HomeMy WebLinkAboutX2019-2826 - Permits.City of Newport Beach - Building Division
c1 _ 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
un,u> Combination Type - BLDG
111111111111111111111111111111111111p11111111111111 JillCOMB Permit: X2019-2826
x 2 9 1 9 2 8 2 6 Project No: 2012-2019
Issued Date : 11/0812019
Inspection Area : 3
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION.
Construction Hours: Monday - Friday 7:00 a.m. to 6:30 p.m. and Saturday from 8:00 a.m. to 6:00 p.m. No work on Sundays or Holidays
Job Address: 2141 INDIAN SPRING LN NB
Description: DEMO (E) POOLIN
SPEa1
Legal Desc.: N TR 6689 LOT 1 p T
UODR
Owner: CHASON CLIFTON
Contractor:
SWAN POOLS OF SOUTHERN CA Architect:
Address: 2141 INDIAN SPRING LN
Address:
24512 BRIDGER ROAD Address:
NEWPORT BEACH, CA 92660
LAKE FOREST CA 92630
Phone:
Phone:
949-859-8466
Phone:
State Lic:
^ ... °
Applicant: ELLISON PAUL
Con State Lic:
440333
Engineer:
LACHER TODD
o
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Address: 24512 BRIDGER RD
Lic Expire:
0313112020
Address:
1201 N TUSTIN AVE
° • ®a •
•
`
LAKE FOREST CA 92630
Bus Lic:
BT96008994
ANAHEIM CA 92807
•
• ° ° `,
Phone: 949-859-8466
Lic Exp Date:
0713112020
Phone:
714.630.6100 State Lic:C-067656 ....
Code Edit : 2016
Worker's Compensation Insurance
P
Designer:
9
•°°° r
Type of Construction:
Carrier:
STATE FUND
Address:
Occupancy Group: U
Policy No:
9228545
Added /New sq.ft. Bldg: 0
Expire:
04/0112020
Phone:
Added /New sq. ft. Garage: 0
No of Stories: 0
Building Setbacks
Rear: 6
Special Conditions: SOME LANDSLIDE AREA-
NoofUnits: 0
Front: 20
• °O
••°°°°
Bldg Height: 0
Left: 6
Bldg Sprinklers:
Right: 6
Flood Zone: X
Use Zone: Parking Spaces:
0 Fire Hazard Zone : N
Construction Valuation: $1,000.00
Building Permit Fee: $104.00
Excise Tax:
$0.00
Planning Department -
Fire Department
Plan Check Fee: $90.48
Additional Fee :
$0.00
Plan check Fee :
$0.00 Fire Inspection:
$0.00
Overtime Plan Ck: $0.00
Grading Bonds Fee:
$0.00
Fair Share :
$0.00 Fire Plan Rev
$0.00
Investigation Fee: $0.00
Grading PC Consultant :
$0.00
SJH Trans :
$0.00 Demolition Fee
Record Management : $0.00
Grading Permit Fee:
$0.00
In -lieu Housing Fee:
$0.00 Building Dept Adm
$0.00
Energy Compliance: $0.00
Grading PC Fee:
$0.00
Public Works Department -
General Service
$0.00
CA Seismic Safety: $0.00
WQ Insp. Fee:
$0.00
Park Dedication : $0.00
Refund Deposit
$0.00
Disabled Access : $0.00
PAN Plan Check: $0.00
Grading Bond:
$0.00
Hazardous Mat $0.00
Electrical W
$0.00
San Dist: $0.00
Building Green Fee : $1.00
Mechanical %:
$0.00
NMUSD Fee: $0.00
$0.00
Plumbing %:
$0.00
$0.00
TOT FEE : $195.48
Plan Check Fee:
$0.00 Fee Due at Permit Issuance :
$195.48
PROCESSED BY:� _
PUBLIC WORKS A 'ROVAL:
ZONING APPROVAL:
PLAN CHECK BY:
GRADING APPROVAL:
APPROVAL TO ISSUE:
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)
(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
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).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or `) 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 legally
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
Profession] Fp(Jq,;s available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.govicalaw.htmi.
Signature of Property Owner or Authorized Agent - Date
410ENSED•CONWTRACTOR'S DECLARATION
....
I he}eby affirm un.der penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 f givi ion 3 of the Business and Profess' s rd', a my rise is in full force
and.effect. Lipense Class License No Date /1 / C3 Contractor Signature
NORKERS:COMPENSATION DECLARATION
NARYING: FAIL RE 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
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirmander penalty of perjury one of the following declarations:
2Y, 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 IN
fie a nce 9f the Work for which this permit is issued. Policy No.
ecce.•
I av 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' compensatior
t n e carogr and policy number are:
R" a e: e e Policy Number _ Expiration Date
Name of Agent Phone #
�I certify that, in the perf e o work or w c is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation la s of California, and agree
:hat, if I should become su ject t e orker co sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
DECLARATION
3D l
7ECLARATION REGA IN C U TION LENDING AGENCY
hereby affirm under pe ally o perjury that there is a construction lending agency for the pe rmance of the work for which this permit is issued (Section 97, Civil Code).
_ender's Name Lend 's ddress
3y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property fiorre
f.
I have read this application and the informatioghe rovi I agree to comply with all applicable city and cricaws Sting to building construction.I authorize representatives of this city or counthe ed operty for in ction purposes./���
signature of Property Owner or Authorized A crit Print PropertyOwner's or Authorized Agent's Name Date
ACTION ___F_7U7 BY DECMRATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
PERMIT EXPIRED i i 1 LI I SUBM ITTED ASBESTOS NOTIFICATION TO
PERMITCANCELLED EPA
PERMITFINAL f(/ry�jj 1GI�G,Y/J,S U ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
CERTIFICATE OF PROPOSED DEMOLITION
OCCUPANCYISSUED SIGNATURE:
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