HomeMy WebLinkAboutH2021-0523 - PermitsCity of Newport Beach - Building Division III 1111111111111111111111111111111111111111111111
=� v� 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 2 1 0 5 2 3
Permit Counter Phone (949)644-3288
I'�4Y;,yxd
Job Address: 715 GOLDENROD AVE BIdg:1 Floor: Suite:
Description of Work: MECH - R/R 2 FAUs
Inspector Area;(, Code Edit:
2019
Legal Description: CORONA DEL MAR BLK 733 LOT 15
Owner: CUSHMAN ELIZABETH
Contractor:
Address: 1325 PACIFIC HWY #3402
Address:
SAN DIEJO CA 92101
Phone:
Phone:
Con State Lic:
Issued Date:09/08/2021
Lic Expire:
Bus Lic:
Processed By:
Lic Exp Date:
HHCM CORPORATION
PO BOX 12784
NEWPORT BEACH CA 92658
949-812-6300
978935
11/30/2022
BT30073531
11/30/2021
MECHANICAL Permit: H2O21-0523
�i - 'S
toProject No : 1047-2021
Inspection Requests Phone (949)644-3255
Worker's Comp Insurance -
Carrier : EXEMPT
Policy No: NO EMPLOYEES
Expire:
TUTOR
'AC Items
FEES
rnacesBoilers & Compressors
Ventilation
to 100K BTU/hr:
2
$44.00
Up to 3HP:
0
$0.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0 $0.00
Other
$0.00
er 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
III/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0
$0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0 $0.00
at Pumps & Package
Units
>30 HP to 50 HP
0
$0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
to 100K BTU/hr:
0
$0.00
>50 HP:
0
$0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigation:
$0.00
=_r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$0.00
to 1 M BTU/hr:
0
$0.00
up to 10K CFM:
0
$0.00
Repair/Alter/Add:
0 $0.00
Model:
Issuance:
$38.00
to 1.75M BTU/hr:
0
$0.00
Over 1 OK CFM:
0
$0.00
Supplemental Fee:
$0.00
Manufacturer:
=r 1.75M BTU/hr:
0
$0.00
VAV Box:
0
$0.00
Zoning PC:
$0.00
TOTAL: $82.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $82.00
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. _
)WNER-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 items
ode: Any city or county that requires a permit to con
Section 7031.5, Business and Professions Cstruct, 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
3rofessions 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
lot 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,
3usiness and
mprovemen s are not intended or offered for sale. ffahowte License
, the building or improvement apply
vement sowner
soldfwithin one year of completioemployees'
n, the Owner Builde ersonal effort,
I havbuilds
e therimproves the burden of proving that itprovided
not that the
mproved 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).
D 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
sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. 1 understand that a copy of the al
Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.oa.gov/caiaw.html.
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 70 0) of Division 3 of the Business a
and effect. Date Contractor Signatu
License Class License No
s covered by this permit, I cannot
Section 7044 of the Business and
in full force
VORKERS' COMPENSATION DECLARATION I�YI,N�M�t
'ARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CI INES UP TO ON HVNONED THOUSAND D L 00900r JIFJ ADDITION TO THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
hereby affirm under penalty of perjury one of the following declarations:
7 I have and will maintain a certificate of consent to self -insure for workers' compensation, issued by the Director of Industrl asp or y Section 3700 of the Labor Code, for th
erformance of the work for which this permit is issued. Policy No.
d M workers' nmm�ensatirn
have and will maintain
ranee carrier and policy
ier
7e of Agent
�ar"fy that, in the Dario
"I should b s
ra of Applicant
ARATION "ant
IJ
re if,
under pe I
compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit Is Issue . y
are:
Policy Number
or w is this permit is issue
w rk Iciir4per cation provisions of
is a
Date
I shall not employ any person in any manner so as to become subject to the workers' cor�npensation laws of California, and agre
qW 3700 of the Labor Code, I shall forthwith comply with those provisions. /Z
Date\7 [/
AGENCY
action lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code).
Lender's Address
my signature belowT, Feertibe h or the Tollowing:
I am the property owner or authorized to act on a pro o er's a If.
I have read this application and the information I hav r Id c me t.
I agree to comply with all applicable city and county i n s la o uilding construction.
I authorize representatives of this city or county v ide f' party for inspection purposes.
mature of Property Owner or Authorized Print Property Owner's or Authorized Agent's Name
Frob
aCTrON / DATE tr y FEDERAL REGULATIONS PART 61 OF TITLE40AND
_ �- — AQMD RULE 1403.
PERM7F P'RE'7 ❑ I SUBMITTED ASBESTOS N077FICATION TO:
--�---- [IEPA
FIRMH CANCELLED ❑ AQMD
PER,MITEXTENDED -Z []--ASBESTOS N077FICA770NIS NOTAPPLICABLE TO
PERMIT FWA, — - —.fOPOSED DEMOUTION.
CERT7FlC.4P- of SIGNATURE:
OCCUPAN'�"rSSL)FP
Date q /O ,