HomeMy WebLinkAboutH2016-0845 - Permitswr�r� City of Newport Beach - Building Division II�IIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIII II
o 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288
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Job Address: 1500 CUMBERLAND LN BIdg:1 Floor: Suite:
Description of Work: MECH/INSTALL A/C UNIT 33dB (TRANE-4TTR4060L1000A)
InspectorArea:3 Code Edit:
2013
Legal Description: N TR 1896 LOT 34
Owner: HERRINGTON MATTHEW
Contractor:
KEYSTONE D C S INC
Address: 1500 CUMBERLAND LN
Address:
9140 TRASK AVE
NEWPORT BEACH, CA 92660
GARDEN GROVE CA 92844
Phone: 949-375-4309
Phone:
714-791-3771
Con State Lic:
1013293
Issued Date:12/14/2016 \
Lic Expire:
04/30/2018
Bus Lic:
BT30056212
Processed By:
Lic Exp Date:
08/31/2017
MECHANICAL Permit: H2O16-0845
Project No: 0757-2016
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance
Carrier: STATE FUND
Policy No: 915753816
Expire :04121/2017
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may'
AC Items
FEES
,nacesBoilers & Compressors
Ventilation
to 100K BTU/hr:
0
$0.00
Up to 3HP:
0 $0.00
Bathroom Fan:
0 $0.00
Fire Dampers: 0
$0.00
�r 100K BTU/hr:
0
$0.00
> 3 HP to 15 HP:
1 $33.00
Exhaust Fan:
0 $0.00
Gas Line: 0
$0.00
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace: 0
$0.00
it Pumps & Package Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
to 100K BTU/hr:
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$37.50
-r 500K BTU/hr.
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
to 1 M BTU/hr:
0
$0.00
up to 1 OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
)r 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Other
$0.00
$0.00
Investigation: $0.00
Plan Check: $28.71
Issuance: $33.00
TOTAL: $132.21 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $132.21
PERMITS F)PIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
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 U 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),
J I am exempt from licensure under the Contractors' State License Law for the following reason:
iy 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 imp
ell 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 applic
'rofessions Code, is available upon request when this application is submitted or at the following Web site:http://www,leginfo.ca.gov/calaw.htmi.
lignature of Property Owner or Authorized Agent
.ICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and P
nd effect.
icense Class License No Date 1Z/( /Z6 Contractor Signature��
VORKERS' COMPENSATION DECLARATION `
DARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUND
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
law, Section 7044 of the Business and
Date
and my licknse is in full force
DOLLARS ($1D0,000), IN ADDITION TO THE
I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrial Relations as provided f�' by Section 3700 of the Labor Code, for IN
pe ormance of the work for which this permit is issued. Policy No.
I have and will m �ntain 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
insurance carrier an �licy number are:.
Carrier 6 Po�c�Vum er Expiration Date
Name of Agent �t.rl r _ Phone #
certify that, in the performance of the work fo which this perm. 's issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agre
that, if I should become subj ct to the orkers' ompensation is on of Section 3700 of the Labor Code, I shall forthwith comply with those provi ii ns. I %
Signature of Applicant Date
DECLARATION REGA ING SONS RUCTION LENDING AGENCY v
I hereby 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).
Lender's Name Lender's Address
By my signature below, I certify to eac of the following:
pert I am the pro, owner or author:led 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 a state laws relati g to building construction.
authorize representatives of this city or county to nter he b e-:dent: no e y f " specti 'purposes. ��
Signature Of Property Owner or Authorized Agent I Prin roperty Owner's or Authorized Agent's Name ` Dat
ACTION DATE t BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFRCE USE ONLY
FEDERAL REGULATIONS PART 61 OF T17LE40AND
PERMITEXPtRED j AQMD RULE 1403.
❑ I SUBMnTEDASBESTOS NOTIFICATION TO:
PERMITCANCELLED ❑ EPA
PERIAITEXTENDED ❑ AQMD
❑ ASBESTOS N077RCARONIS NOT APPLICABLE TO
PERMIT FINAL . Z. PROPOSED DEMOUTION.
CE3T7F1C4TE OF
OCCUPANCYISSUED SIGNATURE.,
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