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H2023-0522 - Permits
�tiwno�;Ta City of Newport Beach II I I III III II IIII I I I II Mechanical Permit : HZO23-O5J22 Community Development Department - Building Division No PerCivic C unterPhone: (949) 718-18gg' CA 92660 ` y. Work C assPlan k Other Y newportbeachca.gov/civic - Issued Date : 08/1812023 Inspection Area : 1 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 : 212 41ST ST, A Legal Desc : Description: (RENEW EXPIRED PERMIT H2O21-0494) MECH NEW HEAT PUMP *TAMPER PROOF CAP REQ & TIMERS PROHIBITED* Owner: LEWIS BRIAN M TR Address : 44700 VILLAGE CT #100 PALM DESERT, CA 92260 Phone : (760) 534-4094 Applicant: LEWIS BRIAN M TR Address : 44700 VILLAGE CT #100 PALM DESERT, CA 92260 Phone : (760) 534-4094 Owner/Builder : LEWIS BRIAN M TR Address : 44700 VILLAGE CT #100 PALM DESERT, CA 92260 Phone : (760) 534-4094 Code Edition : 2019 Type of Construction Occupancy Groups: Building Setbacks Flood Zone: Use Zone PROCESSED BY: Fire Hazard Zone : NO Contractor : J P T CONSTRUCTION INC Address : 409 62ND ST NEWPORT BEACH, CA 92663 Phone : (714) 336-1966 Con State Lie : 879360 Lie Expire : 06/30/2024 Bus Lie : BT30014788 Bus Lie Expire:01131/2024 Workers' Compensation Insurance Carrier : WESCO INS CO Policy No: WWC3579585 W. C. Expire: 4/7/2024 SPECIAL CONDITIONS: HIGH DENSITY ZONE / RENEW EXPIRED PERMIT H2O21-0494 Manufacturer: MITSUBISHI Model# : MXZ-4C36NA TIMERS PROHIBITED ON HEAT PUMPS NO CCNSTR11CT'O,lN WORK ON SAT�JnDq,y,5 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 chackmark(s) I have placed next to the applicable itern(s) 'action 703L5, Husiness and Professions Code` Any city or county that requires a pannit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance, also requires the applicant for is permit to Via 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 'rofassions 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 Rran five hundred dollars ($500). 3 1, as owner of the property, or my employees with weg'bs as their sole compensation, will do I_) all of of (_) portions of the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professions Cade; The Contractors' State License Law does not apply to an owner of property who, through employeesor 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 n roved for the purpose of sale). as owner of the properly, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not pply to an owner of property who builds or Improves thereon, and who contracts for the projects with a incensed Contractor pursuant to the Contrac(ors' State License Law). J I am exempt from licensors under the Contractors' State License Law for the following reason! ly 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 legall, . 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 Ihat a copy of the applicable low, Section 7044 of the Business and 'rofessions Code, is available upon request whaWM a placation is submitted or t 1 following "A'sb site:blip:llwww.laginfo.ca..govlcalaev, html. �� �Z�j signature of Property Owner or Authorized Agent ��1� _m____..m ______�� Date ^ .ICEN'SED CONTRACTOR'S DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of Chap r 9 {commencing with Section 7000) of Division 3. of the Business and Professions Code, and ny license is of full force he affect. License Class License No Date Contractor Signature VORKERS' COMPENSATION DECLARATION 'ARNINO: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 19 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TD CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS (§I00,0001, IN AUDITION TO1 DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37H OF THE LABOR Coot, INTEREST, AND ATTORNEY's FEES. hereby affirm under penalty of perjury one of the following declarations: 3 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 eremrance of the work for which this permit is issued. Policy No. 31 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' componsa Issrance carrier and policy number are. Policy Number Expiration Date no of Agent certify that, inthe performance of the work for which . 1f I should become sutuaa- the workers' comppm of Applicant is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, andagre ns of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. _ Date_8'— l e—ZO2-3 hereby affirm under penatty of perjury that there is a constructiob lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code), _ender'9 Name _ _ _ _ _,�__ Lenders Address 3y my signature below, I certify to each of the following: I am the property owner or authorized to acton the property owner's behalf. I have rand this application and the information I have provided is correct. I agree to comply with ail applicable city and county ordinances and state ws r©laturg to building construction. I authorize representative, of thi°., city or comr ter In above nilfi p rt for inspection purposes. 19 SI nature of Property Owner rr Aulhnhzed Agent IPrint Pro ert C4mer's or Authorized Agent Nam - L, ACTION DATE BY DECLARATION OF COMP IANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY R FGUI,ATIONS PART fit OF TIT4.F 40 AND AQMD RULE 1403 PERMIT EXPIRE© 1 SUBMITTED ASBESTOS NOTIRCATION TO PERMIT GANC:ELlF,P 1 IJERA PERMIT EXFEN06D < ' am r—�LJl1 PERMIT FINAL �} ram. ` MASHE510S NOTIPICAi'ION 15 NOI APPLICAKI• 10 CERTIFICATE CE r L"� v"' , `Kn PROPOSED DEMOLITION OCCUPANCY ISSL"D V^'. SiGNATUREt Date ,7' ��-