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Home My WebLink AboutH2018-0696 - PermitsyYa,�Y1'4' City of Newport Beach - Building Division IIII�IIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIII x4 100 Civic Oenter Drive, Newport Beach, CA 92660 H 2 0 1 8 0 6 9 6 Permit Counter Phone (949)644-3288 Job Address: 113 VIA QUITO BIdg:1 Floor: Suite: Description of Work: MECH/ NEW A/C & FAU C/O "TAMPER RESISTANT CAP REQ" Inspector Area:1 Code Edit: 2016 Legal Description: TR 907 LOT 133(AND SWLY 17 FT LOT 132 Owner: JOHNS" -RAN E Contractor: SHALOM HEATING & AIR Address: 113 1A QUITO Address: 9191 VIA BALBOA CIR PORT BEACH A 92663 Carrier : NORGUARD BUENA PARK, CA 90620 Phone: Phone: 714-886-2021 Up to 3HP: Con State Lic: 967182 Issued D a 111021201 11021201 8 Lic Expire: 10/31/2019 ®••°^, Bus Lic. BT30065018 Processed'.By: Lic Exp Date: 11/30/2019 MECHANICAL Permit: H2O18-0696 Project No: Inspection Requests Phone (949)644-3255 AC Items FEES 11 dh4'Oi L{ •nacesBoilers & IW ' Worker's Comp Insurance - _V entilation Carrier : NORGUARD o. ° ° % Policy No: JOWC945078 Up to 3HP: 1 $19.00 ° Expire :04/1112019 Fire Dampers: o®.°m° ®••°^, AC Items FEES •nacesBoilers & Com essors _V entilation to 100K BTU/hr: 1 $19.00 Up to 3HP: 1 $19.00 Bathroom Fan: 0 $0.00 Fire Dampers: :r 100K BTU)hr: $0.00 > 3 HP to 15 HP: 0 $0.00 Exhaust Fan: 0 $0.00 Gas Line: II/Floor Heaters: 0 $0.00 >15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: it Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 Record Mgt Fee: to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee ;r 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 to 1M BTU/hr: 0 $0.00 up to 10K CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: .r 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 e � mmmee o 8UBJECTTOroT4:D INSPFC'ToRo REVIEW.AND°APPR6.N;A_ o 0 0 oe.°o Other 0 $0.00 0 $0.00 0 $0.00 $0.00 °°cmm mm 0 0°0 mm a $16.53 Investigation: Plan Check: 4A7L6036AIssuance: AMERICAN STND Zoning PC: TOTAL: $129.53 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $129.53 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. ommmo $O.ob ... $0.00 $0.00 $0.00 $35.00 $40.00 JVVINCR-OVILUCR umML nMI IVIY J+. 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 )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 lot more than five hundred dollars ($500). 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, 3usiness 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 mprovemenls 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 m roved 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 Ipply 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: 3y 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 legall) ;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://ww .leginfo.ca.gov/calaw.html. signature of P14Rgr vMDwner or Authorized Agent Date _ICENSED CONTRACTOR'S DECLARATION ,hereby affirm order eenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700 of Division 3 of the Business and Professions Code, and my license is in full force and effect. ricerl9g Class _ License No Date �% Contractor Signature NORKERS' COMPENSATION DECLARATION !NINQ: FAILU4E6T0,SeCURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMP OYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,OOD(, IN ADDITION TO THE :013 OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. bowby affirmunder penalty of perjury one of the following declarations: .. . �•1•Rave 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 0111fam,02ace of tre wolk for which this permit is issued. Policy No. 37"hal A wI I malRtain 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 ism-alite terrier-arW.Dolicv number are: .0..0 Policy Number Expiration Date Agent ce 'fy that, in the performance 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 agre M uld become subjectto a workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions,% .� / fApp1REGt RDING C ST 6TI® ENDING AGENCY DaI /DJI P� I hereby affirm underenalty 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). 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 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 countKt r the above -identified roperty for inspection purposes. Signature of Property Owner or Authorized AgentPrint Property Owner's or Authorized Agent's Name l� Da ACTION DATE BY DECLARATIO.OFCOMPLIANCEtMTHCODEOF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TIILE40AND AOMDRULE 1403. PERMIT EXPIR€D ❑ i SUBMFTTEDASSESTOS NOIIFICATtON TO. ❑ EPA ❑ AQMD P€RMJTTCANCELL€D P€RMFT€XTENDED ❑ ASBESTOS NOTIFICAHOMIS NOT APPLICA13LE TO PROPOSEDDEMOLLTION. PERMITRNAL C€RTWICATEOF SIGNATURE: OCCUPANCYISSUED