HomeMy WebLinkAboutS2018-0184 - PermitsHEN' PpR
City of Newport Beach - Building Division IIGIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIII II
4 % 100 Civic Center Drive, Newport Beach, CA 92660 2 0 1 8 0 1 8 4
Permit Counter Phone (949)644-3288
a
.lob Address: 369 SANTA ISABEL AVE Floor: Suite: Bldg: 1
Description of Work:NEW POOL & SPA *CHANGE OF CONTRACTOR* (WORK IN PRGRS) 560 SF
Inspector Area: 3 Plan Check No: 2673-2016
Code Edit: 2013
Legal Description: TR 300 LOT 105 POR OF LOT
Owner: ADRIENNE M A WORLEY Contractor: OWNER/BLDR
Address: 369 SANTA ISABEL AVE Address: ADRIENNE M A WORLEY
NEWPORT BEACH, CA 92660
Phone
Applicant: ADRIENNE M A WORLEY
Address: 369 SANTA ISABEL AVE
NEWPORT BEACH, CA 92660
Phone:
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $0.00
Phone: 949-500-0103
0
Can State Lic: CIS
Lic Expire:
Bus Lic:
Lic Exp Date:
Worker's Compensation Insurance
Carrier:
Policy No:
Expiration:
FEES
Architect
Address:
POOL -Permit: S2018-0184
Project No: 2673-2016
Inspection Requests Phone (949)644-3255
Phone: State Lic
Engineer: PASOL DAWN
Address: 1411 N BATAVIA STE 208
ORANGE CA 92867
Phone: 714-363-3585 State Li¢C-061163
Special Conditions:
C2016-0247
RPLC PERMIT S2016-0179, OIB AUTH A-T
Issued Date: 1011612018
Building Permit Fee :
$0.00
Record Management:
$0.00
Water Quality --
Permit Issuing Fee:
$0.00
Building Dept Inspection Fee:
$0.C^_
Investigation Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Building Green Fee:
$0.00
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:
$0.00
$0.00
Building PC Investigation :
$0.00
Additional Fee :
$35.00
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE : $35.00
Plan Check Fee :
Fee Due at Permit Issuance : $35.00
PROCESSED BY: PLAN CHECKED BY::
ZONING APPROVAL: APPROVAL TO ISSUE:
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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)
ction 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
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
fessions 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
more than five hundred dollars ($500). 1411 N BATAVIA STE 208
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
,iness 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
`�vements are not intended or offered for sale. If, however, th 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
`5,ed for the purpose of sale).
r(as owner of the property, am exclusively contracting wit li nsed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
ly to an owner of property who builds or improves thereo , a who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law),
J I am exempt from licensure under the Contractors' SI
ly my signature below 1 acknowledge that, except for my
ell a structure that I have built as an owner -builder if it h'
'rofessions Code, is available upon request when this a
'signature of Property Owner or Auth
ICENSED CONTRACTOR'S ISECIL
hereby affirm under penalty of perjury that I am Iicen d
nd effect. License Class
COMPENSATION
dense Law for the following reason:
net residence in which I must have resided for at least one year prior to cor
been constructed in ijs a tirety by licensed contractors. I understand that a
3n is submitted,pr at �F followin;NVeb site;http://Www.leginfo.ca.gov/calaw
under provisions of Chapter 9
License No
of the applicable law, Section
Section 7000) of Division 3 of the Business and Pro
_ Date Contractor Signature
of the Business and
and my license is in full force
'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION CdVERAGE 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
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
7 I hr've and .:l r.laintain 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
erformance or fh='n'ork for which this permit is issued. Policy No.
have and will maintain worlSgrs' 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'
rance carrier and policy n per are:
Policy Number Expiration Date
f Agent _IF
fy that, in the pert m9 nce of the work for which
should beuome t Ct to the workers' comoenE
is issued, I shall not employ any person in any manner so as to become subject to the
,i9J s of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
hemby affu . of a y of perjury that there is a coion lendin §ency for the performance of the work for which this permit is issued
-ender's Name nst c Lender's Address
3y my signature below, I certify to each of the following
I am the property o er or authorized to act on t pr arty owner's behalf.
I have read this application and the information ha provided is correct.
I agree to comply with all applicable city and 96uX ordinances and sta I�ws relat' g to building construction.
I authorize represent s of this city, or cou enter the above-ide ' I d prop for inspection purposes.
31gnature of Prop e Owner or Author -Print Property Owner's or Authoriz d A ends m
ACTION DECLARATION OF COMPLIANCE WI CODE OF FEDERAL FOR OFFICE USE
REGULATIONS PART 61 OF TITLE 40 NDAQMDRULE
PERMIT EXPIRED
1403 v
I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT EXTENDED UAQMD
POOL ALARMS ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
INSTALLED 1C �f� PROPOSED DEMOLITION.
(,� i SIGNATURE:
W
Civil Code).
alarms,latches
as part of a pool / spa
barrier, shall be in place
prior to approval to fill
pool/spa & shall remain In
place & be intainegJar
the lif P P3/
laws of California, and
PERMIT FINAL
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