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HomeMy WebLinkAboutH2020-0632 - Permits>&w City of Newport Beach - Building Division IIII�IIIIIII�IIIIIIIIIIIIIIIIII�IIIIIIIIIIIII
100 Civic Center Drive, Newport Beach, CA 92660 H 2 8 2 8 0 6 3 2
Permit Counter Phone (949)644-3288
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MECHANICAL Permit: H2O20-0632
Project No: 2519-2019
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : OAK RIVER
Policy No: BAWC125355
Expire :10/22/2021
li%lic
Job Address: 1021 BALBOA BLVD W Bldg:1 Floor: Suite:
Description of Work: MECH (2) A/C UNITS *TAMPER PROOF CAP
REQ*
Inspector Area:1 Code Edit:
2019
Legal Description:
° ° ° ° • °
FurnacesBoilers&Compressors
Owner: DA LIU DAVID & PENG TINA
Contractor:
BASIC AIR INC
Address: 1021 W BALBOA BLVD
Address:
1157 SALINAS AVENUE
NEWPORT BEACH CA 92663
°••®
Other •°...°
COSTA MESA CA92626
Phone:
Phone:
714-469-4542
Up to 3HP:
Con State Lie:
909834
Issued Date:10/27/2020Lie
Expire:
01/31/2022
0 $0.00
Bus Lie:
BT30045172
Processed By:
Uc Exp Date:
10/31/2020
MECHANICAL Permit: H2O20-0632
Project No: 2519-2019
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : OAK RIVER
Policy No: BAWC125355
Expire :10/22/2021
HVAC Items
FEES
° ° ° ° • °
FurnacesBoilers&Compressors
Ventilation
®•
�eoe^^^
•ooeo•�
R. oe°•
°••®
Other •°...°
••
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
2
$42.00
•°°
0 $0.00
Fire Dampers:
0 $0.00
•
Over 1OOK BTU/hr:
0
$0.00
> 3 HP to 15 HP:
°•
. . °
HVAC Items
FEES
° ° ° ° • °
FurnacesBoilers&Compressors
Ventilation
°••®
Other •°...°
°
°°°'
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
2
$42.00
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:
$36.54
Up to 1M BTU/hr:
0
$0.00
up to 10K CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
NH4A448AKAIssuance:
$37.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0
$0.00
Supplemental Fee:
$0.00
Manufacturer:
FERGUSON
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0
$0.00
Zoning PC:
$46.25
TOTAL:
$161.79
Plan Check Fee:
$0.00
Fee Due at Permit Issuance :
$161.79
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 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, providedAhat 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 legall)
sell a structure that I hate 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 Coda, %*04ilable 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
Ia�I INdED CONTT2 NCTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencin ith Section 7000) of Division 3 of the Business a Profess' s de, and my license is in full force
LicenseggClass •C •-• ZZ7 License No \ I JL� Da �—� w Contractor Signatur
T
W;Rk!RS' COMPENSATION DECLARATION
YJ(1[tyIP FAILUREO.SECI?RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP To ONE NORED TH ND DOLLARS ($100,000), IN ADDITION TO THE
C CIJMPENSADON, DAMAGES AS PROVIDED FOR IN SECTION 6706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I Rdree8l affirm under penalty of perjury one of the following declarations:
.I:havhav
g and uYill rrlSlQtain 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, forth
pe ormance of tho work for which this permit is issued. Policy No.
�b%ve•and wiUM&Aain 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
nra rarrier 9htlklblicv number are:
Policy Number
Date
ne of Agent
certify that, in the pert rmance of the work or which this permit is issued, I shall not employ any person in any manner so as to become subject to a workers' compensation laws of California, and agre
t, if I should becom bject to the r ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those pr visi s.
nature of Applicanpealty
Date D Z%
CLARATION REGG NSTRUCTION LENDING AGENCY
:reby affirm under of perjury that there is a construction lending agency for the performance of the work for which this permit is issued/e tion 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. n 1
I have read this application and the information I have provided is correct. J
I agree to comply with all applicable city and county ordinances ad state laws relating to building construction. / �J—
I authorize representatives of this city or county enter enter 6 -identified property for inspection purposes. /t /��.!�
nature of Prooertv Owner or Authorized Agent I \ "�-- Print Property Owner's or Authorized Agent's Name i i Date
ACTION DATE V BY
UCLLAtt Jrury VV i.a,,a--- —
FEDERAL REGULATIONS PART b9OFT1ILE40ANO
�
AQUD RULE 1403.
❑ 1 SUBMfTrEDASBESTOS NODFfCATION TO:
❑ EPA
[I AQMD
❑ ASBESTOS DEMOLITION. iONISNOT APPLICABLE TO
PROPO5EDDEMOIITION.
SIGNATURE:
PERMITEXPIRED
PERMIT CANCELLED
PERMITEXTENDED
PERMIT —FINAL
CERTIFICATEOF
OCCUPANCYISSUED
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