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Home My WebLink AboutS2021-0035 - Permitsw City of Newport Beach - Building Division IIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIII II ¢` 100 Civic Center Drive, Newport Beach, CA 92660 5 2 0 2 1 0 0 3 5 `t Permit Counter Phone (949)644-3288 r �^��rYx>LLN�• Job Address: 1621 KENT LN Floor: Suite: Description of Work:SFR REM EXTG POOL & SPA Inspector Area: 3 Legal Description: N TR 1896 LOT 44 Owner: MILLER THOMAS Address: 1621 KENT LN NEWPORT BEACH, CA 92660 Phone: Applicant: FOSTER MICHAEL Address: 600 W FREEDOM AVE ORANGE, CA 92865 Phone: 909-263-6344 Building Rear: Setbacks: Front: Left: Right: Construction Type : Construction Valuation: $22,000.00 Building Permit Fee Permit Issuing Fee: Investigation Fee: Building Green Fee: Plan Dept Plan Check: Building Dep Plan Chec Building PC InvestiRafiton Plan check Ext. e : WQ Complianc Insp Fee: PROCESSED BY: Bldg: 1 Plan Check No: 0269-2021 Code Edit: 2019 Contractor: GARDNER POOL PLASTERING Address: 600 W FREEDOM AVE Phone: ORANGE CA 92865 Phone: 174-630-6300 Con State Lie: 896061 Lie Expire: 05/31/2021 Bus Lie: BT30018497 Lie Exp Date: 0113112022 Worker's Compensation Insurance Carrier: DEPARTMENT OF INDUSTRIAL Policy No: 4503-118 Expiration: FEES Architect Address: P001 -Permit: S2021-0035 Project No : 0269-2021 Inspection Requests Phone (949)644-3255 lfflt ` . • ,! $450.00 Record Management: $2.00 Water Quality --- Phone: State Lic: • ° Building Dept Inspection Fee: $0.00 $0.00 Drainage Permit Fee : $0.00 Water Quality Dept Insp Fee: $0.00 • c Engineer: $0.00 q°• •® °•••_� $0.00 Grading Consultant Fee: $0.00 m Address: $3$1.50 • •• $0.00 $ 0 m n $0.00 $0.00 Phone: State Lie: m • ° ° mmommm • D • m m D Special Conditions: • m • ° m ° m m e ocean mmmm • °0.00 O Issued Date: 02119/2021 ° • - ° • D 000W00 D DmOD $450.00 Record Management: $2.00 Water Quality --- $0.00 Building Dept Inspection Fee: $0.00 $0.00 Drainage Permit Fee : $0.00 Water Quality Dept Insp Fee: $0.00 $1.00 Drainage Plan Check: $0.00 Building Dept WQ Plan Check: $0.00 $0.00 Grading Consultant Fee: $0.00 Others: $3$1.50 $0.00 $ 0 Additional Fee : $0.00 $0.00 Plan Check Fee : PLAN CHECKED APPROVALTOI PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION at Issuance : 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) lection 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 e 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 rofessions 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 rt more than five hundred dollars ($500). as owner of the property, or my employees with wages as their sole compensation, will do U all of or L) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business id 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 iprovements 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 iproved for the purpose of sale). 11, 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 )ply 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: V my signature below I acknowledge that, except for my personal residence in which I must haveresidedfor at least one year prior to completion of the improvements covered by this permit, I cannot legall, :11 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 rofessions Code, is available upon request when this application is submitted or at the following Web site:http://w .leginfo.ca.gov/calaw.htmi. ignature of Property Owner or Authorized Agent Date ICENSED Cz®NIrR.ACTOR'S DECLARATION ierebyy affirm under -penalty of perjury that I am licensed under provisions f Chapter 9 (commencing with Section 000) ivisi n 3 of the Business and Professions Co d my li full force i0pact. Licarlse Gass lJ r License No k�9G0�� Date Z /�( Contractor Signature%.,— IORI?ERS' &WPENSATION DECLARATION ' IJNIN(k FAILURE TQ SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE )SPOF COMPENSETION, pAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I ereby affirm LRQ@Ppgnalty of perjury one of the following declarations: l*have and WIN 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 Ihpnce only%h& for which this permit is issued. Policy No. 9•ha a and will fnaintain 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' compensatioi �d6 oe carrierJ��anidpolicy number are: p ler • Cs��j"fairtiti✓� C �%"'lT ,�iC Policy Number /J JS Expiration Date 3me a�ADent lFf��f (ZVL? Phone # lkn 75 - / 1.. • ,.-.-..T. . certify that, in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre at, if I should become subject two thy' rkersiGDmpaR erortSDPSaction 3700 of the Labor Code, I shall forthwith comply with those provisions. / gnature of Appfca Date_ ECLARATION REG A DING CONSTRUCTIO NDING AGENCY lereby affirm under p natty 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). inder's Name Lender's Address I 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 information I have provided is correct. I agree to comply with all applicable city and county ordin nces and state laws relating to building construction. - /q I authorize representatives of this city or county t t d property for inspection purposes. Gnature of Prooertv Owner or Authorized ADent _ Print Property Owner's or Authorized Agent's ACTION I DATE I BY PERMIT EXPIRED PERMIT CANCELLED Y INSTALLED I` \ I J 9 INSTALLED _DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY . REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE All required alarms.latches 1403 1 SUBMITTED ASBESTOS NOTIFICATION TO as part of a pool./ spa EPA barrier, shall be in place LJAQIVID prior to approval to fill ASBESTOS NOTIFICATION 15 NOT APPLICABLE TO pool/spa & shall remain in PROPOSED DEMOLITION. place & be maintained for SIGNATURE: theJlfC— t _J/.�pa