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Home My WebLink AboutH2021-0169 - Permits- City of Newport Beach - Building Division MECHANICAL Permit: H2021-0169 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 1 6 9 Project No: Permit Counter Phone (949)644-3288 Inspection Requests Phone (949)644-3255 Job Address: 428 CABRILLO TER Bldg:1 Floor: Suite: Description of Work: MECH FURNACE CHANGE OUT (SAME LOCATION) Inspector Area:5 Code Edit: 2019 Legal Description: N TR 1237 LOT 76 °moo° Owner: FIORILLI FRANK Contractor: GREENSTAR HOME SERVICES Worker's Comp Insurance - Carrier: LIBERTY INS Address: 428 CABRILLO TER Address: 965 RIDGE LAKE BLVD #201 MEMPHIS TN 38120 Policy No: WA763D508631010 ° NEWPORT BEACH, CA 92625 Phone: 949-885-0102 Expire :1010112021 Phone: Con State Lic: 795556 Issued Date:03/01/2021 Lic Expire:' 02/28/2022 Bus Lic: BT30056111 Goa000 aosoo Processed By: Lic Exp Date: 08/31/2021 G HVAC Items FEES e 9 O a O c+c4^GO ° P ° Other FurnacesBoilers & Compressors 1 $21.00 Ventilation Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 $0.00 Up to 100K BTU/hr: Over 100K BTU/hr: 0 $0.00 Over I > 3 HP to 15 HP: 0 $0.00 Exhaust Fan: 0 0 $0.00 Gas Line: 0 $0.00 $0.00 Metal Fireplace: 0 $0.00 all/Floor Heaters: 0 $0.00 a >15 HP to 30 HP: 0 $0.00 Attic Fan: >15 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 $0.00 Heat Pumps Package Units Up to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee: $0.00 Investigation: Plan Check: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 0 $0.00 Repair/Alter/Add: 0 $0.00 Issuance: $0.00 Model: $37.00 Up to 1 M BTU/hr. 0 $0.00 Up to 1.75M BTU/hr: 0 $0.00 up to 10K CFM: Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: Zoning PC: $0.00 Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $58.00 TOTAL: $58.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7.00 a.m.to 6.30 p.m.and to 6:00 Saturday from 8:00 a.m.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 Rem(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 lie 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 roe ��' p p rty, 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 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 isale).. ❑ 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 lic ensure 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, ) have builtas 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 Professions Code is available upon request when this application is submitted or at the following Web site:http://www.leginfo.Ga.gov/calaw.html. E , ignatunp of Propefrty' Owner or Authorized Agent Date L`it clv1,:kED C( NTRA.CTOR'S DECLARATION [[ I hereby affirm v7iuer`p=enalty of perjury that I am licensed under provisions of Chapter 9 (commencing w• h Wction 70t70) o ion 3 of the Business Profess' ns Code, an sense is in full force aced effect. License Class License No Date Contractor Signature 1VORKERS' C(&1r WENkSATION DECLARATION NARNING: FAILURE TO SECL-RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED CJST ErsCONIPENS`..161 , r);aMAGESTHOUSAND DOLLARS ($100,000), IN ADDITION TO THE I AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY S FEES. Ncrw} affirm under penalty of� perjury one of the following declarations: 71`Ir6av; and wiV m�,;rtain 21certificate 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 thr rmance of thp,, ;.York for which ,this permit is issued. Policy No. ve^and Will mainVn 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' compensatior uran a carrier and po..cyi number are: 'arrier Policy N er Expiration Date flame of Agent _ Phone # certify that, in the . if I should becon re of Applicant RATION REGI, 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 ation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prolt_�j Date rwury c,vev I ILJIV LtrvuiNG AGENCY hereby affirm under penalty of hat there is a construction lending agency for the performance of the work for which this permit is issued (S cti n 3097, Civil Code). ender's Name Lender's Address y my signature below, I certify'to each of the following: am the property owneriorauthorized to act on the property owners beha�reltingg I have read this application.and the information I have pro ' ed is correct. I agree to comply with all applicable city and county fib es and st o building construction. I authorize representatives Hof this city or coun to ttz entified property for inspection purposes. JI ignature of Property Owner or Authorized Agent Print Property Owner s or Authorized Aoent's Name t I, � �/ 1 Ill) O % %i�/��A r)J �! � � �./ of tbs-work for t} DATE BY PEiaMITEXPIRED PERMIT CAdifCELLED PrRWITO(TEd DED d ! PERMIT FINALZA 1 CERPFII A E OF € CC UPANCYISSUED A . ■ f . i ! , ll ■ EPA ® m i►.. ■ a AppLIcABLE To PROPOSED f SIGNATURE. FOR OFRCE USE ONLY