HomeMy WebLinkAboutS2021-0210 - PermitsCity of Newport Beach - Building Division III'����������������������������V������������������� II POOLPermit : S2021-0210
100 Civic Center Drive, Newport Beach, CA 92660 I' S 2 0 2 1 0 2 1 0
p Project No : 2110-2021
Permit Counter Phone (949)644-3288
2 Z� Inspection Requests Rhone (949)644-3255
g tn. 1.2-t If applicable: t
Job Address: 21 HARCOU
Description of Work:SFR DEMO
Inspector Area: 6
Legal Description:
Owner: SUCHARD ANA & T,
Address: 21 HARCOURT
NEWPORT BEACH,
Phone:
Applicant: AHUEJOTE RAFAEI
Address: 32303 CARIBBAN D
DANA POINT CA 9:
Phone: 949/456-3303
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $78,000.00
Building Permit Fee : $1,050.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$0.00
Building Green Fee:
$4.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$913.50
Building PC Investigation :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTALFEE:
Con State Lic: 1076463
re
i '-" c(Lxpl D > 1 0 2 9
(work started)
Worker's Compensation Insurance
g�j Carrier: NO EMPLOYEES
i� ota; Policy No:
State
Engineer: LACHER TODD
TU
h 714 6FA State Li C_-067656
(no work starter) INS kj I
Special Conditions:
Issued Date: 0912
inso. initials:
Record Management:
$0.00
Water Quality --
Building Dept Inspection Fee:
$0.00
Drainage Permit Fee :
$237.00
Water Quality Dept Insp Fee:
$0.00
Drainage Plan Check:
$199.00
Building Dept WQ Plan Check:
$0.00
Grading Consultant Fee :
$0.00
Others
$0.00
Additional Fee :
$0.00
$0.00
Plan Check Fee:
$1,112.50 Fee Due at Permit Issuance
: $1,291.00
PROCESSED BY: .�r` PLAN CHECKED-BW:a • .5
ZONINGAPPROVAL: wwli�APPROVAL TC°'°LS�E: • : a °° a °®•
0 0 •• o o w ®'° o �
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PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID GI gPEG'oION.
0 0 0 00 ° oo° woo
0 0 0
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co c o 0
woo 000 0 °
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons 1 ar
(Section 7031.5, Business and Professions Code: Any city or county that re prove, demolish, or repair any structure,
the permit to file a signed state n o e provisions of the Contractors' State License Law (Chapter 9 (commencing
Professions Cod'gj o a e or she is exempt from licensure and the basis for the alleged exemption. An >�i ¢Ifr5e7031.5 by any applicant fc
u
not more than fide„h dred dollars ($500). 12 2Z- 1201 N TUSTIN AVE '�,,�
❑ I, as owner*T:th propGaAay, elr sole compensation, will do L) all of o ,F�cc �ttllgqpps f lay ,�,p n�.tpe G,pirars
Business and Rrcdes Ions Code: The Contractors' State License Law does not a ly t e f propedbrfF.fBu e14r Ip o�ee-s'or personal effort
improvements arnintended or offered for s , how r, th uil a Is s within one year of completion, the Owner -Builder will
imoroved for the Bur seo
LJ I, as owner fiflthe
apply to an ownW of
❑ I am exempi6n
By my signaturebelo
sell a structure that I
Professions Code, is
Signature of Property
LICENSED CONTI
I hereby affirm under
and effect. License
IARNING: FAILURE TO SEA
:OST OF COMPENSATION,
hereby affirm under F
I ve and will m;
o ante of the wo
JI h1ve and will mai
isucance carrier and 1
1pMysive ontr cti 'c e n to tec�$e6r444; Bvstness and P� rofessions Cc
Deor i h on, ho tra th ec s with a licensed Contractor pursuant to the Contractors'
ena Contractors' State License Law for the following reason:
acknowledge that, except for my personal reside v d for at least one year prior to completion of the
e b ner-b i s c In ire b en contractors. I understand that a copy of the al
Iila upon r est 's a do - e g eb :http://www.leginfo.ca.gov/calaw.html.
I have placed next to the applicable item(s)
1r to~•its issuance, also requires the applicant for
1 Section 7000) of Division 3 of the Business and
permit subjects the applicant to a civil penalty of
intended or offered for sale (Section 7044,
iIds or improves the property, provided that the
e the- burden of proving that it was not built or
at I am licensed under provisions,Qpf C�lapter 9 commencing with Section 7000) of i1, n �,o`f 1
tl1e Business and '
License No !y/��,3 to �7 %y/moo» rSignatul
PION ECLARATION g��IrC�j
CO V GE 1$etlQI I SHALL sU&IE AN E LO E�R 5 1 E CI FINES DP TO ONE HUN01
1 VI 1 I N 11 F8 ai Cf DE, INTEREST, I hY'S FENS.
o f ng de ^a,r4at`ions: (no work started
a certificate .,,,,,I,t Starflied) for workers' compensation, issued by the Director of Industrial Relations as provided
Which this permit s i}Sued. Policy No.
compensation insurance, as required b
Number
ie of Agent Z
certify that, in the pe ormance of the work for
if I should become subjectytq the workers' o
lature of AoDlicant I 7`>%/Lr`,
-fffe—performance of the
InS€i. Initials: -
ued,�l sshall not employ any person in any manner so as to become subject to the workers'
of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
State License Law does not
Law).
s covered by this permit, I cannot
Section 7044 of the Business and
Date
DOLLARS ($100,000), IN ADDITION TO
3700 of the Labor Code, for
is issued. My workers'
laws of California, and
2.o /�2U21
;reby affirm under penalty 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).
Ider's Name Lender's Address
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 ordinances and state laws relating to building construction.
I authorize representatives of this city or county to egk theP;3bove-iVderltifdl�iJ pgfO�party f r inspection purposes.
nature of Property Owner or Authorized Agent SO �?,r/�. it nY✓✓�nrrt,%/�, Print Property Owner's or Authorized Agent's Name
ACTION
PERMIT EXPIRED
PERMITC4NCELLED
PERMIT EXTENDED
POOLALARMS
INSTALLED
DATE BY `� DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
U PSUBMI%T Eb ASBESTOS NOTIFICATION TO
• PQ
I,rAQM6 • °
ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
PROPOSED DEMOWTJON.
4IGN9?l1RE76••
Date
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