HomeMy WebLinkAboutS2021-0114 - Permits�1rk City of Newport Beach - Building Division II�III��II��IIIlliil��lI������IIIII II
oar; 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 1 0 1 1 4
ti . •. ',i. Permit Counter Phone (949)644-3288
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Job Address: 41 ROYAL SAINT GEORGE RD Floor:
Description of Work:SFR POOL & SPA 775 SF
Inspector Area: 4
Legal Description: N TR 7223 LOT 71
Owner: HENDERSON CHRISTIAN
Address: 41 ROYAL SAINT GEORGE RD
NEWPORT BEACH, CA 92660
Phone:
Applicant: DE VORE LARRY
Address: PO BOX 828
SN JUAN CAPISTRANO CA 92693
Phone: 949-547-1366
Building Rear:
Setbacks: Front:
Left:
Right:
.ansuucnon type: vo
Construction Valuation: $70,000.00
Suite: Bldg:1
Plan Check No: 1057-2021
Code Edit: 2019
Contractor: DE VORE POOLS & SPAS
Address: PO BOX 828
SAN JUAN CAPSTRNO CA 92693
Phone: 949-547-1366
Con State Lic:
401549
Lic Expire:
04/3012022
Bus Lic:
BT97026761
Lic Exp Date:
11130/2021
Workers Compensation Insurance
Carrier: STATE COMP INS
Policy No: 1222520
Expiration: 11/01/2021
FEES
Architect:
Address:
Phone:
POOLPermit : S2021-0114
Project No : 1057-2021
Inspection Requests Phone (949)644-3255
State Lic:
Engineer:
PETROV PLAMEN
Address:
28161 CASITAS CT
LAGUNA NIGUEL CA 92677
Phone:
714-717-7542 State Lic:C-066947
Special Conditions:
Issued Date: 05/19/2021
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0
Building Permit Fee :
$430.00
Record Management:
$14.00
Water Quality- --
Permit Issuing Fee:
$0.00
Building Dept Inspection Fee:
$0.00
Investigation Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$0.00
Building Green Fee:
$3.00
Drainage Plan Check:
$0.00
Building Dept WQ Plan Check:
$aoo
Plan Dept Plan Check:
$0.00
Grading Consultant Fee :
$336.00
Others
Building Dep Plan Check:
$387.00
$0.00
Building PC Investigation :
$0.00
Additional Fee :
$0.00
$0.00
Plan check Ext. Fee :
$0.00
WQ Compliance Insp Fee:
$0.00
TOTAL FEE : $1,170.00
Plan Check Fee :
$347.00 Fee Due at Permit Issuance
: $823.00
PROCESSED BY: \ by - PLAN CHECKED BY:: V v
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ZONING APPROVAL: V /'�. APPROVAL TO ISSUE: �I
.. 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 t icense Lnw for the reasnn(s) inoicated 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 t,i consvuct alterimprove, demolish, or repair any structure, prior to its issuance, also requires the applicant for
the 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
Professions 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
not more than five hundred dollars ($500). 28161 CASITAS CT
❑ I, as owner of the property, or my employees with wages as their sole compensation, will eo (_) 311 3f cr L) portions aF the work, and the structure is not intended or offered for sale (Section 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property wno, through efip-oyees' or personal effort, builds or improves the property, provided that the
improvements are not intended or offered for sale. If, however, the building or improver. ur,t is sold withi,, onu yLar of completion, the Owner -Builder will have the burden of proving that it was not built or
�i"m"�proved for the purpose of sale).
T 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
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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).
am exempt from licensure under the Contractors' State License Law for the following reason:
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 legally
sell 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7pOQl.pf Division 3 of the Business and Professie, and my license is in full f ree
and effect. License Class License No Datef/ .7 —`? l Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (E100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 have and will 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,
pefrbfmance of the work for which this permit is issued. Policy No.
and will maintain workers' 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'
carrier and policy number are:
Policy Number
Date
ie of Agent Phone #
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 agree
if I should become subject to th workers' compens-preaisionsof Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
/
tatureofApplicant ( Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ender's Name Lender's Address
y my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners 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,togatwthe above -identified property for inspection purposes. y
of
Owner's or
ACTION
DATE
BY d
DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL
FOR OFFICE USE ONLY
REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE
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PERMITEXPIRED
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as part of a pool / spa
barrier, shall be in place
PERMIT CANCELLED
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PERMIT EMENDED
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POOL ALARMS
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ASBESTOS NOTIFICATION IS NOTAPPLICABLE TO
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