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Home My WebLink AboutH2021-0486 - PermitsCity of Newport Beach - Building Division III III 11111p11111p11111111111p11111p111111111 MECHANICAL Permit: H2O21-0486 e I d 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 4 8 6 Project NO : 2488-2019 .. n Permit Counter Phone (949)644-3288 0v. a .$ '�aa}riti" Inspection Requests Phone (949)644-3255 Job Address: 1940 TERESITA LN BIdg:1 Floor: Suite: Description of Work: MECH - INSTIL (2) A/C CONDENSERS. TAMPER -RESISTANT CAPS REQUIRED InspectorArea:3 Code Edit: 2019 Legal Description: N TR 1806 LOT 49 Owner: CONN ROBERT & PT Contractor: Address: 1940 TERESITA LN Address: NEWPORT BEACH, CA 92660 Phone: Phone: Con State Lic: Issued Date:08/18/2021 Lic Expire: Bus Lic: Processed By: Lic Exp Date: QUALITY AIR INDUSTRIES INC' 2120 S STATE COLLEGE BLVD ANAHEIM, CA 92806 (714)718-2946 1052628 04/30/2023 BT30075259 05/3112022 ,? , Worker's Comp Insurance - STATE COMP �plcy 4Q7366 Ezpire�F{14/2 HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 2 $44.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Over 100K 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 $0.00 Heat Pumps & Package Units. >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 Up to 1 OOK BTU/hr: 0 $0,00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee: $0.00 Investigation: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $38.28 Up to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: WCA5244GKA Issuance: $38.00 Up to 1.751M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: AIRE Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $52.00 TOTAL: $172.28 Plan Check Fee : $172.28 Fee Due at Permit Issuance : $0.00 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 6:0019.m. q p B® 7B 6W0 6 W •e WC• W 9 Y W W Y Wi iiy G'Ji Q J aGi GV9 Y G aO W GG• i0 p0 'NER-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 checkmark(s) I have placed next to the applicable item(s) ction 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 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 fessions 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 more than five hundred dollars ($500). LU 1, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, throul improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of cc improved for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 70. apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contra( ❑ I 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 or sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.le Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 700C and effect. �/r0' Z License Class License No Dat COMPENSATION DECLARATION ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL 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: the work, and the structure is not intended or offered for sale (Section 7044, employees' or personal effort, builds or improves the property, provided that the pletion, the Owner -Builder will have the burden of proving that it was not built or Business and Professions Code: The Contractors' State License Law does not pursuant to the Contractors' State License Law), year prior to completion of the improvements covered by this permit, I cannot iderstand that a copy of the applicable law, Section 7044 of the Business and Date Division 3 of the Business and Professions Code, and my license is in full force Contractor ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS S100,000), IN ADDITION TO THE 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 'mance of the work for which this permit is issued. Policy No. Eve and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the v nce carrier and policy number are: ri r Policy Number ie of Agent of the work for which this permit is issued. My workers' Date 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 agree if I should become subject to the compensation of Section 3700 of the Labor Code, I shall forth ith comply with those provisions. Q �f nature of Applicant `7 Date d— CLARATION REGARDINIG CCFNSTRUCTION LENDING AGENCY :reby 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). 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 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 and state laws relating to building construction. I authorize representatives of this city or county to enter the abovev id tified pr y for inspection purposes. �� ,,, nature of Property Owner or Authorized Agent '/ /// Print Property Owner's or Authorized Agent's Name �SGo"rill Go Dates �/ _I R 2 ACTION {LATE BY DECLARATIONOF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY •„ •�° FEDERAL REGULATIONSPART 61 OF TITLE40 AND • AQMDRULE 1403: PERM=T • •' .F,'r%'f�R • ❑ I SUBMITTED ASBESTOS NOTIFICARON TO:. ❑ EPA ❑ AQMD LT PERP407;0+40QALED ' `• • • PERMIT EXTENDED OQASB€ TOS 10DEL77RCNRONIS APPLICABLE TO PERMIT FINAL, , • CER77FICATE&OF '• s • e • ' e UCCUPANCY'ssLLb • ^ SIGNATURE: •• e°c ec