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HomeMy WebLinkAboutS2015-0002 - Permits (2)City of Newport Beach - Building Division 04 100 Civic Center Drive, Newport Beach, CA 92660 F Permit Counter Phone (949)644-3288 r U Job Address: 8 TWILIGHT BLUFF Floor: Suite Inspector Area: 6 Legal Description: Owner: BUCKLEY KEITHMESSICA/TIMIJENNIFER Address: 8 TWILIGHT BLUFF NEWPORT COAST CA 92657 Phone: Applicant: DENNY TOM Address: 610 S JEFFERSON PLACENTIA CA 92870 Phone: 714-606.6122 POOLPermit : S2015-0002 Project No: 0035-2015 Inspection Requests Phone (949)644-3255 Bldg: 1 Description of Work:P001- REMODEL/INFINITY EDGE Plan Check No: 0035.2015 Code Edit: 2013 Contractor: CORRELL CUSTOM POOLS Address: 610 S JEFFERSON ST UNIT A PLACENTIA, CA 92870 Phone: 714-528-5571 Con State Lie: 906940 Lie Expire: 11/30/2015 Bus Lic: BT30049579 Lie Exp Date: 01/31/2016 Architect: Address: Phone Engineer: LACHERTODD Address: 1201 N TUSTIN AVE ANAHEIM CA 92807 Phone: 714-630-6100 State Lie: State Lic:C-067656 ' Building Rear: Setbacks: Front: Left: Right: Construction Type : Worker's Compensation Insurance Carrier: EMPLOYEE SVC GROUP Policy No: WC439177605 Expiration: 06/01/2015 Special Conditions: LANDSLIDE ZONE Issued Date: 01/09/2015 -- FEES Construction Valuation: $10,650.00 Building Permit Fee: $234.00 Record Management: $12.00 Water Quality --- Permit Issuing Fee: $0.00 Building Dept Inspection Fee: $0.00 Investigation Fee: $0.00 Grading Permit Fee : $0.00 Water Quality Dept Insp Fee: $24.00 Building Green Fee: $1.00 Grading Plan Check: $0.00 Building Dept WQ Plan Check: $0.00 Plan Dept Plan Check: $32,00 Grading Consultant Fee : $0.00 Others Building Dep Plan Check: $168.48 $0.00 Building PC Investigation : $0.00 Additional Fee : $0.00 $0.00 Plan check Ext. Fee : $0.00 WQ Compliance Insp Fee: $36.00 TOTAL FEE : , $507.4$ Plan Check Fee : $200.48 Fire Due at Pirmit Issuance : $307.00 PROCESSED BY: ZONING APPRO\, PLAN CHECKED BY:: APPROVAL TO ISSUE PERMIT EXPIRES 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION )WNER-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 to 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). 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, 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). 3 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). 1 am exempt from Iicensure 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 C4hT RACTOR'S DECLARATION hereby affirm ur.da, penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes ins Code, and my license is in full force rd Ef e-,t. t s icense Class License No Da Contractor Signat VGRKERS' COTAPENSATION DECLARATION DARNING: FAILURE -C rE-URE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAR 100,000), IN ADDITION TO THE CST OJ COMPENSATION. LAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hercty affirm under penalty of perjury one of the following declarations: J I na,.'e and w'I! m3intain 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 the @,foul lance of the work for which this permit is issued. Policy No. �a JIB avc and will main(ain 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' compensatior nce carrier and prlicy number are: Carrier Policy Number Expiration Date Name of Agent Phone # I certify that, in the performan e f 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 bec Me s t e workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / c7 Signature of Applic DaL — C DECLARATION REDING CONSTRUCTION LENDING ASY I hereby affirm under penalty of perjury that there is a constru io,A lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). 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 hav;ord-Irianc Orad is correct. I agree to comply with all applicable city and county sand state laws relating to building construction.I authorize representatives of this city or count to ea ove-identified property for inspection purposes. Signature of Property Owner or Authorized Age Print Property Owners or Authorized gent's Nam - Dat ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TIILE40 AND AQMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS N017FICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMITEXTENDE➢ ❑ ASBESTOS NOTIfiCA710NIS NOTAPPLICABLETO PROPOSED DEMOLITION, PERMIT FINAL 1A, L CER77RCA TE OF SIGNATURE: OCCUPANCYISSUED