HomeMy WebLinkAboutH2020-0374 - Permits4 m City Newport Beach - Building Division IIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII MECHANICAL Permit: H2O20-0374
100 Civicis Center Drive, Newport Beach, CA 92660 u
E+ 'q Permit Counter Phone (949)644-3288 H 2 0 2 0 0 3 7 4
� Project No: 1152-2016
�'d4isvetF��':
Inspection Requests Phone (949)644-3255
Job Address: 15 ROCKY POINT RD BldgA Floor: Suite:
Description of Work: MECH/ A/C "TAMPER RESISTANT CAP REQ" c®
Inspector Area:4 Edit: 2016 I N V 1 ECT® R
Legal Description: N TR 7386 LOT 86
Owner: LOHIY UNITA Contractor: GOLDBAUM'S AIR/HEATING
Address: 1 ONA INT RD Address: 1072 B WEST 9TH ST Worker's Comp Insurance -
CORONA DEL AR, CA 92625 Carrier: FALLS LAKE FIRE
Phone: Phone: UPLAND, CA 91786 Policy No: FLA006238
932367 -2406 Expire :06/30/2021
Issued ate:06/30/2020 Con State Lic: 832367
Lic Expire: 02/28/2022
Processed By: Bus Lic: BT30053286
Lic Exp Date: 11/30/2020 ....
SIMJFCT TO FIELD INSPP,rZ �K'6
HVAC Items MVIL-.W AND APP$OYB.1-
o
FurnacesBoilers & Co FEES °
pressors Ventilation
Up to 100K BTU/hr: 0
$0.00 Up to 3HP: 1 $20.00 Bathroom Fan: 0 p Other
Over 1oor BTU/hr: 0 $0.00 > 3 HP to 15 HP: 0 $0.00 Exhaust Fan: 0 $0.00 Fire Dampers: p
Wall/Floor Heaters: 0Line: $0.00 $0.00 "
Heat Pumps & Package Units 00 15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: 00 $0.00 $0 0�
9 30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 p $0.00 c
Up to I OOK BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Record Mgt Fee: $0.00
Dver 500K BTU/hr: 0 °
$0.00 Air Handling Units $0.00 Additional Fee: °
JP to 1M BTU/hr: 0 g Comm. Hood: 0 $0.00 $0.00 Investigation:` $0A0 °
$0.00 up to 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: Plan Check®°° $17ab°°°
JP to 1.75M BTU/hr: 0 $0.00 Over 1 OK CFM: 0 $0.00 Supplemental Fee: NH4A460AKAIssuance: ° ° ° °$35,000-0
)ver 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Manufacturer: TEMPSTAR
$0.00
Zoning PC: $83.00
TOTAL: $155.40 Plan Check Fee: $0.00
Fee Due at Permit Issuance: $155.40
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.
f g
VNER-BUILDER DECLARATION
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
usiness 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
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)
;coon 7031.5, B th
applicant to a civil penalty of
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State
)fessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of
ns oftion the 7031 and the structure isnotmended or offered for sale (Section 7044,
I more than five hundred dollars ($500). will do all of or (_) p
I, as owner of the property, or my employees with wages ns their sole compensation, r o who, through employees' or personal effort, builds or improves the property, provided that the
Isiness and Professions Code: The Contractors' State License Law does not apply to an owner of property
�provements 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 to proving that n was not built or
iproved 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 no
I I, to an owner of property who builds iv improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
I am exempt from licensure under the Contractors' State License I Il
Law for the following reason: p Section 7044 of the Business and
V 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 lega
:II 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 thea applicable law, Date
rotes structure
ions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
ignature of Property Owner or Authorized Agent
ss and .ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of .Chapter 9 (commencing with sine
ect�n 7000) of
Sn 3 of the ignalure\�ofessions Code, and my license is in fu force
Ind effect. �\gyp Date
.!cerise Class
License No THE
VORKERS' COMPENSATION DECLARATION
YARNING: FAILURE 48 Sre-UR WORKERS'
S' COMPENSATION
IDED FOR IN SECTION AGE is THE `LA60R CODE, FUL, AND INTERESTEAND ATTORNEY'S FEESRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (510a,00aj, IN ADDITION TO
:OST OF affirm tMR1N,
jeji3r affirm urrder•penalty of perjury one of the following declarations:
I have and'will'maintain acertificate 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 t
nce of th0 work for which this permit is issued. Policy No. for the erformance of the work for which this permit is is,EgpolqTiasued. My workers' compensation
and willfn �il+tain workers' compensation insurance, as required by Section 3700 of the Labor Code, p Expiration Date
Ls"r
aa a carri6r`anil policy number are: policy Number phone #
Ne :g pfAgent ����
c®dify that, inthe Derformance 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 Californsa, an ag :
tf]at'if I .$hould f�� �me�ub]ecyto the workers' compensation provisions of Section 3700 of the Labor Code, i shall forthwith comply with thos Datev son ���\� A�
�m&IV4 of Applisant he
iD,LARATION DING CONSTRUCTION LENDING AGENCY
:reby affirm under p ally of perjury that there is a construction lending agency fo rt
Lenders Address of the work for which this permit is issued (Section 3097, Civil Code).
Ider's Name
my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have provided is correct.
building construction.
I agree to comply with all applicable city and county ordinances and state laws relating to
1 authorize representatives of this city or county to r the above -identified property for inspection Property Owner's or Authorized Agent's Name
_....,..,r v.,..rty Owner or Authorized Agent _ , .,,,r„ rnr>F nF fOR O
ACTION IDATE I � RY
61
❑ I SUSMITTEOASBESTOS N071FICATION .
❑ EPA
❑ AQMO
[3OP��OSED S�N0 7C AON/S NOT APPLICABLE TO
CERTIFICATE OF I SIGNATURE:
OCCUPANCYfSSUED