HomeMy WebLinkAboutH2021-0265 - PermitsCity of Newport Beach - Building Division MECHANICAL Permit: H2O21-0266
4a 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 2 6 5 Project No : 2359-2020
Permit Counter Phone(949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 115 42ND ST BIdg:1 Floor: Suite:®O`��
Description of Work: MECH - INSTIL2 A/C CONDENSORS ON ROOF DECK. TAMPER-RESISTANT CAPS REQUIRED, TIMER REQ0 �N
Inspector Area:1 Code Edit: 2019
Legal Description: RIVER SECTION BILK 42 LOT 22 ®®G �a
Owner: BARTLETT DAN Contractor: OWNER/BLDR Worker's C��u ance -
Address: 1520 HIGHLAND DR Address: BARTLETT DAN Carrier:
NEWPORT BEACH CA 92660 Policy No:
Phone: 949-433-1060 Phone: 949-433-1060 Expire:
Con State Lic: O/B
Issued Date:04/20/2021 Lic Expire: \40�SG
Bus Lic:
Processed By: Lic Exp Date:
AC Items
FEES
"\.d
o�\A I
•nacesBoilers & Compressors
Ventilation
��
Other
to 100K BTU/hr:
0
$0.00
Up to 3HP:
1
$21.00
Bathroom Fan:
0 $0.00
Fire Da
t a 0 $0.00
$0.00
:r 100K BTU/hr.
0
$0.00
> 3 HP to 15 HP:
1
$38.00
Exhaust Fan:
0 $0.00
Gas Lin
0 $0.00
$0.00
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0
$0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0 $0.00
it Pumps & Package Units
>30 HP to 50 HP
0
$0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
to 100K BTU/hr:
0
$0.00
>50 HP:
0
$0.00
Residential Hood:
0 $0.00
Additional Fee:
$0.00
Investigation:
$0.00
:r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$57.33
to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
24AHA41ssuance:
$37.00
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0
$0.00
Supplemental Fee:
$0.00
Manufacturer:
CARRIER
:r 1.75M BTU/hr:
0
$0.00
VAV Box:
0
$0.00
Zoning PC:
$48.25
TOTAL: $193.58 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $193.58
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° 0!06 p.m. m
m m
en • +' o o eoe u
o e.. •� o o a o 0 0
o • e
+ m
onm o
u . eem
VB 6 P
ey mm• • e' eye o®• e
eo aye
V �•,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 U 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
!Mproved for the purpose of sale).
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
�ap ly o 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).
� exempt from licensure under the Contractors' State License Law for the following reason:
By 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)
a structure that I have built as an owner -builder if it has notgeah construc d in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 ofthp Business and
Professions Code, is available upon request when h' applica s lsbm' or aP!!! Web site:htlp:/lwww.leginfo.ca.gov/calaw.html. •,
Signature of Property Owner or Authorized Agent JCS 6 D _l 2
LICENSED CONTRACTOR'S DECLARATII5N
1 hereby affirm under penally 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 Class License No Date Contractor Signature
WORKERS' COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS'16100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
ZI I 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 lh
3erformance of the work for which this permit is issued. Policy No.
Z11 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' compensatio
nsurance carrier and policy number are:
Policy Number
of Agent
Date
�c rtify 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 workers' compensation laws of California, and agre
t f I should become subject t/ "711Jorkers' coo/gppensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. //'
nature of Applicant I / //. /L- '��---v -�- Dat u / Z, /%� L
CLARATION REG NGtC 3TRUC�ION LENDING AGENCY
Ireby 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, Civil Code).
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 pro ided is correct.
I agree to comply with all applicable city and county o inan as and state laws relating to building construction. Iy'���q^, A � /J
I authorize representatives of this city or count to a r t abov = entified pr�nspection purposes. r� N7 -I IV �ttl `T L l� Date
nature of Property Owner or Authorized Age - Print Property Owners or Authorized Agent's Name
ACTION
HATE BY
DELEARATIOU OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
•, .,.
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AQMORULE 4403.
PERMITEXPIIjEO • z
• . • •
•
❑ I SUBMITTEDASBESTOS M071FICATIONTO.'
❑ EPA
❑ AQMD
PERMtT CANC4LEZr . •
' •
PERMITEXTtN Et}
ASBESTOS M017RCAIIONIS NOT APPLICABLE TO
PROPOSEDDEMOUTION,
PERMIT FINAL
CERTFFICAT€OF ...
OCCUPANCYISSU€D "
• " •
SIGNATURE: