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Home My WebLink AboutH2019-0367 - Permits�vt City of Newport Beach - Building Division III��IIIIIIIIIIIIIIIIIIII�III�IIIIIIIIIIII 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 9 0 3 6 7 t+ .j Permit Counter Phone (949)644-3288 �"R rrr�t' `off Job Address: 1240 BALBOA BLVD W Bldg:1 Floor: Suite: Description of Work: MECH/ MINI -SPLIT SYSTEM (2) (H2O19-0211) Inspector Area:1 Code Edit: 2016 Legal Description: N TR 234 BILK 112 LOT 11 Owner: GRIEBEL DENNIS L Address: 1036 W BALBOA BLVD #B NEWPORT BEACH, CA 9266 Phone: 714-478-1950 Issued Date:06/19/2019 Processed Contractor: POLAR BEAR HTG & AIR Address: 23422 PERALTA DR#G LAGUNA HILLS CA 92653 Phone: 949-388-9484 Con State Lie: 968411 Lie Expire: 12/3112019 Bus Lie: BT30060265 Lie Exp Date: 04/30/2020 MECHANICAL Permit: H2O19-0367 Project No : Inspection Requests Phone (949)644-3255 Worker's Comp Insurance - Carrier : MID-CENTURY INS Policy No: A09468247 Expire :1113012019 HVAC Items FEES ° m°mo °®o•oo� FurnacesBotlers&Compressors Ventilation HVAC Items FEES FurnacesBotlers&Compressors Ventilation Other Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 2 $38.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 ..... $010 ° 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 ° ° $0,0D... 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 Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 .... Up to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee: $0.00 Investigation: $0.00 Over 500K BTU/hr. 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $33.06 Up to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: RXS09LVJUIssuance: $0.00 Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $10.00 Manufacturer: DIAKIN Over 1.75M BTU/hr. 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $40.00 TOTAL: $121.06 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $121.06 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). ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or L) 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 legally sell a structure that 1 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://www.leginfo.ca.gov/calaw.html. 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 Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. ."", License Qass ,,,, License No Datw Contractor Signature ��>• WO3fil ths, COI Pt%SATION DECLARATION WARNING,FAILURE fO SE'EbRE 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 CQSTOf COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I helebyaffirm under penalty of perjury one of the following declarations: ® I lv:e and will?Llrl aln 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 thi Wince of toe nark.for which this permit is issued. Policy No. 1711 lime -and will mainiain 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' compensation Mraacacarrier anH policy number are: Carrier : Policy Number Expiration Date if I of ill 1112,ReTformance 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 agree become subje to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provision // plicant Date(� 1 /Z CLARATION REGAAADING 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 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 above -identified property for inspection purposes. ''ll '' nature of PrODertv Owner or Authorized Acent w-1 — Print Property Owner's or Authorized Agent's Name ACft0N DATE '1 BY I PERMITEXPIRED I I I I PERMITCANCELLED I I I PERMITFINAL CERTIRCAT€OF OCCUPANCYISSUED I SUBMITTEDASBESTOS NOTIFICATIONTO: ❑ EPA ❑ AQMD ASBESTOS M077RCA170NIS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: Civil Code). tS P.