HomeMy WebLinkAboutS2019-0002 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIII�IIIIIIIIIIII��IIIIIIIIII�IIII
II 13001 -Permit: S2019-0002
X0'1 100 Civic Center Drive, Newport Beach, CA 92660
S 2 0 1 9
_.0 0 0 2
Project No: 0037-2019
Permit Counter Phone (949)6443288
Inspection Requests Phone (949)644-3255
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Job Address: 133 VIA HAVRE Floor:
Suite: Bldg: 1
Description of Work:SFR SPA 60 SF
-
Inspector Area: 1
Plan Check No: 0037-2019
Code Edit:
2016
Legal 'Description: NTR 907 LOT 791
• • • • r, �° _:3
Owner: SHUBIN SCOTT & JESSICA
.Contractor:
PROMONTORY POOLS INC
Architect:
_
,
Address: 133 VIA HAVRE
Address:
17401 IRVINE BLVD STE B
Address:
, • • °
e ... • U1'" °
NEWPORT BEACH, CA 92663
TUSTIN CA 92780
o
Phone:
Phone:
714-993-0564
Phone: State Lie:
Applicant: ELLISON PAUL
Con State Lie:
404194
Engineer: LACHER TODD
Address: 17401 IRVINE BLVD #13
Lie Expire:
03131/2019
Address: 1201 N TUSTIN AVE
, °, • • °
TUSTIN CA 92780
Bus Lie:
BT30043247
ANAHEIM CA 92807
• • ° °
e o
Phone: 714-508.0557 -
Lie Exp Date:
05/31/2019
Phone: 714.630-6100 State Lic:C-067656
° ° _,,
_�• . ®° °
Building - Rear:
Worker's Compensation Insurance
Special Conditions:
®° ° ° • °
Setbacks: Front:
Carrier:
EXEMPT
LIQUEFACTION AREA
° • • _ ° °
Left:.
Policy No:
NO EMPLOYEES
X2018.3447 YARD DRAINAGE
_ Right:
Expiration:
Issued Date: 01/04/2019
....
Construction Type
FEES
Construction Valuation: $20,000.00
Building Permit Fee: $405.00
.Record Management:
$8.00
Water Quality- --
.
Permit Issuing Feer $0.00
Building Dept Inspection Fee:
$0.00
Investigation Fee; $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:
Building Dep Plan Check:. $361.00
$0.00
Building PC Investigation : $0.00
Additional Fee :.
$0.00.
$0.00
Plan check Ext. Fee: $0.00
WQ Compliance Insp Fee:. $0.00
TOTAL FEE : $819.00..
Plan Check Fee:
$0.00 Fee Due atPermitIssuance
: $819.00
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ZONING
PROCESSED BY:
PLAN CHECKED BY:: -
APPROVAL:
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APPROVAL TO ISSUE: �44JV \
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 items)
action 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
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
Ifessions 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
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 L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
ainess 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 Wat the
Movements 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 t uilt or
moved 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
)ly 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:
my signaturploti W,l 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 legal
a qucture t1ldi }lave 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
Ifass+ons Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
natu}e of Prb0Jriy owner or Authorized Agent Date
jEIl COKTRACTOR'S DECLARATION b
ii affirm ugge�rpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 )�/ Iy Ion 3 of the Business and Profs to o m, icense is in full force
I eRect. License Class License No Date /�/ `r / Contractor Signature
• u*I*P
)RKERS' C;QQQE}}INSATION DECLARATION
Hi FAILURE fCOMPENSA�ItOdAMACES AS PROVIDED FOR IN SECT COVEON 3'rOeIOF THE LABOR CODE, IS UNLAWFUL, AND ANTEREST, AND ATTORNEY'S FEES.
LL SUBJECT AN EMPLOYER TO RIMIN L PENALTIES AND CIVIL FINES UPI O Hill HED THOUSAND DOLLARS ($100,00i IN ADDITION TO TH
Jelyy affirm under penalty of perjury one of the following declarations:
I have and willmatrltain 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 tl
Famance of the work for which this permit is issued. Policy No.
.[Me and All pj)rpitain 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' compel
Trance carrier and policy number are:
Policy Number
Date
[me of Agent vnone sertify that, in the p ormanc 5ers'�c
r hich thi mit is issued, I shall not employ any person in any manner so as to become subject to the workers' comp sation haws f California, and agre
f I should bell Iect a wo pensprovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 1 / '�
IignatureofApplican Date /
IECLARATION REG DI G STRU N LENDING AGENCY.
hereby affirm under y 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).
ender's Name Lender's Address
ly 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 informals4oe
rovided is
I agree to comply with all applicable city and nces nd at e s r sting to building construction.
I authorize representatives of this city or thea v ' entifi roperty for inspection purposes.Ii nature of Property Owner or Authorized A enPrint Property Owner's or Authorized Agent's Na a/ Date /
4CTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY /
EGULATIONS PART 61 OF TITLE 40 AND AQMD RULE x
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