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HomeMy WebLinkAboutH2019-0211 - Permits0City of Newport Beach - Building Division H2O19-0211 '� 100 Civic Center Drive, Newport Beach, CA 92660 H °� Permit Counter Phone (949)644-3288 °'+a MECHANICAL Permit: H2O19-0211 Project No Id pection Requests Phone (949)644-3255 Job Address: 1240 BALBOA BLVD W Bldg:1 Floor: Suite: Description of Work: MECH/ MINI -SPLIT SYSTEM (2) 7','J�_ InspectorArea:1 Code Edit: 206 Legal Description: N TR 234 BLIt112 LOT 11'i Owner: GRIEBE Contractor: POLAR BEAR HTG & AIR Worker's Comp Insurance - Address: ` 1036 BAddress: 23422 PERALTA DR#G Carrier: MID-CENTURY INS NE POR661 LAGUNA HILLS CA 92653 Policy No: A09468247 JBEAC, Phone: 7 -478-1Phone: 949-388-9484 Expire:11/3012019 Con State Lic: 968411Issued Date: 4/12/201Lic Expire: 12/31/2019 Bus Lic: BT30060265 ;,tJ 3JFCfTO FIFL)Fwl"SPFOT�Qgl rt Processed By: Lic Exp Dater 04/30/2020 r,,EVIEW A1'4 NPexeVXL HVAC Items FEES ®� ° FurnacesBoilers & Com essors Ventilation m a n ooe°° Other Up to 1o0K BTU/hr: 0 $0.00 Up to 3HP: 2 $38.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 - $0.00 $0.00m<o 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.©0 ° 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 Record Mgt Fee: $0.00 c Up to 100K BTU/hr. 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee: $0.00 Investigafiior:C� $0.00 ° Over 500K BTU/hr. 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $33.06 Up to 1M BTU/hr.. 0 $0.00 up to 1 O CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: 3MXS24NMVJU118U Issuance: $35.00 Up to 1.75M BTU/hr: 0 $0..00 Over 1 O CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: MAKIN Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $40.00 2- /Vt xs t9NNI U? TOTAL: $146.06 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $146.06 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. )WNER-BUILDER DECLARATION 1 hereby affirm under penalty of perjurythat 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 is 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 (_) 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 nf�roved for the purpose of sale). J 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). 7 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 legalil 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.htmi. signature of Property Owner or Authorized Agent Date .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se tion 7000) of Division 3 of the Business and Professions Code, and my license is in full force nd effect. y'� icense Class ° • • • License No Date ay Contractor Signue v VORKERS' CCUPENSATION DECLARATION AAIAG:2:AILURE•ID0*CURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE OST OF COMPENSATIa01,AAMAGES AS PROVIDED FOR IN SECTION 370$ OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: I hove and 1y))I•rpgi(tain 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 eF ce of the work for which this permit is issued. Policy No. IL 41*I: and w4rmalfifAin 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 l carrier AM policy number are: Policy Number Date I teltity that, in the pgrformance 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 agree tr g Fshould becomesubject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. [� .... ! — / 2 - nature of Applican D CLARATION REG DING CONSTRUCTION LENDING AGENCY areby affirm under p rally 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. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this city or county enter the above -identified property for inspection purposes. �-� I / &In C of PrODertv Owner or Authorized GTrfY!•hl��+l �t ��pl'I rr.�.r6* Irr�nly�nx.� � IPERMITEXTENDED I I I OCCOPANCYISSOED ❑ t SUBMITTEDASBESTOS M07IFICAT/ON iOr ❑ EPA ACIMD ❑ ASBES ros momuRONIS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE.