HomeMy WebLinkAboutXR2023-1895 - Misc (3)�P0Rr CITY OF NEWPORT BEACH
COMMUNITY DEVELOPMENT DEPARTMENT
F ; n BUILDING DIVISION
U y- ' -T 100 Civic Center Drive I P.O. Box 1768 1 Newport Beach, CA 92658-8915
www.newportbeachca.gov 1 (949) 644-3200
[Voluntary]
CONTRACTOR/PROPERTY OWNER SELF -CERTIFICATION DECLARATION
FOR RESIDENTIAL PROPERTIES
(Dishwasher, Garbage Disposal, Water Closet)
Project Address: SOO o/✓f Land 1,,102rI 80"k Cf A y.1.60
Date: _5Z 17 I- U Permit #: )C R )14) i H5 10 �L
The following is to be completed by the California licensed plumbing contractor or owner -builder, participating in
the City of Newport Beach t.
��ch Self -Certification Program. Please type or prin
Installer's Name: ct ub 'TVF?r,5 License No (if applicable)
Installer's Mailing Address: Phone # (required): 562- 871(- 907
Installer's Email: 0* FAX #: N A_
Installer
I certify that the installation is in compliance with applicable code requirements.
I further affirm that I have reviewed and understand the requirements of the applicable 2013 California Plumbing Code
and Newport Beach Municipal Code and that all self -certification reports submitted will be based on the code
requirements contained therein.
Please check the appropriate box below for work to be completed under this Self -Certification declaration:
DISHWASHER. Installed same size and in the same location. Air gap fitting installed per
2013 California Plumbing Code, 807.4.
lx4 GARBAGE DISPOSAL. Installed same size and in the same location.
WATER CLOSET. Replaced in the same size and 1.28 gallon per flush.
Cam- -Av S <-rA v r c
50 IN
Date
Property Owner (Required)
As the property owner of the project address noted above, I have read, understand and agree to participate in the
System Self -Certification Program. I further understand that by participating in this program, the plumbing system will
not be inspected by a City of Newport Beach Building Inspector during construction or after installation unless
requested. The Building Division may request and reserves the right to verify code compliance after the installation is
2A
Date
zacewelIacwoc. COM
Email
This form must be completed and returned to the City of Newport Beach, Building Division, for a final approval
of the plumbing permit. Please return this form to the Building Division by mail or fax.
Please mail to: City of Newport Beach Phone: (949) 718-1888
Community Development Department Fax #: (949) 644-3250
Building Division
P. O. Box 1768
Newport Beach, CA 92658
Forms\Contractor-OwnerSelf-CertDeclaration-DishwasherGarbageDispWaterCloset 08/11/16
PROJECT SUMMARY
Project Name:
Address:
City, State, Zip:
Building Department:
Permit Number:
Building Energy Code:
M23-2719RRR
1500 Lincoln Ln
Newport Beach, CA 92660
Newport Beach, City of
XR2023-1895
2022 Standards
HERS VERIFIABLE
MEASURES
ENERGY CODE
COMPLIANCE
CERTIFICATE OF COMPLIANCE (CF1 R)
Scan to Validate
COMPLETE O
COMPLETE O
DATE DOCUMENT TITLE REGISTRATION NUMBER
02/05/2024 CF1R-PRF-01-E Performance Compliance 424-P010021327A-000-000-0000000-0000
CERTIFICATE OF INSTALLATION (CF2R)
DATE DOCUMENT TITLE REGISTRATION NUMBER
05/14/2024 CF2R-ENV-01-E Fenestration 424-P010021327A-000-001-E01001A-0000
05/14/2024 CF2R-ENV-03-E Insulation Installation
05/14/2024 CF2R-LTG-01-E Lighting
05/14/2024 CF2R-MCH-01d-E HVAC, Ducts and Fans
05/14/2024 CF2R-PLB-02-E Single Family Hot Water
BEDROOM
05/14/2024 CF2R-MCH-20a-H Duct Leakage
05/14/2024 CF2R-MCH-22a-H Fan Efficacy
05/14/2024 CF2R-MCH-23a-H Airflow Rate
COMMON AREA
05/14/2024 CF2R-MCH-20a-H Duct Leakage
05/14/2024 CF2R-MCH-22a-H Fan Efficacy
- avngnued on next page -
424-PO 1 0021327A-000-0 0 1 -E03002A-000 0
424-PO10021327A-000-001-1-01003A-0000
424-PO 10021327A-000-001-M01004A-0000
424-P010021327A-000-001-BO2013A-0000
424-P010021327A-000-001-M20006A-0000
424-PO 100 21 327A-0 00-00 1 -M 2201 OA-00 00
424-PO10021327A-000-001-M23008A-0000
424-PO10021327A-000-001-M20005A-0000
424-PO 10021327A-000-001-M22009A-0000
STATUS
STATUS
tart NOTICE: This compliance summary report has been generated by a registration platform provided by CHEERS using
�` i `^ F R information that has been uploaded to that registration platform by third parties that are not affiliated or related to
;,I II v H ` E , `S CHEERS. Therefore, CHEERS is not responsible for, and cannot guarantee, the accuracy or completeness of the Page 1 of 2
information contained in this certificate. 9
Scan to Validate
CERTIFICATE OF
INSTALLATION
(CF2R)
DATE DOCUMENT
TITLE
REGISTRATION NUMBER
STATUS
05/14/2024 CF2R-MCH-23a-H
Airflow Rate
424-P010021327A-000-001-M23007A-0000
-
WHOLE HOUSEI
05/14/2024 CF2R-MCH-25c-H
Refrigerant Charge
424-P010021327A-000-001-M25011A-0000
05/14/2024 CF2R-MCH-25c-H
Refrigerant Charge
424-P010021327A-000-001-M25012A-0000
05/16/2024 CF2R-MCH-26-H
High SEER & EER
424-P010021327A-000-001-M26014A-0000
05/16/2024 CF2R-MCH-26-H
High SEER & EER
424-P010021327A-000-001-M26015A-0000
CERTIFICATE OF
VERIFICATION
(CF3R)
DATE DOCUMENT
TITLE
REGISTRATION NUMBER
STATUS
BEDROOM
424-P010021327A-000-001-M20006A-
05/14/2024 CF3R-MCH-20a-H
Duct Leakage
M20A
05/14/2024 CF3R-MCH-22a-H
Fan Efficacy
424-P010021327A-000-001-M22010A-
M22A
05/14/2024 CF3R-MCH-23a-H
Airflow Rate
424-P010021327A-000-001-M23008A-
M23A
COMMON AREA
05/14/2024 CF3R-MCH-20a-H
Duct Leakage
424-P010021327A-000-001-M20005A-
M20A
424-P010021327A-000-001-M22009A-
05/14/2024 CF3R-MCH-22a-H
Fan Efficacy
M22A
424-P010021327A-000-001-M23007A-
05/1412024 CF3R-MCH-23a-H
Airflow Rate
M23A
WHOLE HOUSEI
05/14/2024 CF3R-MCH-25c-H
Refrigerant Charge
424-P010021327A-000-001-M25012A-
M25A
05/14/2024 CF3R-MCH-25c-H
Refrigerant Charge
424-P010021327A-000-001-M25011A-
M25A
424-P010021327A-000-001-M26014A-
05/16/2024 CF3R-MCH-26-H
High SEER & EER
M26A
424-P010021327A-000-001-M26015A-
05/16/2024 CF3R-MCH-26-H
High SEER & EER
M26A
\`t.rfy NOTICE: This compliance summary report has been generated by a registration platform provided by CHEERS using
all : information
CHEERS
that has been uploaded to that registration
platform by third parties that are not affiliated or related to
CHEERS, Therefore, CHEERS is not responsible
for, and cannot guarantee, the accuracy or completeness of the
Page 2 of 2
information contained in this certificate.