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Home My WebLink AboutH2020-0179 - Permitst,4 City of Newport Beach - Building Division IIII�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII MECHANICAL Permit: H2O20-0179 100 Civic Center Drive, Newport Beach, CA 92660 H 2 H 2 0 0 1 7 9 p Project No :0038-2020 F. u. Permit Counter Phone (949)644-3288 0Y��iPtl%�.Y" 0 Inspection Requests Phone (949)644-3255 Job Address: 1700 SKYLARK LN BIdg:1 Floor: Suite: Description of Work: MECH/INSTALL (1) NEW A/C UNIT 43dB (STAR AIR; SAK-12DTMS229V) InspectorArea:3 Code Edit: 2019 Legal Description: N TR 3082 LOT 63 Owner: MATSLER SEANINATALIE Contractor: GRAVES M H INC Worker's Comp Insurance - Address: 1700 SKYLARK LN Address: 5852 MULLER ST Carrier: OAK RIVER INSURANCE NEWPORT BEACH, CA 92660 BELL GARDENS CA 90201 Policy No: MHWC127932 Phone: Phone: 562-833-3703 Expire :01/0112021 Con State Lic: 241731 Issued Date:04/071202 Lic Expire: 03/31/2022 Bus Lic: BT30034436 Processed By: Lic Exp Date: 04/30/2021 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 : $0.00 Investigation: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $17.40 Up to 1M 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 1 OK 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: $113.90 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $113.90 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 6:09 p.rnv o ° OO O O O O B O° GOO O 00 0°0 0 °°• c c c coc o ° e c c oc o 0 000 000 0 o aoU o0 omo 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 applicable item(s) (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 legalll 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 Se ion 000 of Division 3 of the Business and Professions Code, and my license is in full force and effect. `` .. License Class ( 'T6 License No i Dae Contractor Signaturel/ NORKERS' COMPENSATION DECLARATION NARNING: 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 COST 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: ❑ 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 th (ysu .rmance 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 of the work for which this permit is issued. My workers' compensationce carrier and policy number are: Policy Number Expiration Date Name of Agent Phone # ❑I certify that, in the performance of/e wor r which this permit is issued, I shall not employ any person in any manner so as to become subject to thew rker 'compensation laws of California, and ogre that, if I should become su t to t works compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. w,�e, Signature of Applicant Dam �(/ DECLARATION REGAR RUCTION LENDING AGENCY I hereby affirm under pen y 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: �,� f� I am the property owner or authorized to act on the property net's half. �„ p �. „ �� _ r� I have read this application and the information I have prov' disc rect. i��W� �V�(� /�.`/w�,�k I agree to comply with all applicable city and county ordi es state laws relating to building construction. �,(� 1 authorize representatives of this city or county t ente ab -ide ' roperty for inspection purposes. /� /!W Sionsture of Prooertv Owner or Authorized Agent Print Property Owners or Authorized Agent's Name Date ACT70N DATE BY uct,r_t flvn VV rnu v,., y, FEDERAL REGULATIONS PART 61 OFTITLE40AND AQMD RULE 1403. PERMITYXVIRE90 . � � . : ❑ I SUBMITTED ASBESTOS N071FIC4TION T0: PERMITCAfY LLEQ •� •.i �,� �• ❑ EPA PERMIT EXTENDED [3 AQMD ❑ ASBESTOS NO77FICA770NIS NOT APPLICABLE TO PERMITFINAI. ;; PROPOSED DEMOLITION. CERTIFICATEOF : SIGNATURE: OCCU RANCY;RW