HomeMy WebLinkAboutH2018-0768 - Permitsq.4Y1'Dk City of NewportBeach - Building Division III�IIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIII
100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 8 0 7 6 8
w n Permit Counter Phone (949)844-3288
Job Address: 1520 KINGS RD Bldg:1 Floor: Suite:
Description of Work: MECH A/C UNITS (4) *TAMPER PROOF CAP REQ'
Inspector Area:2 Code Edit:
2016
Legal Description: N TR 1219 BILK F LOT 3
FEES
Owner: TROESH JON & ELSA
Contractor:
D L S HEATING & A/C
Address: 336 CATALINA DR
Address:
8542 LARTHORN DRIVE
NEWPORT BEACH, CA 92663
Ventilation
HUNTINGTON BEACH CA 92646
Phone: 951-760-4230
Phone:
714-231-8002
Con State Lic:
584220
Issued Date:12/10/2018
Lic Expire:
01/31/2020
�5Q�Lic
Bus Lic:
BT98040420
Processed By:
Exp Date:
12/31/2018
MECHANICAL Permit: H2O18-0768
Project No : 1663-2017
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : FALLS LAKE
Policy No: FLA008068
Expire `.01/01/2019
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HVAC Items
FEES
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FurnacesBoilers & Compressors
Ventilation
Other
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
4 $76.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0 $0.00
$0.00
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
Heat Pumps & Package
Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
Up to 1o0K BTU/hr.
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$66.12
Up to 1M BTU/hr:
0
$0.00
up to 1OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$35.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
DAY & NIGHT
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$40.00
TOTAL:
$217.12
Plan Check Fee:
$0.00
Fee Due at Permit Issuance:
$217.12
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.
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 iteryRs)
(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 Br-�ness 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 c'vkfl>-alt- 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 (_) all of or `) 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
roved for the purpose of sale).
LI 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 riot
apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractorpursuant to the Contractors' State License Law).
❑ I am exempt from licensure under the Contractors' State License Law for the following reason:
By my signature belpw 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 Viet hhave 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:hftp://www.leginfo.ca.gov/caiaw.htmi.
SiVaature of rtopgft; Owner or Authorized Agent Date
LICENSED OONTRACTOR'S DECLARATION
I refeyy affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencingPERTOCMMINAL
000) of Division 3 of the Business nd Brafese' ns C d my license is in full force
and effect. . • '--�
License CIas9"'.: License No DatContractorSignatu eNORKERS'GOMPENSATION DECLARATION
NXWONG: FAILUI!16iOSECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLO PENALTIES AND CIVIL FINES UP TO NE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
pR COMPENSAT ION, DAMAGES AS PROVIDED FOR IN SECTION 37DS OF THE LABOR CODE, INTEREST, AND ATTORN
rg�p: affirm u� der pgnally of perjury one of the following declarations:
�IhNaeoe and'4G71•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 the
Ierince of toe Ipprk for which this permit is issued. Policy No.
K•ITeNe wiY m
and aintain 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' compensation
su ce carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
I certify that, in the perfo ante work for hich this permit is issued, 1 shall not employ any person in any manner so as to become subject the workers' compensation laws of California, and agre
that, if I should become sub' ct the rk ' ompensation ns of Section 3700 of the Labor Code, I shall forthwith comply with those prov' ions.
Signature of Applicant Dat
DECLARATION REGAR IN ONSTRUCTION LENDING AGENCY
I hereby affirm under pe alty 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).
Lender's Name Lender's Address
By 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 ave provided is correct.
I agree to comply with all applicable city and co my o ' aHres and state laws relating to building construction.
I authorize representatives of this city or count toe er t / -identified pro rirt"spection purposes. _
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name/D_6fy4'. fU Ce to U
ACDON
DATE By
DECLARATION OFCOMPLIANCEWITRCODEOF
FOR OFFICE USE ON
FEDERAL REGULATIONS PART fit OF 1771 E40AND
AQMDRULE1403.
PERMfTEXPIRED
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