HomeMy WebLinkAboutS2021-0236 - Permits:wtr{ City of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
''rix-3stc^ a
,lob Address: 1822 BUTTONSHELL LN Floor. Suite: Bldg: 1
Description of Work:SFR NEW POOL & SPA 595 SF W/ DRAINAGE
Inspector Area: 3
Legal Description: N TR 3763 LOT 69
Owner: SHEA PETER
Address: 1822 BUTTONSHELL LN
NEWPORT BEACH, CA 92660
Phone:
Applicant: ELLISON PAUL
Address: 24642 VIA RAZA
LAKE FOREST CA 92630
Phone: 949-683-9861
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
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
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Plan Check No: 2460-2021
Code Edit: 2019
POOL -Permit: S2021-0236
Project No : 2460-2021
Inspection Requests Phone (949)644-3255
Contractor:
LANDCRAFTERS INC
Architect:
Address:
29512 ANA MARIA LANE
Address:
LAGUNA NIGUEL CA 92677
Phone: -
949-249-1086
Phone: State Lic:
Con State Lic:
764071
Engineer: THOMPSON MATTHEW
Lic Expire:
0913012022
Address: 12021 N TUSTIN AVE
Bus Lic:
BT30039467
ANAHEIM CA 92807
Lic Exp Date:
05/31/2022
- Phone: 714-630-6100 State Lic:C-086051
Worker's Compensation
Insurance
Special Conditions:
Carrier:
EMPLOYEE SERVICE GROUP
Policy No:
WC5897031
¢ rN ti`O`r f �%—
Expiration:
12JO112021
Issued Date: 10/19/20210 C�O
FEES
Record Management:
$6.00
Water Quality ---
Drainage Permit Fee :
$237.00
Building Dept Inspection Fee: $0.00
Water Quality Dept Insp Fee:
Drainage Plan Check:
$199.00
$152.00
Building Dept WQ Plan Check: $0.00
Grading Consultant Fee :
$0.00
Others :
Additional Fee
$0.00
$0.00
$0.00
1 TOTAL FEE : $1,432.00 Plan Check Fee $0.00 Fee Due at Permit Issuance $1 432 00
PROCESSED BY: PLAN CHECKED BY::
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ZONING APPROVAL: APPROVALTOISSUE: °°o o° ° ° ®°°a o. ° o o
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PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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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'Tr
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). I 12021 N TUSTIN AVE
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions
3usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throu
mprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of c
mproved for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7C
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contra
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least o
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors.
Professions Code, is available upon request when this application is submitted or at the following Web site:http://Www.1,
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700
and effect. License Class License No Date _
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PI
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 have and will maintain a Certificate of consent to self -insure for workers' compensation, issued by the Directi
performance of the work for which this permit is issued. Policy No.
1:11 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for tf
(insurance carrier and policy number are:
Carrier Policy Number
le of Agent
certify that, in the
if I should bacon
this permit is issued, I shall not employ any person in any
at' rovisions 700 of the Labor Code, I shall
nature of Applica �
CLARATION RE AIjHIN STRUCTION LENDING AGENCY
lreby affirm unde nalty of perjury that there is a construction lending agency for the performance of the work f
Ider's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the prop owner's behalf.
I have read this application and the information hav prov' ed is correct
1 agree to comply with all applicable city and count ordin s and s e wS r ng to building construction.
I authorize representatives of this city or county t ante above' Ified party for inspection purposes.
mature of Property Owner or Authorized Agent / Print Property Ownel
DATE I BY
13rCOMPUANCE WITH CODE OF FEDERAL I FOR
PART 61 OF TITLE 40 AN D AQM D RULE
the work, and the structure is not intended or offered for sale (Section 7044,
employees' or personal effort, builds or improves the property, provided that the
Dation, the Owner -Builder will have the burden of proving that it was not built or
Business and Professions Cade: The Contractors' State License Law does not
pursuant to the Contractors' State License Law).
e year prior to completion of tI
understand that a copy of the
of the Business and Pro
Contractor Signature
Tents covered by this permit, I cannot
law, Section 7044 of the Business and
full force
TIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
of Industrial Relations as provided for by Section 3700 of the Labor Code, for
performance of the work for which this permit is issued. My workers'
Date
so as to become subject to the workers' compensation laws of California, and agre
i comply with those provisions. ( 6
Date_
i this permit is issued (Section 3097, Civil Code).
USE ONLY
PERMIT EXPIRED ® I SUBMITTED ASBESTOS NOTIFICATION TO gates & fences which serve
PERMIT CANCELLED • • ' •: . •• • EPA as Pali Of a Pool / Spa
OA
PERMIT EXTENDED I�QMD barrier, shall be in place
• • ° ',
POOLALARMS BESTOS NOTIFICATION IS NOT APPLICABLE To prior to approval to fill
pool/spa & shall remain in
INSTALLED �1 : • • • WPOSED DEMOLITION. lace
• •51QNATURE: P & be maintai ed for
the ' e
• • s ° • p(Ae
PERMIT FINAL S
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