HomeMy WebLinkAboutH2017-0039 - Permits�aWw,QT City of Newport Beach - Building Division 11p111111111111111111111111111111111111111111111111
a` ow 100 Civic Center Drive, Newport Beach, CA 92660
ti y Permit Counter Phone (949)644-3288
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Job Address: 2290 LA LINDA CT BIdg:1 Floor:
Suite:
Description of Work: MECH/INSTALL (1) A/C UNIT 46dB (AMANA;
ANX14-0481A)
Inspector Area:3 Code Edit: 2016
Legal Description: N TR 9353 LOT 7
Owner: NGOC PHAM
Contractor:
BAUM CONSTRUCTION
Address: 2290 LA LINDA CT
Address:
2900 FIDLER AVE
NEWPORT BEACH, CA 92660
LONG BEACH, CA 90815
Phone:
Phone:
562-424-2286
Con State Lie:
1003379
Issued Date:01/25/2017
Lie Expire:
05/31/2017
Bus Lie:
BT30054653
Processed By: " - (/
Lie Exp Date:
04/30/2017
MECHANICAL Permit: H2O17-0039
Project No : 0614-2016
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier: STATE COMP. INS
Policy No: 9111257
Expire :08/29/2017
�L.FI/2S
VERIFIka,ATI®N RSQ
HVAC Items
FEES
Furnaces Boilers & Compressors
Ventilation
Other
Up to 100K BTU/hr:
0
$0.00
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:
1 $33.00
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:
$37.50
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$28.71
Up to 1 M BTU/hr:
0
$0.00
up to 1OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$33.00
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
TOTAL:
$132.21
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$132.21
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
OWNER -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)
(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
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-Builderwill have the burden of proving that it was not built or
improved 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
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 leg —all,
,
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, Section 7044 of the Business and
Professions Code, is available upon request when this application is submitted or at the following Web site:hftp://www.leginfo.ca.gov/calaw.htmi.
Signature of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I 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 Prof I d ,and my lic se is in full force
and effect.
License Class License No // 2oosE7 Date Contractor Signature
NORKERS' COMPENSATION DECLARATION
YARNING: 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
:OST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 7706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S 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 th
reArmance of the wprlt for which this permit is issued. Policy No.
have and will ma tai workers'
rier rance carand p .cy umber
ier I _
le of Agent I,-
:ertify that, in the performance o
if I should become subject to th
of Applicant
insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers'
Date
t 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
ns of ection 3700 of the Labor Code, I shall forthwith comply with those provisions.
Date )
CY If
sreby affirm under pehalty of perjury that there is'�'jcgf)9tr, Ton lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
lder's Name /V/ f/ 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 ordinan es an ate laws relay g to building construction.
I authorize representatives of this city or county to Iten _ e /gbjgryyl for inspection purposes. /yt//]/, ,/
nature of Property Owner or Authonzed Agenne �, � t� ( Print Property Owner's or Authorized Agent's Namb, _ L�44 I Wr Dat 0
ACTION
DATE
BY
DECLARATION OF COMPLIANCE IMTN CODF OF
FEDERAL REGJLA T IONS PAPT 61 OF TITL_—40 AND
AQMD RULE 1403.
❑ 1 SUBA TIED ASBESTOS NGTIFICATIGN TO:
❑ EPA
❑ AQMD
❑ ASBESTOS NOPFCA770N/F NOT APPI'CABLE TO
PROPOSED GEM'OUNJ&
SIGNATURE:
FOR OFFICE USE ONLY
PERMIT EXPIRED
PERMITCANCELLED
PERMITDOENDED
PERMIT FINAL
CERTIFICATEOF
OCCUPANCYISSUED