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Home My WebLink AboutH2010-0297 - PermitsCity of Newport Beach Building Department MECHANICAL Permit No: H2010-0297 PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 Job Address: 1 (44) HOAG DR BIdg:1 Floor: Suite: Description of Work: MECH/NEW AIR HANDLING UNIT 2000 CFM "CONFERENCE CENTER" (UPS ROOM) (PER RB-WILL CK IN FIELD) Inspector Area:7 Code Edit : 2007 Legal Description: Owner: HOAG HOSPITAL FD & C Address. 500 SUPERIOR AVE #300 NEWPORT BEACH CA 92663 Phone: 949-764-4486 Issued Date:10121 /2010 Processed By: Contractor: Address - Phone: Con State Lic: Lic Expire: Bus Lic: Lic Exp Date: AIRTRONIX INC 17595 HARVARD, STE C#513 IRVINE CA 92614 949-679-5571 950389 07/31/2012 Worker's Compensation Insurance - Carrier : STATE COMP Policy No: 1943411-10 Expire :03/01/2011 HVAC Items Furnaces Up to 100K BTU/hr: 0 $0.00 Over 100K BTU/hr: 0 $0.00 Wall/Floor Heaters: 0 $0.00 Heat Pumps & Package Units Up to 100K BTU/hr: 0 $0.00 Over 500K BTU/hr: 0 $0.00 Up to 1M BTU/hr: 0 $0.00 Up to 1.75M BTU/hr: 0 $0.00 Over 1.75M BTU/hr: 0 $0.00 Boilers & Compressors Up to 3HP: 0 $0.00 >3HPto15HP: 0 >15 HP to 30 HP: 0 >30HPto50HP 0 >50 HP: 0 Air Handling Units up to 10K CFM: 1 Over 10K CFM: 0 VAV Box: 0 TOTAL : $50.15 $0.00 $0.00 $0.00 $0.00 $12.80 $0.00 $0.00 FEES Ventilation Bathroom Fan: 0 $0.00 Exhaust Fan: 0 $0.00 Attic Fan: 0 $0.00 Down -Draft Fan: 0 $0.00 Residential Hood: 0 $0.00 Comm. Hood: 0 $0.00 Repair/Alter/Add: 0 $0.00 Plan Check Fee : $0.00 Misc Fire Dampers: Gas Line: Metal Fireplace: ICBO App. #: 0 0 0 $0.00 $0.00 $0.00 Other $0.00 $0.00 Record Mgmt Fee: $1.05 Investigation: $0.00 Plan Check: $3.20 Issuance: $33.10 Supplemental Fee: $0.00 Fee Due at Permit Issuance : $50.15 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION •.• ••. •.• .•. • • • • • • •. • • • • •. • • ••• • •• •• • •• •••• • • •. ••• •• • : • • • :• :• •.. . •• • • • • •••. • l LP4wo- 7-799- /boa 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 J all of or f 1 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 propertywho through employees' or personal effort, builds or improves the property, oneyea oftpthemOwneare r-Builder t intended 111 have the or sale. provingthatnot built improvement rrofor the purpose of sale). completion,p 9 P ❑ 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 w). ❑ I 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 pnor 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:httpi/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 1 am licensed under provisions of / apter 9 (commencing with Section 7000) of Division 3 of the Business d Professions Code, and my license is In full forc:; d effect. Liven e Class License No. Date i (� Contractor Signat�re��aArr WORKERS' COMPENSATION DECLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVEREGE I N AWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,00(), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3700 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. I 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 Indu trial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is No. have and will maintain workers' compensation Insurance, as required. by; Section 3700 of the Labor Code, for the ance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: er Policy Number Expiration Date Name of Agent Phone # ❑ t certify that, in the performance o work for which this permit is issued, I shall not employ anyperson in any manner so as to become subject. to, the wo C': ompensation laws of California and agree that if I should become subjefct to the workers' compensation pirovi. of Vii"� n 3�1,t. e Labor Code, I shaft forthwith comply with thgserovisi ns Signature of Applicant j�� Date "^ - DECLARATION RE :SST %`'STRUCTION LENDING AGENCY I hereby affirmunof perjury that there is a construction lending agency for the performance of the work for which this permit is issued _ 'on 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 own =behalf. I have read this application and the information I have provide • correct. I agree to comply with all applicable city and county ordi st..:.: relating to buildingconstruction. I authorize.representatives of this city or count to ert-�'. = ntified property for inspectin pu •ose Signature of Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name: Date ACTION DATE: BY: PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED PERMIT FINAL 4-G 1l CERTIFICATE OF OCCUPANCY ISSUED FOR OFFICE USE ONLY • ••• ••• �•• • •• .•. • •• es • • •• • • • • .• • •• • • •• • • •• ••• • • • • • • • • • •.. • • • • • • • • •• • •• • • 01/01/2009 I •• •• •••