HomeMy WebLinkAboutH2019-0588 - PermitsCity of Newport Beach - Building Division; III I[IfilII1111111111Jill 111111111111111111111111
100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 9 0 5 8. a
Permit Counter Phone (949)644-3288
TIMER REQUIRED ON EQUIPMENT
MECHANICAL Permit: H2O19-0588
Project No :
Inspection Requests Phone (949)644-3255
W SHUT OFF BFTW€€N 10 P M AND 7 A M
Job Address: 214 EMERALD AVE BIdg:1 Floor: Suite:
Description of Work: MECH/CHANGE OUT (E) F.A.0 & ROOF MOUNTED (1) (E) A/C UNIT 55.5dB* (CARRIER: 24AHA4) *TIM( IRED ON EQUIPMENT TO SHUT OFF
BETWEEN 10PM & 7AMIva (6,
*NOISE AGREEMENT W/PERMIT
Inspector Area:2 Code Edit 2016 �)� A
Legal Description: BALBOA ISLAND RESUB SEC 1 BLK 4 LOT 25 6J
O OA, ®V/�/
wner. MORALES JAVIER
Contractor:
KEMNITZ A/C & HEATING INC
Worker's Comp a
®�
Address: PO BOX 9879
Address:
186 TECHNOLOGY SUITE C
Carrier: NORGUARD
NEWPORT BEACH CA 92662
Phone:
Phone:
IRVINE CA 92618
949-453-6500
Policy No: KEWC036134
Expire :02101/2020
Con State Lic:
695874
Other
` o
Issued Date;09@7/2019
Lic Expire:
09/30/2020
Up to 3HP:
1 $20.00
Bathroom Fan:
Bus Lic:
BT30010593
VERIFICATION
REQ
Processed By:
Lic Exp Date:
07/31/2020
HERS
> 3 HP to 15 HP:
HVAC Items
FEES
FurnacesBollers & Compressors
Ventilation
Other
Up to 100K BTU/hr;
1
$20.00
Up to 3HP:
1 $20.00
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
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:
$17.40
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$0.00
Up to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$35.00
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 Bax:
0 $0.00
Zoning PC:
$41.50
TOTAL: $133.90
Plan Check Fee:
$0.00
Fee Due at Permit Issuance:
$133.90
. e. nr• o .00 oc
PERMITS EXPIRE 180,AW;'AY-TER 1wSU (INCE OR IAST,W4LID INSPECTION
Construction Hours: Monday- Fridfy,7:00 p.rh.tp 0:3ft.m.at1)1 S4tugday from 8:00 a.m. to 6:00 p.m.
40Y Yt, Y4t N O O�4 IJOo
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 appliciAle 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 (_) 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 anownerof 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).
13 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).
13 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 legal)
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://www.ieginfo.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 Sectio 1 7000, of Division 3 of the Business and Profe s nd my license is in full force
and effect.
License Class License No Date - Contractor Signatu
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 THOU DOLLARS 1$100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
111 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 the
pe mance of the work for which this permit is issued. Policy No.
I have and will m ' In 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 oli number arq;oe' A t`•
Date
ame of Agent :M=� C N-0%.! j(, J UL/L ruone n
]I 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 works s' com ensation laws of California, and agree
tat, if I should become su ct to the sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
Aalty
t�e��� � �Jignature of ApplicantV Date `ECLARATION REGANG CO CTIO ING AGENCYhereby affirm under p0f p ry that the 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 sta laws relating to building construction.
I authorize representatives of this city or countyo ertver� a led proper y for Inspection purposes. /'(d1hN f / v� A/( \ �S/Z% J��
ianature of Prooertv Owner or Authorized Agent �A. _.. Print Property Owner's or Authorized Agent's Nam�(Vr7UV LTi r J -�afCr
ACTION DATEv RY VCULAI triviv yr wnrrLIAIV.c ryirn �vvc yr
L/ ••FEA4RAL REQUR4NONSPARTO OFTITLE40AND
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