HomeMy WebLinkAboutH2022-0221 - Permits*a£wrf,�A City of Newport Beach - Building Division H2O22-0221
G� 100 Civic Center Drive, Newport Beach, CA 92660
Permit Counter Phone (949)644-3288 ,9¢ e a y ,�- m--,,.+; , •.vy r--�
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Job Address: 211 EVENING CANYON RD Bldg:1 Floor: Suite:
Description of Work: MECH: R/R (1) A/C UNIT @ SIDE YARD. "TAMPER RESISTANT CAPS REQUIRED"
Inspector Area:5 Code Edit:
2019
Legal Description: N TR 1116 LOT 124
Owner: CLARK DONALD A
Contractor:
WHITE MECHANICAL INC
Address: 211 EVENING CANYON RD
Address:
27221 BURBANK
CORONA DEL MAR, CA 92625
FOOTHILL RANCH CA 92610
Phone: 949-355-5370
Phone:
949-716-8379
Con State Lic:
822474
Issued Date:04/2712022
Lic Expire:
08/31/2023
Bus Lic:
BT30055645
Processed By:
,J
Lic Exp Date:
06/30/2022
MECHANICAL Permit: H2O22-02
Project No :
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier: TRAVELERS CASUALTY
Policy No: B31R5812182026G
Expire :10/0112022
'AC Items
FEES
rnacesBoilers & Compressors
Ventilation
to IOOK BTU/hr:
0
$0.00
Up to 3HP:
0 $0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
er I OOK BTU/hr:
0
$0.00
> 3 HP to 15 HP:
1 $39.00
Exhaust Fan:
0 $0.00
Gas Line:
III/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
at Pumps & Package Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
to 1OOK BTU/hr:
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee
er 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
to 1.75M BTU/hr:
0
$0.00
Over 1OK CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
er 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Other
0 $0.00
0 $0.00
0 $0.00
$0.00
i
$0.00
$0.00
$0.00 Investigation: $0.00
Plan Check: $33.93
38QRRO601ssuance: $38.00
CARRIER
Zoning PC: $52.01
TOTAL: $162.93 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $162.93
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.
OWNER -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.
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
improved for the purpose of sale).
❑ 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
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).
❑ 1 am exempt from iirensure under the Contractors' State License Law for the following reason:
By my signature be,o� 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
SO;; a a:ructure t:i; t I Save 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 Code, 's available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.govlcalaw.html.
Sign-atum of Property Owner or Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm wider penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions license is in full force
aid eYoct. `T Y I1 Z7Z�(
L censP Class License No Date /: " -z-Bontractor Signature / �+
V/ RYERS' COMPENSATION DECLARATION
ViAI'IINOr FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1013,I)D01, IN ADDITION TO THE
COS'. OF COMPENSA rION, CAMAGES AS PROVIDED FOR IN SECTION 0706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
I herebv affirm unJ�r pe.ralty of perjury one of the following declarations:
hove and Tv111 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, forth(
performance of the work forwhich 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' compensatior
insurance carrier and policy number are:
Carrier Policy Number Expiration Date
Name of Agent Phone #
❑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 agref
that, if I should become su Oct to�r ers' ensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. (.-� '7
Signature of Applicant Date K l Z�J
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
Order's 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 I have provided is correct.
I agree to comply with all applicable city and county ordinances and state laws relating to building construction.
I authorize representatives of this city or county to enter the abopg identified property for inspection purposes.
of
Authorized Agent's Name
Civil Code).
ACTION
DATE
BY
DECLARATION OF COMPLIANCE WITH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF TITLE 40 AND
AQMD RULE 1403,
PERMIT EXPIRED
❑ I SUBMITTED ASBESTOS NOTIFICATIONTO:
❑ EPA
❑ AQMD
PERMIT CANCELLED
PERMIT EXTENDED
❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERMIT FINAL
i
CERTLrICATE OF
OCCUPANCYISSUED