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Home My WebLink AboutS2022-0095 - PermitsCity of Newport Beach - Building Division 111111III 11111p111111111111111111p111111111111111111 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 2 0 0 9 5 Permit Counter Phone (949)644-3288 n tlrrl4� .lob Address: 4515 SURREY DR Floor: Suite: Bldg: 1 Description of Work:SFR NEW (360 SF) POOL & (49 SF) SPA Inspector Area: 5 Legal Description: N TR 3519 LOT 73 Owner: SMITH JEREMY & DANA Address: 4515 SURREY DR CORONA DEL MAR, CA 92625 Phone: 949-351.6393 Applicant: POOL ICONS / H. CHRIS Address: 14790 PIPELINE AVE #C CHINO HILLS, CA 91709 Phone: 562455-8883 Building Rear: 6 Setbacks: Front: 12 Left: 6 Right: 6 Construction Type : Construction Valuation: $40,000.00 Building Permit Fee : $440.00 Permit Issuing Fee: $0.00 Investigation Fee: $0.00 Building Green Fee: $2.00 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 TOTALFEE: PROCESSED BY: ZONING Plan Check No: Code Edit: Contractor: POOL ICONS INC Address: 15935 DEL PRADO DR HACIENDA HEIGHTS CA 91745 Phone: 562-455-8883 Con State Lic: 479446 Lic Expire: 10/3112023 Bus Lic: ET30077496 Lic Exp Date: 1213112022 Worker's Compensation Insurance Carrier: STATE COMPENSATION INS FUND Policy No: 9268030 Expiration: 0111612023 FEES Record Management: $6.00 Drainage Permit Fee : $0.00 Drainage Plan Check: $0.00 Grading Consultant Fee : $0.00 Additional Fee : $0.00 1062-2022 2019 Architect: Address: POOLPermit : S2022-0095 Project No : 1062-2022 Inspection Requests Phone (949)644-3255 Phone: State Lic Engineer: BIEDENBACH CHRISTOPHER Address: 1201 N TUSTIN ANAHEIM CA 92807 Phone: 714-630-6100 State Lic:C-074003 Special Conditions Issued Date: 0510512022 Water Quality -- Building Dept Inspection Fee: $0.00 Water Quality Dept Insp Fee: $152.00 Building Dept WQ Plan Check: $0.00 Others $0.00 $0.00 Plan Check Fee : $396.00 PLAN CHECKED BY:: �/� APPROVALTOISSUE: 4.�C - Fee Due at Permit Issuance PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjurythat I am exempt from the Contractors' State License Law for the reason(s) indic (Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, dem the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License L Professions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Secti not more than five hundred dollars ($500). 1 I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of the M and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of comp improved for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor I am exempt from Iicensure 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 y sell a structure ti,at I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I unl PsfDcaions Ccd=_, is available upon request when this application is submitted or at the following Web site:http://www.legini Signature of Property Uwner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION i heieoy affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secti 0 f 11Tof a.id effect. License C:ass License No D COMPENSATION DECLARATION RE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL NSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. harcahy affirm under penalty of perjury one of the following declarations: I have and' will ,maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of 'crmance of the work for which this permit is issued. Policy No. have and wlll maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pe Rance canner and p licy nuj are: 'n[�� S�jl/t C.e � / ��, rier �{-all�C, C�i�t� y�-1-VPlolicy Number O ��-% ne of Agent d below by the checkmark(s) I have placed next to the applicable item(s) Ih, or repair any structure, prior to its issuance, also requires the applicant for (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 1 N TUSTIN and the structure is not intended or offered for sale (Section 7044, Business personal effort, builds or improves the property, provided that the sn, the Owner -Builder will have the burden of proving that it was not built or and Professions Code: The Contractors' State License Law does not to the Contractors' State License Law). nor to completion of the improvements covered by this permit, I cannot and that a copy of the applicable law, Section 7044 of the Business and gov/calaw.html. Date :isiacy 3Af the Business and Proft sion;.CpDya my license i crfdlI force �C_—Contractor Signaturefl AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE Relations as provided for by Section 3700 of the Labor Code, for 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 that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. r— 7 Signature of Applican Date \ —� ^ C 7- DECLARATION REG RDIONSTRUCTION QEXIDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which I iis permit is issued (Section 3097, Civil de). 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 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 ter thhe�ab e-identified rty for inspection purposes. Signature of Property Owner or Authorized Agent _ > / i/ Print Prooertv Ownere s or Auth rized ADent's Nam (, A tal i �1011-1oec-7 na dt .S S ACTION DATE BY DBI; f ATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE ISE ONLY � REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE t an; All required alarms,latches PERMIT EXPIRED I SUBMITTED ASBESTOS NOTIFICATION TO EPA PERMIT EMENDED I IAQM D POOLALARMS l BESTOS NOTIFICATION 15 NOT APPLICABLE TO INSTALLED L'�`' `�� Don Dncrn ncn.mt irinni PERMIT FINAL as part of a pool / spa barrier, shall be in place prior to approval to fill poollspa & shall remain In place & be rnaa4fined for the lifethe DON/soa