HomeMy WebLinkAboutH2021-0673 - Permitskfar„�� City of Newport Beach - Building Division H2O21- 3 CQ'MfCI
100 Civic Center Drive, Newport Beach, CA 92660 0'o Prbfgc
Permit Counter Phone (949)644-3288
1 OZ
6�
Ins ct
Y
Job Address: Work:
PORT
2)NEWLEAT Bldg SO*loor: uite: O ON HEAT PUMP,,
Description of Work: MECH (2) NEW HEAT PUMPS *TAM R PROOF ACR., :. y
Inspector Area:6 Code Edit: 201
Legal Description: N TR 7845 LOT 72
Owner: MDG REAL ESTATE LLC
Address: 2339 PORT CARLISL
NEWPORT BEACH, C
Phone: 714-904-4734
Issued Date:11/30/2021
Processed
tractor,.K A CONSTROWONIINGENINT
1 POST SUITE 200
tiAdoress';i
Phone: `
v IRVINE CA 92618
714-904-4734
Nt)
Con StateoLic:
928591 -
Lc Expire:
02/28/2023
C
Bus Lic:
BT30074364
Lic Exp Date.
02/28/2022
V N
jrnacesBoilers & Com- ss ve a
15 30 HP:
t3_ 0HPto50HP
r
> P P:
HP:
Dvf
ver 1.75M BTU/hr: D $0.00 VA`
TOTAL: $172.28
p to 100K BTU/hr:
0
;f10
ver 100K BTU/hr.
0
$ F,fl
0 $0.
0
ox-
0# (COO
COO
0 $0.0
0 $.0
d
FEES
ANICALPermit: H2O21-0673
No:1535-2020
Phone(949)644-3255
s :C�non emp uyee
t�i7CEMPT
to: no emp gees
a+ti9
EuCTO R
'gym Fan: $0. ire Dampers:
st Fan:
0 .0 Gas Line:
Fan:
0 0 Metal Fireplace:
I -Dr an:
0.00 Record Mgt Fee:
i ial Ho
$0.00 Additional Fee
m. Hoo
dr/ r/
0 $0.00
0 $0.00 Model:
m al Fee:
$0.00 Manufacturer:
Other
0 $0.00
$0.00
0 $0.00
$0.00
0 $0.00
$0.00
$0.00
Investigation:
$0.00
Plan Check:
$38.28
Issuance:
$38.00
MITSUBISHI
Zoning PC:
$52.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance : $172.28
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 reason(s
(Section 7031.5, Business and Professions Code: Any city or county that requires a permit to constru [ter, improve,
the permit to file a signed statement that he or she is licensed pursuant to the provisions of the C actors' State Licei
Professions Code) or that he or she is exempt from licensors, and the basis for the alleged ex ion. actors'
A
not more than five hundred dollars ($500). QD
I, as owner of the property, or my employees with wages as their sole c
Business and Professions Code: The Contractors' State License Law does
improvements are not intended or offered for sale. If, however, the building
improved for the purpose of sale). ,/
I, as owner of the property, am exclusively contracting with licenspfrContractors to c
apply to an owner of property who builds or improves thereon, an o contract r the
I am exempt from licensors under the Contractors' Stab
tense Law f e folloyy
By my signature below I acknowledge that, except form rsonal resi BE
in w f�
sell a structure that hale built as an owner -builder as not bee onstru i E
Professions Coca, is available upon request wh i61
s appl Is subrLtiY e
Signatur., of Property Owner or Authorized t
LICENSED CONTRACTOR'S DEC ATIO��
I hereb; affirm under penalty of per' that l;, n ed under provisions of.(>Fiapter 9
,and'effAcL
License Class 7 License No
✓ORKERS' CUMi'
'ARNIN ,: FAILURE 7 'LL
OST OF r'oMPEN 9Y, [
hereby aff `'p Pr pe
have a ? it a
erformance ow�rl
I ha`,e and wrl[Y rTtn
ISurance carrier a ..
lame of Agent
1 certify that, in the p
la , I should become
ignature of Applicant
by fki�checkmark(s) I have placed next to the applicable item(s)
7 anfaktructure, prior to its issuance, also requires the applicant for
comtiir�ncing with Section 7000) of Division 3 of the Business and
at app nt for a permit subjects the applicant to a civil penalty of
will do Qf'cf or(�p ottlons of the , and the
an o�prope��at'io, through ployees' or pe
10& Id vK't kn ne year of c pletion, the Owne
ISATION DECLARATION
iE WO COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJ�YAN
M E, P5 PROVIDED FOR IN SECTION 3706 O6 THE LABOR CODINTERES AND 0
of pegj one of the following declarations
tain a ifi of consent to self -insure for workers' compensatiol
for Ich this p it Is issued..Policy No.
of
hereby affirm under penalt of p t
Ender's Name
y my signature below, I certify to ea`,` f t
I am the property owner or authoriz _40
I have read this application and the infer
I agree to comply with all applicable city
I authorize representatives of this city or
Ore project etion 7044, Business and Professions D
with a ed Contractor pursuant to the Contractors'
bided for at least one year prior to con
licensed contractors. I understand that a
Web site:htto://www.leainfo.ca.aov/calaw
Date
of
D� <N�o
D"ctor of Ind
insurance, as required by Section 00 of the Labor Code, for
PolicyN umber Al �/
Business and
CIVIL FINES 9-TO ON4 1
any
I Reip�l�s`a` roe
VIP
work for which this permit is issued. My workers'
intended or offered for sale (Section 7044,
Ids or improves the property, provided that the
e the burden of proving that it was not built or
Cntractors'
State License Law does not
se Law).
r e' covered by this permit, I cannot legally
:ab coon 7044 of the Business and
rof Sipnd my license is in full force
Date
1FE U`'AND DOLLARS ($100,000), IN ADDITION TO THE
i for by Section 3700 of the Labor Code, for th
this permit€yJj'��� t�d, II h o%�mplo t/ son in a a r so as to become subject to the workers' compensation laws of California, and agree
ation pr V" f Seot'I 00 of the L or Code, al hwith comply with those provisions. I
� Date 7 l 3d a-1
IL ENCM( v
�struc cglji ding agency the pert an of the work for which this permit is issued (Section 3097, Civil Code).
the property
I have orovic
grelating to building construction.
property for inspection purposes.
Print Property Owner's or Authorized
ACTION
DATE
DECLARATION OF COMPLIANCE WITH CODE OF
FOA FFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AOMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS N077FICATION TO:
❑ EPA
❑ AOMD
PERMITCANCELLED
PER+7ITEXTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
Y•L2-
.0A.4.—
CERTf R'CA TE OF
SIGNATURE:
OCCUPANCYfSSUED