HomeMy WebLinkAboutS2019-0184 - PermitswTwwo WA114 City of Newport Beach -Building Division 111111III 11111p111111111111111111p11111111 ill 1� POOLPermit : s2o19-0184
,.� 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 1 9 0 1 8 4 Project No : 2590-2019
h Permit Cou'ii�'r Phone (949)644-3288
Inspection Requests Phone (949)644-3255
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,lob Address: 1603 ARCH BAY DR Floor:
Suite: Bldg: 1
Description of Work:SFR SPA W/YARD DRAINAGE
Inspector Area:
Plan Check No: 2590-2019
Code Edit:
2016
Legal Description: N TR 15222 LOT 27
Owner: MADDEN LISA
Contractor:
OWNERIBLDR
Architect:
Address: 1603 ARCH BAY DR
Address:
Address:
NEWPORT BEACH, CA 92660
Phone:
Phcp_
State Lic:
Phone: 850-974-4202
Applicant: DON
Con State Lie:
OIB
Engu er: LACHER TODD
Address: 1603 ARCH BAY DR
Lie Expire:
Address: 1201 N TUSTIN AVE
NEWPORT BEACH CA 92660
Bus Lie:
ANAHEIM CA 92807
Phone: 714-630-6100
State Lic:C-067656
Phone:
Lie Exp Date:
Building Rear:
Worker's Compensation
Insurance
Special Conditions:
Setbacks: Front:
Carrier:
Policy No:
Left:
Right:
Expiration:
Issued Date: 12102/2019
V
Construction Type : VB°'�'
;
FEES
Construction Valuation: $15,000.00
Building Permit Fee : $418.00
Record Management:
$8.00
Water Quality --
Building Dept Inspection Fee:
$0.00
Permit Issuing Fee: $0.00
Investigation Fee: $0.00
Drainage Permit Fee :
$322.00
Water Quality Dept Insp Fee:
$0.00
$0.00
Building Green Fee: $1.00
Drainage Plan Check:
$322.00
Building Dept WO Plan Check:
Plan Dept Plan Check: $0.00
Grading Consultant Fee :
$0.00
Others:
$0.00
Building Dep Plan Check: $373.00
$0.00
Building PC Investigation : $0.00
Additional Fee :
$0.00
Plan check Ext. Fee : $0.00
WQ Compliance Insp Fee: $0.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance : $1,433.00
TOTAL FEE : $1,433.00
PLAN CHECKED BY::�
PROCESSED BY: _ _ _
APPROVAL TO ISSUE:
ZONING APPROVAL:_ __
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). 1201 N TUSTIN AVE
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U 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-Builderwill have the burden of proving that it was not built or
improved for the purpose of sale).
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
a I 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).
pr L In
exempt from licensure under the Contractors' State License Law for the following reason:
By 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 legalh
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 thN yplication is s t the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent X Da
tey
LICENSED CONTRACTOR'S DECLARAT
I hereby affirm under penalty of perjury that I am licensed provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, 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 PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1DOAD0), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby 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 th,
Derformance 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'
rance carrier and policy number are:
Policy Number Expiration Date
of Agent
Q ertify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
Ia , if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Ignature of Applic Da t _/T�'7A/ �l
DECLARATION R G NG C UC LENDING AGENCY
hereby affirm under p of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civl Code).
ender's Name Lender's Address
y 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 state laws relating to building construction.
I authorize representatives of this city or countf enter the above-i ro erty for inspection purposes.
pe i nature of Prorty Owner or Authorized Agent/ 1l Print Property Owner's or Authorized Agent's e ( Date
ACTION DATE BrfV DEC OF COMPLIANCE WITH CODE OF FEDERAL
GULATIONS PART 61 OF TITLE 40 AND AQMD RULE
1403
PERMIT EXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED UEPA
PERMIT EXTENDED QMD
POOLALARMS I ASBESTOS NOTIFICATION IS NOT APPUCABLE TO
INSTALLED PROPOSED DEMOLITION.
FINAL lD v'{_�`
7 �,
FOR OFFICE USE ONLY
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