HomeMy WebLinkAboutH2022-0209 - Permits (4)'F•wi�o,Fr ,. City of Newport Beach - Building Division H2O22-0209
d' Go 100 Civic Center Drive, Newport Beach, CA 92660
,; •;. �ti �. Permit Counter Phone (949)644-3288
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Job Address: 4521 PERHAM RD BIdg:1 Floor:
Suite:
Description of Work: SFR MECH: REPLACE A/C UNIT. 52.7dB *TIMER REQUIRED*
Inspector Area:5 Code Edit: 2019
Legal Description: N TR 3357 LOT 114
Owner: FLUOR LISA
Contractor:
KLONDIKE AIR INC
Address: 4521 PERHAM RD
Address:
1308 LOGAN STE E
CORONA DEL MAR, CA 92625
COSTA MESA CA 92626
Phone: 949-413-2681
Phone:
714-979-2070
Con State Lic:
754456
Issued Date:04/22/2022
Lic Expire:
09/30/2022
0-5
Bus Lic:
BT30060482
Processed By:
Lic Exp Date:
09/30/2022
MECHANICAL Permit: H2O2
Project No :
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : FALLS LAKE FIRE & CASUAL
Policy No: FLA00809504
Expire :01/0112023
AC Items
FEES
'nacesBoilers & Compressors
Ventilation
to 100K BTU/hr:
0
$0.00
Up to 3HP:
0 $0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0
$0.00
;r 10oK BTU/hr:
0
$0.00
> 3 HP to 15 HP:
1 $39.00
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
:r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
to I BTU/hr:
0
$0.00
up to 1OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
RA1648AIssuance:
to 1.75M BTU/hr:
0
$0.00
Over 1 OK CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
RHEEM
�r 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Other
$0.00
$0.00
Investigation: $0.00
Plan Check: $33.93
$38.00
Zoning PC:
TOTAL: $162.93 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $162.93
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. '
TIMER REQUIRED ON EQUIPMENT
TO SHUT OFF CETWEEN 10 P.M. AND 7 A.M.
7
)WNER-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 items)
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
he 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 _
iot 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,
3usiness 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
mprovements 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
m roved 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 or 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:
3, :T.y signature uelow 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
sell a structure tha; 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Sigl,&ture of Pl Owner or Authorized Agent ate
LICENSED CON TRACTOR'S DECLARATION
I hey Eby 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 Prof sions ode, an 11 force
and effect.�� �Zi
License Class License No Date Contractor Signature
xnRKERS' COMPENSATION DECLARATION
NARNINC. FAILURC TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS 16100,0001, IN ADDITION TO THE
COST OF COMPENS-; ION, 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:
J I have 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 th,
cgrformance of the work for which this permit is issued. Policy No.
have 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'
rance carrier and policy number are:
ie of Agent
certify that, in the p,
. if I should become
re of
Policy Number
Date
Ice o the work for his % i Issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
to th workers c pe atic provi I f Section 3700 of the Labor Code, I shall forthwith comply with those provissi(ons. for his
Date Z'Z.�L Z Z
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, Civil Code).
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 ed is Gorr
I agree to comply with all applicable city and countydinan s and sta la relat' g to building construction.
I authorize representatives of this city or county to nter the ove-i inspection purposes. A
of
Print Property Owner's or
2z71
ACTION
DATE
BY
DECLARATION OFCOMPUANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF T/RE40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS N077FICATION TO:
❑ EPA
❑ AOMD—
%�] ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
, WOPOSED DEMOLITION.
PERMIT CANCELLED
PERMITEXTENDED
_
PERMIT FINAL
CERTIFICATE OF'
SIGNATURE: �(
OCCUPANCYISSUED