HomeMy WebLinkAboutH2020-0702 - Permits (3)w,. � City of Newport Beach -Building Division IIIII�IIIIIp11111p11p111111111p111111111111111 MECHANICAL Permit: H2O20-0702
�' G� 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 0 0 7 0 2 Project No : 1408-2020
i`. Permit Counter Phone (949)644-3288
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e� > Inspection Requests Phone (949)644-3255
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Job Address: 3514 SURFVIEW LN Bldg:Q Floor: Suite:
Description of Work: MECH - R/R FAU & A/C CONDENSER. TAMPER -RESISTANT CAP & TIMER REQUIRED
Inspector Area:6 Code Edit: A tot9l
Legal Description: N TR 6228 LOT 3
Owner: KATZ ROBERT
Contractor:
CAPISTRANO HVAC
Worker's Comp Insurance -
Address: 3511 SURFVIEW LN
Address:
2301 MOULTON C-13
Carrier: FALLS LAKE FIRE & CASUALTY
CCRONA DEL MAR, CA 92625
LAGUNA HILLS, CA 92653
Policy No: FLA01415200
Phone:
Phone:
949-481-9605
Expire :05/0412021
Con State Lic:
910228
Issued Date:
Lic Expire:
09/3012021
Bus Lic:
BT30073651
Frocessed 6y
Lie Exp Date: 12/31/2021
5
Lz
:KViAC Items
_
FEES
FurnacesBoilcrs & Compressors
Ventilation
Other
Up to 10OK BTU/hr: 1 $21.00
Up to 3HP: 1
$21.00 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 100K 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:
$36.54
Up to I BTU/hr: 0 $0.00
up to 1OK CFM: 0
$0.00 Repair/Alter/Add:
0
$0.00
Model: Issuance:
$37.00
Up to 1.75M BTU/hr: 0 $0.00
Over 10K CFM: 0
$0.00 Supplemental Fee:
$0.00
Manufacturer: LENNox
Over 1.75M BTU/hr: 0 $0.00
VAV Box: 0
$0.00
Zoning PC:
$46.25
TOTAL: $161.79 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $161.79
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).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) 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 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
apply 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).
❑ 1 am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature 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 legall)
sell a 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 Busi'IPss and
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force
and effect.
License Class C ' aci License No Ct ( 0 �a- Date Contractor Signature
NORKERS' COMPENSATION DECLARATION -
NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOO E HUNDRED OUSAND DOLLARS ($100,001(, IN ADDITION TO'. F:=
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby.afffrm under penalty of perjury one of the following declarations:
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 th- lauur Code, fur
:e of the work for which this permit is issued. Policy No.
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
carrier and poll number} are:
X5 �0 k.R_ = Y CC4�1- �J Policy Number 1(-tA- 6 ly \`' � - 6 � Expiration Date
of Agent
JI certify that, in the performance of the work 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
iat, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
signature of Applicant " Datg�
IECLARATION F ONSTRUCTION DING AGENCY
hereby affirm under penalty perjury that there("there(is,4 construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
ender's Name Lender's Address
Iy my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have provided is Correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county ter a nspection purposes.
ignature of Property Owner or Authorized Agent . above-identi ed perty for iPrint Property Owner's or Authorized Agent's Name ON/ Date 0-
ACTION
DATE
Ry
DECLARATION OFCOMPLIANCE V#7THCOOE OF
FEDERAL REGULATIONS PART 61 OF TITLE40ANO
AQMD RULE 1403.
❑ 1 SUBMITTEOASDESTOS NOTIFICATIONTO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
PERMIT EXPIRED
PERMIT CANCELLED
PERMIT EXTENDED
PERMIT FINAL
Q,.20-7!
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