HomeMy WebLinkAboutH2018-0718 - Permitsxr, City of Newport Beach - Building Division- IIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIII
FEES
•nacesBoilers & Com
ressors
100 Civic Center Drive, Newport Beach, CA 92660
H 2 0 1
8 0 7 1 8
.i Permit Counter Phone (949)6443288
to 100K BTU/hr:
1
$19.00
Up to 3HP:
1 $19.00
Bathroom Fan:
Job Address: 111 VIA QUITO Bldgil Floor: Suite:
Fire Dampers:
Description of Work: MECH/ AIC, FAU C/O & DUCTING "TAMPER RESISTANT CAP REQ"
Inspector Area:1 Code Edit: 2016
$0.00
Legal Description: N TR 907 LOT 134
0 $0.00
Owner: RANI I, N Contractor:
SHALOM HEATING & AIR
Address: 11117NIA QUITO Address:
9191 VIA BALBOA CIR
WPORT BEAC , CA 92663
BUENA PARK, CA 90620
Phone: Phone: i
714-886-2021
Con State Lic:
967182
Issued D te:11/13/2018 Lic Expire:
10/31/2019
Bus Lic:
BT30065018
Processe By: Lic Exp Date:
11/30/2019
MECHANICAL Permit: H2O18-0718
Project No :
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance - ° e
Carrier: NORGUARD °0°°•°
Policy No: JOWC946078 ° o mem
Expire :04/11/2019
AC Items//
FEES
•nacesBoilers & Com
ressors
Ventilation
to 100K BTU/hr:
1
$19.00
Up to 3HP:
1 $19.00
Bathroom Fan:
0 $0.00
Fire Dampers:
:r 100K BTU/hr:
0
$0.00
> 3 HP to 15 HP:
0 $0.00
Exhaust Fan:
0 $0.00
Gas Line:
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
1t Pumps & Package
Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
to 100K BTU/hr:
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee
:r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
to 1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
0 $0.00
Repair/Alter/Add:
1 $19.00
Model:
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
�r 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
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0 $0.00
0 $0.00
0 $0.00
$0.00
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Other
$0.00°emc
$0.00
$16.53 Investigation:
Plan Check:
4A7L6036AIssuance:
AMERICAN STND
Zoning PC:
TOTAL: $148.53 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $148.53
PERMITS EXPIRE 180 DAYS AFTERISSUANCE 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.
$0.00
$0.00
$35.00
$40.00
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark(s) I have placed next to the applicable items)
action 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
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
�fessions 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
more than five hundred dollars ($600). r„
I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
riness 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
Irovements 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
(roved for the purpose of sale).
1, 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
fly 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 am exempt from licensure under the Contractors' State License Law for the following reason:
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
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
fessions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
nature of Rrop"40wner or Authorized Agent Date
TENSED CONTRACTOR'S DECLARATION
Hit, affiar6l=rli 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, and my license is in full force
I effect.
31 Class • License No Date '' Contractor Signature —�
)RKERS' P.QIJpPgNSATION DECLARATION
MINS: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100,000), IN ADDITION TO THE
it 5F COMPEdSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
ftg affirm':4Aerjenalty of perjury one of the following declarations:
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 thf
�'b • nce of the work for which this permit is issued. Policy No.
�� and will maiAtain 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
Ira a carriei•and%olicy number are:
fi r • • • Policy Number Expiration Date
of Agent
certify that, in the performance of the work for which 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 agrer
I, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
nature of Applicant\!0% S Datez �/'�3•��75
CLARATION REGAR ING CO ST LENDING AGENCY
:reby 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 provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or countyr he -id 'led r 13yior inspection purposes. _
nature of Prooertv Owner or Authorized AGent nt Print Progertv Owner's or Authorized Aqent's Name^ ? —�
ACT70N DATE BY
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FEDERAL REGULATIONS PART 61 OFTITLE40AND
AQMDRULE1403.
PERMITEXPIRED
❑ I SUBMITTEDASBESTOS NG7IFICATION TO:
❑ EPA
❑ AQMD
PERPAITCANCELLED
PERMITEXTENDED
PROPOSED DEMOUTfON TTONIS NOT APPLICABLE TO
PERMITPINAL
CERTINCATEOF
SIGNATURE:
OCCUPANCYISSUED