HomeMy WebLinkAboutH2023-0023 - Permits,EwPORT City of Newport Beach — III I I I II I III II II II I III II Mechanical Permit : H2o23-0023
p� d Community Development Department- Building Division
100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No:
}�^ z Permit Counter Phone: (949) 644-3288 Work Class : Other
ck Inspection Requests Phone: (949) 644-3255
CqG/rO0.N�P newportbeachca.govfinspections Issued Date: 01/10/2023
Inspection Area : 2
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL 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 : 123 VIA ORVIETO Legal Desc : N TR 907 BLK LOT 526 TR 907 LOT 526(AND NELY1/2 LOT 527
Description: MECH NEW HEAT PUMP AND 2 AIR HANDLERS *TAMPER PROOF CAP REQ*
.•°.
Owner: JOHANNA STAPLE Contractor:: A/C PLUMBING °,°,°•
Address : 2547 XANTHIA CT DENVER, CO 80238 Address : ' 532 MALLOY CT CORONA, CA 92880
Phone: 303 525-5843 °°°°°°
( ) Phone: (714),336-6159 °
Con State Lic : 1047781 °
Applicant: BEN. MEDINA tic Expire : 12/31/2024
Address : 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362 Bus Lic : BT30077958
Phone: (818)735-7876 'Bus LicExpire: 02/28/2023 °°°°®
Workers' Compensation Insurance ......
°°°•° .....
Owner/Builder: Carrier: AMERISURE ° °•°°•
Address: '- Policy No:: 21221200002
Phone: W. C. Expire: 12/1/2023
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Code Edition : 2022 Fire Hazard Zone : NO Manufacturer: AC PRO ° ° ° • ° ° ° ° ° °
Type of Construction : Model# : AWHD24ND3GO
Occupancy Groups:
Rs
Building Setbacks : Front: 0, Front: 4, Side: 4, Side: 4 F,� :
Flood Zone : X
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Use Zone: R-1 - Single -Unit Residential
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PROCESSED BY:
SPECIAL CONDITIONS:
OWNER -BUILDER DECLARATION
t hereby affirm under penalty of perjury that t am exempt from the Contractors' State License Law for the resson(s) indicated below by.th
LJ 1; as owner of the property, or my employees wii
Business and professions Coda: The Contractors'. S
improvements are not intended or offered forsale.
Im roved for the purpose of safe).
I; as owner of the property, am exclusively contt
a�plyto an Owner of property who builds or improve
l�l I am exempt from Iicensure under the Contractc
sed Contractors to C
(ho. contracts for the
s Law for the fottow[t
asidence'in which I I
sby affirm upt&T pena1ty of perjury that I am licensed under provisions of Chapter 9 (commencing with Sectjofi 00).
itfect. LicerttVass License Noi :Date
MiRS' C049961SATION DECLARATION
IN : FAILURE TO'SECJI E WORKERS' COMPENSATION ZOVERAGE IS UNLAWFUL, AND $HALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT
O QOMPENSATIPN, DAMAGES AS PROVIDED -FOR IN SECTION 37118 OF THE LABOR CODE, INTEREST, AND ATTORNEY'$ FEES.
_tf affirm under peaaltyof perjury one of the following declarations:
Ve and will mailtain a certt0cate of consent to self -insure for workers'. compensation,issued by :the Director. of
rmance of the we* for which this permit is issued. PolicyNG..
( 'end will Vainlain workers' compensation insurance, as roquired by Section 3700 of the Labor Code, for the pe
anc ecarrier ant[ policy number are:
er. ' _..__' ." Policy Number.
p:19ent
IL94 that, lrithepo Iformanoe of the worka clt fats ed, t shai[ not employ any person m any manners
If I should fxc'ome �ubjecf to the wor as prov€si¢ns;o{Section 3744 of the Latrrn Code, (:shalt forthwith
I hereby affirm under penalty :o_. r ury that there is a construction lending agency for the performance of the work for which'
Lender's Name - _.tender'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.
t have read :this application and the Information t have provided o... rmot,
i agree to comply with all applicable city and county ordin and. state taws relating s ruction.
[ authorize representatives of this city or c, to en ha above adent' party for Inspection purposes.
Signature of Property Owner: or Authorized flan Print Property Owner's or Autl
ACTION DATE BY ON OF COMPLIANCE WITH CODE OF FEDERAL I FOR OFFICE
15NOTAPPLICABLE. TO
a the burden of proving that It was .not built or I)
The Contractors` Stale Licensee Law does not.
e License Law).
LSf the Business and Pro 'salons my license is in full force'
Contractor Signatu
:Nit FINES UP TO ONE HUND USAND DOLLARS (4100,0001, IN ADDITION TO THE
it Relations as provided for by Section 3700 of the, Labor Code. for tti
:e of the work for which this permit is issued. My workers' compensatio
_,Expiration. Date
Phone#
abject to the workers' mpensation laws of California. and agre.
I provisions.
Dater D 23
ad (Section 3097, Civil Code);.
u