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Home My WebLink AboutH2021-0530 - PermitsCity of Newport Beach - Building Division H2O21-0530 1? ? 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 INISPEU 1® t• �''rnvN'� t5* Job Address: 4601 SURREY DR BIdg:1 Floor: Suite: Description of Work: MECH FURNACE CHANGE OUT (SAME LOCATION) InspectorArea:5 Code Edit: 2019 Legal Description: N TR 3519 LOT 72 Owner: YOUNG ROBERT Contractor: SERVICE CHAMPIONS HTG Address: 4601 SURREY DR Address: 3150 E BIRCH CORONA DEL MAR, CA 92625 BREA CA 92821 Phone: Phone: 714-777-7777 Con State Lic: 799170 Issued Date:09/1512021 Lic Expire: 10131/2021 s Lic: BT01080105 Processed By: _Lic Exp Date: 09/30/2021 MECHANICAL Permit: H2O21-0530 Project No Inspection Requests Phone (949)644-3255 Worker's Comp Insurance - Carrier : EVEREST NATIONAL INS CO Policy No: RM8WC00054201 Expire :04/01/2022 HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 1 $22.00 Up to 3HP: 0 $0.00 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: $0.00 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 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $0.00 TOTAL: $60.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $60.00 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 6:00 p.m. 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). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, andthe 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). 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 pp:y t3 en 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 am exempt `r9m licensure under the Contractors' State License Law for the following reason: ly :ny s'gnature 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 legal],. ell 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, Section 7044 of the Business and 'I ofessions CoJc, is 3-ailable upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. ;ignatLre of Property Owner or Authorized Agent Date :LENSED CONTRACTOR'S DECLARATION hrml—)y affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business pry Professions Cade, se Is in full force nd effect. �-- v1j/ icanse Class License No Date J Contractor Signatur � vORKERS' COMPENSATION DECLARATION I Ic 'ARNING: FAILURE TO SE:URE 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 DST OF COMPENSAD0.4, 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: I 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 th Ijrformance of the work for which this permit is issued. Policy No. �rnd 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' carrier and policy number are: Policy Number of Agent Date I certify that, in the performance of the wor which thi 1 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 It, if I should become subject to the wor ' co sation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. QQ � J� )nature of Applicant --- DatelV iCLARATION REG D - NST N LENDING AGENCY ereby affirm under ty o perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). nder'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 property owner's behalf. I have read this application and the information I have provided is coper' I agree to comply with all applicable city and county ordinances TlSstate laws r aEin o building construction. "�/ I authorize representatives of this city or county t enter the ove-ide 'fi property for inspection purposes.Signature of Property Owner or Authorized Agent r Print Property Owner's or Authorized Agent's Name / \y% .%�% ACTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART tit OF TITLE 40 AND AQMD RULE 1403. PERMITEXPIRED ❑ I SUBMITTED ASBESTOS N077FICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED ASBESTOS NOTIFJCATIONIS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL CERTIFICATEOF OCCUPANCYISSUED SIGNATURE: