-0255 - Permits$ ,r+�, City of Newport Beach -Building Division 111111111111111111111111111111111p11111p11111111111 POOLPermit : S2021-0255
d 100 Civic Center Drive, Newport Beach, CA 92660 5 2 0 2 1 0 2 5 5 Project NO : 2650-2021
N, Permit Counter Phone (949)644-3288
04
Inspection Requests Phone (949)644-3255
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INSPECTOR
Job Address: 20352 KLINE DR Floor:
Suite: Bldg: 1
Description of Work:SFR ABOVE GROUND PRE-FAB
POOL WIELECTRICAL
Inspector Area: 3
Plan Check No:
2650-2021
Code Edit:
2019
Legal Description:
Owner: GOLSON GARY
Contractor:
OWNER/BLOR
Architect:
AHN KENNETH ,
Address: 1712 ORCHARD DR
Address:
AUHT AGENT:
Address:
2040 LOMITA BLVD #104
NEWPORT BEACH CA 92660
JASON GOLSON
GARDENA CA 90717 ,
Phone: 562-477-6894
Phone:
714-391-1392
Phone:
310-341-3436 State Lic:C030675 ,.
Applicant: GOLSON JASON
Con State Lic:
O/B
Engineer:
- -' -
Address: 1712 ORCHARD DR
Lic Expire:
Address:
NEWPORT BEACH CA 92660
Bus Lic:
-
Phone: 562-477-6894
Lic Exp Date:
Phone:
State Lic:
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $1,000.00
Worker's Compensation Insurance
Carrier:
Policy No:
Expiration:
FEES
Special Conditions: • _ '
Issued Date:
Building Permit Fee :
$112.00
Record Management:
$0.00
Water Quality- --
Building Dept Inspection Fee:
$0.00
Permit Issuing Fee:
Investigation Fee:
$0.00
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Building Green Fee:
$1.00
Drainage Plan Check:
$0.00
Building Dept WQ Plan Check:
$0.00
Plan Dept Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Building Dep Plan Check:
$97.44
$0.00
Building PC Investigation :
$0.00
Additional Fee :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE : $210.44
Plan Check Fee :
$97.44 Fee Due at Permit Issuance
: $113.00
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�/� PLAN CHECKED BY::
PROCESSED BY:
ZONING APPROVAL:
r Q,--
APPROVAL TO ISSUE:
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). ❑
wn a property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business
rofessions 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 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).
I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signatl•m b�!ov 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)
sell a structure that I nave built as an owner -builder' 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
O-cfcesions Code, i. available upon request whe Is apgplication is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm].
Signature of Property Owner or Authorized Agent _ A� Dat I
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm I rdq- penalty of perjury that I am license under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, an my license is in full force
Lnd effect. License Class License No Date Contractor Signature
WGKKERS' COMPENSATION DECLARATION
AARA,Nr: 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 ($100,000), IN ADDITION TO THE
COS' OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hgreb), affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for thl
r.-fcrT.ance of the work for which this permit is issued. Policy No.
J, nave and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensatioi
nsurance carrier and policy number are:
-arrier Policy Number Expiration Date
Name of Agent Phone #
:1I certify that, in the paante of the work forwhich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compe at nde efCal r a, and agre
if I
:hat, should becom ubj t to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.��
Signature of Applicant1VVDat
DECLARATION REG D TRUCTION LENDING AGENCY
"Civilde).
hereby affirm under pens yof perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097,
-ender's Name Lender's Address
3y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owner's behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county ordinances and ate laws relating to building construction. SG$vr
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authorize representatives of this city or cou ent he above entified property for inspection purposes.
Signature of PropertyOwner or Authorized Agent Print Property Owner's or Authorized Agent's Name4
Date!
ACTION
DATE
BY
BE91ARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
RRGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMITEXPIRED
LJ I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
LJEPA
PERMIT EXTENDED
nCMD
POOL ALARMS
A11 EST04 NP TIFICA N NOT APPLICABLE TO
INSTALLED
PR SED IOLITI
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