HomeMy WebLinkAboutH2022-0478 - PermitsCity of Newport Beach
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Community DevelopmentDepartment- Building Division
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100 Civic Center Drive, Newport Beach, CA 92660
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Permit Counter Phone: (949) 644-3288
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Inspection Requests Phone: (949) 644-3255
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newportbeachca.gov/inspections
II II III I II Mechanical Permit
Plan Check No:
Work Class : Other
Issued Date:
Inspection Area : t
H2O22-0478
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARSFROMORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address: 4206 RIVER AVE Legal :Desc : A TR CANAL SECTION BLK 242LOT 4
Description: MECH -INSTALL MINI -SPLIT HEAT PUMP CONDENSER & 2 AIR HANDLERS. TAMPER -RESISTANT CAP REQUIRED
Owner: BENSON NUEL C TR BENSON TR Contractor : RIGHTIME HOME SER S
Address : 4206 RIVER AVE NEWPORT BEACH, CA 92663 Address :. 1821 MCGAW AVE IRV 92614
Phone: Phone: (714)„998 4300 fit.
Applicant:
Address
Phone:
Con State Lic : 765074 q
BEN MEDINA -Lic Expires: 06130/2023 f�
31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362 Bus Lic : BT30078653
(818) 735-7876 :Bus Lic Expire:0513112023
Workers'Compensation Insurance
Owner/Builder:
Carrier:
LIBERTY INS CO=
Address:
Policy ,No:
WA763D508631011
Phone :
W. C..Expire:
.10/1/2022
Code Edition :
2019 Fire Hazard Zone :. N
Manufacturer
Type of Construction
:
Model# :
Occupancy Groups:
Building Setbacks :
Front: 4, Front: 20, Side: 3, Side. 3
Flood Zone:
AE, 8 FT; X
Use Zone :
R-2 - Two -Unit Residential
PROCESSED BY:
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CARRIER
38MGRQ30D
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I hereby affirm under penalty of perjury that 1 am exempt from the Contractors' State License Law for the reason(;).. indicated below
xiion 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter,: improve, demolish, or re,
exemption.
next to the
he applicant for
.he Business and
more than five hundred dollars($500).. - .. _, -.-.: ,--.--.__---- >_...._acivit penalty of
1; as owner of the property,: or my employees with wages as their sole compensation, will do U all of or U portions of the work, and the structure Is not intended proffered for sale. (Section 7044,
iness and Professions Code: The Contractors' Slate License Law does not apply to an owner of property who, through amployees' er personal tMon. builds or improves Ina property, provided that the
-ovements 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 not built or
oved for the purpose of sale).
I, as owner of the property, am exclusivelycontracting with licensed Contractors to constructthe project (Section 7044, Business and Professions Code: The Contractors' State License Law does not
y 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 Larr):
I am exempt from ficensure under the Contractors' State License Law for The following reason:
ny signatures 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 at that i have built as an owner -builder if it has not been constructed inits.entirety by licensed contractors. I understand thata' copy of the. applicable law, Section 7044 of the Business and
essions Code, is: available( upon requestwhan this application Is submitted or at:the following Web site:http:liwww.leginfo.caoovlcalaw.html.
.IE..ENSEU GUN 1 KAt: f L7K'5 DECLARATION
hereby affirm under penalty of penury that I am licensed under previsions of Chapter 9 (commencing with Section700 ��: ++1 w�,3 of the Business and Profession de-ar.> m llcenseis in full force
Ind effect. License Class License No Date C(i GL .Contractor Signature
VORKERS' COMPENSATION DECLARATION
rARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL; AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONEHUNDRED. THOUSAND DOLLARS (E10a,000), IN. ADOITION TO THE
:CST OF COMPENSATION, DAMAGES AS PROVIDED FOR: IN SECTION a706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. - -
hereby affirm under penalty, of perjury one of the following declaratlons:
3 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 IN
ormance of the work for which this permits 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' compensation
1s r ce carrier and policy number are: - - -
.arrier Policy Number Expiration Date
tame of Agent Rhone #
"II certify that, in the performance of t r which this permit is issued, I shall not employ any person inanymanner so. as to become subject to the workers' campensahan laws of Callfcmia, and agrw
tat, If I.should become subject. i e ;;ait�hete
kars' compensation provisions. of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. /r -
lignature of Applicant Date
1ECLARATtON REGARDI CON G AGENCY /�
hereby. affirm under pane is a construction lending agency forthe performance of the Work for which this permit is issued (Section 309 -Cil it Code)..
-�ders Name - lenders. Address -
my signature below, I certify to Each of the folbiving:
I am the property. owner or authorized to act on the property owners : behalf,
t have read this application and the information I have provided is correct.
I agree to comply with all applicable city and county Drdin�YGMe�rr ate laws relating to building consiruc
I authorize representatives of this city or county hi4- a.�hnv 4dentified mmnd "'nn-rnrm<x
PERMIT FINAL
CERTIFICATE OF l
FEDERAL ] FOR OFFICE
RULE j
NOTIFICATION IS NOT APPLICABLE TO
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