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Home My WebLink AboutH2019-0591 - PermitsCity of Newport Beach - Building Division IIII�IIIIIIIIIIIIIIIIII�IIIIIIII�IIIIIIIIIIIIII 100. Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 9 0 5 9 1 Permit Counter Phone (949)644-3288 ``�<ernsanafV0 % Job Address: 36 MISSION BAY DR BIdg:1 Floor: Suite: Description of Work: MECH/OVER 40 LF OF DUCT WORK Inspector Area:4 Code Edit 2016 MECHANICAL Permit: H2O19-0591 Project No Inspection Requests Phone (949)644-3255 ® „vN N418� �� TyE lNFFK Legal Description: N TR 7432 LOT 6 E/V® Owner: PERLMUTTER DAN M Contractor: GREENSTAR HOME SERVICES Worker's Comp Insurance - Address: 250 NEWPORT CENTER DR#300 Address: 1951 N MAIN ST Carrier: LIBERTY INS NEWPORT BEACH CA 92660 ORANGE CA Woe�63 Phone' -885-0102 Expire :10/01/2019 on state uc: 795556 3f2� (if applicable: Issued Date:09/27/2019 � is E>Sate: 071 9l n n us Lic; BT30056111. ❑ 80% or 0 100% refund :.Processed By: is E 06/3 to whom: ri AN C roacesBoilers & Compressors Ventilation to 100K BTU/hr: 0 $0.00 Up to 3HP: ;r.100K BTU/hr: 0 $0.00 > 3 HP to 15 ill/Floor Heaters: 0 $0.00 >15 HP to 30 st Pumps & Package Units . >30 HP to 50 to 100K BTU/hr: 0 $0.00 >50 HP: :r 500K BTU/hr: 0 $0.00 Air Handling to 1 M BTU/hr. 0 $0.00 up to 1 OK CF to 1.75M BTU/hr; 0 $0.00 Over 10K CFI :r 1.75M BTU/hr. 0 $0.00 VAV Box: TOTAL: $55.00 FEES Other 0 EsXt $ 0 $0.00 0 $ 0 $ s LinjD 0 $0.00 0 0 $ 00 0 $0.00 . 0 i Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 0 $0.00 Residential Hood: 0 $0.00 Additional Fee : $0.00 Investigation: lits 0.Comm. Hood: 0 $$0.00 Ilin h' 0 0.rD n ot/ 4lxrtv,620.00 S h0.00 M e i r sclaid ." o.00(work started) (no work started) zoning PC: Plan Check Fee : $0.00 Fee Due at Permit Issuance $55.00 SP. Construction Hours:n-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 (_) 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 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.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 I am licensed under provisions of Chapter 9 (commencing with Sectio 7000) of Division 3 of the Business and P /license is in full force and effect. .Z r ,In License Class. License. No VIIORKERS' COMPENSATION DECLARATION /� ,t Eppy NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UN WFUL AND SHALL SU A R 7 I N f CIVIL FINES UP TO ONE'I�N�YY 4�I,LARS (E700,000), IN ADDITION THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF T LAS R IMEREST 0 TT E FES hereby affirm under penalty of perjury one of the following declar ions: p p �'( Qn% �r 1 (j0% refund I have and will maintain a certificate of consent to self-insur for ens ' suer the ec o ri o as ro d $Y Section 7b0 of the Labor Code, r th 3ethemance of the work for which this permit is issued. Policy No.c remand will maintain workers' compensation insurance, as quir by Se 137 of t - d o p r c wl�iiWb@ .i"wPdrtn,.,�,dmm!-ooFApen atiol nce carrier a>d ptf cy number are; f is of Agent certify that, in the performancg.GfAIhSrWMVfN which this if I should becomes bject to the workers' Sens Iature of Applicant__ Ireby affirm under penalty of perjury tFat there is a construction I Ider's Name my signature below, I certify to each of the following: I am the property owner or authorized to act on the property ow I have read this application and the information I have provided I agree to comply with all applicable city and county .QpknI06es I authorize representatives of this city or county r nature of Prooertv Owner or Authorized ADent ACTION I. DATE PERMITEXPIRED for the performance of the work for which this permit is issued _ Lender's Address bicap ispestian pu p�s. Print PrODertv Owner's or Authorized Agent's Name EXTENDED 0 AQMD FINAL - t[ OPO ED OS IV 01 RCADON15 NOT APPLICABLE TO SIGNATURE: Date t the workers' compensation laws of California, and grf i ns. !? ;action 3097, Civil Code),.. E c It ei (no work started)