HomeMy WebLinkAboutH2020-0265 - PermitsCity of Newport Beach - Building Division 11111111111111111111111111111111111111111111111
, 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 0 0 2 6 5
Permit Counter Phone (949)644-3288
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Job Address: 621 ROCKFORD RD BIdg:1 Floor: Suite:
Description of Work: MECH (2) A/C UNITS ON GROUND *TAMPER PROOF CAP REQ*
Inspector Area:5 Code Edit : 2016
Legal Description: N TR 3519 LOT 138
Owner: CHRISTENSEN DANAE Contractor:
Address: 621 ROCKFORD RD Address:
CORONA DEL MAR, CA 92625
Phone: Phone:
Con State Lic:
Issued Date:05126/2020 Lic Expire:
n n Bus Lic:
Processed By: t, ; i /y \ Lic Exp Date:
RANCHO VIEJO A/C & HEATING
22596 COTTONWOOD CIR
LAKE FOREST CA 92630
949-212-4870
745018
11/30/2021
BT30031040
03/31/2021
MECHANICAL Permit: H2O2
Project No: 2896-2018
Inspection Requests Phone (949)644-3255
TIMER REQUIRED ON EQUIPMENT
'1
TO SHUT OFF BETWEEN 10 P.M, AND 7 6.
Worker's Comp Insurance -
Carrier : NORGUARD INSURANCE ,
Policy No: LAWC000721
Expire :01/01/2021
4C Items
FEES
nacesBoilers & Compressors
Ventilation
- Other
to 100K BTU/hr:
0
$0.00
Up to 3HP:
1 $20.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0
$0.00
;r 100K BTU/hr:
0
$0.00
> 3 HP to 15 HP:
1 $36.00
Exhaust Fan:
0 $0.00
Gas Line:
0
$0.00
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0
$0.00
it Pumps & Package Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
to 100K BTU/hr:
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigation:
;r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
to I BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
124ANS036/048
Issuance:
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
BRYANT
;r 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
TOTAL: $181.22 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $181.22
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.
IWNER-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
is 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
'rofessions 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
of more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness 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
nprovements 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
n roved for the purpose of sale).
1, a5,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
pply 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).
I I am exempt from licensure unden the Contractors' State License Law for the following reason:
ly 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 legally
ell 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 Business and
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www.loginfo.ca.gov/calaw.html.
signature of Property Owner or Authorized Agent Date
.ICENSED CCJNI RACTOR'S DECLARATION
hereby affirm unaer penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with edion 7000) of Division 3 of the Business and rofessions C e my license is in full force
nd effect.
;tense Class License No Date i3. )-� Contractor Signature
VO4KERS' COMPENSATION DECLARATION
'ARNIYG; FAILURE TO ScIiURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (E100,000), IN ADDITION TO THE
OJT Or COMPENPATION, bAMAGES 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:
I have ana 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 th
grforrPance, of tke work for which this permit is issued. Policy No.
P
�JiLhave and will me.ntain 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
In,-rance carriEr and policy number are:
Policy Number
Date
lame of Agent Phone #
]I certify that, in the pert rmance of the work f r h this permit is issued, I shall not employ any person in any manner so as to become subject to a workers' compensation laws of California, and agre
iat, if I should become s bject to the workers' om nsation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisi ns.
ignature of Applicant Date 2>J
IECLARATION REGA DING CONSTRUCTI LENDING AGENCY
hereby affirm under nalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued ( ection 3097, Civil Code).
ender's Name Lender's Address
ly 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 cQQQ���(((ecI
I agree to comply with all applicable city and court ft ordinances,�n to laws relating to building construction.
I authorize representatives of this city or county tQ enter the a e tified property for inspection purposes.
AC7ION
DATE
&Y
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY.
FEDERAL REGULATIONS PART 61 OF TIRE 40AND
AQMO RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMIT EXTENDED
❑ ASBESTOS M07IRCATIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTfFICATEOF
SIGNATURE:
OCCUPANCYISSUED