HomeMy WebLinkAboutH2023-0368 - PermitsCity of Newport Beach
Community Development Department - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
h Permit Counter Phone: (949) 718-1888
U�. r newportbeachca.gov/civic
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Mechanical Permit
Plan Check No :
Work Class : Other
Issued Date : 06/0612023
Inspection Area : 2
H2O23-0368
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 : 123 VIA ORVIETO Legal Desc : N TR 907 BLK LOT 526 TR 907 LOT 526(AND NELY1/2 LOT 527
Description: MECH NEW HEAT PUMP *TAMPER PROOF CAP REQ*
Owner:
Johanna Staple
Address :
2547 XANTHIA CT DENVER, CO 80238
Phone:
(303) 525-5843
Applicant :
DEPENDABLE GRAHAM AC
Address :
2952 CENTURY PLACE COSTA MESA, CA 92626
Phone :
(714) 546-1653
Owner/Builder
:
Address
Phone:
Code Edition : 2022
Type of Construction
Occupancy Groups:
Building Setbacks
Flood Zone
Use Zone:
PROCESSED BY:
Front: 0, Front: 4, Side: 4, Side: 4
R-1 - Single -Unit Residential
SPECIAL CONDITIONS:
Contractor :
DEPENDABLE GRAHAM AC
Address :
2952 CENTURY PLACE COSTA MESA, CA 92626
Phone :
(714) 546-1653
Con State Lic
: 472690
Lic Expire : 04/30/2024
Bus Lic: BT01013104
Bus Lic Expire:12/31/2023
Workers' Compensation Insurance
Carrier : SERVICE AMERICAN INDEMNITY CO
Policy No: SAMTWC0072801
W. C. Expire: 7/1/2023
Fire Hazard Zone : NO Manufacturer : DAIKIN
Model# : 5MXS48TVJU
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that ( 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. items)
Section 7031-5, Business and Professions Code: Any city or county that requires a permit to constrict, alter, improve; demolish, or repair anystructure, prior fo its issuance, also requires the applicant for
io permit file a
igned
he Is
revisions of the Controctors' State License Law (Chapter 9 (conemencing
th Section 7000) of
n 3 of the Business and
ofofeasionsCode)sor that he statement he isexemptat he or from liciefture and the bass for censed pursuant to the pthe alleged exemption. Anyviolation of Seotian'7031.5 by eM ppli0 nt fore permit subjects he applicant to a civil penalty of
lot more hen five hundred dollars ($500).
1, as owner of the property, or my employees with wages as their sole compensation, will do U oil of or `) portions of the work; and the structure is not intended oroffered'for sale (Section 7044,
tusiness and Professions Code: The Contractors' Stale License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the
nprovemnts are not intended or offered for sale. If, however, the building or improvement Is sold within one year of completi,6M the Owner -Builder will have the burden of proving that it was not built or
nproved for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Bu mess and Professions Code: the Contractors' State License Law does not
rP�ly to anowner of property who builds or improves thereon, and who contracts for the projects with a licensed Contractor pu uant to the Contractors' State License Law),
J I am exempt from licensure under the Contractors' State License Law for the following reason:
ly my signature below 1 acknowledge that, except for my personal residence in which I must have resided for at least one yen prior to completion of the Improvements covered by this permit, I.cannot legally
ell a structure that I have built as an o"er-builder if It has not been constructed In its entirety by licensed contractors. I under Stand that a copy of the applicable law, Section 7044 M the Business and
'rofessicns Code, Is available upon request when this. application is submitted or at the following Web sfte:http:/Iwww.leginfo. a.gov/calaw.himl-
signature of Property Owner or Authorized Agent Date
.ICENSED CONTRACTOR'S DECLARATION /
hereby affirm under penalty of pequry that I am licensed under provisions of Chapter 9 (commencing with Sectio ) of D'Asion 3 of the Business and Pjpfesslo Code, end k erise in full force
Ind effect. License Class License No Det Contractor Signalu .� 1m�-n ��,Is,EGt'\
YORKERS' COMPENSATION DECLARATION
!ARMING: FAILURE TO SECURE WORMERS* COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CANNINAL PENALTIES AND CIVIL FIRES, UP TO ONE HUNDRED THOUSAND DOLLARS ISrSD,eOS), IN ADDITION TO THE
DST 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:
I have and will maintain a. certificate of consent to self -insure for workers' compensation, issued by the Director of It
ormance of the Work for which this permit is issued. Policy No.
ave and will maintain workers' compense0on insurance, as required by Section 3700 of the Labor Code, for the park
ran carrier and policy number are:
'ier Policy Number
he of Agent
certify that, in the perform ce of the work for which this permit Is issued, I shall not employ any person In any manner so
If I should becomes to workers' Dom�p �lion p vsions of Section 370D of the Labor Code, I shalt forthwith c
iature of Applicnt. nP
hereby affirm under penalty of perjury that there is a construction lending agency for he performance of the work for which
enders 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 owner's behalf.
I have read this application and the Information.! he provided is correct.
I agree to comply With all Applicable city and DOLjntrordinseces and state Caws relating to building construction
I authorize representatives of this city or county fije"t the,#hove-oantinn prpperty for Inspection purposes.
ACTION I DATE I BY
Itl4iuf11
LEROFICATE OF )p7 1t`
OCCUPANCYIS'SUED Ctl
OF COMPLIANCE WITH CODE OF FEDEI
PART61 OF TITLE 40 AND AQMD NUKE
1403
Ll I SUBMITTED ASBESTOS NOTIFICATION TO
U A5R,5TOS'4Cn1Fh:ATIO1`! IS NOT APPLICABLE To
PgO`OSf D DEMOU'70N
SIGNATURE:
Relations as provided for by Section 3700 of the Labor Code, for
theworkfor which this permit Is issued. My workers'
Date
to become subject to the workers` oompensation laws of Calitomis. and agree
Iply with those provisiena. �
Date c�� --_� S
permit is issued (Section 3097, Civtl ode).
ONLY
'am f7—r— .