HomeMy WebLinkAboutH2022-0599 - Permits�EWPoR�
City of Newport Beach III II I II
I II I II III II II II
Community Development Department- Building Division
Mechanical Permit
> 1y"
100 Civic Center Drive, Newport Beach, CA 92660
Plan Check NO
Permit Counter Phone: (949) 644-3288
Work Class: Other
C9G/Fp
Inspection Requests Phone: (949) 644-3255
Issued Date
AN,P
newportbeachca.gov/inspections
Inspection Area : 4
H2O22-0599
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 2119 VISTA LAREDO Legal Desc : N TR 5692 BLK LOT 15 TR 5692(L.L.84-214027) PAR 15
Description: MECH - R/R A/C CONDENSER. TAMPER -RESISTANT 'CAP & TIMER REQUIRED
Owner: BAGDASAR KENT E TR K E '�-,
-Contractor I:
SERVICE: CHAMPIONS HTG
Address : 2119 VISTA LAREDO NEWPORT BEACH, CA 92660
Address :
3150 E BIRCH BREA, CA 92821
Phone:
Phone:
(714)777-7777
Con State Lie
: 799170
Applicant: BEN MEDINA
Lie Expire :
10131/2023
Address : 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362
Bus Lie:
RM8WC00054221
Phone: (818) 735-7876
'Bus Lie Expire:04/01/2023
Workers' Compensation
Insurance
Owner/Builder :
Carrier :
EVEREST PREMIER INS CO
Address :
Policy No:
RM8WC00054221
Phone :
',W. C. Expire:
4/1/2023
Code Edition : 2019 Fire Hazard Zone :. NO
Manufacturer: LENNOX
Type of Construction :
Model# : XC21-048
Occupancy Groups:
Building Setbacks:
Flood Zone: X
Use Zone: R-1 - Single -Unit Residential
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PROCESSED BY:
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SPECIAL CONDITIONS:
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roved for the purpose of sale)..
1, as owner of the property, an
,lyto an owner of: property who
I am exemot from licensure ut
in under penalty of perjury that am licens
License Gass
;'COMPENSATION DECLARATION
License Law does not apply So an owner of property who, through. employees' or personal effort, builds or improvas ihe:property, provided that the
iwever, the building or improvement is sold within one year of completion, the Owner-Builderwill have the burden of proving that it was not built or
ig with licensed Contractorsto constructthe project (Section 7044, Business and Professions Gode: The. Contractors"Stale License Law does not.
Freon, and who: contracts for the projects with a licensed Contractor pursuant to the Contractors' State License Law):..
mate License: Law for the following reason.
y personal residence in which I must have resided for at feast one year prior to completion of the improvements coveredby this permit, I cannot leg
ias not been constructed In its entirely by licensed contractors. I understand that a' copy of the applicable law, Section 7044 of the Business and
is in full force
AN EMPLOYER TO ORRAINAL PENALTIES AND CML FINES UP TO ONE-HUNDRl6THOUSANO DOLLARS t5700.000}; IN. ADDITION TO THE
retry affirm under penaffypf perjury one ofthe following declarations:
I have and wall maintain 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
oprmance of the work for which this permill Is issued. Policy No.
eve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for they performance of the work for which this permit is Issued. My workers' compensado
I nee carrier and policy number are'.
ter. Policy Number Expiration Date
neof Agent Phone#..
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' compensation laws of California, and ago
, If I. should become subject to the s ':compensation provisions; of Section 3700of the Labor Code, I -shall forthwith comply with those provisions.
mature of Applicant Date„_
;LARATIONREGAROI NL�ENTNsG,,ENGY
reby affirm under pe attFlere ion tend',ig agency forihe parformanDe of the work for which this permifis issued (Section 3097, Givit Code).
I am the property owner or authorized to act on the property own
I have read this application and the Information I have provided h
1 agree to comply with all applicable city and coumy ordin$ppas f
I authorize representatives of this city or conntv3o ao racafsa6
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