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H2022-0326 - Permits
City of Newport Beach - Building Division H2O22-0326 100 Civic Center Drive, Newport Beach, CA 92660 's Permit Counter Phone (949)644-3288 MECHANICAL Permit: H2O22-0326 Project No Inspection Requests Phone (949)644-3255 Job Address: 31 ANDIAMO BIdg:1 Floor: Suite: Description of Work: MECH: R/R A/C UNIT @ SIDE YARD & FURNACE. **TAMPER RESISTANT CAPS REQUIRED** Inspector Area:6 Code Edit : 2019 a©a Legal Description: N TR 15337 LOT 56 "'°`• , a Owner: RIPP JAMES A Contractor: DAVID ROBERT ROHLEDER ° Worker's Comp Insurance - o Address: 31ANDIAMO Address: 28562OSOPARKWAY #D338 Carrier: STATE COMPENSATION INS FUND NEWPORT COAST, CA 92657 RANCHO SANTA MARGARITA, CA 92688 Policy No: 9278931 Phone: 949-861-1759 Phone: (949) 751-6240 - Expire :0612712023 vo Con State Lic: 1036499 Issued Date:06/28/2022 Lic Expire: 0813112023 Bus Lic: BT30079117 �...: Processed By: Lic Exp Date: 0613012023 Wo` e 'a a mac• eroro VAL; Items FEES urnacesBoilers & Compressors Ventilation Other p to 100K BTU/hr: 1 $22.00 Up to 3HP: 1 $22.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 ver 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 (all/Floor Heaters: 0 $0.00 >15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: 0 $0.00 eat Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 p to 10OK BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee : $0.00 Investigation: $0.00 ver 500K BTU/hr: 0 $0.00 - Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $38.28 p to 1 M BTU/hr: 0 $0.00 up to 10K CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: AULD60WIA-D Issuance: $38.00 p to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: AC PRO ver 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $52.00 TOTAL: $172.28 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $172.28 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 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 ($500). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law). ...+ I am exempt -from licensure under the Contractors' State License Law for the following reason: DJ' In signature be%w I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improvements covered by this permit, I cannot legal[) Sett a structure tpgt lr ye built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is -available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Ngriature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I.he.ebyaffirm u+ndeip(fnalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Profes r ns ode, a my li ens in full force Ind e5$ct. Lndelb lass +�_. License No Date Cl Z Contractor Signature Mr�RKERS' COMPENSATION DECLARATION +yA'A� :FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA DOLLARS I$100,000), IN ADDITION TO THE POST OF COMPENsATIV, 42TAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I.heaetay affirm ur%r p€'nalty of perjury one of the following declarations: L1 I'r12ve and will ma stain 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 performance of the work forwhich this permit is issued. Policy No. 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' carrier and policy number are: Policy Number ie of Agent Date certify that, in the perfore of the or or which ' 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 if I should become subj to the k s' p tion provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. / nature of Applicant Date x' —CA Y / CLARATION REGAR NGCibNSTRYICTION LENDING AGENCY ' . :reby affirm under perfalty 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 prov Is correct. I agree to comply with all applicable city and county o ante I authorize representatives of this city or count �t er the o A le is relating to building construction. property for inspection purposes. Print Property Owner's or Authorized Agent's Name AC77ON DATE by DECLARATION OF COMPLIANCE VVITH CODE OF _ FOR OFFICEUSE ONLY FEDERAL REGULATIONSPART61 OF T17L.€40AND AOMD RULE 1403. PERMITEXPIRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMIT CANCELLED PERMIT EXTENDED El ASBESTOS NOTIRCA770NIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERm+TFLNAL _� 2 _ 22 Dj`--]`.. CE.R77FICATEOF SIGNATURE:: OCCUPANCYISSUED