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Home My WebLink AboutS2020-0206 - Permitsawn„�T City of Newport Beach - Building Division IIII�IIIIIIIIIII�IIIIIIII�IIIII II POOLPermit : S2020-0206 100 Civic Center Drive, Newport Beach, CA 92660 S 2 0 2 0 0 2 0 6 Project No : 2330-2020 Permit Counter Phone (949)644-3288 J m. Inspect�n Requests Phone (949)644-3255 Job Address: 4508 DORCHESTER RD Floor: Suite: Bldg: 1 ' P�"3 �" CT Description of Work:POOL REMODEL - ADD BAJA STEP & REPLASTER , N S G L,�C Inspector Area: 5 Plan Check No: 2330-2020 Code Edit: 2019 Legal Description: N TR 3519 LOT 77 Owner: JACOBSON JEFF A Contractor: TIMELESS POOLS INC Architect: Address: 4508 DORCHESTER RD Address: 660 DUNDEE CT Address: CORONA DEL MAR, CA 92625 BREA CA 92821 Phone: 949-653-3620 Phone: 714-618-3326 Phone: State Lie: ' Applicant: ELLISON PAUL Con State Lie: 1019202 Engineer: LACHER TODD Address: 24642 VIA RAZA Lie Expire: 08/3112021 Address: 1201 N TUSTIN AVE LAKE FOREST CA 92630 Bus Lic: BT30071641 ANAHEIM CA 92807 ++ + Phone: 949-683-9861 Lie Exp Date: 04/3012021 Phone: 714-630-6100 State Lic C-067656 • „' , Building Rear: Worker's Compensation Insurance Special Conditions: + "" Setbacks: Front: Carrier: STATE FUND Left: Policy No: 9206353 Right: Expiration: 03/10/2021 Issued Date: 12/16/2020 , Construction Type FEES Construction Valuation: $12,000.00 Building Permit Fee : $280.00 Record Management: $10.00 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: $1.00 Drainage Plan Check: $0.00 Building Dept WQ Plan Check: $0.00 Plan Dept Plan Check: $0,00 Grading Consultant Fee : $0,00 Others Building Dep Plan Check: $243.60 $0.00 Building PC Investigation : $0.00 Additional Fee: $0.00 $0.00 Plan check Ext. Fee : $0� WQ Compliance Insp Fee: \I //////00 TOTAL FEE : $fff60 34. Plan Check Fee : $0.00 a Due at Permit Issuance : $534.60 PROCESSED BY: ZONING APPRO\o PLAN CHECKED BY:: APPROVAL TO ISSUI 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 items) 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). 1201 N TUSTIN AVE 1 I, as owner of the property, or my employees with wages as their sole compensation, will do t_) 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 licensure 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 legally 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. signature of Property Owner or Authorized Agent Date .ICENSED CONTFACTOR'S DECLARATION hereby Lffirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 00 o, BN io %3 of the Business and Professio a d Ic Is in full force Ord effec. License (jars License No Date 6 2") Contractor Signature VCRKZRS' COMPENSATION DECLARATION U.11NIN3. 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 ($100,000), IN ADDITION TO THE :DST OF COMPENSATOR. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: 1 ' `I3 a 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 erfo Ance 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' compensatiol 6�0dnite carrier 3ndgofcy number are: Policy Number Expiration Date ,lams a: Agent - Phone # :1I certify that, in the =that for wh' is permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensgonws o California, and agre hat, if I should becomcom sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant Data DECLARATION REGN LENDING AGENCY hereby affirm under pre is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). -ender's Name Lenders Address 3y 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 ided is rre I agree to comply with all applicable city and countyoe rid ateelelartting to building construction.I authorize representatives of this city or county toe-identiy for inspection purposes. Signature of Property Owner or Authorized Age Print Pro ert Owner's or Authorized Agent's Name Dat ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403 PERMITEXPIRED U I SUBMITTED ASBESTOS NOTIFICATION TO All required alarms,latches gates & fences which serve as part of a pool / spa barrier, shall be in place prior to approval t0 fill pool/spa & shall remain in place .& be maintained for .. .- -.. .. PERMITCANCELLED UEPA PERMITEXTENDED EIAQMD POOLALARMS INSTALLED n I Vl Ll ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMIT FINAL I�lf