HomeMy WebLinkAboutH2021-0516 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 1000 BALBOA BLVD E BIdg:1 Floor: Suite:
Description of Work: MECH FURNACE C/O
InspectorArea:1 Code Edit: 2019
Legal Description: BALBOA TR EAST SIDE ADD ELK 15 LOT 1
Owner: SENOUR BOB
Contractor:
Address: 1000 BALBOA BLVD E
Address:
NEWPORT BEACH, CA 92661
Phone: 949-673-2447
Phone:
Con State Lie:
Issued Date:09/02/2021
Lie Expire:
Bus Lie:
Processed By:
Lie Exp Date:
H2O21-0516
BASIC AIR INC
1157 SALINAS AVENUE
COSTA MESA CA92626
714-469.4542
909834
01131/2022
BT30045172
10/31/2021
MECHANICAL Permit: H2O21-0516
Project No : 2258-2020
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : OAK RIVER
Policy No: BAWC125355
Expire:10122/2021
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HVAC Items
FEES
FurnacesBoilers & Compressors
Ventilation
Other
Up to 100K BTU/hr:
1
$22.00
Up to 3HP:
0
$0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0 $0.00
$0.00
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
$0.00
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 100K 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 10K CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$38.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K 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:
$60.00
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$60.00
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.
OWNER -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)
(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
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 U all of or (_) 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 it was not built or
improved 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
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).
••••
I am exernpt pro m 4icensure under the Contractors' State License Law for the following reason:
By my gignature 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
11 e-Jructure tAMt•I hive 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
rofesslons Codes is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
gnat(ye of Property Owner or Authorized Agent Date
ICENSED CQNTRACTOR'S DECLARATION
I A ret % affirm Lp4er,poenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a d Professions Cod nd my license is in full force
end effect. r
1.IG80s- Class • �•• • License No Date % Zj Contractor Signature'7X�
MRKIERS' COMPENSATION DECLARATION
'f148M110. FAILURE TO SECURE 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
COW OFt OMPENJATIV, 4AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereb
••y affirm urf%r penalty of perjury one of the following declarations:
••
• 1 iwve and nill nwmintain 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 IN
performance of the work for which this permit is issued. Policy No.
I have and will maintain 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' compensatio
ns ance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
I certify that, in the performance of the wor o 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
that, if I should becom s ject tot wor pens"ti o ection 3700 of the Labor Code, I shall forthwith comply with those pro .(�
Signature of Applicant DateisiDsl (?��_
DECLARATION REGARDift MNSTRUCTION LENDINC,015ENCY
I hereby affirm under penalty 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:
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 count ordinances and state laws relating to building construction.
I authorize representatives of this city or count t enteLlbe,ab e-identif e y for inspection purposes. \ '1. _ a ry
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name V iK.�'''1 6 G Dat f
ACTION DATE BY DECLARATION OF COMPLIANCE
IMTN CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 67 OF T1RE40AND
AOMD RULE 7403.
PERMt7 EXPIRED
❑ I SUBMITTEDASBESTOS NOTtF1CATI0N TO:
❑ EPA
❑ AQMfi
❑ ASBESTOS NOTIRCARONfS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMITCANCELLED
PERMIT EXTENDED
PERMIT FINAL
0
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SIGNATURE:.
OCCUPANCYf55UED
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