HomeMy WebLinkAboutH2023-0631 - Permitsk�eWPQR, City of Newport Beach
Community Development Department - Building Division
100 Civic Center Drive, Newport Beach, CA 92660
u = Permit Counter Phone: (949) 718-1888
ti newportbeachca.gov/civic
Mechanical Permit : H2023-0631
Plan Check No : PC2023-2002
Work Class : Other
Issued Date : 09/28/2023
Inspection Area : 2
PERMITS EXPIRE 180. DAYS AFTER ISSUANCE OR LAST VALID INSPECTION, BUT NO LATER THAN 3 YEARS FROM ORIGINAL ISSUANCE DATE
NO CONSTRUCTION RELATED NOISE ON SATURDAY OR SUNDAY IN HIGH DENSITY AREAS AND NO WORK ON SUNDAY AND HOLIDAYS IN ALL AREAS
Job Address : 4 HARBOR ISLAND Legal Desc : N TR 802 BLK LOT 4 TR 802 LOT 4 ALL -INC BET SAME
Description: MECH R/R 2 WALL MOUNTED A/C UNITS AT SIDE. R/R 2 FAU AND DUCTWORK. **TAMPER RESISTANT CAPS REQUIRED** (XR2023-2291)
Owner : FTK 2 LLC
Address : 20409 YORBA LINDA BLVD YORBA LINDA, CA 92886
Phone :
Applicant: BEN MEDINA
Address: 31225 LA BAYA DR WESTLAKE VILLAGE, CA 91362
Phone : (818) 735-7876
Owner/Builder :
Address:
Phone:
Code Edition : 2022 Fire Hazard Zone
Type of Construction
Occupancy Groups:
Building Setbacks : Front: 15, Front: 15, Side: 4, Side: 4
Flood Zone : X
Use Zone : R-1 - Single -Unit Residential
PROCESSED BY: S
SPECIAL CONDITIONS: HIGH DENSITY ZONE
Contractor : SERVICE CHAMPIONS HTG
Address :
3150 E BIRCH BREA, CA 92821
Phone :
(714) 777-7777
Con State Lic :
799170
Lic Expire :
10/31/2023
Bus Lic:
BT01080105
Bus Lic Expire:
07131/2024
Workers' Compensation Insurance
Carrier :
EVEREST PREMIER INSURANCE COMPANY
Policy No:
RM8WC00054231
W. C. Expire:
8/1/2024
NO Manufacturer: LENNOX
Model# : VPC060H4M-39
ON SATUR®AYS
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that t am exempt from the Contractors State License Law for the reasons) indicated Wow by the checkrnark(s) I have placed next to the applicable items)
iedtiOn 703t.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
re 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
'rofrseons Code) or that he or she is exempt from Iicensme and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a. permit subjects the applicant to a civil penaty of
of more than five hundred dollars ($5000).
3 I, as owner of the property, or my employees with wages as their sole compensation, will do (_) all of or {_) portions of the work, and the structure is not intended or offered for sale (Section 7044,
usinass 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
nprovements 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
1roved for the purpose of sale)_
1, asowner 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
pley 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).
I I am exempt from iicensure under the Contractors' State License Law for the following reason:
y my signature below I acknowledge that, except for my personal residence in which I must have matted for at least one year prior to completion of the improvements covered by this permit, I cannot legal[,
ell a structure that € 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
7ofesslons Code, Is available upon request when this application Is submitted or at the following Web site:http:tlwww.leginfD.ca.gov/caiaw.html.
ignature of Properly Owner or Authorized Agent Date
]CENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) MR Ir 3 SIT the Business and Professe de, a rise is in full force
nd effect. License Class ,License No Date X Contractor Signature
WORKERS' COMPENSATION DECLARATION
ARNINO: FAILURE To SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES UPTO ONE NUN SAND DOLLARS i$400.090, IN ADDITION TO THE
DST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 1706 OF THE LABOR CODE, INTEREST, AND ATTORNEYa FEES.
hereby affirm under penalty of perjury one of the following declarations:
I I 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
erformance of the work for which this permit 1s issued. Policy No.
11 have 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' compensatiol
Isurance, carrier and policy number are:
anier Policy Number Expiration Date
ame of Agent Phone d
11 certify that, in the performance of the or which this permit is issued, I shall not employ any person In any manner so as to become subject to the workers' compensation laws of California, and agre
tat, if I should become subject to the w ers comper rahon provisions of Section 3700 of the Labor Code, f shall forthwith comply wild those provisions. x
igryehure of Applicant X ...,.,...,- , , .,.�,. ____ _��_ _ ------------------ —.__. _w._..,._.. Date_.' ^ I?
hereby affirm under pencil uL�ti>,r-its is a construction lending agency for the performance of the Work for which this permit is issued (Section 3097, Civil Code).
enders Name Lenders Address
ly my signature below, 1 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 bpp,cation and the information I have provided is correct.
I agree to comply wRh all applicable city and county ordinances and state laws relating to building construction, ,
auriorite repr_�.,erhL tines of this city or county to enter the ab - c enmified pror>,erty4r rinspection purposes.
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