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Home My WebLink AboutH2023-0021 - PermitsSEW °p� City of Newport Beach III II I III III II II III II I II Mechanical Permit : H2O23-0021 Community Development Department - Building Division y 100 Civic Center Drive, Newport Beach, CA 92660 Plan Check No : PC2022-2573 � n Permit Counter Phone: (949) 644-328B Work Class : Other Ue.T Inspection Requests Phone: (949) 644-3255 Issued Date : c9G/Fe PN�P newportbeachca.gov/inspections Inspection Area :3 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS Job Address : 1936 GALAXY DR Legal Desc : N TR 4224 BLK LOT 19 Description: MECH CHANGE OUT A/C UNIT "TAMPER PROOF CAP REQ" Owner: HOLIDAY FAMILY REVOCABLE TRUST Address : 1700 E OCEAN BLVD NEWPORT BEACH, CA 92661 Phone: (949)630-8991 Applicant : BEN MEDINA Address : 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362 Phone: (818)735-7876 Owner/Builder : Address Phone: Code Edition: 2022 Type of Construction Occupancy Groups: Fire Hazard Zone : NO Building Setbacks : Front: 10, Side: 6, Side: 6, Rear: 6 Flood Zone: X Use Zone : R-1-6000 - Single -Unit Residential (6000 indicates minimum lot area) PROCESSED BY SPECIAL CONDITIONS: Contractor : HG HOME SERVICES Address: 1501 WESTCLIFF DR NEWPORT BEACH, CA 92660 Phone: (949)877-2821 Con State Lic : 1077757 Lic Expire : 07/31/2023 Bus Lic: BT300768818 Bus Lic Expire:02/28/2023 Workers' Compensation Insurance Carrier: CLEAR SPRING PROP & CASUALTY CO Policy No: CWC00016801 W. C. Expire: 6/16/2023 Manufacturer: AC PRO AULD60W2 Model# : OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reasons) indicated below by the checkmark{s) I have placed next to the applicable Items) (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 then five hundred dollars ($500). ❑ 1, 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 -Builder will have the burden of proving that it was not built or rovedforfor the purpose of sale). lJ 1, 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 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), LI I am Exempt from ticensure 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 by4his permit, cannot legail! sell a structure that I have built as an owner -builder if it has not been constructed in its Entirely by licensed contractors. I understand that 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 fallowing Web site:http:!lwww.leginfo.ca.gov/ca;aw.htmt. 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 Secti p0) p 'v of the Business Pro ip s Code,. and m Ii,Pn`w is in full force and effect. License Class License. No Do k t Contractor n NORKERS' COMPENSATION DECLARATION' NANNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES A140 CIVIL FINES UP TO ONE NUN OUSAND DOLLARS ($100,000), IN ADD91ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. hereby affirm under penalty of perjury one of the following declarations: -1 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 wformance of the work for which this permit is issued. Policy No. 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' carrier and policy number are: Policy Number Date (Jame of Agent Phone # ❑I certify that, in the pert once of th for which this permit is issued, shall not employ any person in any manner so as to become subject to the workers' ompens tlGn laws of California, and ogre that, If I should become su et to the s' compensation provisions of S Lion 3700 of the Labor Code, I shall forthwith comply with those. provisions. Signature of Applicant Date / Z3 DECLARATION REGA IN S .� G G AGE I hereby affirm under penalty of perju a is a construction lending agency for the performance of the work for which this permit is issued. (Section 3097, Civil Code). Lenders Name Lender's Address By my signature below, I certify to each of Vie following: I am the property owner or authorized to act on the property ovmer's behalf, I have read this application and the inforinatio 1 hove provid . correct. I agree to comply with.. all applicable city an c unty ordi and state law g to building construction. 1 / I authorize representatives of this city or co toe th ova led property for inspection purposes, I z Signature of Pro err Owner or Authorized A eat Print Pi Owner's or Authorized A ent's Nam Date ACTION DATE RV DECLAR N OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY IATlONS PART 61 OF TITLE 40 AND AOMD RULE 1403 PERMIT PE.RMJT EXTENDED PEANAL / 11- l / CERTATIRIFfCATEOF l% OCCUPANCY 155UED TO SS NOTIFICATION 15 NOT APPLICABLE TO DEMOLITION