HomeMy WebLinkAboutH2022-0691 - PermitsApplicant
Address
Phone:
o��Ewao @m City mm nit Ncewport Beamhnt- Building Division III II I III II I II IIII III I II Mechanical Permit : H2O22-0691
y 100 Civic Center Drive, Newport Beach, CA 92660
? Permit Counter Phone: (949) 644-3288 Plan Check No:
Inspection Requests Phone: (949) 644-3255 Work Class : Other
C9G/FORN�P newportbeachca.govfnspections Issued Date:
Inspection Area : 2
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 : 126 VIA ORVIETO Legal Desc : N TR 907 BLK LOT 84
Description: MECH - R/R FURNACE
Owner: FREIDSON MAURY TR THE M/R FREIDSON FAMILY TR ,
Address: 126 VIA ORVIETO NEWPORT BEACH, CA 92663
Phone:
NEXGEN A/C INC
700 N VALLEY ST STE K ANAHEIM, CA 92801
(657)208-1987
Owner/Builder:
Address :
Phone:
Code Edition :
Type of Construction
Occupancy Groups:
Building Setbacks
Flood Zone:
Use Zone :
PROCESSED BY
2019
Front: 0, Front: 4, Front: 1.5, Side: 3
X
R-1 - Single -Unit Residential
SPECIAL CONDITIONS:
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Contractor :
NEXGEN A/C INC
Address ;
. 700 N VALLEY ST STE K ANAHEIM, CA 92801
Phone :
(657),208 1987
Con State Lie
: 1011173'<
Lie Expire:
02/29/2024
Bus Lie:
BT30055503
Bus Lie Expire:06130/2023
Workers' Compensation
Insurance
Carrier :
OLD REPUBLIC GENERAL INSURANCE CORP
-. Policy No:
Al CWA0011502
W. C. Expire:
3/112023'
I, as owner of the pro
iness and Profession;
rovements are not int+
roved for the purpose
1: as owner ofthe tiro
ly to art owner of prof
I am exempt from lit,
my signature below I i
nsure and the basis for the alleged exemption. Any violation of
ages as their sole Compensation, will do-(_) all of or ( ;) Portior
License Law doesnot apply to on owner of property who, this
owever, the building or improvement is sold within one year of
ng with licensed Contractors to Construct the Project (Seaton
ereon, and who contracts for the projects with a licensed Cont
pursuant
a or improves the property, provided that the
the burden of proving that it was not built or
the Contractors' State License Law does not
ell :a structure that I have built as an owner-bullDer it R nas not Caen cunsuu4xeu n, . • -.i- ,-. - - - - -... ..
eofessions Code, is available: upon request when this application is submitted or at the following Web sifa;htlP.//wArv✓:legi fo.ce.govlcataw.htrnl. Date.
lignatura 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 70 ) f Ofvision 3 of the Business and Profe ons Co :and my I' is in full force
Ind ef#ecf. License Class License No
Date a_ 22. Contractor Signatu _ 7
UORKERS' COMPENSATION DECLARATION
rARNING: FAII..URETO.SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL. AND SHALL SUBJECT AN EMPLOYER TO CnBBNAL PENALTIES AND CIVIL PINES UP TO ONE HUNDRED THOUSAND DOLLARS (5100.000): IN AUDITION TO THE.
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR iN SECTION SN B, OF THE. LABOR CODE; INTEREST, AND ATTORNEY'S FEES.
hereby affirm under panatty of perjury one of the following declarations:
31 haveandwill maintain a certiftcate 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 thi
I - - rmance of fhe work for which this permit is Issued. Policy No.
have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for they ger€ormance of the work for which this permit is issued. My workers' compensatior
rance carrier and policy number are:
crier Policy Number F.xpira6on Date
n
,fame of Agent Phone
(certify that, in the performance of the workfor which this permit Is Issued, I shall not employ any person In any manneiso as to become subject to the workers' compensation laws of California, and agre,
hat, it I should become subject to the rkers' co on provisions of Section 3700 of the Labor Code, I -shall fort€twi h comply with those provisions. ,?/Z
3lgnafure of Applicant k a�
DECLARATION REGAR ING: CONSTRUCTION LENDING AGENCY
hereby affirm Under penalty of perjury that there is a construction lending agency for the performance ofthe work for which this permit'is issued (Section 3097,.Civil Code).
I am the
the" Tf
I agree I
I: author!
tV
U t SUBMITTED ASOSTOS NOTIIIICATION TO
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PROPOSED DEMOLITION:
ISSUER 4
SIGNATURE;
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