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Home My WebLink AboutH2017-0612 - Permitssw1n City of Newport Beach - Building Division 1111111 IIIIIIIIIIIIIIIIIIIIIIIII 11111111111111 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 7 0 6 1 2 w Permit Counter Phone (949)644-3288 `�'�ttrexu�x� Jab Address: 1200 BALBOA BLVD E BIdg:1 Floor: Suite: Description of Work: MECH A/C (2) CHANGE OUT *TAMPER PROOF CAP REQ* Inspector Area:1 Code Edit: 2016 Legal Description: BALBOA TR EAST SIDE ADD LOT 1 ELK 19 AND BALBOA BAY FRONT TR LOT 1 Owner: ROSE ANDREW S Contractor: DEPENDABLE GRAHAM AC Address: 1200 BALBOA BLVD E Address: 2952 CENTURY PLACE NEWPORT BEACH, CA 92661 COSTA MESA CA 92626 Phone: Phone: 714-546-1653 Ventilation Con State Lic: 472690 Issued Date:10/2612017 Lic Expire: 04/30/2018 Other Bus Lic: BT01013104 Processed By: Lic Exp Date: 12/31/2017 2 $36.00 Bathroom Fan: 0 $0.00 MECHANICAL Permit: H2O17-0612 Project No: Inspection Requests Phone (949)644-3255 4ra6<✓ 6 O e'±D�6 O" p • O O f P ..r. k7 o n eo •�)�:'me u Worker's Comp Insurance - • •• o 'c.. . Carrier: FALLS LAKE FIRE AND CASUALTY •<•• •• " O •oo° Ck Policy No: FLA000131 Expire :07/01/2016 g4ieeco o m o c o ooeecc .e. e O 0 OnOC� OE HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 2 $36.00 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 1OOK 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: $31.32 Up to 1M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: NH4A436124AKA Issuance: $33.00 Up to 1.75M BTU/hr: 0 $0.00 Over IOK CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: DAY N NIGHT Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $37.50 TOTAL: $137.82 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $137.82 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 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). ❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do L) 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 improved for the purpose of sale). ❑ I, as ownemi:4"property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not Npply 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). "r9i exemRt'ffom licensure under the Contractors' State License Law for the following reason: By myMsignaturebblbk 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) selka 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, isevailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. ;fWafte of Pr8R%,Fy Qwner or Authorized Agent Date LICENSED CO.%%RRACTOR'S DECLARATION IlveseUyMaffirm gndbi p2nalty of perjury that I am licensed under provisions of Chapter 9 (commencing wi Section 7000) of Division 3 of the Business an essions Code, I Il my fe se is in full force orxiafiect. ,t .�/ 4iperysB.Class License No Da / %%' / Contractor Signet f ✓ *CTRKkRS' OCEM4SATION DECLARATION WAR61WOMFAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMP OYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO NE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE OOS T OF eOMPENtATwTJ*&MAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm untler penalty of perjury one of the following declarations: 1 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 th ormance of the work for which this permit is issued. Policy No. ave 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 insur nce carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone # I certify that, in the pert ance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to a workers' compensation laws of California, and agre that, if I should become 8ubjecLt�q the worke s' compee conn provi ns of Section 3700 of the Labor Code, I shall forthwith comply with those provi ons. Signature of Applicanty/�c7� �Y1 Sz`- 3�6-+1'f/L. Da DECLARATION RE RDING CONSTRUCTION LENDING AGENCY I hereby affirm unde penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is is ed (Section 3097, Civil Code). Lender's Name Lender's Address By 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 cou tyordinances and state laws relating to building construction. I authorize representatives of this city or count nter t above ' ntifie property for inspection purposes. Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name CTDK 0 A/ C^�4 #M ate m -2,C-/ ACDON DATE BY DECLARATION OF COMPLIANCE WITNCODEOF FOR OFFICE OS NLY FEDERAL REGULATIONS PART 61'flFT1ILE40AND PERM1rEXP1RED AQIc4Q RULE 1$03. ❑ ESUBMITTED ASBESTOS N071FICAT!ONTO: PERMfTCANCECLED ❑ EPA PERMITEX7ENDED ❑ AQMD ❑ ASBESTOS NORRCATJONIS NOTAPPLICABLE TO PERMITFINAL PROPOSED DEMOLITION. CERTIFfCA7E DF OCCUFANCYtS5DE0 SIGNATURE. 4 - [ EP I >, - !�l,. # ! k k / -, ,{_(�}(� , , r . . ( { ƒ � § R. ƒ _ z - \ , , , 0 & : }( / �=v�� roA s u w N �^ N ° 3 m3 n H n < N < p 9 3d J � o. wU-n'a A �=v�� roA a c a°-3 wwa W --x° m3 j3„ 333 p 9 3d o. wU-n'a 15 °Aa'ya„ "30 orvm o N �oe - oa- aa.s 9aa A tiiA ��3 3aa8 n y m y T_32 xw N P MH T N T ww o ap n- na 3 m m �_ 3gD Son 3 p D i F F 6 3wA w' w' Sao ID iZ u q q p � A A n w Q �m s 3 n a 9 O C O •I _ mo o mo off, n \ \ - 6 \gn 3. } 2I!/0 0 - - 2 {8 !! § _ / \�/� ] E ! )/ } _ ism