HomeMy WebLinkAboutH2021-0023 - Permits0��w City of Newport Beach - Building Division H2O21-0023 MECHANICAL Permit: H2O21-0023
4 100 Civic Center Drive, Newport Beach, CA 92660
'�. Permit Counter Phone (949)644-3288 Project No: 2388-2019
��i�� Inspection Requests Phone (949)644-3255
Job Address: 609 JASMINE AVE BIdg:1 Floor: Suite:
F
SP
Description of Work: MECH - (3) ROOF -DECK A/C CONDENSORS. TAMPER -RESISTANT CAPS
'REVISED 417121'
REQUIRED
IbR
Inspector Area:6
Code Edit: 2019
Legal Description: CORONA DEL MAR BILK 636 LOT 9
Owner: MILLER LINDA Contractor:
Address: 609 JASMINE AVE
AIR MAX
Worker's Comp Insurance -
°
° ....
Address:
CORONA DEL MAR CA 92625
27260 LOS ALTOS #123
Carrier: STATE COMP.INS
Phone:
MISSION VIEJO CA 92691
Policy No: 9170882
....
Phone:
626-468-9999
Expire :12/08/2021
Con State Lic: 1015725
IssuedDate:01/08/2021 Lic Expire:
07/3112022
......
.°°° o
°
Bus Lic:
BT30065145
v
Processed By: Lic Exp Date: 11/30/2021
°
HVACltems
FEES
0
oc ,a
Furnaces Boilers &Compressors Ventilation
°
Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 2
Over 100K BTU/hr: 0 $0.00
$42.00 Bathroom Fan: 0
$0.00
Fire Dampers: 0 $0.00
Other
$0.00
> 3 HP to 15 HP: 0
Wall/Floor Heaters: 0 $0.00 >15 HP to 30 HP: 0
$0.00 Exhaust Fan: 0
$0.00
$0.00
Gas Line: 0 $0.00
$0.00
Heat Pumps & Package Units >30 HP to 50 HP 0
Attic Fan: 0
$0.00 Down -Draft Fan: 0
$0.00
$0.00
Metal Fireplace: 0 $0.00
Record Mgt Fee:
Up to 100K BTU/hr: 1 $21.00 >50 HP: 0
Over 500K BTU/hr: 0 $0.00 Air Handling Units
$0.00 Residential Hood: 0
$0.00
$0.00
Additional Fee: $0.00
Investigation:
$0.00
Up to 1M BTU/hr: 0 $0.00 up to 1OK CFM: 0
Comm. Hood: 0
$0.00 Repair/Alter/Add: 0
$0.00
$0.00
Model:
Plan Check:
$54.81
Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0
$0.00 Supplemental Fee:
$0.00
AULD36W21A-D
Manufacturer:
Issuance:
$37.00
Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0
$0.00
AC PRO
Zoning PC:
$46.25
TOTAL: $201.06 Plan Check Fee : $161.79 Fee Due at Permit Issuance: $39.27
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.
,JVVIYCR-OUILVCR
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 items
(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' Stale 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 (_) 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 sigmatrre 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
sell a strEylyrV JMat 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
Pqrofessiona erode, is available upon request when this application is submitted or at the following Web site:hltp:/Aw .leginfo.ca.gov/calaw.html.
tknature Wr��opperty Owner or Authorized Agent Date
LICENSECS UJNTRACTOR'S DECLARATION
1 Rereby 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
L
ffecj.••• se Clear•License No S� -�� Date C1 `a a c� m Z-�'ZI Contractor Signature
K�y"COMPENSATION DECLARATIONNG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINFS UP TO ONE HUNDRED THOUSAND OOLLA0.51f100,000), IN ADDITION TO THE
OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3T0S OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
by a%rm yrl0er penalty of perjury one of the following declarations:
have end 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 thl
rmanoe 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' compensahor
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Phone #
Name of Agent
I certify that, in the perfo ance 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
hat, if I should becom ject to the `CONSTRUCTION
compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Signature of Applicant J' 1 av�� � Datekecon
q — — ' L r
DECLARATION REGA ING CONSTRUCTION LENDING 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 (97, Civil Code).
Lenders Name Lenders Address
By my signature below, I certify to each of the following:
I 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 ordinances and state laws relating to building construction. ,�/)
1 authorize representatives of this city or coup t nter a ab ve-Id Iri pr/9perty for inspection purposes. ' 7��� )t Da �j - '7 2"
Signature of Property Owner or Authorized Agent county / `7� Print Property Owner's or Authorized Agent's Name /7//�
ACTION
DATE
BY
PERMfT EXPIRED
PERMfT CANCELLED
PERMITEXTENDED
PERMIT RNAL
I�70'27
CERTIFICATEOF
OCCUPANCYISSUED
AND
❑ ISUBMtTFEDASB€STOSAYITIFICATIONTO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIRCARONISNOT APPLICABLE TO
PROPOSEDDEMOLITION.
SIGNATURE: