HomeMy WebLinkAboutS2017-0018 - Permits�,� City of Newport Beach - Building Division IIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIII II POOLPermit : S2017-0018
iJ� " 7; 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 1 7 0 0 1 8 Project NO : 2672-2016
' +Y v. Permit Counter Phone (949)644-3288
a^'thrrv.'r Inspection�uPhone (949)644-3255
Building Rear:
Setbacks: Front:
Left:
Right:
Construction Type :.
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9130715
Expiration: 04/23/2017
Special Conditions:
Issued Date: 01127/2017
Job Address: 208 TUSTIN AVE Floor:
Suite: BI 9�
FEES
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Description of Work:NEW POOL & SPA .W/DRAINAGE 317 SF 'CHG OF CONTRACTOR" (52016-0178)
1 f
Inspector Area:%/
eck No:
2672-2016
I
Building Permit Fee :
Code Edit:
2013
$0.00
Water Quality-
Legal Description: N TR 1133 LOT 22
Permit Issuing Fee:
$0.00
Building Dept Inspection Fee:
Owner: WOOD WILLIAM F
Contractor:
CROSS LANDSCAPE POOL & SPA
INC
Architect:
Water Quality Dept Insp Fee:
Address: 7575 PELICAN BAY BLVD #1106
Address:
1181 PUERTA DEL SOL STE 130
Address:
$0.00
Building Dept WQ Plan Check:
NAPLES, FL
Plan Dept Plan Check:
SAN CLEMENTE, CA 92673
Grading Consultant Fee :
$0.00
Others
Phone:
Phone:
949-388.8215
Phone:
State Lie:
Applicant: ELLISON PAUL
Con State Lic:
924361
Engineer:
LACHER TODD
Address: 25652 TALADRO CIR #F
Lie Expire:
10/31/2018
Address:
1201 N TUSTIN AVE
MISSION VIEJO CA 92691
Bus Lie:
BT30067856
ANAHEIM CA 92807
Phone: 949-677-2835
Lie Exp Date:
01/31/2018
Phone:
714-630-6100
State Lic:C-067656
Building Rear:
Setbacks: Front:
Left:
Right:
Construction Type :.
Worker's Compensation Insurance
Carrier: STATE FUND
Policy No: 9130715
Expiration: 04/23/2017
Special Conditions:
Issued Date: 01127/2017
FEES
Construction Valuation:
$0.00
°oeo
Building Permit Fee :
$380.00
Record Management:
$0.00
Water Quality-
Permit Issuing Fee:
$0.00
Building Dept Inspection Fee:
0.00°
Investigation Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
6.00 ° °
Building Green Fee:
$0.00
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:
$0.00
6.00°
Building PC Investigation :
$0.00
Additional Fee :
($347.00)
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE $33.00
Plan Check Fee :
$0.00 Fee Due at Permit Issuance ; $33.(
PROCESSED BY:
PLAN CHECKED BY::
eo
ZONING APPROVAL:
APPROVAL TO ISSUE:
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),' -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 app licant�'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 (_) 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 -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).
❑ 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 one year prior to completion of the improvements covered by this permit, I cannot legalll
sell 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 this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700) f i 3 of the Business and Pr BID o e, my li is in full force
and effect. License Class License No 2 Contractor Signatu
NORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
:OST 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,
lerformance 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:
Agent _
Y that, in the
gNgir'S Name
y myasignature
•
.1 I am the pro
• I ave read I
• •14ag#ee to cc
. •I.w orize n
ACTION • •••••
PERMIT EXPIRED
PERMITCANCELLED
Number
Date
lance the work r wh' this pe it issued, I shall not employ any person in any manner so as to become subject to the workers' compen ation I we of California, and agre
:ct to th r e co ensation r Isions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. �+
D
3 ST ON L N CY
of that there is a construction lending agency for the performance of the work for which this permit is issued (Section 309ode).
r----�LPnder's Address
tify to each of the followin
or authorized to ac the property owners
on and the inf ationvha e orro 'ided is cc
all applicable'city and
TE
city or
relating to building Z
onerty for inspection
Print Pro
OF COMPLIANCE WITH CODE OF FEDERAL
PART 61 OF TITLE 40 AND AQMD RULE
SUBMITTED ASBESTOS NOTIFICATION TO
POOLALARMS❑ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
INSTALLED PROPOSED DEMOLITION.
.j, .I I n SIGNATURE:
oses. %
Owner's or Authorized Acent's Nam^ly
V FOR OFFICE USE ONLY
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