HomeMy WebLinkAbouth2021-0243 - Permitsw City of Newport Beach - Building Division H2O21-0243 MECHANICAL Permit: H2O21-0243
100'Civic Center Drive, Newport Beach, CA 92660 Project No : 1390-2018
Permit Counter Phone (949)644-3288
Inspection Requests Phone (949)644-3255
Job Address: 501 TUSTIN AVE BIdg:1 Floor: Suite:
Description of Work: MECH 4 HEAT PUMPS 'TAMPER PROOF CAP REQ'
Inspector Area:3 Code Edit: 2019
Legal Description: FIRST ADD TO NEWPORT HEIGHTS BILK 35 LOT 24
Owner: MOHR STEVENIMOHR CAMMY Contractor:
GRAVES M H INC
Worker's Comp Insurance -
Address: 40410TH ST Address:
5852 MULLER ST
Carrier: OAK RIVER INSURANCE • •
• ®•
HUNTtNGTON BEACH CA 92648
BELL GARDENS CA 90201 Policy No: MHWC232915 ..•
• •
Phone: Phone:
562-833-3703
•
Expire:01/0112022
• • •
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Con State Lic:
241731 -
V
•.
IssuedDate:04/07/2021 Lic Expire:
03/3112022
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Bus Lic:
BT30034436
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Processed By:- Lic Exp Date:
04/30/2021
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HVAC Items
FEES
...0
FurnacesBotlers & Compressors
Ventilation
Other
Up to 10oK BTU/hr:
0
$0.00
Up to 3HP:
0 $0.00
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 1o0K BTU/hr:
3
$63.00
>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:
$54.81
Up to 1M BTU/hr:
0
$0.00
up to 1OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
AC054KNZDCH
Issuance:
$37.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
SAMSUNG
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$46.25
TOTAL:
$201.06
Plan Check Fee:
$0.00
Fee Due at Permit Issuance:
$201.06
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.
✓NER-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)
action 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
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
�fessions 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
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,
>iness 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
)rovements 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
)roved 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
)ly 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).
I am exempt from licensure under the Contractors' State License Law for the following reason:
my signature I jlpv 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 legall
a structure %al Lhgve built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy oAdofes
ection 7044 of the Business and
Ifessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
nature of Proper Owner or Authorized Agent Date
)EL(SED CONfl2ACTOR'S DECLARATION
RP�fy/affirm undlrr penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with ecti nA7O) of Division 3 of the Busiode, and nse is in full force
i effect./)anse.Class •....• License No Date// Contractor Sign
)AKERS' OOMPE•NSATION DECLARATION
ININGr FAILURC i0 SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TND DOLLARS I$100,0001, IN ADDITION TO THE
t'r•(1R COMPENSATUON, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
;d affirm urjder ppalty of perjury one of the following declarations:
I have and Willi;nktain 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 the
Pormance of tl✓e work for which this permit is issued. Policy No.
••••••
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' compensation
)rance carrier and policy number are:
of Agent
Policy Number Expiration Date
Phone #
I certify that, in the performan of the ork 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,
it, if I should become bject the rs' ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pro)fl 'sions./J / p
mature of Applica t Dat /
:CLARATION RE RD ONS RUCTION LENDING AGENCY
ereby affirm under p Ily of perjury that there is a construction lending agency for the performance of the work for which this permit is issued Se 'on 097, ivil Code).
nder's Name Lender's Address
my signature below, I certify to each of the following:
I am the property owner or authorized to act ojprolpeown rs behalf.
I have read this application and the informatiocorrect.
I agree to comply with all applicable city and cnd state laws relating to building construction.
I authorize representatives of this city or coun-id Ie .property for inspection purposes. (� /
(nature of Property Owner or Authorized Agent _ Print Property Owners or Authorized Agent's Name! V&� Cat
ACT70IV
DATE
BY
DECLARATION OF COMPLIANCE MTH CODE OF
FOR OFFICEUSE ONLY
FEDERAL REGULATIONSPART 64 OF T17L.E49 AND
AOMDRULE 4403.
PERMITEXPIRED
❑ I SUBWTT€DASBESTOS NODFICATIM TO:.
❑ EPA
❑ AOMO
PERMIT CANCELLED
PERMIT EXTENDED
❑ ASBESTOS NO-URCARONIS NOT APPLICABLE TO
PROPOSEDOEMOUTION.
PERMtTRNAL
CERTIFICATEOF
SIGNATURE.
OCCUPANCYISSU€D