HomeMy WebLinkAboutH2022-0333 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
Job Address: 100 VIA FLORENCE BIdg:1 Floor: Suite:
Description of Work: MECH CHANGE OUT (1) A/C UNIT
Inspector Area:2 Code Edit: 2019
Legal Description: N TR 907 LOT 972
Owner: RUSHMORE DAVID C
Contractor:
Address: 100 VIA FLORENCE
Address:
NEWPORT BEACH, CA 92663
Phone:
Phone:
Con State Lic:
Issued Date:06/30/2022
Lic Expire:
s Lic:
Processed By:
Li Exp Date:
ALPS A/C & HEATING INC
1895 S SANTA CRUZ ST
ANAHEIM, CA 92805
714-633-8892
667953
04/30/2023
BT30047511
0713012022
MECHANICAL Permit
Project No :
H2O22-0333
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier: INS OF THE WEST
Policy No: WSD506354500
Expire :12/25/2022
AG Items
FEES
nacesBoilers & Compressors
Ventilation
Other
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
:r 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
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0
$0.00
it Pumps & Package Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
to 100K BTU/hr:
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigation:
$0.00
:r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$19.14
to 1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
MLI4XCI.36issuance:
$38.00
to 1.75M BTU/hr:
0
$0.00
Over 1 OK CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
LENNOX
)r 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- Friday 7:00 a.m. to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m.
,
e. e,
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 Iicensure 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 L) all of or L) 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 exen" kpm Iicensure under the Contractors' State License Law for the following reason:
By my signature belldw 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])
sell astructure 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
Rrofessions Q8(V, isavailable upon request when this application is submitted or at the following Web site:http://vww. leginfo.ca.gov/calaw. htni
Signature of PropORy Owner or Authorized Agent Date
LJCENSED CONTRACTOR'S DECLARATION
I h6ieby affirm underpenalty of perjury that I am licensed under provisions of Chapter 9 (commencing with c 1bn 7 00) of Division 3 of the Business and Prof sons Code, my license is in full force
and elect.
Lica%e Class License No Dat Z Contractor Signatur
WORKERS"C'.OEAAIENSATION DECLARATION
WARMING: 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
0lSJ QJ COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I h9rebt affirmunder penalty of perjury one of the following declarations:
..I.IhaNe and dill rgpintain 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 the
berJQ, Dance of th%No(c 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
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
I certify that, in the performance of the work r whit permit is issued, I shall not employ any person in any manner so as to become subject to the workers' c mpensation laws of California, and agree
that, if should become subject to the work c ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant Date to i
DECLARATION REGA ION LENDING AGENCY
I hereby affirm under penalty of pe ry t there is a construction lending agency for the performance of the work for which this permit is issued (Se tion 3097, Civil Code).
Lender's Name Lender's Address
By 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.
have read this application and the information have Is orrect. &AlOel
�//f!�/agree to Comply with all applicable city and tyl ordinances d staws relating to building construction.� I authorize representatives of this city or county er the o entified property for inspection purposes.Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Nam Data
AC77ON
DATE
Y
DECLARATIONOF COMPLIANCE VATH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 69 OF TITLE40AND
AQMD RULE 1403.
PERMITEXPfRED
,
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERMI'TEXTEPIDED
❑ ASBESTOS NOTII7CA noNIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
P€RWITFINAL
CERRFICATEOF
SIGNATURE:
OCCUPANCYISSUED