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Home My WebLink AboutH2021-0691 - Permitsorwt'n% City of Newport Beach - Building Division H2O21-0691 w -� 100 Civic Center Drive, Newport Beach, CA 92660 rw , n Permit Counter Phone (949)644-3288 Job Address: 1865 PORT CARLOW PL Bldg:1 Floor: Suite: Description of Work: SFR MECH - REPLACE FURNACE Inspector Area:4 Code Edit: 2019 Legal Description: N TR 6938 LOT 11 Owner: CIMBALUK JULIAN & SUSAN Contractor: Address: 1865 PORT CARLOW PL Address: NEWPORT BEACH, CA 92660 Phone: 714-829-0134 Phone: Con State Lie: Issued Date:12/0712021 Lie Expire: Bus Lie: Processed By: 5--5 Lie Exp Date: MECHANICAL Permit: H2O21-0691 Project No : 2735-2021 Inspection Requests Phone (949)644-3255 SERVICE CHAMPIONS HTG Worker's Comp Insurance - - 3150 E BIRCH Carrier: EVEREST NATIONAL INS CO BREA CA 92821 Policy No: RM8WC00054211 - 714-777-7777 Expire :04/01/2022 - - 799170 •'--- 10/31/2023 BT01080105 07/31/2022 HVAC Items FEES Other Furnaces Boilers & Compressors 1 $22.00 Ventilation Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Up to 100K BTU/hr: 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 $0.00 Heat Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: Residential Hood: 0 $0.00 0 $0.00 Record Mgt Fee: Additional Fee : $0.00 Investigation: $0.00 Up to 1oOK BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Comm. Hood: 0 $0.00 Plan Check: $0.00 Over 500K BTU/hr: 0 0 $0.00 $0.00 Air Handling Units up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: Issuance: $38.00 up to 1 M BTU/hr: Up to 1.75M BTU/hr: 0 $0.00 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 TOTAL: $60.00 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $60,00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:00 a.m.to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m. CE cn 11 ■ JI a:aJ 31J A_\.71\ I Lill P 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 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 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 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 )-censure under the Contractors' State License Law for the following reason: 3v 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) -ell a st-ucture'hat 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htm1. 31gilatule of Property Owner or Authorized Agent Date LICENSED CCNTRACTOR'S DECLARATION ' hereby affirm ur.da: ,penalty of perjulhat I am licensed under provisions of Chapter 9 (commencing with Sectio 7 00) of Division 3 of the Business and Pr3fessi s Code, and y.lieerr�aI is in full force and effect. a rt Li. unsa Class License No Date Contractor Signature X wvORKERS' COI`.9PENSATION DECLARATION v MARNING; FAILURE TO SE )RE 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 DST OF 90MPENLATIOd, LAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. h 3 Eby affirm under penalty of perjury one of the following declarations: ,, I nave 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 )erformance 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: is of Agent -1 VI certify that, in the performance if I should become subject ta( lature of Applicant x Policy Number Expiration Date ,emit is issued, I shall not employ any person in any manner so as to become subject to the workers' com ensation laws of California, and agre provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ions. � Date ,\ l--I // 2/ Cl�lI1lV\I Iury rtemranulN OB I IUN LLNUING AGENCY hereby affirm under penal perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 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 owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county or i es and state laawws.re glattF to building construction. I authorize representatives of this city or county to enter the a lerrllf ad property for inspection purposes. Y y L1 ignature of Property Owner or Authorized Agent X Print Property Owner's or Authorized Agent's Name "/� ir riA1 I r � A�7%L D A j I. Civil Code). ACTION DATE y DECLARATION OF COMPLIANCE KITH CODE OF FEDERAL REGULATIONS PART 61 OF TITLE40AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PROPOSED ASBSOEMOOI77 DCN 71ON IS NOT APPLICABLE TO SIGNATURE: FOR OFFICE USE ONLY PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL `L CERTIFICATE O:F CCCUPANCYISSUED