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HomeMy WebLinkAboutH2019-0819 - Permits1 City of Newport Beach - Building Division 111111111111111111111111111111111111111111111111111 100 Civic Center Drive: Newport Beach, CA 92660 H 2 0 1 9 0 8 1 9 Permit Counter Phone (949)644-3288 s7 4r Job Address: 2110 VISTA ENTRADA BIdg:1 Floor: Suite: Description of Work: MECH -RIR FAU MECHANICAL Permit: H2O19-0819 Project No : Inspection Requests Phone (949)644-3255 Inspector Area:8 Code Edit: 2016 Legal Description: TR 5878 (L.L.84-214031) PAR 9 Owner: BLACK DIANA F Contractor: DEPENDABLE GRAHAM AC Worker's Comp Insurance - Address: 2110 VISTA ENTRADA Address: 2952 CENTURY PLACE Carrier: FALLS LAKE FIRE AND CASUALTY NEWPORT BEACH, CA 92660 COSTA MESA CA 92626 Policy No: FLA000131 Phone: Phone: 714-546-1653 Expire :07/01/2020 Con State Lic: 472690 Issued Date:12/13/2019 Lic Expire: 04/30/2020 ff.. Bus Lic: BT01013104 Processed By: `dI Lic Exp Date: 12/31/2019 HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 1 OOK BTU/hr: 1 $20.00 Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Over 1OOK 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 1OOK 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: $0.00 Up to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: Issuance: $35.00 Up to 1.75M BTU/hr: 0 $0.00 Over 1OK CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $0.00 TOTAL: $55.00 Plan Check Fee : $55.00 Fee Due at Permit Issuance: $0.00 .0 .1. © PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION i �Conytructimn.Hb 1Ps: Mbhyaq'- 9-riday 7:00 a.m.to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m. vy ° o°° °Yo n Y ° 9 Y4• Y• Y• ER -BUILDER DECLARATION 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 item (a) (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 (_) 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 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 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 lega11, 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.html. 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 Sec ion 7 00) of Division 3 of the Busine nlimyl ense and effect. License Class License No Date 1 Contractor Signature NORKERS' COMPENSATION DECLARATION NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($700,000), IN ADDITION TO THE :OST OF COMPENSATION, 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: JormIave 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 ance of the work for which this permit is issued. Policy No. ve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance o he work for which this permit is issued. My workers' compensatiol ce carrier and policy number are: Policy Number ne of Agent Date I certify that, in the per rt�rarteEblt r4 is-pertnit-is-issoed I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree I, if I should become subj am a Ion provisions of Section 3700 o the Labor Code, I shall forthwith comply with those provisions. /pj y nature of Applicant - c Da/ ��CLARATION REGARDI CTION 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 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 have provided is correct. _.. I agree to comply with all applicable city and I r Ing construction. S I authorize representatives of this city or co y o ante I led property for inspection purposes. Signature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Nam /,M Date ACTION DATE BY DECLARATION OF COMPLIANCE fMTNCODEOF FOR OFFICE USE ONLY FEDERAL REGULATIONSPART 61 OFTITL�4ikVD •. • ° • • • •, AQMDRULE1403. • . • ; • •• PERMITEXPtRED ❑ 1 SUBMITTED ASBESTOS N07IFICATQN Td.• PERMIT CANCELLED ❑ EPA • • • ° ° i e • • i ❑ AQMD s PERMITEXTENDED ❑ ASBESTOS M077FICATIONIS NOT APPLICABLE TO PERMIT.FINAL PROPOSED DEMOLITION. • • • • ° CERT RCATE OF OCCUPANCYISSUED SIGNATURE: • ;• ••