HomeMy WebLinkAboutS2021-0283 - Permitsgwrr}4, City of Newport Beach - Building Division `S2021-0283"
100 Civic Center Drive, Newport Beach, CA 92650
Permit Counter Phone (949)644-3288
.lob Address: 2419 SANTIAGO DR Floor: Suite: Bldg: 1
Description of Work:SFR *STOP WORK' NEW POOL/SPA 364 SF & DRAINAGE
Inspector Area: 3
Plan Check No:
2977-2021
Code Edit:
2019
Legal Description: NEWPORT HEIGHTS LOT 287 NWLY 78.75 FT SELY 315 FT
Owner: VANDERHOOK RUSSELL
Contractor:
OUTDOOR CONCEPTS
Architect:
Address: 2419 SANTIAGO DR
Address:
28241 CROWN VALLEY PKWY, F293
Address:
NEWPORT BEACH, CA 92660
LAGUNA NIGUEL CA 92677
Phone:
Phone:
949-363-7932
Phone:
Applicant: OUTDOOR CONCEPTS
Can State Lic:
831378
Engineer:
Address: 28241 CROWN VALLEY PKWY, F293
Lic Expire:
02/28/2022
Address:
LAGUNA NIGUEL CA 92677
Bus Lic:
BT30060506
Phone: 949-363-7932
Lic Exp Date:
09130/2022
Phone:
Building Rear:
Setbacks: Front:
Left:
Right:
Construction
Construction Valuation: $70,000.00
Building Permit Fee :
$440.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$440.00
Building Green Fee:
$3.00
Plan Dept Plan Check:
$0.00
Building Dep Plan Check:
$396.00
Building PC Investigation :
$0.00
Plan check Ext. Fee:
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE : $1,727.00
PROCESSED BY:
ZONING APPROt,
POOLPermit : S2021-0283
Project No: 2977-2021
Inspection Requests Phone (949)644-3255
INSPnECTOn
State Lic:
THOMPSON MATTHEW
12021 N TUSTIN AVE
ANAHEIM CA 92807
714-630-6100 State Lic:C-086051
Worker's Compensation Insurance Special Conditions:
Carrier: BENCHMARK INS CO STOP WORK
Policy No: CST5021783
Expiration: 06/1812022 Issued Date: 1212012021
FEES
Record Management:
$12.00
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 :
$0.00 Fee Due at Permit Issuance
: $1,727.00
PLAN CHECKED BY::.
I C
—�,
APPROVALTOISSUE:`
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)
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
ie 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
of more than five hundred dollars ($500). 12021 N TUSTIN AVE
I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness 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
nprovements 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
nproved 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
pply 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).
I am exempt from Iicensure under the Contractors' State License Law for the following reason:
ly 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 legall)
ell 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://www.leginfo.ca.gov/calaw.html.
lignature of PronPNy Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION
'icrsby affirm wider penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7 O) of ivis"o 3 of the Business and Pro s ode, an me' in full farce
nd effect. Lice:rye Crass License No Date Contractor Signature 7
VORK_RS' COIJIPENSATION DECLARATION
IARNING: FAILURE 0 SLGORE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED TH AND DOLLARS ($100,000), IN ADDITION TO THE
UST Or 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:
I ha-e and wall ,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
ertoimance of the work for which this permit is issued. Policy No.
have and wi6 maimain workers' compensation insurance, as required by Section 3700 of the Labor Code,
nonce c Ier al,d pGlicyynnumber are:
ier ��" !— `p7lI Policy Number
is of Agent
for the performance of the work for which this permit is issued. My workers'
Date
I certify that, in the performance of the work for 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
It, if I should become subj ttyuorkers' pensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /y
(nature of Applicant _ 1L i Da4e/L 20'A`
:CLARATION REG ONSTRUCTION LEN15INqAIGENCY /
ereby affirm under pena f perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ty
nder'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 cou ty antes and st laws relating to building construction.
I authorize representatives of this city or cou�.jgA nter he ab a-i ntified erty for inspection purposes.
nature of Prooertv Owner or Authorized Agent '.X/'� �� Print Property Owner's or Authorized
DATE BY D LARATION OF COIJff'LIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY gates
GULATIONS PART 61 OF TITLE 40 AND AQMD RULE as
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