HomeMy WebLinkAboutH2016-0836 - PermitsCity of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beacn, CA 9Zd60 H 2 0 1 6 0 8 3 6
Permit Counter Phone (949)644-3286
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Job Address: 420 DAHLIAAVE BIdg:1 Floor: Suite:
Description of Work: MECH/(3) A/C UNITS 44dB, 41.5dB & 44dB (DAY & NIGHT124ANS-30 & 36)
InspectorArea:5 Code Edit:
2013
•
Legal Description: COOKS ADD # 2 BLK 432 LOT 2
340
Owner: NIEMANN DAVID & CORINNE
Contractor:
GRAVES M H INC
Address: 2221 WELCH ST #402
Address:
P O BOX 3030
HOUSTON, TX 77019
FurnacesBoilers & Compressors
BELL GARDENS CA 90202
Phone: 714.624-9688
Phone:
562-833-3703
Con State Lie:
241731
Issued Date:12/08/2016
Lie Expire:
03/31/2018
0
Bus Lie:
BT30034436
Processed By:
Lic Exp Date:
02/28/2017
MECHANICAL Permit: H2O16-0836
Project No: 0131-2016
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : SECURITY NATL
Policy No: SWC1095664
Expire :01/01/2017
HVAC Items
•
340
4
FEES
•30
O 0.0
O •
FurnacesBoilers & Compressors
Ventilation
� 'O
6
0
Other
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
2
$36.00
Bathroom Fan:
0 $0.00
Fire Dampers: 0
$0.00
$0.00
Over 100K BTU/hr:
0
$0.00
> 3 HP to 15 HP:
1
$33.00
Exhaust Fan:
0 $0.00
Gas Line: 0
$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
f
E
Heat Pumps & Package
Units
>30 HP to 50 HP
0
$0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
O
DO
000
Up to 100K BTU/hr:
0
$0.00
>50 HP:
0
$0.00
Residential Hood:
0 $0.00
Additional Fee:
$37.50
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$60.03
Up to 1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$33.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0
$0.00
Supplemental Fee:
$0.00
Manufacturer:
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0
$0.00
TOTAL:
$199.53
Plan Check Fee
: $0.00
Fee Due at Permit Issuance:
$199.53
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
•
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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).
❑ I, 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 legally
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 applicabl law, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:hltp://www.leginfo.ca.gov/calaw.htm1.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Secti n 7 00) of Division 3 of the Business and P fessi s Code, and my license is in full force
and effect.
License Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION r
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI INA PENALTIES AND CIVIL FINES UP TO OE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3705 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S 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 thl
performance of the work forwhich this permit is issued. Policy No.
have and wiltIffaiqtain 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
Nance carrier ARd p6jicy number a
rier
m r Expiration Date
ne of Agent
Phone #
certify that, in the performabw k 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 agree
I, if I should become sub' cork rs' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi Ions.nature
Dat 1�CLARATION
of Applicant
REGAR INUCTION LENDING AGENCY
Ireby affirm under penal 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 propert)
wner's behalf.
I have read this application and the information I have prov
ed is correct. ,
I agree to comply with all applicable city and county ordin
ces and state laws relating to building construction.
I authorize representatives of this city or county t e ter t e
a ove-identified propert inepec on purposes.
nature of Property Owner or Authorized Agent
Print Property Owner's or Authorized Agent's Name Date
ACTION DATE
OY
DECLARATION OF COMPLIANCE fNITR CODE OF
FOR OFFICE USE ONLY
FEGtRAC FEGULOUIONSPART B'4QFTJ4E40AND
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❑ 0 S ESTOS N017RC41YONIS NOT APPLICABLE TO
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PERMIT EXPIRED
PERMIT CANCELLED
PERMITEXTENDED
PERMIT FINAL
CERTIFICATEOF
OCCUPANCYISSUED
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