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Home My WebLink AboutH2018-0682 - Permits9,� City of Newport Beach - Building Division II��IIIII�IIIIIIIIIIIIII�IIIIIIIIII MECHANICAL Permit: H2O18-0682 °� 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 8 0 6 8 2 Project No: w� `� Permit Counter Phone (949)644-3288 e. a Inspection Requests Phone (949)644-3255 Job Address: 420 PROSPECT ST BIdg:1 Floor: Suite: Description of Work: MECH/FAU C/O Fy y P a InspectorArea:3 Code Edit: 2016 (ua s Legal Description: TR 772 LOT 13 BILK 20 SLY 20 FT THEREOF AND ALL (EXSLY 16 FT) LOT Owner: FITZSIMONS SCOTT BROOKS Contractor: DEPENDABLE GRAHAM AC Worker's Comp Insurance - Address: 42 OSP T ST Address: 2952 CENTURY PLACE Carrier: FALLS LAKE FIRE AND CASUALTY .. e o WPORT B CH, CA 92663 COSTA MESA CA 92626 Policy No: FLA000131 ¢ ... ..... o m o Phone: Phone: 714-546-1653 Expire :07/0112019 0 o Con State Lie: 472690 ` .m m Issued Da :10/26/2018 Lie Expire: 04/30/2020 Bus Lie: BT01013104 o Processed By: Lie Exp Date: 12/31/2018 °°°° m m m ....o o¢ o m o¢moo m o momoeo ¢ o 0 HVAC Items FEES ° om000 Furnaces Boilers& 0oompressors Ventilation Other °°°o°¢ `m°®° Up to 1 OOK BTU/hr: 1 $19.00 Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 ° ° $0.00 Over 1OOK 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 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 Up to 10OK BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee: $0.00 Investigation: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $0.00 Up to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: Issuance: $35.00 Up to 1.75M BTU/hr: 0 $0.00 Over 1OK CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $0.00 TOTAL: $54.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $54.00 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. DECLARATION I hereby affirm under penalty of perjury that 1 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 applicantfsr 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 L) 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 1t was not built or improved for the purpose of sale). - ❑ 1, 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 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) sell a structure that 1 have built as an owner -builder if it has not been constructed in its entirely 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.htm]. Signature of Propprty Oyvner or Authorized Agent Date LICENSED CONTRRCTOR'S DECLARATION I'jte&Jyhffiml LmVp penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profe�e, my license is in full force and effest. License Class "•' License No Datd, Contractor Signature 't AIORNERS' COMPENSATION DECLARATION NARNING: FAILURSTO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE .OST g eOMPENSAMN, 17AMAGES AS PROVIDED FOR IN SECTION 5706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. •IWZW affirm inVVi-pr nalty of perjury one of the following declarations: •% i 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 thi iiMiaRance of thework for which this permit is issued. Policy No. I ha • and vf4ma4ain 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' compensatior nawrill carrier and policy number are: ne of Agent certify that, in the performai , if I should become subject Of Policy Number Expiration Date Phone # 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 r ers' col nsation ' ovisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisio Date CLARATION REGTDING CONSTRUCTION LENDING AGENCY ?reby affirm under p nalty 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 at laws relating to building construction. I authorize representatives of this city or county to^t bgye-idZhe at propfiftty for inspection purposes. ACTION DATE BY DECLARATION OF O P A T HCODEOF FOROFRCEUSEONtY FEDERAL REGULATIONSPART B? OF 717LE40AND AQMO ROLE 1403. PERMITEXPIRED ❑ ISUSMITTEDASDESTOSNOTIFICATION TO; ❑ EPA ❑ AQMD PERMITCANCEILED PERMIT EXTENDED ❑ ASBESTOS NOTIRCARONIS NOTAPPLICABLE TO PROPOSEDDEMOLITION. PERMITRNAL 6 • CERTIRCATEOF OCCUPANCYISSOED SIGNATURE: Pl S N 'a N W cQpi O cm A .d. o� p�N V � c m¢ ry U v� vU� EN g+ NMr�/1 C LO '14' OO M M r r 7 M M r r U � r LLL + + d U = d L 'a N N � d S @T o W LL N m N C N E� r U C W - lL co U U g M a o. O � Z U C 7I