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Home My WebLink AboutH2015-0388 - Permits (2),wab� City of Newport Beach - Building Division IIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIIIIIIIII II 4 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 5 0 3 8 8 H Permit Counter Phone (949)644-3288 st e Job Address: 2183 VISTA ENTRADA Bldg:1 Floor: Suite: Description of Work: MFR - CONDENSER & FAU C/O "TAMPER RESISTANT CAP REQ" InspectorArea:3 Code Edit: 2013 Legal Description: TR 5878 (L.L.84-214031) PAR 61 Owa2183VI ER MARCELLA Contractor: AdA ENTRADA Address: BEACH CA 92660 PhPhone: Con State Lie: Iss Lie Expire: Bus Lie: Pr Lie Exp Date: to 100K BTU/hr: 1 $19.00 ar 10oK BTU/hr: 0 $0.00 II/Floor Heaters: 0 $0.00 at Pumps & Package Units to 100K BTU/hr: 0 $0.00 -r500K BTU/hr: 0 $0.00 to 1M BTU/hr: 0 $0.00 to 1.75M BTU/hr: 0 $0.00 :r 1.75M BTU/hr: 0 $0.00 Boilers & Compressors LEWIS AIR SERVICES 23121 ANTONIO PKWY#155 RANCHO SANTA MAR CA 92688 949-589-0609 972182 04130/2016 BT30046705 12/31/2015 Up to 3HP: 1 $19.00 > 3 HP to 15 HP: 0 $0.00 >15 HP to 30 HP: 0 $0.00 >30 HP to 50 HP 0 $0.00 >50 HP: 0 $0.00 Air Handling Units up to 1 OK CFM: 0 $0.00 Over 10K CFM: 0 $0.00 VAV Box: 0 $0.00 MECHANICAL Permit: H2O15-0388 Project No : Inspection Requests Phone (949)644-3255 Worker's Comp Insurance- INFECTOR... Carrier: NORGUARD INS SUBTFCTT0FV!191NSPHCT0R'S Policy No::LEWC649494 REVIEW ANDAPPR(-YVz Expire :0612412016 m m oomo m o m• o FEES Ventilation Misc Bathroom Fan: 0 $0.00 Fire Dampers: 0 Exhaust Fan: 0 $0.00 Gas Line: 0 Attic Fan: 0 $0.00 Metal Fireplace: 0 Down -Draft Fan: 0 $0.00 ICBO App. #: Residential Hood: 0 $0.00 Additional Fee Comm. Hood: 0 $0.00 Repair/Alter/Add: 0 $0.00 m mm 0 0 o mmeoc mmmo m �� VERINGA`TICILV toy cemeoo 0 00o m 0 o m momo Other $0.00 $0.00 $0.00 $0.00 $0.00 Record Mgmt Fee: $0.00 $13.68 Investigation: $0.00 Plan Check: $0.00 Issuance: $35.00 Supplemental Fee: $0.00 TOTAL: $86.68 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $86.68 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION 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 Iicensure 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 L) all of or U 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). ❑ 1, 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 exempLIM" igensure under the Contractors' State License Law for the following reason: By my signature bet" 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 Iegall,. sell asiracture lhatl 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 Corte, V4,Ailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html. Sligrlatdrg of Property Owner or Authorized Agent Date UICENISED CONTRACTOR'S DECLARATION .... I hereby affirm under �enally�of-'1perjury that I am licensed under provisions %of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code an my license Is In full force Weiff Class _.(% .20 License No � ?I �� ` Da ctor Signature A`QRKERS' CCMPENSATION DECLARATION WVll Q4FAILURE TeSECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT N EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000(, IN ADDITION TO THE OOSV OF OOMPENSA(ION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AN ATTORNEY'S FEES. hereby affirm under penalty of perjury one of the following declarations: 11L6sjte and V111;m2iptain 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 3polvance of tfie v1Drk forwhich this permit is issued. Policy No. I h e 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 p issued. My workers' compensatioi ns r carrier and Ip�olic/y �number are / �CI!G S- .,arner ��'Ci t�--l3�U G�f Policy Number C� �( Expiration Date b of Agent certify that, in the performance 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 workers' com ensation laws of California, and agre t, if I should become subject to the ers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thos 'sions. �- r )Iture of Applicant P Da e CLARATION REGARDING CONSTRUCTION LENDING AGENCY veby 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 and county ordinances and state laws relating to building construction. authorize representatives of this city or county to an r�1fT� above-iden ified property for ins n purposes. Ali f, ature of Property Owner or Authorized Aqent Property Owner's or Authorized Agent's Nam / / Dares 7 ACTION DATE BY DECLARMON OF COMPLIANCE WITH CODE OF FOR OFFICE FEDERAL REGULATIONS PART 61 OF TITLE 40AND AQMDRULE 1403. PERMIT EXPIRED ❑ ISUBMITTEDASBESTOSNOTIFICATIONTO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED [IASBESTOS NOWICATIONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERN77TF1NA1 / Or1- CERTIFICATEOF SIGNATURE: OCCUPANCYISSUED