HomeMy WebLinkAboutH2020-0035 - Permits (4)City of Newport Beach - Building Division H2O20-0035 MECHANICAL Permit: H2O20-0035
100 Civic Center Drive. New ort Beach, CA 92660 p Project No : 2189-2018
(9)
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 4703 RIVER AVE BIdg:1 Floor: Suite:
Description of Work: MECH NEW A/C UNITS (4) ON ROOF *TIMERS ON UNITS 2 & 4 & TAMPER PROOF CAP REQ*
*PERMIT REVISED 09-0 INSPECTOR
Inspector Area:1 Code Edit:
20162016
Legal Description: R BK 32 PG 50 PAR 11A
Owner: CEFALIA JIM
Contractor:
BEST QUALITY HEATING & AIR INC
Worker's Comp Insurance -
Address: 1224 W OCEAN FRONT
NEWPORT BEACH CA 92661
Address:
130 A E COLLINS AVE
ORANGE CA
Carrier : HARTFORD CASUALTY
Phone: 949-933-7986
Phone:
99867
714-759-0167
Policy No 57WECDE6068
Expire :05110/2021
Con State Lic:
949468
Issued Date:VN12020
Lic Expire:
06130/2022
71NIER REQUIRED ON EQUIPMENT
Bus Lic:
BT30060260
10 P.M. AND 7 A.M.
Processed B •
Lic Exp Date:
08/30/2021
TO SHUT OFF g.-'jN(EEN
A(: Items
FEES
•nacesBoilers & Compressors
Ventilation
Other
to 100K BTU/hr:
0
$0.00
Up to 3HP:
0
$0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0 $0.00
$0.00
at 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
at 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:
4
$80.00
>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:
$69.60
to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
DAY AND NIGHT
Issuance:
$35.00
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0
$0.00
Supplemental Fee:
$0.00
Manufacturer:
NHA436AKA/424AK
-r 1.75M BTU/hr:
0
$0.00
VAV Box:
0
$0.00
Zoning PC:
$41.50
TOTAL: $226.10 Plan Check Fee : $226.10 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
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do L) 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).
❑ 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 legal1
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:hftp://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 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
and effect.
License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
WARNING: 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
COST OF COMPENSATION, DAMAGES AS Pt.OVIDED FOR IN SECTIOX V06 OF THE LABOR CODE, INTEREST, AND ATTORNETS FEES.
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 thf
performance 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' compensatior
insurance carrier and policy number are:
Policy Number
Date
is of Agent -vnone s
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
if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
ignature of Applicant Date
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY
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).
ender's Name Lender's Address
y 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 above -identified property for inspection purposes.
of
ACDON
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FEDERAL REGULATIONS PART 61 OFTITLE40AND
FOR OFFICE USE ONLY
AQMDRULE 1403.
❑ ISUBMITFEDASBESTOS NOTIFICATION TO:
PERMITEXARED
PERMITCANCELLED
❑ EPA
❑ AQMD
❑ ASBESTOS M077RCA170NIS NOT APPLICABLE TO
PERMIT EXTENDED
PERMIT FINAL
PROPOSED DEMOLITION.
CERTIFICATEOF
SIGNATURE:
OCCUPANCYISSUEO