HomeMy WebLinkAboutH2015-0557 - Permitssar�4 City of Newport Beach - Building Division IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII II
100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 5 0 5 5 7
Permit Counter Phone (949)644-3288
MECHANICAL Permit: H2O15-0557
Project No :
Inspection Requests Phone (949)644-3255
Job Address: 2107 VISTA ENTRADA Bldg:1 Floor: Suite:
Description of Work: MECH/bUCTING
Inspector -Area 3 Code Edit: 2013
Legal Description: TR 5878 (L.L.84-214031) PAR 17
Owner: HILLMA 7RALPH D Contractor: SERVICE CHAMPIONS HTG Worker's Comp Insurance -
Address: 2107 VI A &VI 7 J 6ddress: 22911 SAVI RANCH Pl(ffYapplicable: Carrier: PACIFIC COMP
NEWPO T B A INDA CA 92887 Policy No: ��,W{{A4'0r0060700
PhonerB
ne 7 ❑ 50% Of E�%/�2%��i'6
plre .
St 99170
Issuedk5p / 2 t0 Whom: —.
CBus 10
Proces Lic Exp Date: 07/31/2016
rnacesBoilers & I
to 100K BTU/hr:
onnores$ors
0 $0.00
Ventilation
Up to 3HP:
0 $0.00
Bat Fa
0 $0.00 Fire Dampers:
room
0
er 100K BTU/
ill/Floor Heaters:
0
0
0
$0. rm%
> 3 HP to 15 HP:
0 $0.00
Q .00
Exh
Atli F
• 0 0. s 0
total i I G: 0
at Pumps & Pack ge
> t 0
�sE $
Do
0. eco Fee:
to 100K BTU/hr:
0
$0.00
ttar{
.00
0 $0.00
gt
R idential Ho�Ao QVOrpstart )onal Fee
ar 500K BTU/hr:
0
�,��SQJI)P�
$0.00
l an�Yng nt
Comm. Hood:
0 $0.00
to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
1 $18.00 Model:
to 1.75M BTU/hr:
�1o11%00
Over 10K CFM:-
-0 $0.00
Supplemental Fee-
yPO.on ti9anufactucer
ar 1.75M BTU/hr:
0
0.00—
Box:
0 $0.00
i17St.1. EilltiaiS:-4�0s....
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
� 000e
Other `°°° °
$0.00 $0.06
$0.00 $0.00
$0.00 °°°°°
00 °
$0.00 Investigation: $0.00
Plan Check: $0.00
Issuance: $32.00
$50.00
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)
ction 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
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
fessions Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.6 by any applicant for a permit subjects the applicant to a civil penalty of
more than five hundred dollars ($500).
I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
;iness and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
rovements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner -Builder will have the burden of proving that it was not built or
roved for the ouroose of
LJ I, as owner of the prop
apply to an owner of props
❑ 1 am exempt from Iicel
By my signature below I a,
sell a structure that I have
Professions Code, is avail
Signature of Property Owr
LICENSED CONTRAC
I hereby affirm under pens
and effect. .
License Class ••••••
OP COMPENSATION, DAMA
ft affirm under penait,
Ale and %Il gVfhtail
nce ofIllevirk for
sv and will aairsain
e carrier apd policy
am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The
ho r
§improves thereon, and who contracts for the projects with a licensed Cpstractor pursuant to the Contractors' State Lic
IT O ifCC1018:
un dntraetors`3tatetieenseiaarforthe-following-reason.--_ ��
vledge that, except for my personal residence in which I must have resided for at least one year prior to completion of the improve
as Sgissmumi if LtAawot ban cont lcte0$in it ggjcety&e}, sW contra toJs8"Srs8pd�t J-8:&� th@�R��able
Signature
IINAL PENALTIES AND CIVIL FINES UP TO ONE
following declarations:
certificate of consent to self -insure for workers' compensation, issued by. the Director of Industrial Relations as provided for
ch thi_,e, Wmit is issued. Policy No.
Rion 3700
of
Date
....
.GEitffY that,:rf 4lepgrfor a ``��of��the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the
should become subj telyq,Qprkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those 'ions.
�—
ture of Applicant ��
CLARATION REGARDIN CQNSTRII T,�_lOnl LENDING AG NCY 'n$ 1331Lf s:
-reby affirm under penalt f er u that there is a construction lending agency for the performance of the work for which this per Is issued (Section
�L tl€F
lder's Name a
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 county ordinances and state laws relating to building construction.
I uthorize representatives of this city or county t teer the above -Id Ified property for in ec n purposes.
ure of Prooertv Owner or Authorized Agent Z��— r' Property Owner's or Authorized Agent's Name
ACTION I DATE I BY
PERM11 CANCELLED ✓
PERMtTEXTENDED
61 OFTITLE40AND
❑ I SUBMITTEDASBESTOS NOTIFICATIONTO:
❑ EPA
❑ AQMD
❑ ASBESTOS N077RCATTOMIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
OCCUPANCYISSUED I I SIGNATURE:
State License Law does not
Law).
s covered by this permit, I cannot
Section 7044 of the Business and
Date
Code, and my license is in full force
DOLLARS ($100,000), IN ADDITION TO THE
Section 3700 of the Labor Code, for
this rrermit is issued. My workers'
compensation laws of California, and
Code).