HomeMy WebLinkAbouth2021-0420 - PermitsCity of Newport Beach - Building Division
100 Civic Center Drive, Newport Be_ .92660
„.. Permit Counter Phone (949)644-3288
Job Address: 208 EMERALD AVE BIdg:1 Floor: Suite:
Description of Work: MECH (3) A/C UNITS *TAMPER PROOF CAP REQ*
Inspector Area:2 Code Edit:
2019
Legal Description: BALBOA ISLAND RESUB SEC 1 BILK 4 LOT 22
Owner: SCHISLER JON
Contractor:
Address: 208 EMERALD AVE
Address:
NEWPORT BEACH, CA 92662
Phone: 949-584-2077
Phone:
Con State Lie:
Issued Date:07/14/2021
Lie Expire:
Bus Lie:
Processed By:
Lie Exp Date:
'nacesSoilers & Compressors Ventilation
to 100K BTU/hr:
0
$0.00
Up to 3HP:
-r 100K BTU/hr:
0
$0.00
> 3 HP to 15 HP:
ill/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
3t Pumps & Package Units
>30 HP to 50 HP
to 100K BTU/hr:
0
$0.00
>50 HP:
-r 500K BTU/hr:
0
$0.00
Air Handling Units
to 1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
:r 1.75M BTU/hr:
0
$0.00
VAV Box:
H2O21-0420
D L S HEATING & A/C
8542 LARTHORN DRIVE
HUNTINGTON BEACH CA 92646
714-231-8002
584220
01/31/2022
BT98040420
12/31/2021
FEES
$44.00
Bathroom Fan:
0 $0.00
$0.00
Exhaust Fan:
0 $0.00
$0.00
Attic Fan:
0 $0.00
$0.00
Down -Draft Fan:
0 $0.00
$0.00
Residential Hood:
0 $0.00
Comm. Hood:
0 $0.00
$0.00
Repair/Alter/Add:
0 $0.00
$0.00
Supplemental Fee:
$0.00
$0.00
MECHANICAL Permit: H2O21-0420
Project No: 1430-2020
Inspection Requests Phone (949)644-3255
°•.°
•
Worker's Comp Insurance -
Carrier: STATE FARM,.. • • , •,
Policy No:92GUV4642
Expire:0�1/06/2022 °°.... A�l�lG
CIM�R r1sak RED ®NQ • y%A P '
aFF 1O P.M. A
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Other
Fire Dampers:
0
$0.00
$0.00
Gas Line:
0
$0.00
$0.00
Metal Fireplace:
0
$0.00
Record Mgt Fee:
$0.00
Additional Fee :
$0.00
Investigation:
$0.00
Plan Check:
$38.28
Model:
NHA536GKCIssuance:
$38.00
Manufacturer:
SEER
Zoning PC:
$52.00
TOTAL: $172.28 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $172.28
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 snag' ark(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 L) all of or L) 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).
I am exemPfffdnl licensure under the Contractors' State License Law for the following reason:
By my signature.beiow 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
$Ell a Stucturethatl 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 Ct=tlp-is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.html.
Signature of Property Owner or Authorized Agent Date
LltEAED COATRACTOR'S DECLARATION
I Per4y affirm wad%r-Analty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 000) oofDivi� on 3 of the Business and Pr fesslons nd my license is in full force
pnC egdct. 'L7/ 01
License Class .... License No Date Contractor Signature
yt(QVJ1ERS' COMPENSATION DECLARATION
RWAFLI',{I,Gj FAILURE TC SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HU DRIED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE
y0§ O POMPENS&TIOIA DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
?herebyaffirm u%Vr penalty of perjury one of the following declarations:
••....
• M I hate and.vC11 gAntain 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 the
De of `rgl8ncdP the worts for which this permit is issued. Policy No.
.3 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'
carrier and policy number are:
Policy Number
Date
me of Agent rnane 0
1 certify that, in the pe. rmance of th work f which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree
t, if I should be bject to a rker compensation provi ' c ion 3700 of the Labor Code, I shall forthwith comply with those pro ens. I �'
(nature of Applicant' Date /
.CLARATION REG DIN O RUCTION LENDING AGENCY
ereby affirm under penalty equry that there is a construction lending agency for the performance of the work for which this permit is issued sect pn 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 owners behalf.
I have read this application and the information I hasgZNkled is correct.
I agree to comply with all applicable city an ounty Drdin ces and state laws relating to b kling construction. p^ J))))
I authorize representatives of this city or co ty e e above -identified or inspection purposes. '�,t-1
Inature of Property Owner or Authorized Agen Print Property Owners or Authorized Agent's Name ✓ "N Sj� Datkz
AC17ON
DATE
BY
DECLARATION OF COMPLIANCE VOITH CODE OF
FOR OFFICE USE ONLY
FEDEPAL REGULATIOINSPART69OFTITLE40AND
AOMD RULE 1403.
❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO:.
❑ EPA
❑ AOMD
PERMIT EXPIRED
PERMITCA.NCELLED
PERMITEXTENOED
❑ ASBESTOS NOVEICA770N IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERMIT ANAL
°
CERTIFICATE OF
OCCUPANCYf55UED