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HomeMy WebLinkAboutH2021-0004 - Permitshfl4 City of Newport Beach - Building Division III III IIIIIpIII IIpIIIII111111p111p11111111111 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 0 0 4 Permit Counter Phone (949)644-3288 MECHANICAL Permit: H2O21-0004 Project No : 1691-2020 Inspection Requests Phone (949)644-3255 Job Address: 2036 GALAXY DR Bldg:O Floor: Suite: Description of Work: MECH/ NEW A/C "TAMPER RESISTANT CAP REQ" Inspector Area:3 Code Edit : 2019 Legal Description: N TR 4224 LOT 9 Owner: SALEN A Contractor: OWNER/BLDR Worker's Comp Insurance - Address: 2036 ALAXY R Address: Carrier: N PORT BE CH, CA 92660 Policy No: Phone: 7 4-745-6546 Phone: Expire Con State Lic: O/B Issued Date:O 05/2021 Lic Expire: Bus Lic: Processed By: Lic Exp Date: INSF S B3FCTTOFTFLT?fN`;PF,C7-i}F':. K) V1bW i1 �Pl'tiCiUAL , 4C Items FEES nacesBoilers & C pressors Ventilation 0 $0.00 Other $0.00 to 100K BTU/hr: 0 $0.00 Up to 3HP: 1 $21.00 Bathroom Fan: 0 $0.00 Fire Dampers: )r 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 I/Floor Heaters: 0 $0.00 >15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: 0 $0.00 it Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee : $0.00 Investigation: $0.00 ;r 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $18.27 to 1 M BTU/hr: 0 $0.00 up to 1 OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: YZV241ssuance: $37.00 to 1.75M BTU/hr: 0 $0.00 Over IOK CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: YORK ;r 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $46.25 TOTAL: $122.52 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $122.52 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. 3WNER-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 imp ovemenls 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 riot built or i. roved for the purpose of sale). 1, as owner cf 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 o ly 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). I am,sxempt f.-ca. 'Lansure 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 legally sJ1 , strecture thatC� have built as an owner -builder if 1wf as not been constwftod4n-fts-enM"-by-kensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is mailable upon request win t s ap a I wing site:http:/fwww.leginfo.ca.gov/calaw.htmi. / Signature of Property Owner or Authorized Agent Date)_[ I J —� LICENSED CONTRACTOR'S DECLARATION 171-' 1 keruLy 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 and cYE-t. LiaPrs=. Class License No Date Contractor Signature NORKERS' C©MfkFNSATION DECLARATION NCPN'N"3_ rAILURE 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 XST OF CUMPENSPT,QN. 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: ❑ 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 thi 7erformance 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' rance carrier and policy number are: Policy Number Expiration Date Agent ce y 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 agre that, if should become s to t 1e o on 3700 of the Labor Code, I shall forthwith comply with those provisions atureofApplicant Date 7�/ /^s DECLARATION REGAR ING ENCY / I 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 (Section 3097, Civil Code). Lender'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 correct. I agree to comply with all applicable city and county ordinances and state lawsrelatingto building construction. 1 authorize representatives of this city or cou„nn� /� for inspection purposes. /I , Signature of Property Owner or Authorized Age Print Property Owner's or Authorized Agent's Name iZka-c Date ACTION IRATE BY DECLARA TION OF COMPLIANCE MTN CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE40 AND AQMD RULE 1403. PERMIT EXPIRED ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD. PERMIT CANCELLED PERMIT: EXTENDED ❑ ASBESTOS NORFICARON IS NOT APPLICABLE TO PROPOSED DEMOLITION'. PERMITRIVAL CERTIFICATEOF OCCUPANCYISSUED SIGNATURE: