HomeMy WebLinkAboutS2017-0130 - Permitst � City of Newport Beach - Building Division IIllmIII 111111111111111p11111111111111p11111p1il
100 Civic Center Drive. Newport Beach, CA 92660 S 2. 0 1 7 0 1 3 0
` Permit Counter Phone (949)644-3288
4
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,lob Address: 220 VIA SAN REMO Floor: Suite: Bldg: 1
Description of Work:NEW SPA 120 SF
POOLPermit : S2017-0130
Project No : 1842-2017
Inspection Requests Phone (949)644-3255
Construction Valuation: $38,000.00
Building Permit Fee :
$380.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
Inspector Area: 1
Plan Dept Plan Check:
Plan Check No:
1842-2017
$338.00
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
Code Edit:
2016
Others
. e
Legal Description: TR 907 LOT 205(AND SWLY 7
FT LOT 204(AND NELY 9 FTLOT 206
$0.00
Additional Fee:
$0.00
Owner: CHRISTIAN RICHARD
Contractor:
RICK DORN CONST
Architect:
$510.00
yc' •�O r'
° ®m ° ° e
Address: 220 VIA SAN REMO
Address:
P 0 BOX 10047
Address:
• °"' -"
e °
NEWPORT BEACH, CA 92663
WESTMINSTER CA 92685
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Phone: 714.612.6630
Phone:
714-585-7322
Phone:
State Lic:
•..
Applicant: DORN RICK
Con State Lic:
357535
Engineer:
LACHER TODD
.'al'
Address: P.O. BOX 10042
Lic Expire:
05131/2019
Address:
1201 N TUSTIN AVE
° e. ° e,u"-
• • ° °
WESTMINSTER CA 92683
Bus Lic:
BT30049443
ANAHEIM CA 92807
Phone: 714-585-7327
Lic Exp Date:
12131/2017
Phone:
714-630-6100 State Lic:C-067656
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Building Rear:
Worker's Compensation
Insurance
Special Conditions:
Setbacks: Front:
Carrier:
WC EXEMPT
drainage on permit X16-3628
Left:
Policy No:
(NO EMPLOYEES)
Right:
Expiration:
Issued Date:
0812312017
Construction Type :
Construction Valuation: $38,000.00
Building Permit Fee :
$380.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$2.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$338.00
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE:
PROCESSED BY:
ZONING
FEES
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 :
$236.00
Others
$0.00
Additional Fee:
$0.00
$0.00
Plan Check Fee:
$456.00 Fee Due at Permit Issuance:
$510.00
PLAN CHECKED BY:: Fv v L"
APPROVAL TO ISSUE:
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 item(s)
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
ffessions 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,
siness 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
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 built or
)roved for the purpose of sale).
1, 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.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
-setrucfure %if (gave 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
Ifessions Code, Vavailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
nature of Property Owner or Authorized Agent Date
MNSED CONTRACTOR'S DECLARATION
-reby affirm'LI Ogr penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 11).pf Division 3 of the Business and Prof ssions e, and m cense is in full force
]effect. License.Class License No Date b� — Contractor Signafur
9RX.ERS' C:pMRENSATION DECLARATION
WAG: FAILURE Tp SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIT NAL PENALTIES AND CIVIL FINES UP TO ONE HU D T OUSAND DOLLARS ($100,000), IN ADDITION TO THE
T.QF.COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I
hebl affirm u4de6 psnalty of perjury one of the following declarations:
d •hare and will Wjlltain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for th
to$mance of 4 herwork 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' compensatiol
trance carrier and policy number are:
e of Agent _
:ertify that, in the
if I should bacon
ature of ADDlican
Policy Number
Date
ice of the work for w is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' mpensation laws of California, and agre
to the workers' mpen ion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Da
_ f i7
N LENDING AGENCY
I hereby affirm undednenury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 30 7, Civil Code).
alty
Lender's Name ( Lender's Address
By my signature below, I certify f each of the following:
I am the propertyowner or authorized to act on the property owners behalf.
I have read this application and the information I have provided is
corr
I agree to comply with all applicable city and co my ordinances o state law elating to building construction.
I authorize representatives of this city or count to enter the ove-lde d property for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Na —,< ' _ , / D e -Z3"1r
ACTION DATE BY DE RATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
-- RE ULATIONSPART61OFTITLE40ANDAQMDRULE Alir quiredalarms ,latches
PERMIT EXPIRED
❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO
as part of a pool / spa
barrier, shall be in place
prior to approval to fill
pool/spa & shall remain In
place & be maintained for
the II f the pool/spa
X -
PERMITCANCELLED
UEPA
PERMIT EXTENED
QMD
POOL ALARMS
INSTALLED
ASBESTOS N TIFICATION IS APPL ABLE TO
PROPOSED S OLITION.
SIGNATURE:
PERMITFINAL
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