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Home My WebLink AboutH2018-0324 - Permits (3)��N•,¢F City of Newport Beach - Building Division 11111111111111111111111111111111111111111111111 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 8 0 3 2 4 H _n Permit Counter Phone (949)644-3288 to c f"L]YeiY�t�' Job Address: 511 FERNLEAFAVE BIdg:1 Floor: Suite: Description of Work: MECH - DUCT WORK ONLY Inspector Area:5 Code Edit : 2016 Legal Description: DEL MAR ELK 532 LOT 11 OF PROJECT 934-61 LOCATED ON AP MECHANICAL Permit: H2O18-0324 Project No : Inspection Requests Phone (949)644-3255 Owner: CRUM MEGAN Contractor: SERVICE CHAMPIONS HTG Worker's Comp Insurance - Address: 511 112 FERNLEAF AVE Address: 3150 E BIRCH Carrier: PACIFIC COMP , CORONA DEL MAR, CA 92625 BREA CA 92821 Policy No: WA000607 Phone: Phone: 714-777-7777 Expire :03/2212019 Con State Lic: 799170 Issued Date:05/24/2018 Lic Expire: 0913012019 Bus Lic: BT01080105 s Processed By: Lic Exp Date: 07/31/2018 HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr. 0 $0.00 Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.03 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: ,0 $0.00 >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: $0.00 Up to 1 M BTU/hr: 0 $0.00 up to 10K CFM: 0 $0.00 Repair/Alter/Add: 1 $18.00 Model: Issuance: $33.00 Up to 1.75M BTU/hr: 0 $0.00 Over 1OK CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $0.00 TOTAL: $51.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $51.00 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. INER-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) ction 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 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 Fessions 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 more than five hundred dollars ($500). I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, ;iness 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 rovements 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 roved 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 ply 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). LJ 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 in 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 appl Professions Code, is available upon request when this application is submitted or at the following Web site:hfp://www.leginfo.ca.gov/calaw.html. Signature of Propertv Owner or Authorized Agent LICENSED CONTRA.CTOR'S DECLARATION I' hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) f Division 3 of the Business and law, Section 7044 of the Business and license is in full force Lnd effs-t. Lirensq Class License No Date 2 L 4`-' Contractor SignatureZ LVORKERS' COMPENSATION DECLARATION Nt.RNW3: FAILURE TO SECJRE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE JOST OF OOMPENSLTION, ^AMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm :,rds- penalty of perjury one of the following declarations: have and whi 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 np rmance of the work for which this permit is issued. Policy No. P6ate and wN T. eirtain 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' compensatiol s,.- ..e carrier and policy number are: Carre-` Policy Number Expiration Date Name of Agent Phone # 131 certify that, in the performancey.Ltd hallhall__ ot^�OV any person in any manner so as to become subject to the workers' compensation laws of California, and agre that, if I should become subjesFi ompensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Signature of Applicant Date DECLARATION IREGAR44LO CONSTRUCT1921 ENDING AGENCY I 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, Civil Code). Lender's Name Lender's Address By 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 pro I agree to comply with all applicable city an as a s relating to building construction. I authorize representatives of this city or cou e-identified property for inspection purposes. r-- Signature of Pro erty Owner or Authorized Ag Print Property Owner's or Authorized Agent's Name Date Il ACT70N DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TFTLE40AND PERMIT EXPIRED AQMD RULE 1403. ❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO. PERMITCANCELLED ❑ EPA PERMITEXTENDED ❑ AQMD ❑ ASBESTOS N077FICA170N IS NOT APPLICABLE TO PERMIT FINAL LY PROPOSED DEMOLITION. CERTIFICATEOF' SIGNATURE: OCCUPANCY6SUED