HomeMy WebLinkAboutP2021-0510 - PermitsCity of Newport Beach - Building Division
'.� 100 Civic Center Drive, Newport Beach, CA 92660
. Permit Counter Phone (949)644-3288
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Job Address: 1100 AVOCADO AVE Bldg: 1 Floor: Suite:
Description of Work: COMM PLUM BOILERR REPLACEMENT "NEWPORT BEACH LIBRARY"
Inspector Area: 7 Code Edit 2019
Legal Description:
Owner: CITY OF NEWPORT BEACH
Address: 100 CIVIC CENTER
NEWPORT BEACH CA 92660
Phone: 949/644-3311
Contractor: THOMAS F M AIR CONDITIONING INC
Address: 231 GEMINI AVE
BREA CA
Phone:
Con State Lic:313574
Issued Date:05/09/2022 Lic Expire: 02/2812023
Bus Lic: BT30078664
Processed By: W Lic Exp Date: 05/31/2023
PLUMBING Permit: P2021-0510
Project No : 2515-2021
Inspection Requests Phone (949)644-3255
Worker's Compensation Insurance -
Carrier : INS CO OF WEST
Policy NowSD505268302
Expire : 01101 /2023
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FEES
Bathroom Fixtures
Kitchen Fixtures
Misc.
Misc.
Other
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Toilet:
0
$0.00
Kitchen Sink:
0
$0.00
Water Piping:
10
$80.00
Roof Drain: 0
$0.00
$0.00
Bidet
0
$0.00
Garbage Disp:
0
$0.00
Water Softener:
0
$0.00
Grease Trap: 0
$0.00
$0.00
Urinal
0
$0.00
Bar Sink:
0
$0.00
Water Heater:
0
$0.00
Grease Interceptor:0
$0.00
Bath Tub:
0
$0.00
Vegetable Sink:
0
$0.00
Gas up to 4 outlets:
0
$0.00
P-Trap: 0
$0.00
Record Mgmt Fee:
$0.00
Shower Stall:
0
$0.00
Ice Maker:
0
$0.00
Gas over outlets:
0
$0.00
Sewer
Investigation:
$0.00
Wash Basin:
0
$0.00
Dishwasher:
0
$0.00
Backflow up to 2":
0
$0.00
Sewer: 0
$0.00
Plan Check:
$69.60
Hydro -Mass Tub:0
$0.00
Lndry[Trap:
0
$0.00
Backflow over 2":
0
$0.00
Sewer Alter/Repair:0
$0.00
Issuance:
$38.00
Floor Sink:
0
$0.00
Regulator:
0
$0.00
Hose Bibb:
0
$0.00
Sewer Abandon: 0
$0.00
Supplemental Fee:
$0.00
Floor Drain:
0
$0.00
Lawn Sprinkler:
0
$0.00
Drinking Fountain:
0
$0.00
Additional Fee :
($187.60)
TOTAL:
$0.00
Plan Check Fee:
$0.00
Fee Due at Permit Issuance: $0.00
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
iot 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 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:
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 lega1l.
sell a structylTu#fh%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
Professions EOaB, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
,5 gWa!Lre of Rroperty Owner or Authorized Agent Date
.• LICENSED CONTRACTOR'S DECLARATION
t Pettily affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing )h Section 7000) of Division 3 of the Business an -Profe n21 s Co e, and my license is in full force
and effect.
LlcenceClass.••••• License No Dat S��_Z'2' ContractorSignatum
WRARS' COFFkINSATION DECLARATION i
YARNWIR: FAILURE TO 8%CtIRE 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
_OST-OFCOMPENSA%TN, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
."byaffirm under penalty of perjury one of the following declarations:
T have and 411 maintain a certificate of consent to self -insure for workers'
fprrp3nce of the worK for which this permit is issued. Policy No.
4mve and v l•gl9injhin 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'
trance carrier and policy number are:
Policy Number
compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for
me of Agent Phone
I 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 sL
IL if I should becomesub(ect to the worlea' compAnsationprovisions of Section 3700 of the Labor Code, I shall forthwith comply with those
Date
to the workers' compensation laws of California, and
Signature of Applicant' /I D � 0%-Z2
DECLARATION REG - DING STRU 10 L DING AGENCY
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:
1 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.
I agree to comply with all applicable city and county ordi nces an state laws relating to building construction.
n r I authorize representatives of this city or y to et e abov operty for inspection purposes. r. 1
Signature of Property Owner or Authorized Age u tPrint Property Owners or Authorized Agent's Na C _rvyt TVOewe D t ✓ �{{
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ACTION
HATE V
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART fit OF TITLE40 AND
AQMD RULE 1401
PERMfT:EXPtRED
❑ I SUBMITTEDASBESTOS NOTIFICATION TO:.
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMITCANCELLED
PERM7TEXTENDED
PERMfTFIJYAL
b -(
CERTIFICATEOF
SIGNATURE.
OCCUPANCYISSUED