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Home My WebLink AboutH2021-0279 - PermitstYl � City of Newport Beach - Building Division 11111111111111p11111p111111p111p111111111p111111 MECHANICAL Permit: H2O21-0279 L b 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 2 7 9 Project No : 2885-2019 rw :.k _ Permit Counter Phone (949)644-3288 0s Inspection Requests Phone (949)644-3255 Job Address: 516 TUSTIN AVE BIdg:1 Floor: Suite: Description of Work: MECH - INSTL 5 MINI-SPLIT/AC CONDENSER UNITS. TAMPER -RESISTANT CAPS REQUIRED Inspector Area:3 Code Edit: 2019 Legal Description: FIRST ADD TO NEWPORT HEIGHTS BLK 36 LOT 5 Owner: ASGHARBEYGI NIMA Contractor: Address: 516 TUSTIN AVE Address: NEWPORT BEACH, CA 92663 Phone: Phone: Con State Lic: Issued Date:04127/202 Lic Expire: Bus Lic: Processed By: Lic Exp Date: J MARTIN INDOOR AIR QUALITY LLC Worker's Comp Insurance - 22343 LA PALMA STE 123 Carrier: FARMERS INS EXCHANGE YORBA LINDA, CA 92887 Policy No: 60588,4489 714-403-6514 Expire :01/01/2022 998956 12/31/2022 'y 08/31 20212 ��j 1 �' HVAC Items FEES Other FurnacesBoilers & Compressors Up to 100K BTU/hr: 0 $0.00 Ventilation Up to 3HP: 0 $0.00 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 $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 0 $0.00 Down -Draft Fan: Residential Hood: 0 $0.00 0 $0.00 Record Mgt Fee: Additional Fee: $0.00 Investigation: $0.00 Up to 100K BTU/hr: Over 500K BTU/hr: 5 0 $105.00 $0.00 >50 HP: Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $91.35 Up to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: MXZ-3C24NA2 Issuance: $37.00 Up to 1.75M BTU/hr: 0 $0.00 Over 1OK CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: MITSUBISHI Zoning PC: $46.25 Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 TOTAL: $279.60 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $279.60 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 neat 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-Builderwill 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). ❑ 1 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 Iegall) sell 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http:/Aw .leginfo.ca.gov/calaw.html. Signature of P,opa,ty Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I t.z-cby affir:T. Lrier penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and PrD ssions Cod and cense is in full force and effect. Cl � y Z}/ ` g - �Z� icense Class License No D e i Zci. Contractor Si nature), IVORKERS' COMDENSATION DECLARATION x_ "ARN'NG FAILURF 1"0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUW ECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE GCS, OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. h3-eby affir-"1 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 thl ,e,.%mance of the work forwhich this permit is issued. Policy No. I hAve and 'A'll 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' compensatior wswa ce camBr and policy number are: ,1 . r M" 2. •'_en k�`-; 11S,r =n ce- Policy Number yGi(>7-1 �(4(3 (51, /0) /r"'07 a of Agent - Explrahon Date �. 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 become subject g_the (Workers' coz s n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. [/ nature of Applicant V' �i-'^mil ,//-� Dates)/Z oZ CLARATION REGA"ING 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 provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. / I authorize representatives of this city or county to enter the aF�,gve-i enti d property for inspection purposes.`G / / nature of Property Owner or Authorized Agent 0-2 / / Print PropertyOwners or Authorized Agent's Name Date Z Z ACTION 12ATE BY DECLARATION OF COMPLIANCE MTN CODE OF FEDERAL REGULATIONSPART61 OF TITLE40ANO AQMD RULE 1403. ❑ L SUBMITTED ASBESTOS NOTIFICATION'TO:. ❑ EPA ❑ AQMD ❑ ASBESTOS NoirmcAnomilsNOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: FOR OFFICE USE ONLY PERMIT EXPIRED PERMIT CANCELLED PERMIT:EXTENDED PERMIT _ —"L // CERTIFICATEOF OCCJPANCYISSUED