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Home My WebLink AboutS2021-0065 - PermitsCity of Newport Beach - Building Division 11111111111111111111p11111111111p111p1111111111111 t 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 1 0 0 6 5 Permit Counter Phone (949)644-3288 �'at3YnAN�� Job Address: 102 ARCHIPELAGO DR Floor: Suite: Bldg: 1 Description of Work:SFR POOL REPLASTER & REMOVE PORTION OF BASIN Inspector Area: 5 Plan Check No: 0514-2021 Code Edit: 2019 Legal Description Owner: MOORE RICK & MARIAM Address: 102 ARCHIPELAGO NEWPORT BEACH, CA 92657 Phone: Applicant: ALAN SMITH POOLS Address: 227 W CARLTON AVE ORANGE, CA 92867 Phone: 208-353.4082 Building Rear: Setbacks: Front: Left: Right: Construction Construction Valuation: $26,000.00 Building Permit Fee: $501.00 Permit Issuing Fee: $0.00 Investigation Fee: $0.00 Building Green Fee: $1.00 Plan Dept Plan Check: $0.00 Building Dep Plan Check: $435.87 Building PC Investigation : $0.00 Plan check Ext. Fee : $0.00 WO Compliance Insp Fee: $0.00 TOTAL FEE: PROCESSED BY: ZONING APPRO'v Contractor: SMITH ALAN POOL PLASTERING Address: 227 W CARLETON AVE ORANGE CA 92867 Phone: 714-628-9494 Con State Lic: 571196 Lic Expire: 06/30/2021 Bus Lic: BT00012422 Lic Exp Date: 08131/2021 Worker's Compensation Insurance Carrier: ARCH INS. CO. Policy No: ZAWC12546402 Expiration: 04/0112021 FEES Architect: Address: Phone: Engineer: Address: Phone: POOLPermit: S2021-0065 Project No : 0514-2021 Inspection Requests Phone (949)644-3255 I .. State Lic: ! , LACHER TODD 1201 N TUSTIN AVE ANAHEIM CA 92807 714-630-6100 State Lic:C-067656 ' Special Conditions: " VHFHSZ LANDSLIDE AREA Issued Date: Record Management: $10.00 Water Quality --- Building Dept Inspection Fee: $0.00 Drainage Permit Fee : $0.00 Water Quality Dept Insp Fee: $0.00 Drainage Plan Check: $0.00 Building Dept WQ Plan Check: $0.00 Grading Consultant Fee : $0.00 Others $0.00 Additional Fee : $0.00 $0.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : PLAN CHECKED BY:: APPROVAL TO ISSUI PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION .87 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 items) '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 .he 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 3rofessions 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 iot 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 (_) 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 mprovements 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 exam;)' :L.m 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 one year prior to completion of the improvements covered by this permit, I cannot legally sell a structure that�l 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 ?rfevsions Coda, is°available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date L:CEUSED CONTRACTOR'S DECLARATION I hereby affirm unaer penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectio 7 0)),,..qqf D_ ivisioaa3 . of the Business and Pro s isen is full force and ef°ect. Licsl,se Class License No Date i - 9— L( Contractor Signature WORKERS' C(JMP,ENSATION DECLARATION NARNINO: FAILURE 10 SECURE 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 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. a�rauc affirm underp,nalty of perjury one of the following declarations: ❑ I have and VAi 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 the onnornance of tte work for which this permit is issued. Policy No. 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 carrier a policy number are: grip y of Agent Policy Number r"�Z j-.Z s $L� Expiration Date Phone # -1 certify that, in the performan f thew r 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 agree I, if I should becom sub' th ers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicant Date 3 2 CLARATION RE G CO RUCTION LENDING AGENCY !reby affirm u r p nalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). 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 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 o i n el e ating to building construction. I authorize representatives of this city or cou t an a ov nti�fied °� spe on purposes. -3 nature of Property Owner or Authorized Agod ct Print Property Owner's or Authorized Agent's Name � DVje ACTION DATE BY% I DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AOMD RULE PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION PERMIT CANCELLED EPA PERMIT EXTENDED OMD POOL ALARMS pt-.L-E-� WA ASBESTOS NO F I Is INSTALLED 1� "" PROPOSED IT PERMIT FINAL