HomeMy WebLinkAboutH2015-0587 - Permits%w,b4 City of Newport Beach - Building Division IIIIIIII I III IIII III IIIIIIII III III III II
�+ r0 too civic Center Drive, Newport Beach, CA 92660 H 2 0 1 5 e 5 8 7
Permit Counter Phone (949)644-3288
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Job Address: 4521 BRIGHTON RD BIdg:1 Floor: Suite:
Description of Work: MECH/C/O (E) F.A.U. & INSTALL (1) NEW AIC UNIT 51.5-
SHUT OFF BETWEEN 10PM & 7AM
Inspector Area:5 Code Edit: 2013
Legal Description: TR 3357 LOT 154 AND P�O 6
Owner: HOFF ROB
Address: 15 BLUFF
IRVINE,
Phone:
Issued Date:12115/2015
Processed By:
926
9260?
nacesBoilers & Compreslon
to 100K BTU/hr: 1 $18 0
ar 100K BTU/hr:
0
$0. 0
ill/Floor Heaters:
0
$0.
at Pumps & Package Units
to 100K BTU/hr:
0
$0.00
er 500K BTU/hr:
0
$0.00
to 1M BTU/hr:
0
$0.00
to 1.75M BTU/hr:
0
$0.00
er 1.75M BTU/hr:
0
$0.00
TOTAL:$1
MECHANICAL Permit: H2O15-0587
Project No :
Inspection Requests Phone (949)644-3255
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Y lt��uu� -c '((�0°f�4/XiOI�j�UUi:`.crrc -o
/ 1600/ 0( IV ANDAPPI A
0160010
v '' ho� Worker's Comp Insurance
d dress Carrier EMPLOYEE SVC
h ,vG 10 92865 Policy :0 01/2 67
p � �'0102-- = Expire 07/01/261$ %MA,
5 pir�',L 0930220 '1 I`;'!v"x„^,
u Lic: B� yg r r'P11�,V
Lic Exp 10te 44� `ram .,.
0 3HP0 $0-n°
anv:
groom Fan:
u
> to 15 HP: + �ttic Fa Fan:
0
>15
OffliA „qg0�
Dtown-Draft Fan:
0
Residential Ho
����,C�Og'�g6�0
andlin�tWfrts
Cood:
0
up to 1 OK CFM: 0 $0.00
epair/Alter/Add'
Over 10K CFM: 0 .00
Supple Fe
VAV V: 0 $0.00
Oi ''
b. 4
Plan Check Fee
D
Fire Dampers:
Gas Li '0.00
!$0.00a16
al Firepl�—
Recollp ce:
$0.00
'Iona
Model:
$0.00
Manufacturer:
7.�.v<,..
R REQUIRED ON EQUIPMENT4 O
Rc
ROUP
Other
$0.00
$0.00
$0.00
$65.34 Investigation: $0.00
Plan Check: $0.00
Issuance: $32.00
$0.00 Fee Due at Permit Issuance : $147.34
PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION
JWNER-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
he 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
'rofessions 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
iot 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 tJ portions of the work, and the structure is not intended or offered for sale (Section 7044,
3usiness 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
mprovements 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 t rden of proving that it was not built or
mproved for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed Contractors to construct the proContracto
project Se mess and Professions Code: The C tractors' State License Law does not
Poly to an owner of property who builds or improves thereon, and who contracts for the nsed r pursuant to the Cohtr s(5fa[eaLicen a Law).
I am exempt from licensure under the Contractors' State L a allowing reason: ��C��JIE:
3y my signature below I acknowledge tha r naI -r-- i must have resided for at IeasP brf�tte�"r prior to completion of the irroq�ne is
fell a structure that have tit ner-builder Ir "' _ ceo In its emir ieense3'Contractors. I under nd �t'�oQf��Q}�g ��bje'law S
'rofessions Code, is avails on request, do s e following Web site:http://wwv, re i�'tOoQaFavd.hfinl.
and effect.
CONTRAC .�; r utho•'� 4may[
signature of Property Ow ,4�
- DE,af ATION t�'
hereby affirm under pena', f rjury that I am censed rovl- ,en "' tion 7oo�fJQtw usiness and Profession
F ° 4- S
.icense Class iFb�,f' � a e - Contractor Signatur
VORKERS' COMPENS i Dit w _
IARNING: FAILURE TO SECURE W. KE 'CO - f�_ 1 OVERAGE IS UNLAWFUL, AND SHALL eIJpJF�
'OST OF COMPENSATION, DAMA S OVIDED FOR IN SECTION 3706 OF THE LABO ("M bF„ E _ —AL I IES AND CIVIL FINES UP TO ONE HUNaRED THOUS
hereby affirm under penaltyat ry one wing ter-.
have and will maintain' rt icate f r�- nsdfe f y -tk compson, y the Director of Industrial Relations as provided for by Sec
erformance of the work for w t pe- Polra'rjy(i
,fit �` e a
JI have and w' maintain w `°`yrS. omp urance, as required by Section 3700 of the Labor Code, f ie 1perform�,-- mit
isurance ca ter a d policy nJ Y'er e: y
aer r icy Number B � Exp'Irak, tiop` ate
ameofA ®.V,y9 "- l
]I certify that, in the performan. "oter, ,�,c pe6RiMISS;d!I s all not employ any person in any m nner so as to become subject to the workers' coml
at, if I should become su ect t a ati n prrovi�i f( 3700 of the Labor Code, I shall forthwith comply with those provisions
/ty
ignature of Applicant R.-'"._
:.L ItAI luN 1ttL9AMILHIVG14�c
CTION LENDING AGENCY _ illitl�:
ereby affirm under penalty ot there is a construction lendin a performance of the work for which thi FIYSissued (Section
rider's NameLender's Address
my signature below, I Gertift e following:
I am the property owner oto act on the ro ehalf.I have read this applicatioor on have
agree to comply with all y ordinances and state IawS,relating to In construction.
I authorize representatives of this city or county to eM a -i nttiXed property for inspection purposes.
(nature of Property Owner or Authorized Agenj-- Print Property Owner's or Authorized Agent's Name
ACTION I OfTE -- BY DECLARATION OFCOMPLLANCEWITN CODE OF FOR
FEDERAL REGULATIONS PAPT 51 OFT.'TLEd9AND
PERMIT EXPFRED AQMD RULE 1403.
• •�' ❑ I SUBMITTEDASBESTJS Ko nt ICA; oN -O:
PERMIT CANCELLED ❑ EPA
PERMITEXTENDED ❑ AQMD
ASBESPERMIT FIN -"jam - PROPOSEDTOS DEMOLITION.RON lS NOT APPLICABLE TO
AL
CERTIFICATE OF
OCCUPANCYISSUED SIGNATURE:
Date
his permit, I cannot
of the Business and
is in full force
DOLLARS ($100,000), IN ADDITION TO THE
3700 of the Labor Code, for
issued. My workers'
laws of California, and
ONLY
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