HomeMy WebLinkAboutH2019-0604 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
,Permit Counter Phone (949)644-3268:
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MECHANICAL Permit: H2O19-0604
Project No :
Inspection Requests Phone (949)644-3255
Pdl
Job Address: 1325G%BAY AVE W Bldg:1 Floor: Suite:
Description of Work: MECH/CHANGE OUT (E) A/C UNIT 47.5dB @ ROOF DECK (CARRIEJ)t*J71µJ!)yY�I DUCT WORK ( THAN 40 LF)
InspectorArea:1 Code Edit: 2016 IEKEN®
Legal Description: TRACT 626 LOT 3 OF PROJECT 939-71 LOCATED ON AP 047-233-32 ,M
TOGETHER
HVAC Items
Owner: DALLAPE THOMAS G
Contractor:
MC MASTER AIR & HEAT
Worker's Comp Insurance -
Address: 1325 W BAY AVE
Address:
2 MCLAREN #C
Carrier: SENTINEL INS CO LTD
NEWPORT BEACH CA 92661
IRVINE CA 92618
Policy No: 72WECZU8138
Phone:
Phone:
949-481-7995
Expire :02/0212020
Up to 100K BTU/hr:
Con State Lic:
726607
Up to 3HP:
Issued Date:10/02/2019
Lic Expire:
12/31/2019
Fire Dampers:
0 $0.00
Bus Lic:
BT30041972
Over 100K BTU/hr:
Processed By:
Lic Exp Date:
01/31/2020
0 $0.00
HVAC Items
FEES
FurnacesBoilers & Compressors
Ventilation
Other
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
1 $20.00
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 100K BTU/hr.
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$17.40
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$0.00
Up to 1M BTU/hr:
0
$0.00
up to 1 O CFM:
0 $0.00
Repair/Alter/Add:
1 $20.00
Model:
Issuance:
$35.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
Over 1.75M BTU/hr.
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$41.50
TOTAL:
$133.90
Plan Check Fee :
$0.00
Fee Due at Permit Issuance:
$133.901,
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PERMITS EXPIRE 180 DAYS AFTER IS�CUAfky OR�Arp VALID INS PECO6GT,'ON
Construction Hours: Monday - Friday 7:00 a.m.tg 18:3q pam!artd Gaturday from 6-:0b a.m. to 6:00 P.M.
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OWNER -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 applicabe item(sj
(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 requirewthe 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 civll'penalty of
not more than five hundred dollars ($500).
❑ 1, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or L) 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
im 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 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 licensure under the Contractors' State License Law for the following reason: - - - -
By 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
sell 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
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business a6fessioode, and my license is in full force
and effect. ,�/License Class —Z License No —7 v` Date Contractor SignatuWORKERS'COMPENSATION DECLARATION
NARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TOONE D DOLLARS ($100,0001, IN ADDITION TO THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 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 thr
oerformance 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' compensatio
insurance carrier glicy number ar
Carrier 1 RJu Expiration Date
Name of Agent Phone #
I certify that, in the perfo mance of th 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 agre
that, if I should become ubjact to th orkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. II/�
Signature of Applica Date/b1/1 I
DECLARATION RE ING 0NSTRIICTf6N LENDING AGENCY
I hereby 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).
Lender's Name Lenders Address
By my signature below, I certify to each of the following:
I am the property owner or authorized to act on the p ner's behalf.
I have read this application and the information I ve provided s correct.
I agree to comply with all applicable city and c my ordi a and state laws relating to building construction.
I authorize representatives of this city or count o h ve-dentified pr or inspection purposes. 1` ,--(J —�
Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name,( IW
ACTION
DATE BY
DECLARATION OF COMPLIANCE VWTH CODEOF
FOR OFFICE USE ONLY
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