HomeMy WebLinkAboutH2017-0270 - Permitswt City of Newport Beach - Building Division III 111111111111111111111111111111111111111111111
6 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 7 0 2 7 0
Permit Counter Phone (949)644-3288
Job Address: 12 ODYSSEY CT BIdg:1 Floor: Suite:
Description of Work: MECH NEW A/C UNIT *TAMPER PROOF CAP REQ*
InspectorArea:3 Code Edit: 2016
Legal Description: TR 7817 LOT 1 UNIT 121 OF PROJECT LOCATED ON AP 424-041-01
TOGETHER
Owner: YANNI DANIEL Contractor: OWNER/BLDR
Address: 12 ODYSSEY CT Address: YANNI DANIEL
NEWPORT BEACH, CA 92663
Phone: Phone:
Con State Lic: O/B
Issued Date:05/17/2017 Lic Expire:
Bus Lic:
Processed By: Z o�S' Lic Exp Date:
MECHANICAL Permit :1-12017-0270
Project No :
Inspection Requests Phone (949)644-3255
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a 5 • ,
Worker's Comp Insurance - " sr
Carrier : •
°
Policy No:
Expire
omm•m• �°.�a�
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HVAC Items
FEES
FurnacesBoilers & Compressors
Ventilation
Other
Up to 10oK BTU/hr:
0
$0.00
Up to 3HP:
1
$18.00
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:
$0.00
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$15.66
Up to 1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
38H00036
Issuance:
$33.00
Up to 1.75M BTU/hr:
0
$0.00
Over 1 OK CFM:
0
$0.00
Supplemental Fee:
$0.00
Manufacturer:
CARRIER
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0
$0.00
TOTAL:
$66.66
Plan Check Fee
: $0.00
Fee Due at Permit Issuance:
$66.66
PERMITS EXPIRE 980 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 items)
(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 applicart 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).
❑ 1, 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
i roved for the purpose of sale).
s 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
annJy to an yvDa -of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law).
IJ p
I am Elkemplfrom licensure under the Contractors' State License Law for the following reason:
Bymy sigr yra below I acknowledge that, except for my personal residence in which I must have resided for at least one ear prior to completion of the improvements covered by t is permit, I cannot legall,
s@I/,a strJoturIs, I have built as an owner -builder if it as not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 70 of the Business and
Professions Code, is available upon request when thi application is mitte or at th ing Web site:hftp:11www.leginfo.ca.gov/calaw.htIn
Sigaature of P operty Owner or Authorized Agent Date J ��I
L•ItENSE?X QWtRACTOR'S DECLARATI
j hEreby affirm undE"r penalty of perjury that I a I ansed under provisions of Chapt 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect..
Lisonse Clad%* License No Date Contractor Signature
(YORKERS' OOMPENSATION DECLARATION
MRA G: FAILURE TO CURE 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
COST F COMPlNSA�Id DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
�;%r9liy affirm undp4 penally of perjury one of the following declarations:
54 4ve 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 th
Derformance of the work for which this permit is issued. Policy No.
JI have 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' compensatior
Isurance carrier and policy number are:
:arrier Policy Number Expiration Date
lame of Agent Phone #
]I certify that, in the perfor ante of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to t workers' compensation laws of California, and agree
iat, if I should becomes ject to the workers' compe visions of Section 3700 of the Labor Code, I shall forthwith comply with those provis' ns.)
ignature of Applicant Dat
IECLARATION REG DING CONSTRUCTIO L DING AGENCY 6
hereby affirm unde penalty Of perjury that there is a gnstruction lending agency for the performance of the work for which this permit is issue IS
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 state laws relating to building construction.
I authorize representatives of this city or county t ter b e-identifi property for inspection purposes.
ianature of Propertv Owner or Authorized Aqent Print Propertv Owner's or Authorized Agent's Name _ _ T) "^^`" Date \�
ACTION DATE / BY \ ucuua uVir air a-VIWrusnva,c rn r n a Vv Ur
\ FEDERAL REGULATIONSPART61'OFTITLE40AND
PERMITEXPIRED AQMDRULE 1403.
❑ 1 SUBM17TED ASBESTOS NOTIFICATION TO:.
PERMITCANCELLED ❑ EPA
PERMITEXTENDED ❑ AQMD
l ❑ ASBESTOS NO7IFICARONIS NOTAPPLICABLETO
PERM1TfiNAt
/ PROPOSED DEMOLITION.
CERTIFICATE OF
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