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H2020-0010 - Permits
City of Newport Beach - Building Division III III IIIIIIIIIIIIIIIIIIIIIIIIII0IIIIIIIIIIIII MECHANICAL Permit: H2020-0010 k"r 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 0 0 0 1 0 Project No Permit Counter Phone (949)644-3288 �'�l(�("°/�9 CONSTRUCTION Yom+ -� "" CONSTRUCTION NOISE Inspection Requests Phone (949)644-3255 HVAC Items ON THE WEEKENM.,r' co Job Address: 308 HAZEL DR BIdg:1 Floor: Suite: FEES Description of Work: MECHICHANGE OUT (E) F.A.0 W/SOME DUCT WORK (+40 LF) FurnacesBoilers & Compressors Ventilation 1 M Inspector Area:5 Code Edit: 2019 Other Legal Description: TRACT NO 673 BLK A LOT 47 AND POR ABAND STIR (GLEN DRIVE) 1 ( ) Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Owner: EPIFANIO PETER ANZALDO Contractor: SERVICE CHAMPIONS HTG Worker's Comp Insurance - Over IOOK BTU/hr: Address: 308 HAZEL DR Address: 3150 E BIRCH Carrier: EVEREST NATIONAL INS CO $0.00 CORONA DEL MAR, CA 92625 0 $0.00 BREA CA 92821 Policy No: RM8WC00044191 Phone: Phone: 714-777-7777 Expire :05/29/2020 .71 0 Con State Lic: 799170 0 $0.00 Metal Fireplace: Issued Date:01/07/2020 Lic Expire: 10/31/2021 Heat Pumps & Package Units >30 HP to 50 HP Bus Lic: BT01080105 Y� w aaa `�fIHII"ii/`4 RAN HE 0 $0.00 Processed By: Lic Exp Date: 07/31/2020 Up to IOOK BTU/hr: HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 1 $20.00 Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Over IOOK 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 IOOK 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 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 IOK 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: $75.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $75.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday 7:061 aah!tb 6:3PP,q.rrE.and Satvrday from 8:00 a.m. to 6:00 p.m. 0 0 . .•. . o o e o ® oo • • m o m m . o•• m o oo• m • o omo o• • o 0 0 0 o a m e • • • o o m o c • e • • 00 o c m • o D o m o 0 eoe •e ee • • ••• •• )WNER-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 applicable item(s) Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, altar, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for is 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 'rofessions 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 of 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 (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, lusiness 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 nprovements 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 nproved 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 pply 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: ly 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 legalq ell 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 'rofessions 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 .ICENSED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 00 of 'sDivision 3 of the Business and Profess.f,. y -license is in full force nd effect./' icense Class License No Date Contractor Signature YORKERS' COMPENSATION DECLARATION DARNING: 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 ($100,000), 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: 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 th grformance 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' compensatiol lance carrier an!!;g y number are: TierExpiration Date Tie of Agent r ' l 71 Phone # certify that, in the performance of the wor arWhich this permit is issued, I shall not emplo an person in any manner so as to become subject to the workers' compgnsation laws of California, and agree t, if I should become sub' co ensation r ' ' o t e Labor Code, s a orthwith comply with those provisl ns. nature of Applicant Date Y� t CLARATION REGARD NN LENDING AGENCY T Ireby 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 ar d£y-D ses� state laws relatin u�IdiHg-ceRskuction— I authorize representatives of this city or county a dentlP property for inspection purposes. /�(2� v�'�%�//P^7 nature of Property Owner or Authorized Agent a Print Property Owner's or Authorized Agent's Name Jam!/ (/Vl� � Date �\ ' I L k ACTION DATE BY DECLARA ION OF COMPLIANCE KgTH CODEOF FOR OFFICE USE ONLY E()ER.gt GULATJQMSPART61OFTITLE40AN0 AQMD RUL 1403. 0. I--dBilt DAS1XS109•NO7IFICATION To: •• a. RD PERMITEXPIRED �•• PERMITCANC€LLED • PERMITEXTENDEDAQ ASBEST S N077FIC47IONIS NOTAPPLICABLE TO ..PJ?OP.OSE LI Tim. 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