HomeMy WebLinkAboutH2022-0204 - Permits (3)City of Newport Beach - Building Division
too Civic Center Drive, Newport Beach, CA 92660
Permit (Anter Phone (949)644-3288
H2O22-0204
MECHANICAL Permit: H2O22-0204
Project No : 0213-2021
Inspection Requests Phone (949)644-3255
w.a t t
Job Address: 1748 PLAZA DEL NORTE BIdg:1 Floor: Suite:
**TIMERS
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Description of Work: MECH: INSTALL (2) ROOF MOUNTED HEAT PUMPS.
PROHIBITED**
.
Inspector Area:1 Code Edit:
2019
Legal Description: N TR 518 BILK L LOT 12
M.
,
Owner: BERGESON JAMES
Contractor:
URBAN MECHANICAL
Worker's Comp Insurance -
'
Address: 1748 PLAZA DEL NORTE
Address:
10621 BLOOMFIELD #25
Carrier : WESCO INS CO
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,
NEWPORT BEACH CA 92661
LOS ALAMITOS CA 90720
Policy No: WWC3545729
910912022
Phone: 9491293-1670
Phone:
714-614-2446
Expire :0
M
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Con State Lic:
594181
Issued Date:04121/2022
Lic Expire:
05/31/2022
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Bus Lic:
BT30005613
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Processed By: W-5
Lic Exp Date:
08/31/2022
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Items
FEESces
Boilers & Compressors
t00K BTU/hr: 0
$0.00
VentilationOther
Upto3HP:
2 $44,00
Bathroom Fan:
0 $0.00
Fire Dampers:
0 $0.00
$0.00
00K 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
$0.00
loor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0
$0.00
umps & Package
Units
>30 HP to 50 HP
0 $0.00
0 $0.00
Down -Draft Fan:
Residential Hood:
0 $0.00
0 $0.00
Record Mgt Fee:
Additional Fee :
$0.00
Investigation:
$0.00
100K BTU/hr:
00K BTU/hr:
L
0
0
$0.00
$0.00
>50 HP:
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$38.28
1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
MXZ4c36NA21ssuance:
$38.00
1.75M BTU/hr:
0
$0.00
Over 1OK CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
MITSUBISHI
Zoning PC:
$52.00
.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
TOTAL :
$172.28
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$172.28
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
Construction Hours: Monday - Friday 7:00 a.m.to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m.
tK-t$OILLI UtCLAKAI ILIN
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
thepermit 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 U all of or U 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 rc• 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 built or
improved for the purpose of sale).
71 L, s'n owner Cf.!he 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, o-� oroperty 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:
By rtiy 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:
soli a structure that : hive 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 Business and
rofnrslons Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Siona!ure of Prrnl@Ijy Owner or Authorized Agent Date
6CEN3ED CONTRACTOR'S DECLARATION aff
irm D
hereby 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 n f t
ens' ebb a
License ClassLicense No Date Contractor Signature X
WORKERS' COMPENSATION DECLARATION --
NARNING: FAILURE:Tn SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
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e 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
n 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 workers' compensatiol
nsurance carrier and policy number are:
Policy Number
of Agent
Date
certify that, in the performance of the e r Ich It is i u , I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
if I should become subject to the r pe ovi n Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ,,11
lature of Applicant X %� C� Z Z Date
:LARATION REGARDIN'�CONSTRUCTION LENDING AGT�i"'
Ireby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097
Ider's Name Lender's Address
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.
I have read this application and the information I have provided is co t.
I agree to comply with all applicable city and county ordinances a e ng ding construction.
I authorize representatives of this city or county to enter the a tif' a Inspection purposes.
of
or Authorized
Civil Code).
�Urw Data
ACTION
DATE
BY
L CLARA I[ON OF COMPLIANCE KgTH CODE OF
FEDERAL REGULATIONS PART 61 OF TITLE40AND
AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOTfRCAnoNISNOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
FOR OFFICE USE ONLY
PERMIT EXPfRED
PERMITCANCELLED
PERMIT EXTENDED
PERMIT FINAL
Z
CERTI RCA TE OF
OCCUPANCYI'SSUED