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HomeMy WebLinkAboutH2021-0708 - Permitswa:r3. City of Newport Beach - Building Division H2O21-0708 MECHANICAL Permit: H2O21-0708 o 8Tr 100 Civic Center Drive, Newport Beach, CA 92660 Project No +( ;, fl Permit Counter Phone (949)644-3288 v fi Inspection Requests Phone (949)644-3255 ��tIY9iY�1Y Job Address: 3 MADISON BIdg:1 Floor: Suite: Description of Work: MECH CHANGE OUT A/C UNIT, FURNACE & DUCT WORK *TAMPER PROOF CAP REQ- Inspector Area:4 Code Edit : 2019 Legal Description: N TR 15409 LOT 111 Owner: ROBBINS JOSHUA Contractor: ALPS A/C & HEATING INC Worker's Comp Insurance - Address: 3 MADISON Address: 1895 S SANTA CRUZ ST Carrier: AMERICN ZURICH INS NEWPORT BEACH, CA 92660 ANAHEIM, CA 92805 Policy No: WC110287600 , Phone: Phone: 714-633-8892 Expire :04/0112022 Con State Lic: 667953 Issued Date:1211412021 Lic Expire: 12023 <\\ Bus Lic: BT30 BT300475047511 Processed By: r(/ v Lic Exp Date: 07/30/2022 HVAC Items FEES Other , FurnacesBoilers & Compressors 1 $22.00 Ventilation Up to 3HP: 1 $22.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Up to 100K BTU/hr: Over 100K BTU/hr: 0 $0.00 > 3 HP to 15 HP: 0 $0.00 Exhaust Fan: 0 $0.00 Gas Line: 0 $0.00 $0.00 $0.00 Wall/Floor Heaters: 0 $0.00 >15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: 0 $0.00 Heat Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 0 $0.00 Record Mgt Fee: Additional Fee : $0.00 Investigation: $0.00 Up to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: Hood: 0 $0.00 Plan Check: $57.42 Over 500K BTU/hr: 0 0 $0.00 $0.00 Air Handling Units up to 1OK CFM: 0 $0.00 Comm. Repair/Alter/Add: 1 $22.00 Model: EL16XC1-048lssuance: $38.00 Up to 1 M BTU/hr: Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: LENNOX Zoning PC: $52.00 Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 TOTAL: $213.42 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $213.42 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:00 a.m.to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m. UVVINCK-0UILUCK UCL:LAKAI IUN 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(s) (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 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). 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). 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 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). I am exempt from licensure 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 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 Cods, Is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw,htmi. Signature of Property c Iwner or Authorized Agent Date LICF143ED CONTRACTOR'S DECLARATION hereby affirmvnder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with action 70 ) of i Ision 3 of the Business and ession e, and m li avid effect. "�s-iR-WIHefee /r�L �_icenre Class License No Date Z C v Contractor Sig natur J''ORKERS' COMPENSATION DECLARATION VARr'It'G: 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 1$100,000), IN ADDITION TO THE -OST OF COMPEASa', I V N, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm un�er penalty of perjury one of the following declarations: 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 >e or nce of, the walk for which this permit is issued. Policy No. ::iLva 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' compensatio rsvr39ce carrier err policy number are: Policy Number of Agent Date certify that, in the performance of th ork for which this sued, I shall not employ any person in any manner so as to become subject to the worker 'com ensation laws of California, and ogre It, if I should become s bject to the work 'com on provisions of Section 3700 of the Labor Code, I shall forthwith comply with those proT - I of Applicant Date !CLARATION REGARD ION LENDING AGENCY sreby affirm under pens 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). ider's Name Lender's Address 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.'),Jr('r,�/ I agree to comply with all applicable city and county ordinances and state Ia tIng Ingyf to building Construction. I w—` � �Ci.-` - �' ' Z I authorize representatives of this city or co nt to enter t ve--' led property for inspection purposes. /�' (nature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Name/ x Date 3 ACTION DATE BY DECLARATION OF COMPi.tANCEWITHCODE OF FEDERAL REGULATIONS PART 61 OF TITL.E4© AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO:. ❑ EPA ❑ AQMO ElASBESTOS NOTIFICATION IS NOTAPPLICABLE TO PROPOSED DEMOLITION, SIGNATURE: FOR OFFICE USEONLY PERMIT EXPI RED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL (Cj Zrs ! CERTIFICATE OF OCCUPANCYISSUED