HomeMy WebLinkAboutS2021-0010 - PermitsCity of Newport Beach - Building Division IIIIIII�III�IIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIII II
l 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 1 0 0 1 0
p Permit Counter Phone (949)644-3288 - -
it,
Job Address: 1207 BERKSHIRE LN Floor: Suite:
Description of Work:POOL & SPA 300 SF W/DRAINAGE
Inspector Area: 3
Legal Description: N TR 3031 LOT 16
Owner: LARKIN
Address: 1207 BERKSHIRE LN
NEWPORT BEACH, CA 92660
Phone:
Applicant: ELLISON PAUL
Address: 25642 VIA RAZA
LAKE FOREST CA 92630
Phone: 949-683-9861
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $46,000.00
Building Permit Fee: $430.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$2.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$387.00
Building PC Investigation :
M0.00
$00
Plan check Ext. Fee:
923454
WQ Compliance Insp Fee:
$0.00
TOTALFEE: $1
PROCESSED BY:
ZONING APPROb
Bldg: 1
Plan Check No: 0066.2021
Code Edit: 2019
Contractor: BLUE PACIFIC POOLS SOUTHERN CALIFORNIA Architect
P001 -Permit: S2021-0010
Project No: 0066-2021
Inspection Requests Phone (949)644-3255
Address:
25108 MARGURITE PKWY #A79
Address:
me••e
MISSION VIEJO CA 92679
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Phone:
949-310-3196
Phone:
State Lie:
Con Stale Lie:
923454
Engineer:
THOMPSON MATTHEW
Lie Expire:
10/31/2022
Address:
12021 N TUSTIN AVE
Bus Lie:
o o n
•• •
ANAHEIM CA 92807
Lie Exp Date:
oo•oo
Phone:
714-630-6100 State Lic:C-086051
Worker's Compensation Insurance Special Conditions:
Carrier: STATE COMP INS FUND
Policy No: 9126143
Expiration: 0212812021 Issued Date: 0110812021
FEES
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$10.00
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Water Quality Dept Insp Fee:
$120.00
Drainage Plan Check:
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Record Management:
$10.00
Water Quality- --
Building Dept Inspection Fee:
$278.00
Drainage Permit Fee:
$232.00
Water Quality Dept Insp Fee:
$120.00
Drainage Plan Check:
$195.00
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
PLAN CHECKE
APPROVALTO
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Fee Due at Permit Issuance:
SL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the resson(s) indicated below by the checkmark(s) I have placed next to the applicable item(sj
lotion 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 itq 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). 12021 N TUSTIN AVE
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044,
3iness and Professions Code: The Contractors' Stale License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
)rovements 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
)roved 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
fly 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,frojr✓, licensure under the Contractors' State License Law for the following reason:
my signature pplpYa'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)
I 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
F69%tons Coglg,,is mailable upon request when this application is submitted or at the following Web site:http://V w ,leginfo.ca.gov/calaw.html.
nature of Property Owner or Authorized Agent Dat
)EASED CONTRACTOR'S DECLARATION
6reb�y affirm uncle? penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 o i ISO �y of the Business and Profess' n od an ny ' rise is in full force
t,effeCt. Licesse.Glass License No Date (/ 1 Contractor Signatur
ARERS' C OMPEJNSATION DECLARATION
iNINGSFAILURE 70 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
W OF COMPENSATIFIN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
wabysffirm under Welty of perjury one of the following declarations:
I 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
f ce of the workfor which this permit is issued. Policy No.
ave and will maint9in 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' compensatiol
nce carrier and policy number are:
;a r Policy Number
Expiration Date
te of Agent
Phone #
of California, and agre
certify that, in the perform nce f wo o hich rmit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensaf n72,
.hat, if I should become subj ct to t wor rs' ompe n provisions of Section 3700 of the Labor Code, I shall forthwith comply with
those provisions. ^
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Signature of Applic
D
)ECLARATION REGA IN C RU LENDING AGENCY
"
hereby arm under pe Ity perjury that there is a construction lending agency for the performance of the work for which this permit
affirm
is issued (Section 3097, Civil Code).
-ender's Name Lender's Address
3y my signature below, I certify to each of the following: -
ehalf.
I am the property owner or authorized to act on the pr rt own250ite
I have read this application and the information I h e p A d ect.
( y
I agree to comply with all applicable city and cou y or enc laws relating to building construction.
I authorize representatives of this city or county n r the ov ntifie party for inspection purposes.
N 5
Signature of Property Owner or Authorized Age - Print Property Owner's or Authorized Agent's Nam Date
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
AN required alarms,latches
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