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Home My WebLink AboutH2014-0014 - PermitsvreoF - City of Newport Beach - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 zt Job Address: 510 BAY FRONTS BIdg:1 Floor: Suite: Description of Work: MECH/INSTALL (1) NEW A/C UNIT & C/O F.A.U. II�I0II�I4IIIIIIYIIIIIIIYNIIIIIIIIIIII:.r . I�flH Inspector Area:2 Code Edit: 2013 Legal Description: BALBOA ISLAND RESUB SEC 1 BLK 9 LOT 6 Owner: RIDDELL SUSAN Contractor: R K M HEATING & AC Address: 510 S BAY FRONT Address: 2929 ELLESMERE AVE NEWPORT BEACH CA 92662 COSTA MESA CA 92626 Phone: Phone: 949-413-8250 Con State Lie: 405194 Issued Date:01/07/2014 Lie Expire: 0513112014 Bus Lie: BT30045393 Processed By: 1'rh/T' Lie Exp Date: 1113012014 MECHANICAL Permit: H2O14-0014 Project No : 2809-2013 Inspection Requests Phone (949)644-3255 Worker's Comp Insurance - 2 Carder: STATE COMP Policy No: 9050385 Expire :04/01/2014 a HVAC Items FEES Furnaces Boilers & Compressors Ventilation Misc Other Up to 100K BTU/hr: 1 $19.00 Up to 3HP: 1 $19.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Over IOOK BTU/hr: 0 $0.00 > 3 HP to 15 HP: 0 $0.00 Exhaust Fan: 0 $0.00 Gas Line: 0 $0.00 $0.00 Wall/Floor Heaters:- 0 $0.00 >15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: $0.00 Heat Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 ICBO App. #: Record Mgmt Fee: $3.00 Up to 1OOK BTU/hr: 0 $0.00 >50 FIR 0 $0.00 Residential Hood: 0 $0.00 Investigation: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $0.00 Up to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Issuance: $36.00 Up to 1.75M BTU/hr: 0 $0.00 Over 1OK CFM: 0 $0.00 Supplemental Fee: $0.00 Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 TOTAL: $89.68 Plan Check Fee: $0.00 Fee Due at Permit Issuance: $89.68 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION ome ° OWNER -BUILDER DECLARATION - - I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasgn(s) indicated below by the checkmark(s) I have placed next to the applicable items) (Section 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alt€i,-improa.;, 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 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). LJ 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). ❑ 1 am exempt from licensure under the Contractors'. State License Law for the following reason: By 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 improvements covered by this permit, I cannot legally sell 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 applicable law, a on 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Da LICENSED CONTRACTOR'S DECLARATION I hereby affirm.under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Se tin of ivision 3 of the Business and Fir s " n C de, and my license is in full force and effect. License Class License No Dat NORKERS' COMPENSATION DECLARATION �� Contractor Signatu NARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: 1 have and will 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 th1 ormanoe of the work for which this permit is issued. Policy No. intain 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' policy numberrare; re of Agent certify that, rep, , if I should become Date VC/%'°L— Phone # for which t ' permit is issued, I shall not employ any person in any manner so as to become subject to the workers' c pensa n law of California, and agre compe on provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. i Signature of Applicant V Date. — DECLARATION REGA IN ONSTRUC LENDING AGENCY 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 each of the following: I am the property owner or authorized to act on the pr p ow is behalf. I have read this application and the information I have ovided i correct. nA!, I agree to comply with all applicable city and county o In nces a d state laws relating to building construction.I authorize representatives of this city or county to en r ' a v identified property for inspection purposes.ffSignatureof Property Owner or Authorized Agent Print Property Owner's or Authorized Agent's Name _. AC170N PATE BY DECLARATION OFCOMPUMICE WITH CODE OF FOR OFRCE USE f7NLY y ; FEti�AL R€GULA11ONS PART 61 OF TIRE40AND • •A RULE 14.01- • • s PERMIT D(PiRED C3 U10 T0.5 N6HRCATION TD:. fl ❑ AQMD PERMiTLANCEI i cn PERMITOCTENDED ❑ ASBESTOSN07113CA� IRONISNOTAPPLiCAETO . 9RCMSE0 DEMOLITIQN. o° e o m e° e• •a° PFRMf7'fIMAt CERTIFICATE OF OCCUPAIVCYISSUED ofRc_. S1SA1A%°