HomeMy WebLinkAboutH2021-0423 - Permitsr.,,�r City of Newport Beach - Building Division III III IIIIIpIII IIpI1111111111p1111111111p1111 MECHANICAL Permit: H2O21-04:
�'t E '�� 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 4 2 3 Project No : 1492-2018
�,'" �..`1 �: Permit Counter Phone (949)644-3288
u �., S
�yi. y µ�,ia Inspection Requests Phone (949)644-3255
Job Address: 1816 NEWPORT HILLS DR E BIdg:1 Floor: Suite:
Description of Work: MECH -NEW MINI -SPLIT *TAMPER -RESISTANT CAP REQUIRED*
InspectorArea:4 Code Edit:
2019
Legal Description: N TR 7031 LOT 71
Owner: CHU CLEMENT Y
Contractor:
ALPS A/C & HEATING INC
Worker's Comp Insurance -
Address: 1816 NEWPORT HILLS DR E
Address:
1895 S SANTA CRUZ ST
Carrier: PREFERRED PROFESSIONAL
NEWPORT BEACH, CA 92660
ANAHEIM, CA 92805
Policy No: ON0915602
Phone: 949-720-0918
Phone:
714-633-8892
Expire :10/1912021
Con State Lie:
667953
Issued Date:07/15/2021�
Lie Expire:
04/3012023
Bus Lie:
BT30047511
Processed By:
Lie Exp Date:
07130/2022
4C Items
FEES
g/qw
QtI1e
nacesBoilers & Compressors
Ventilation
4/
�yyJ
to 100K BTU/hr:
;r 100K BTU/hr:
0
0
$0.00
$0.00
Up to 3HP:
> 3 HP to 15 HP:
0 $0.00
0 $0.00
Bathroom Fan:
Exhaust Fan:
0 $0.00
0 $0.00
Fire Dampers:
Gas Line:
0
0 V..;� q0
�00
$0.00
$0,00
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0 ��
It Pumps & Package
Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
to 100K BTU/hr:
1
$22.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigation:
$0.00
:r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$32.19
to I BTU/hr:
0
$0.00
up to 1OK CFM:
1 $15.00
Repair/Alter/Add:
0 $0.00
Model:
NAXSMT24AI12
Issuance:
$38.00
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
MITSUBISHI
;r 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$52.0(
TOTAL: $159.19 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $159.19
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Constructor, It,)urs: Monday- Friday 7:00 a.m.to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m.
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(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
:he 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
lot 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).
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature below 1 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.htm1.
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 wl h Secion 700 of Division 3 of the Business and Professions d-azy-ViesRse,-is in full force
and effect. y
License Class License No Dat 6 G Contractor Signature
NORKERS' 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 THOUSAND DOLLARS (6100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
hereby affirm under penalty of perjury one of the following declarations:
RI 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 the
e onngnce 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
of Agent
Date
certify that, in the performance o the wW4rfor which this permit is issued t employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
I, if I should become sub j ct a ers' came slons of Section 3700 of the Labor Code, I shall forthwith comply with those prove ns.
nature of Applicant Dates/
CLARATION REGAW1N@-1C-0-BaT4edCTION LENDING AGENCY
:reby affirm under penalty o 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.
I agree to comply with all applicable city and county ordinanc a e laws relatin c eon. --
I authorize representatives of this city or cou t enter above -id roperty for inspection purposes. 7
nature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Nam ✓1 Date C
ACTION
DATE
BY
DECLARATION OFCOMPLIANCE WITH CODEOF
FOR OFFICEUSEONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS N077FICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERM➢T CANCELLED
PERMfTEXTENDED
PERMIT FINAL
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUED