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Home My WebLink AboutH2022-0209 - Permits (3)City of Newport Beach - Building Division 111111111111p1111111111111p11111111111p111111 MECHANICAL Permit: H2022-02 9 �£w,.,,�.r 0'1 n 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 2 0 2 0 9 Project No r~ y ,s' n; Permit Counter Phone (949)644-3288 t.d(iy 'µ��a.~ Inspection Requests Phone (949)644-3255 Job Address: 4521 PERHAM RD BIdgA Floor: Suite: Description of Work: MECH - R/R A/C CONDENSER. TAMPER -RESISTANT CAP REQUIRED Inspector Area:5 Code Edit: 2019 Legal Description: N TR 3357 LOT 114 Owner: FLUOR LISA Contractor: KLONDIKE AIR INC Worker's Comp Insurance - Address: 4521 PERHAM RD Address: 1308 LOGAN STE E Carrier: FALLS LAKE FIRE & CASUAL CORONA DEL MAR, CA 92625 COSTA MESA CA 92626 Policy No: FLA00809504 Phone: 949.413-2681 Phone: 714-979-2070 Expire :01101 /2023 Con State Lic: 754456 Issued Date:04/22/2022 Lic Expire: 09/3012022 Bus Lic: BT30060482 Processed By: Lic Exp Date: P`�l 09/30/2022 INSPECTOR HVAC Items FEES Furnaces Boilers & Compressors Ventilation Other 0 $0.00 $0.0( Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: Over 100K BTU/hr: 0 $0.00 > 3 HP to 15 HP: 1 $39.00 Exhaust Fan: 0 $0.00 Gas Line: 0 $0.00 $0.0 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 0 Investigation: $0.0 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $33.9 Up to 1 M BTU/hr: 0 $0.00 up to 10K CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model:D60IN2/A-D Issuance: $38.0 Up to 1.75M BTU/hr: 0 $0.00 Over 1 OK CFM: 0 $0.00 Supplemental Fee: $0.00 ManufactuPRO Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $52. CDueit TOTAL: $162.93 Plan Check Fee : $162.93 FeI uance : $0.00 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. 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 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 -Builder will have the burden of proving that it was not built or 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). ❑ 1 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 legall) 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 Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. Signature of Property Owner or Authorized Agent Date LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Pro ssio Code, m e se is full force and effect.5 Z $ Z2—Contractor Signatur License License Class License No Date WORKERS' COMPENSATION DECLARATION WARNING: 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 ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: 41 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 th pNormance of the work for which this permit is issued. Policy No. 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' carrier and policy number are: Policy Number Expiration Date ne of Agent Phone # certify that, in the performan of he work for wh�1&onssof Isued, shall not employ any person in any manner so as to became subject to the workers' compensation laws of California, and ogre [, if I should becom�'�errsubject o th workers'Amp Section 3700 of the Labor Code, I shall forthwith comply with those provisions. nature of Applicar)k. Day -rZZ-- CLARATION REGARDING CONSTRUCTION LENDING AGENCY !reby 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). Ider'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 pro 'ded is correct. I agree to comply with all applicable city and county or a ces and st ti g to building construction. I authorize representatives of this city or county to a er t above en' pop for inspection purposes. �'/r(� _ I nature of Prooertv Owner or Authorized Aoentll Print Prooertv Owner'�.Yi4�(�aat s or Authorized Anent's Name Y f-fyV e 5/7,/Z ACTION DATE BY UL�LAr nUly Ur wMPIJAWILL VWIn CUUt Ur FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE40 AND AQMD RULE 1403, PERMIT EXPfRED ❑ 1 SUBMITTEDASBESTOS NOTIFICATION TO: ❑ EPA ❑ AQMD PERMITCANCELLED PERMIT EXTENDED ❑ ASBESTOS NOTIFICATION IS NOT APPLICABLE TO PROPOSED DEMOLITION. PERMIT FINAL J.-, CERTIRCATEOF SIGNATURE: OCCUPANCYISSUED