HomeMy WebLinkAboutS2023-0031 - Permit Application" WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEWPORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
SWIMMING POOL F SPA Eg-'
Check Awromiate box for ADolicant
ESTIMATED $ VALUATION
POOL FENCING ❑ DRAINAGE ❑
3. OWNER'S NAME
LAST
FIRST
7
ADDRESS
/ ,�i✓On��
OWNER'S E-MAIL ADDRESS
Y) 9 r,lZIonC f)Ctv,ci,I,LG✓
CITY
STATE
ZIP
PH E NO.
U't S �; 2 le/
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
AME JJBUSINESS
5. CONTRACTOR'S Lju,1de,,r,
LICENSE
STATE LICENSE
No. Class
ADDRESS i
CONTRACTOR'S E-MAIL ADDRESS
EC:17y:
STATE
ZIP
PHONE NO.
:E USE ONLY M�
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
WORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
CITY OF NEW PORT BEACH
BUILDING DIVISION
PLEASE PRINT OR TYPE
1. PROJECT ADDRESS (NOT MAILING ADDRESS) I
l % /��%.I A
LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK /AJeh/ Zi✓ - FiroUNJi St�/�/+�/n/�✓FI d 00/ ce S)0,4-
ESTIMATED $ VALUATION / SK
SWIMMING POOL I' SPA [!�� POOL FENCING ❑
Check Appropriate box for Applicant
DRAINAGE ❑
3. OWNER'S NAME
/114FElE
LAST
FIRST
,Zgrn ELo'n/ 14LZ
ADDRESS
/ 9 /)Ave"i,Q
OWNER'S E-MAIL ADDRESS
CITY
8',*c W
STATE
(,,,A"
ZIP
9ZraS7
PHONE NO.
4. ENGINEER'S NAME
LAST
FIRST
LICENSE NO.
ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
5. CONTRACTOR'S NAME
BUSINESS LICENSE
STATE LICENSE
No. Class
ADDRESS
CONTRACTOR'S E-MAIL ADDRESS
CITY
STATE
ZIP
PHONE NO.
:E USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
4' pojRr CITY OF NEWPORT BEACH
�`� 1'S�
v' COMMUNITY DEVELOPMENT DEPARTMENT
BUILDING DIVISION
100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
Cq<Ipp FN\P www.newportbeachca.gov i (949) 644-3200
ACKNOWLEDGMENT OF NO CONSTRUCTION -RELATED NOISE
ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS
On June 11, 2019, the City Council adopted an ordinance restricting
construction -related noise on Saturday in High Density Areas effective
August 12, 2019.
I acknowledge that any construction -related noise, (including, but not limited
to operating power equipment or machinery in a manner that produces noise)
is not allowed on Saturday or Sunday in High Density Areas in accordance
with Newport Beach Municipal Code 10.28.040. As the owner of the
property, I am responsible to ensure all persons working on the property
comply with this provision of the Newport Beach Municipal Code.
Project Address: / % / A V'0/'1 - t
Permit Number: S ZO Z 3— V U 3`
Owner's Name: _ AgMtzOW f4Ll n/RFCT C
Owner's Signature: _
Contractor's Signature:
Date:
Forme cknoWedgment_No_S@Wrday_ConsWcfion_HighDensitykeas