HomeMy WebLinkAboutH2022-0120 - Permitswtr, City of Newport Beach - Building Division III 1111111111111111111111111111p1111111111111111 MECHANICAL Permit: H2O22-0120
�. 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 2 0 1 2 0 Project No : 0607-2022
�. Permit Counter Phone (949)644-3288
u 2
r•,r. y. uN�a Inspection Requests Phone (949)644-3255
Job Address: 3706 CHANNEL PL BIdg:1 Floor: Suite:
Description of Work: MECH - INSTALL NEW A/C CONDENSER. TAMPER -RESISTANT CAP REQUIRED
Inspector Area:1 Code Edit:
2019
Legal Description: CANAL SECTION LOT 4 BLK 637 ALL -INC BET
SAME & HIGH TIDE
LINE -
Owner: LEIFER LAWRENCE
Contractor:
OWNER/BLDR
Worker's Comp Insurance -
Address: 3706 CHANNEL PL
Address:
LIEFER LARRY
Carrier :
NEWPORT BEACH, CA 92663
Policy No:
Phone: 9491290-2627
Phone:
949-290-2627
Expire
Con State Lic:
O/B '
Issued Date:03/29/2022
Lic Expire:
Bus Lic:
Processed By:
Lic Exp Date:
OR
to
r
ya
HVAC Items
FEES
FurnacesBoilers & Compressors
Ventilation
Other
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
1 $22.00
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 100K 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:
$19.14
Up to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$38.00
Up to 1.75M BTU/hr:
0
$0.00
Over 1 OK CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$52.00
TOTAL:
$131.14
Plan Check Fee
: $0.00
Fee Due at Permit Issuance:
$131.14
Construction F(ou sf: Mono'ayIRE FridalAT.•00 a.m.ToS 6 30 p.m0and Saturday f oaa.m.`tS 0 p mCTIv,v N0195
ON THE WEEKEND
LDER 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)
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
ie 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
'rofessions 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
of more than five hundred dollars ($500).
1 I, as owner of the property, or my employees with wages as their sole compensation, will do L) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044,
lusiness 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
nprovements 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
nproved for the purpose of sale).
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
p 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).
I a exempt from licensure under the Contractors' State License Law for the following reason:
Iy m ignature 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 legallt
structure that I have built as an owner -builder if it has not ben constructed in " s e titby licensed contractors. I understand that a copy of the applicable law, Section 70 4 of t e Business and
'rofessions Code, is available upon request when this a lication Is ubmitted cr at he ollng Web site:http://www.leginfo.ca.gov/calaw.html. / as
ignature of Property Owner or Authorized Agent L�gte J di �-'
.ICENSED CONTRACTOR'S DECLARATION L.
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 Professions Code, and my license is in full force
nd effect.
icense Class License No Date Contractor Signature
COMPENSATION DECLARATION
ARNING: 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
BET 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:
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
3rmance of the 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 the performance of the work for which this permit is issued. My workers' compensa
rance carrier and policy number are:
Policy Number
of Agent
Date
AI rtify that, in the performanc of the work forwhich 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 agre
i if I should become subject t�the workers' Corppgnsat'tpn provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions.
IignatureofApplicant v Jeu. J ll (N�t �— Date
IECIARATION REGARDI CONSTRUCTION LENDI AGENCY
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 tion 3097, Civil Code).
Ender's Name Lender's Address
ly my signature below, I certify to each of the following:
I am the property owner or authorized to act on the property owners behalf.
I have read this application and the information I have provided is correct.
I agree to comply with all applicable city and coun y ordinances and state laws relating to building construction.
I authorize representatives of this city or county to enter the abo e=/J"�en�ied property for inspection purposes. ^ / i ' .t ,�
ignature of Property Owner or Authorized Agent fl,,L- . '-�7I�� Print Property Owner's or Authorized Agent's Namel X L.4i AC �. Vt') F91 Date �W�"
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 0r TITL E40 AND
AQMD RULE M03. -
PERMITEXPIRED
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ASBEST NO 77RCATIONIS NOT APPLICABLE TO
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