HomeMy WebLinkAboutS2022-0098 - PermitsCity of Newport Beach - Building Division 11111111111111p11111111111111111111111111111111111111
100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 2 0 0 9 8
Permit Counter Phone (949)644-3288
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Job Address: 1947 WINDWARD LN Floor:
Description of Work:SFR POOL/SPA 442 SF
Inspector Area: 3
Legal Description: N TR 4463 LOT 9
Owner: PHAM TUAN
Address: 1947 WINDWARD LN
NEWPORT BEACH, CA 92660
Phone: 469/348.4421
Applicant: MATA JOSE
Address: 910 E 4TH ST
SANTA ANA CA 92701
Phone: 714-393-6358
Building Rear.
Setbacks: Front:
Left:
Right:
Construction Tvoe :
Construction Valuation: $75,000.00
Building Permit Fee :
$440.00
Permit Issuing Fee:
$0.00
Investigation Fee:
$D.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
TOTALFEE:
PROCESSED BY:
ZONING APPRO�
Suite: Bldg:1
Plan Check No: 1124-2022
Code Edit: 2019
Contractor: MATA'S MASONRY
Address:
910 E. 4TH ST
SANTA ANA CA 92701
Phone:
714-393-6358
Con State Lie:
861800
Lie Expire:
07/31/2023
Bus Lie:
BT30015664
Lie Exp Date:
04/30/2022
Worker's Compensation Insurance
Carrier: OAK RIVER INSURANCE CO
Policy No: MAWC233435
Expiration: 02/0112023
FEES
Architect:
Address:
POOLPerri : S2022-0098
Project No : 1124-2022
Inspection Requests Phone (949)644-3255
Phone: State Lie
Engineer: BIEDENBACH CHRISTOPHER
Address: 1201 N TUSTIN
ANAHEIM CA 92807
Phone: 714-630-6100 State Lic:C-074003
Special Conditions:
Issued Date:
Record Management:
$4.00
Water Quality ---
Building Dept Inspection Fee:
$0.00
Drainage Permit Fee :
$0.00
Water Quality Dept Insp Fee:
$152.00
Drainage Plan Check:
$0.00
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
PLAN CHECKED BY::,
APPF.OV'AI TO ISSUE
PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST \,ALID INSPECTION
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Due at Permit Issuance : $995.00
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 (a)
(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
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 Iicensure 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). 1201 N TUSTIN ❑
I, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of 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 who, through employees' or personal effort, builds or improves the property, provided that the
improvements 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
improved for the purpose of sale).
❑ 1, 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
apply 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).
❑ 1 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 year prior to completion of the improvements covered by this permit, I cannot legail)
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 700 ) of ision of the Business and Pro essio ode "tense is in fullforce
and effect. License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOPAND DOLLARS ($�e6,60D), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3766 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
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
:e of the work for which this permit is issued. Policy No.
have and will Tiworkers' 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'
Fence carrier andf.00lic number arei I .i9 a
ier 1 .v/d 1 Poliblr: // Exoiration Date
of Agent
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
if I should become subject to the worke% co pe sation provisions of Section 37D0 of the Labor Code, I shall forthwith comply with those provisions.
9
lAR of Applicant Date '
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areby affirm under penalty 1'jfthat there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ider'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 s to laws relatin uilding construction.
I authorize representatives of this city or county to enter roperty for inspection purposes.
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nanrl D
ACTION DATE BY ATI F COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY
1403 LATION5 PART 61 OF TITLE 40 AND AQMD RULE All required alarms.latches
PERMIT EXPIRED
PERMIT CANCELLED
POOLALARMS
INSTALLED
I SUBMITTED ASBE57 6 NOTTICAT-ON TC
LJ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.. ,
SIGNATURE:
lake a Fences wnicn serve
as part of a pool / spa
barrier, shall be in place
prior to approval to fill
pool/spa & shall remain in
piece & be maintained for
the life of the pool/spa