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Home My WebLink AboutS2021-0096 - PermitsCity of Newport Beach - Building Division II�IIIIIIIIIIIIIIIIIIIIIUIIIIIIIIIIIIIIIIIIII� III P00LPermit : S2021-0096 100 Civic Center Drive, Newport Beach, CA 92660 m Project No : 0836-2021 "�. � Permit Counter Phone (949)644-3288 a1 c .. "titn�` Inspection Requests Phone (949)644-3255 .lob Address: 4500 ROXBURY RD Floor: Suite: Bldg:1 INSPECTOR Description of Work:POOL & SPA 500 SF Inspector Area: 5 - Plan Check No: 0836-2021 Code Edit: 2019 Legal Description: N TR 3357 LOT 11 Owner. ROWSHAN KASRA Contractor: ALDERETE POOLS INC Architect: Address: 4500 ROXBURY RD Address: 63 VIA PICO PLAZA #447 Address: CORONA DEL MAR, CA 92625 SAN CLEMENTE CA 92674 Phone: Phone: 949-395-6734 Phone: State Lie: • • • Applicant: ELLISON PAUL Con State Lie: 830602 Engineer: THOMPSON MATTHEW ° "" • ° Address: 63 VIA PICO PLAZA #447 Lie Expire: 01/31/2022 Address: 12021 N TUSTIN AVE :"` :"``: SAN CLEMENTE CA 92674 Bus Lie: BT30056921 ANAHEIM CA 92807 .... Phone: 949395-6734 Lie Exp Date: 16/31/2021 Phone: 714-630-6100 State Lic:C-086051 • ° ° �' Building Rear: Worker's Compensation Insurance Special Conditions: =°eoe• s • Setbacks: Front: Carrier: STATE COMP `y: Left: Policy No: 9058446 ° • Right: Expiration: 06I0312021 Issued Date: 04116I2021 ° °®°•• Construction Type: FEESa=•�°• Construction Valuation: $60,000.00 • Building Permit Fee: $430.00 Record Management: $12.00 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: $0.00 Building Green Fee: $3.00 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: $387.00 $0.00 Building PC Investigation : $0.00- Additional Fee : $0.00 $0.00 Plan check Ext. Fee : $0.00 WO Compliance Insp Fee:/ $0.00 TOTAL FEE : $832.00 Plan Check Fee : $0.00 _ � Fee Due at Permit Issuance : $832.00 PROCESSED ZONING APPI PLAN CHECKED APPROVAL TO I: '\ PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION OWNER -BUILDER DECLARATION 1 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). 12021 N TUSTIN AVE ❑ 1, 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http:/Aw .leginfo.ca.gov/calaw.html. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm uridePpanalty of perjury that I am licensed under provisions Of Chapter 9 (commencing with Section 7 �) Div ion 3 of the Business and ProfGss�ps�ej5)d m Icense is in full force and effept. LiceM*Class License No Da e r Contractor Signature Y� �L(�// lS% IURS' MNIPENSATION DECLARATION VVARNINB: FAILURE T69EURE 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 LOW OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. IIh�hrrereby affirm under penalty of perjury one of the following declarations: 4+ 1Ja*e and will malhtain 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 thl jrpance of�h (* rk for which this permit is issued. Policy No. e and w111 mamtam 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 a. carver Ad policy number are: rn r : Policy Number Expiration Date ,,NN+a-a,me v6Agent • � � • Phone # L31'dettify that, Mtht'Wofpednury wo r which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre, that, if I should becomr compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.�� / Signature of Applicant Date DECLARATION REGUCTION LENDING AGENCY I hereby affirm under pat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owners behalf. I have read this application and the information i have rovided is r ect. I agree to comply with all applicable city and county rdi aj n state ws relating to building construction. �?40� C/// /' / I authorize representatives of this city or county t t t a -ide i led pr party for inspection purposes. .b �ISianature of PrODertv Owner or Authorized Agent Print Property Owner's or Authorized Agents Nam Da ACTION DATE I BY I REGULATIONNSSPPART 610 OF 40ANDAQMD RULEF COMPLIANCE WITH CODE OF I FOR OFFICE USE ONLY PERMIT EXPIRED U I SUBMITTED PERMITCANCELLED E rPA PERMIT EXTENDED I I yHQMD NOTIFICATION IS NOTAPPLICABLE TO INSTALLED I 1 I I A/-) I PROPOSED DEMOLITION. PERMIT FINAL