HomeMy WebLinkAboutH2019-0413 - Permits'p City of Newport Beach - Building Division
ct + 100 Civic Center Drive, Newport Beach, CA 92660
'< Permit Counter Phone (949)644-3288
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Job Address: 21 IMA LOA CT BIdg:1 Floor: Suite:
Description of Work: MECH NEW A/C UNIT ON GROUND *TAMPER PROOF CAP REQ*
MECHANICAL Permit: H2O19-0413
Project No :
Inspection Requests Phone (949)644-3255
TIMER REQUIRED ON EQUIPMENT INSPECTOR
Inspector Area:3 Code Edit: 2016 TO SHUT OFF BETWEEN 10 P.M. AND 7 A.M.
Legal Description: TR 7817 LOT 3 UNIT 150 OF PROJECT LOCATED ON AP 424-041-01
TOGETHER
Owner: SUGDEN ROMAN
Contractor:
Address: 21 IMA LOA CT
Address:
NEWPORT BEACH, CA 92663
$0.00
Phone:
Phone:
$0.00
Con State Lic:
Issued Date:07/12/2019
Lic Expire:
$0.00
Bus Lic:
Processed By:
Lic Exp Date:
nacesBoilers & Compressors
to 100K BTU/hr:
0
$0.00
:r 100K BTU/hr:
0
$0.00
I/Floor Heaters:
0
$0.00
at Pumps & Package Units
to 100K BTU/hr:
0
$0.00
Br 500K BTU/hr:
0
$0.00
to 1M BTU/hr:
0
$0.00
to 1.75M BTU/hr:
0
$0.00
ar 1,75M BTU/hr:
0
$0.00
TOTAL: $140.45
m ee
0 o e
000•
Other °°°°
Ventilation
0
$0.00
GUARANTEED AIR
Worker's Comp Insurance -
....
m c
1250 VALEVI EW AVE
Carrier: MID-CENTURY INS
'•° °
°°••°
-$3&00-
Exhaust Fan: --0---
o ®
o 0
ANAHEIM CA 92807
Policy No: A09484276
Attic Fan:
0 $0.00
714-777-6600
Expire :05/05/2020
0 $0.00
o
997377
Record Mgt Fee:
ioeeo•
0 $0.00
Residential Hood:
0 $0.00
Additional Fee
o e
10/31/2020
Comm. Hood:
0 $0.00
°
up to 1 O CFM:
0 $0.00
Repair/Alter/Add:
e• o
BT30053897
Over 10K CFM:
s e o
00000
02/28/2020
Manufacturer:
°
mmmoo
mmmmmm
°
o®mmoo
m o
TOTAL: $140.45
m ee
0 o e
FEES
Other °°°°
Ventilation
0
$0.00
$0.00
0 -- _
Up to 3HP:
0 $0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
> 3 HP to 15 -HP: ---1
-$3&00-
Exhaust Fan: --0---
$0:00-
- Gas Line: --
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee
Air Handling Units
Comm. Hood:
0 $0.00
up to 1 O CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
VAV Box:
0 $0.00
TOTAL: $140.45
Zoning PC: $40.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance : $140.45
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 6:00 a.m. to 6:00 p.m.
m ee
0 o e
e
•e0e
Other °°°°
0
$0.00
$0.00
0 -- _
$0.00
$0.00-
0
$0.00
$0.00
$0.00 Investigation:
$0.00
Plan Check:
$30.45
CSA1BE48KIssuance:
$35.00
SEER
Zoning PC: $40.00
Plan Check Fee : $0.00 Fee Due at Permit Issuance : $140.45
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 6:00 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 Sof 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 an owner of property who, throughemployees' 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).
0 I, as owner of the property,. am exclusively contracting withlicensed 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 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 Codet ie -available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Prop9rty.6wner or Authorized Agent Date
LICENSED CJ0NJ"CTOR'S DECLARATION
t hereb9 affirm Dpder penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with action 7000) of Division 3 of the BusiYON
and of Bions Codd my license is in full force
and effect. ��-,
Liceasa Class License No Date Contractor Sign
IVORKERS' fi®MPLNSATION DECLARATION
NARNOM: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP T HUNDRED THOUSAND DOLLARS (E100,000(, IN ADDITION TO THE
r91llT.q1F COMPEIVATI91f, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
k%rlp¢yaffirm uAder penalty of perjury one of the following declarations:
Ml.have and A 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 IN
yeedhorn$nce of t6%WC6( for which this permit is issued. Policy No.
0 hem 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' compensatio
ns raace carrier and policy number are:
)arrier .... Policy Number Expiration Date
Jame of Agent Phone #
:1I certify that, in the perfor an o th ork for whic thl permit is issued, I shall not employ any person in any manner so as to become subject to th workers' compensation laws of California, and agre
hat, if I should become su act o the o ers' c mpen ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provision . �/ p,
3ignature of Applicant Date G--' 1 I
)ECLARATION REGAR ING STRUCTION LENDING AGENCY
hereby affirm under pe Ity 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
3y 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 haye provided is correct.
I agree to comply with all applicable City and counV o i n s and state @ws relating to building construction.
I authorize representatives of this city or county 1241. t bove-ide fied property for inspection purposes. /� 7 _
3i nature of Property Owner or Authorized A ant ¢ice Print Property Owner's or Authorized Agent's Name b SI-uk11-71&1 Date
ACTION DATE
BY
DECLARATION OF COMPLIANCE116TU CODE OF
FOR OFFICE dISEONLY
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