HomeMy WebLinkAboutH2021-0410 - Permits0wr„�� City of Newport Beach -Building Division H2O21-0410 MECHANICAL Permit : H2021-0410
e 100 Civic Center Drive, Newport Beach, CA 92660 Project No : 1476-2020
�„ ,.', Permit Counter Phone (949)644-3288
� "aa a 1� C Inspection Requests Phone (949)644-3255
Job Address: 1701 STARLIGHT CIR BIdgA Floor: Suite:
Description of Work: MECH (1) NEW HEATPUMP & (1) HEAT PUMP CHANGE OUT *TAMPER PROOF CAP REQ*
Inspector Area:3 Code Edit: 2019
Legal Description: N TR 3763 LOT 28
Owner: JOHNSON LINDSAY & DANIELLE Contractor:
Address: 1701 STARLIGHT CIR Address:
NEWPORT BEACH, CA 92660
Phone: 949-307-1252 Phone:
Con State Lic:
Issued Date:07108/2021 Lic Expire:
Bus Lic:
Processed By:- Lic Exp Date:
PACIFIC WEST CONCRETE INC
3672 PROVINCETOWN AVE
IRVINE CA 92606
7141396-0088
639232
05/31/2023
BT30071085
12/31 /2021
INSPECT l
Worker's Comp Insurance -
Carrier: EXEMPT
Policy No:
Expire
HVAC Items
FEES
Furnaces Boilers & Compressors
Up to 100K BTU/hr: 0 $0.00
Ventilation
Up to 3HP:
0 $0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0 $0.00
Other
$0.00
Over 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
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:
2
$44.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigation:
$0.00
Over 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$38.28
Up to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
48LMAS1lssuance:
$38.00
Up to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
FUJITSU
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$52.00
TOTAL:
$172.28
Plan Check Fee
: $0.00
Fee Due at Permit Issuance :
$172.28
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.
ER -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 fora 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 (_) 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
li 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).
I 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 legally
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 Cooe, s available upon request when this application is submitted or at the fallowing Web site:http://www.leginfo.ca.gov/calaw.html.
Srra'Lre of P, opei ly Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I n9reo" affirm unrter penalty of perjury that I am licensed under provisions of Chapter 9 (commencing 'th ection 7000) of Division 3 of the Business nd rotes 'en nd my license is in full force
and e,fect. _
Lcen:.e Class License No Date — — Contractor Signatdre
'NOZRERS' COMPENSATION DECLARATION (�
AA,,NIHG. FAILURe TO SFCU RE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS I$100,0001, IN ADDITION TO THE
CnFT OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I hP .hy affirm under penalty of perjury one of the following declarations:
1 I ha✓e and will ,na,,ntain 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 the
..0 ince of the work for which this permit is issued. Policy No.
Ihave and will malmain 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' compensatiod
insurance carrier and policy number are:
Policy Number Expiration Date
of Agent
I certify 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 agree
It, if I should become u ject to th ork pensa' n provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi i ns.
Inature of Applicant Dated
iCLARATION REGARMINGCONSTRUCTION LENDI 0 AGENCY
ereby 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).
nder's Name 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 coun y ordina n to laws relating to building construction.
I authorize representatives of this city or count abov id tified�ro ert for ins ection ur oses. P Y P Y P .P P � /T^ C
Inature of Property Owner or Authorized Age O Print Property Owner's or Authorized Agent's Name {—'iZ�jj CCy Dat %'1�-2.. l
ACTION
DATE
BY
DECLARATION OF COMPLIANCE tN1TN CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART BI OF TIRE 40 AND
AQMD RULE 1403.
PERMIT EXPIRED
❑ ]SUBMITTED ASBESTOS NOTIFICATIOP( TO:
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERMIT EXTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTIRCAT60F
OCCUPANCYISSUED
SIGNATURE.