HomeMy WebLinkAboutS2020-0040 - Permits� ,� City of Newport Beach - Building Division 111111III11i11p111111111111111111p111p11111111p111POOLPermit : S2020-0040
' .ram 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 0 0 0 4 0 Project No: 0480-2020
'E;,, Permit Counter Phone (949)644-3288
0s
e� � Inspection Requests Phone (949)644-3255
Job Address: 5 HONORS DR Floor:
Suite: Bldg: 1
Description of Work:SFR IN -GROUND SPA 60 SF wI DRAINAGE
Inspector Area: 8
Plan Check No:
0480-2020
Code Edit:
2019
Legal Description: N TR 15389 LOT 29
Owner: JERVIS DONALD D
Contractor:
FIVE STAR POOLS
Architect:
Address: 5 HONORS DR
Address:
9146 GARDENIA AVENUE
Address:
NEWPORT BEACH, CA 92660
FOUNTAIN VALLEY CA 92708
Phone:
Phone:
714-847-4177
Phone:
State Lic:
Applicant: ELLISON PAUL
Con State Lic:
608969
Engineer:
LACHER TODD
Address: 9146 GARDENIA AV
Lic Expire:
0713112020
Address:
1201 N TUSTIN AVE
FOUNTAIN VALLEY CA 92708
Bus Lic:
BT30071311
ANAHEIM CA 92807
Phone:
Lic Exp Date:
0313112021
Phone:
714-630-6100 State Lic:C-067656
Building Rear:
Setbacks: Front:
Left:
Right:
Construction Type :
Worker's Compensation Insurance
Carrier: WIC EXEMPT
Policy No: (NO EMPLOYEES)
Expiration:
Special Conditions:
Issued Date:
N, i t �
��'�j,
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FEES
Construction Valuation: $20,000.00
Building Permit Fee:
$418.00
Record Management:
$4.00
Water Quality ---
Permit Issuing Fee:
$0.00
Building Dept Inspection Fee:
$0.00
Investigation Fee:
$0.00
Drainage Permit Fee :
$322.00
Water Quality Dept Insp Fee:
$0.00
Building Green Fee:
$1.00
Drainage Plan Check:
$322.00
Building Dept WQ Plan Check:
$0.00
Plan Dept Plan Check:
$0.011
Grading Consultant Fee :
$0.00
Others
Building Delp Plan Check:
$0.00
-
$0.00
$0.00
Building PC Investigation :
$0.00
Additional Fee :
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE: $1,067.00
Plan Check Fee :
$0.00 to Due at Permit Issuance: $1,067.00
PROCESSED BY:
ZONING APPROV
PLAN CHECKED BY::
APPROVAL TO ISSUI
PERMIT EXPIr.rG 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) indic
Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, dem
IS permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License L
rofessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Secti
of more than five hundred dollars ($500).
] I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) portions of tl
usiness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through (
nprovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of comp
nproved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044,
pply 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:
y my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one y
all a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I on
rofessions Code, is available upon request when this application is submitted or at the following Web site: http://www.leginl
ignature of Property Owner or Authorized Agent
ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of
nd effect. License Class _ - _. License No DatL
COMPENSATION DECLARATION
IARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENAL"
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:
I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of
erformance of the work for which this permit is issued. Policy No.
71 have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the pe
isurance carrier and policy number are:
(r�er Policy Number
g of Agent
erf ify that, in the perform ce of th��''��99ork fooy�'hich this permit is issued, I shall not employ any person in any manner
if I should become sub' ct eiW orZIAmpensation provisions of Section 3700 of the Labor Code, I shall forthwit
signature of Applicant L/
IECLARATION REGAMWa-CON9TRUCTION LENDING AGENCY
hereby affirm under pebbIty of perjury that there is a construction lending agency for the performance of the work for wl
ender's Name Lender's Address
ly 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' come
I agree to comply with all applicable city and cou o i s nd to laws relating to building construction.
I authorize representatives of this city or county e r t ov de ed property for inspection purposes.
sionature of Prooertv Owner or Authorized Aoent Print Prooertv Owner's or
ACTION DATE BYWA DECLARA ION OF COMPT 61 TNTCE WITH E40AN CODE OFAQMD EDLERAL I FOROFFICE
PERMIT EXPIRED
L_I I SUBMITTED ASBESTOS NOTIFICATION TO
PERMIT CANCELLED
Epq
PERMIT EXTENDED
QM D
POOLALARMS
INSTALLED
LJASEIESTOS NOTIFICATION IS NOTAPPLICABLE TO
PROPOSED DEMOLITION.
Id below by the checkmark(s) I have placed next to the applicable item(s)
sh, or repair any structure, prior to its issuance, also requires the applicant for
I (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
N N TUSTIN AVE
work, and the structure is not intended or offered for sale (Section 7044,
ployees' or personal effort, builds or improves the property, provided that the
on, 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).
to completion of the improvements covered by this permit, I cannot
that a copy of the applicable law, Section 7044 of the Business and
Date
ion 3 of the Business and Profe Si _ y I in full force
Zo Contractor Signature,` -
ID CIVIL 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
as to become subject to the workers' compensation laws of California, and agre
imply with those provisions.
D15� / a
is permit is issued (Section 3097, Civil Code).
ONLY
Name V ' "r""t
s,
PERMIT FINAL