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Home My WebLink AboutH2022-0735 - PermitsaEwao� City of Newport Beach III I I I II I II I II II IIII II II Mechanical Permit : H2O22-0735 Community Development Department- Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No: Permit Counter Phone: (949) 644-3288 >+� Work Class : Other -a. Inspection Requests Phone: (949) 644-3255 cgcrcoa"'P newportbeachca.gov/inspections Issued on A e2123/2022 Inspection Area : 4 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 : 119 CORSICA DR Legal Desc : N TR 12306 BLK LOT 6 UN 99 TR.12306 LOT 6 UNIT 99 OF PROJECT LOCATED ON AP Description: MECH -INSTALL (1) A/C UNIT AND (1) FURNACE "PROVIDE TAMPER -PROOF CAPS AS REQ'D` Owner: ANDREW SZUMLAS Contractor: TRIFECTA HVAC Address : 119 CORSICA DR NEWPORT BEACH, CA Address : 5281 BUSINESS DRIVE HUNTINGTON BEACH, CA 92649 Phone: Phone: (714)362-6425 Con State Lie : 930444 - Applicant: TRIFECTA HVAC Lie Expire i 03/31/2023 Address : 5281 BUSINESS DRIVE HUNTINGTON BEACH `CA 92649 Bus Lie: BT30070937 Phone: (714) 362-6425 Bus Lie Expire:10131/2023 Workers' Compensation Insurance Owner/Builder: Carrier: SECURITY NATIONAL INSURANCE COMPANY Address: Policy No: SWC1389214 .• o••••: Phone: W. C. Expire;: 6/15/2023 Code Edition : 2019 Fire Hazard Zone: -, NO Manufacturer: AC PRO • ° ° ° • ° Type of Construction: Model#: AULD36W22/A-D(U) °••° °° •'• Occupancy Groups: Building Setbacks ..®°° Flood Zone : X ° • • ®°®�•. Use Zone: PC - North Ford ° • • ° • • • ° ° 01i50° PROCESSED BY: SPECIAL CONDITIONS: OWNER•BUILV ER, DECLARATION t hereby aff rm:under penalty of perjurythat I am exempt Rom file Contractors' State License. Law forthe:reason(s).indicated below by the (Section 7031:5. Business and Professions Code: Any city or countythat reouires-aoermitto construct, after. improve. demolish. or rebairan 1J I, as owner of the property, or my employees With wages as their sole compensation, will do j_) all of or U portions of the work,:and the structure is not intended oroHered-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-Builderwill have the burden of proving that It was not builtor improved for the purpose of sate). [3 1, 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 LJ . I am exempt from liwho builds or improves thereon, and who contracts for the with a licensed Contractore under the Contractors* Stale License Law for the following reason, Pursuant to the Ggn#raators' State License Law).: a 1 to an owner ofproperty Signature of Property Owner or AuthorizedAgant -Date, LICENSED CONTRACTOR'S DECLARATION ! hereby affirm under penalty of perjury that am licensed under provisions of Chapter g (commencing with Section 7g00) Divisia 3 of the Business antl Profes�r Co ;an my' license is in full force and effect License Class License. No Date,1.2.. Contm( Signature WORKERS' COMPENSATION DECLARATION 1 j WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES HP TO ONE HUNDREDTH , ANDDOLLARS ASI04,000), IN ADDITION TO THE MST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3746 OF THE LABOR CODE: INTEREST, AND ATTORNEYS FEES, 1 hereby have and will maintain a certificate of consento of self -insure -iinsure for workers compensation,. issued by: the Director o penalty pal 7 g ' �f Industrial Relations as provided for by Section 3700 of theLabor Code, for its performance of the work for which this permit is issued. Policy No. ' i-have and'VAt maintain workers' compensation insurance, as required by Section 3700 of the Labor Cade, for the performance -of the work for which this permit is issued. My workers' compensatio .. insurance came: andpaiicy number area Policy Number_ Expiration Date Name of Agent • • ' Phone tf r;ft that, in'the performance of the work for which this permit is issued, I shall not employ any person in any mannerflf so as to become subject io the workers' compensation laws of California, and agre . twat, 3.fI should bacQmg subject t the wor Ts' compensation provisions of Section 3700 of the Labor Code,:: I shall forthwrllh comply with those provisions. ignafureofAppli¢ant bate AT REtiARtY1N NSTRUGTtON LENDING AGENGY 41 06 r affiirm""i 4r_panatty of pa0'ury thatthera is a construction lending agency For the performance of the work for which'this permit is issued. ISection 3097, .Civil Code). Lendors Name • Landers Address. y..mNrignaturebelonelcsrtify to each ofthafollowing: -- I am v,o proieeriytiyrneroF'autharizedtoact on thepropertyovrner's behalf. ..Tn. ve'Bad it4 appllcationand theinformation t hone prouided 15: torrecL. t agree to craaply Uh all applicable city; and county: ordinances and state laws relating to building construction. I authorize representatives:of this city orcounty to en rtha b e4deni fied property for inspection purposes.�00nature of Pro Owner or.Authorized A nt ' Print Fro a Owner's or Authorized- lent's Name... �� .Dater 3 2 .ACTION. I DATE BY LARATION OF COMPLIANCE WITH GODE_OF FEDERAL I FOR OFFICE USE ONLY ON IS NOT APPLICABLE TO or /SS