HomeMy WebLinkAboutH2017-0631 - Permits1�a City of Newport Beach - Building Division III III IIIIIpIII111111p111111111111111p11111111
n 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 7 0 6 3 1
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Permit Counter Phone (949)644-3288
Job Address: 216 AGATE AVE BIdg:1 Floor: Suite:
Description of Work: MECH NEW A/C UNIT *TAMPER PROOF CAP REQ*
InspectorArea:2 If, Co dit: 2016
Legal Description: BALBOA I$LAN RE 10 LOT 33
Owner: HILLMAN KAREN 6 a.wt•ie• Contractor: 139N4 LOg�ERS V
Address: 20 BRENA -Aid4m 9W2E WAY
IRVINE CA 92620 GROVE CA 92644
Phone: M Phone:e 714-271-45
Con S(atd 6ic r 100 7
Issued Date: 11/06/2017A Bu
Licxpire3/3 1
Processed By: Lic Exp Da 12
r
nacesBoilers & Compressors
to 100K BTU/hr:
0
$0.00
ar 100K BTU/hr:
0
$0.00
II/Floor Heaters:
0
$0.00
at Pumps & Package Units
to 100K BTU/hr:
0
$0.00
ar 500K BTU/hr:
0
$0.00
to 1 M BTU/hr:
0
$0.00
to 1.75M BTU/hr:
0
$0.00
ar 1.75M BTU/hr:
0
$0.00
Ventilation
0
�A rJ
Up to 3HP:
1
$18.00
> 3 HP to,15 HP:
0
$0.00
>15 HP to 30 HPC
q
$0.90
>30 HP to 5o HP
e$O IJa•a
>50 HP:
0.10 Additional Fee :
omoo
Air Handlrrlg Wn1di,r
a ,1
up to 1 O CFM.
0
`$0.00
Over 10K CFM:
0
$0.00
VAV Box: ,Q $0.00
MECHANICAL Permit: H2O17-0631
Project No : 1686-2016
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance
Carrier: EVEREST
Expire :02103121
1f aF'P'jCable:
Q 80%
'O
�
'orL-] �Gr�of '•��,;rd
to !h'i�0�:
Ba31rgm Ill$ 0 Fire Dampers:
0
$0.00
Exhaust Fan:
3
mmeeoe
$0.00
0
j
o m
$0.00
comeos
0 $0.00 Record Mgt Fee:$0.0
e
0.10 Additional Fee :
omoo
$0.0
o u
emoe
�
nova
0 '- gam;+ PSA4BG024K
50 l AIC r..,I fjllY,7'QG
O 00 ®� 1 �
Ork Started)
0 o e
-r
no c
Q 80%
'O
�
'orL-] �Gr�of '•��,;rd
to !h'i�0�:
Ba31rgm Ill$ 0 Fire Dampers:
0
$0.00
Exhaust Fan:
00 Gas Line:
0
$0.00
Attic Fan:
0 0.00 Metal Fireplace:
0
$0.00
wn Draft Fan:
0 $0.00 Record Mgt Fee:$0.0
sidential H o
0.10 Additional Fee :
$0.0
Comm. Hood
Repel r/AIII ter/A
Supplemental F e:
0 '- gam;+ PSA4BG024K
50 l AIC r..,I fjllY,7'QG
O 00 ®� 1 �
Ork Started)
TOTAL: $104.16 " Plan Check Fee: $B9 Fee Due at Permit
873P. tntttais:
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR L N IN��=--
Construction Hours: Monday - Friday 7:00 a.m.to 6:30 p.m.and Saturday from 8:0`0'a.r. tgoi 8J
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ec
Other
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0 0
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$0.00
$0.00
Investigation: $0.00
Plan Check: $15.66
Issuance: $33.00
Zoning PC: $37.50
: $104.16
INER-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)
ction 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 .
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
fessions 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
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,
,iness 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
rovements 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
roved for the purpose of sale).
I, as ownerr,1IJ4eg Croperty, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
ly to an owner of pFoperty who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
I
kam exemgt f&q;q tcensure under the Contractors' State License Law for the following reason:
ny signature below-] 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 legal
a Stjucture that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 1 understand that a copy of the applicable law, Section 7044 of the Business and
Ieesions Codg•ig available uponl6gyest,an tthhis application is submitted or at the following Web site:http //www.leginfo ca gov/calaw.html.
iafure of Property Owner or Adkhorized Agent _ ,.� Date
EMBED CONTRACTOR'Si. ECLARATION
L4W14y affirm oriddrpenalty of pe jur
Cicde`n ee Class
WORKrRS' C0VJ344SAT10DI
WARNING- FAILURE TO SECIIRE WORKS' C
@
` 1 bP yOMPENSATIO&J1DAMAGESAir RO
I h9fdbq affirm kder penalty of pjun
131 have and will maintain a cific
Derformance of the work for whithis
Y31-aave and will maintain wor
insurance carrier and policy nun
is of Agent _
certify that, in the
if I should beton
lature of Applicar/
7000) of Division 3 of the
License No
Is UNL
✓EGE A '� I ND. L A OIMINAL PENaLt�lEa'/tj�ll] CJV�I:'F�IN�S ye`Se''lyJtE HUtlpfjEp THQ
10 y08O�MF�CO �', NOATTO Er 7rO tcsli.IClL
wn
to self -insure for workers' compensation, issue ct6f�olttdli>iT:Relations as provided for by
,to.,
,RolicuNo._
license is in full force
IN ADDITION TO THE
..'3700 of the Labor Code, for
the performance of the work for which this per It is i§sued. My workers'
g
Expiration Date
this per tis' d, I shall not employ any person in any manner so as to become subject to
a son Section 3700 of the LaborACo51e, I shall forthwith comply with those provisy
laws of California, and
I hereby affirm under p ally of'perjury that there' cr irugtipq lendiffpg agency for the perforrpaf 71`1he Wdfk f8r`taflidWtt9s j5e7m9T„f91 iss[feri'(;¢ � 3197, Civil ode,,
Lender's Name I �'" ..ynIl UYLender's ABddress 99�-
s H
By my signature below, I certiTy!4o each of the following: Started)
I am the property owner or'suthoriz�,: fo act on the property owner's behalf. ;
I have read this application: and the informationTFi
I agree to comply with all applicable city and cot y ordl s d st f rel3' o building cons ru
I authorize representatives of this'clfy or r- - - roe or' tion-purpe s.
Signature of Property Owner or Authorized'Adentr Pnn ro c -A ST�dbf�l61'��ffi it F to /1-/Z 7
ACTION
DATE BY "
DECLARATION OF COMPLIANC
FogiFFICEUSEMLY
FEDERAL REGULATIONS PART 61OFTIILE40AND
AQMD RULE 9403.
PERMITEXPIRED
❑ I SUBMITTEDASBESTOS M071FICATtON TO:
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❑ AQMD
PERMITCANCELLED
Za
PERMfTEXTENDED
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❑ ASBESTOS U07IRCA710NIS NOT APPLICABLE TO
PROPOSEDDEMOLITION.
PERMtTFINAL
CERTIFICATE OF
OCCUPANCYISSUED
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