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H2022-0237 - Permits
City of Newport Beach - Building Division III III Ip111111111111111111111111111111111111111 ,y 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 2 0 2 3 7 v `y Permit Counter Phone (949)644-3288 n . Job Address: 2111 VISTA ENTRADA Bldg:1 Floor: Suite: Description of Work: MECH -A/C CONDENSER. TAMPER -RESISTANT CAP & TIMER REQUIRED Inspector Area:4 Code Edit: 2019 Legal Description: TR 5878 (L.L.84-214031) PAR 18 Owner: MILIK MICHAEL Contractor: Address: 2111 VISTA ENTRADA Address: NEWPORT BEACH, CA 92660 Phone: 310-822-3770 Phone: Con State Lie: Issued Date:05/12/2022 Lie Expire: Bus Lie: Processed By: Lie Exp Date: __�F MECHANICAL Permit: H2O22-0237 Project No : 0991-2022 Inspection Requests Phone (949)644-3255 OWNER/BLDRWorker'sCompInsurance- MILIKMICHAEL Carrier: Policy No: Expire : O/B TIMER REQUIRED ON EQUIPMENT TO SHUT OFF BETWEEN 10 P.M. AND 7 A.M. rA 0 1 HVAC Items FEES - FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 1 $22.00 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: $19.14 Up to 1 M BTU/hr: 0 $0.00 up to 10K CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: 4TTL6042A11ssuance: $38.00 Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: TRANS Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $52.00 TOTAL: $131.14 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $131.14 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday- FridV7:09,a.m.tc A'3@V-m.artt7 Saturday from 8:00 a.m. to 6:00 p.m. G •09 •°i • • •Y° Gli° ©GG )WNER-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 ie 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 'rofessions 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 I, of ore than five hundred dollars ($500). -,. 7 as owner of the property, or my employees with wages as their sole compensation, will do ,) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, slness and Professions Code: The Contractors' State License Law does not apply to an own r o property who, through employees' or personal effort, builds or improves the property, provided that the vements 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 ed for the purpose of sale). s 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 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 Pexempt from licensure under the Contractors' State License Law for the following reason: ly 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) ell 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 the applicable law, Section 7044 of the Business and 'rofessions Code, is available upon request wlee a� ubmitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. {ignature of Property Owner or Authorized Agen � — Datav .ICENSED CONTRACTOR'S DECIARA 0 4 hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force nd effect. icense Class License Na- - - - -= Date Contractor Signatu- VORKERS' COMPENSATION DECLARATION IARNING: FAILURE TO SECURE WORKERS'. COMPENSATION'COVERAGE IS UNLAWFUL, AND SHALL SUBJECT ANEMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty 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 th erformance of the work for which this permit is issued. Policy No. 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' compensatiol ,Trance carrier and policy number are: Tier Policy Number Expiration Date ne of Agent Phone # certify that, in the performance 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 California, and agre t if I should becomes y cctt�to thew rs�compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prvis/iO Ss C nature of Applicagi Da1TiC J — /2 " 1/1;;:, CLARATION REGARIOG CONSTRUCTION LENDING AGENCY �reby 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). 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 rovided is correct. �- )- i✓I A f / [agree to comply with all applicable city and coun ordinances and state laws relating to building construction. 1G I authorize representatives of this city or coun enter ve-identified property for inspection purposes. �� /' nature of Property Owner or Authorized Agen Print Property Owner's or Authorized Agent's Namei�` �� Date �'Z d ACTION DATE BY DECLARATION OF COMPLIANCE MTH CODE OF FOR OFFICE USE ONLY FEQERAL REGULATIONSPART 61 OFTITLE40AND AQL#D R01%Mg! - ., ... • 9 • % SiiBkQITED-ASBES'TtLS KQRFtCATION TO: ...❑ Ei A • . . ❑ AQMD' . - PERMITEMPIRED PERMIT CANCELLED PERMITEXTENDED ❑ ASBESTOS NOIIRCA770H IS NOT APPLICABLE TO DEMOLITION- .c • . •. . • a •'' PERMIT FINAL / /1/L7VO <•,9ROPQSED CERTIFICATEOF OCCUPANCYISSUED St�NAT2;.