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Home My WebLink AboutH2024-0623 - Permits�EWPok, City of Newport Beach Community Development Department - Building Division 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone: (949) 718-1888 U ? newportbeachca.gov/civic 9 C N11 /GO%' Mechanical Permit Plan Check No : Work Class : Other Permit Status: Issued Issued Date : 09127/2024 Inspection Area : 2 H2O24-0623 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: S4 1 DIAMOND AVE Legal Desc : A TR BALBOA ISLAND SEC 3 BILK 14 LOT 10 Description: MECH INSTALL HEAT PUMP AT DECK "TAMPER RESISTANT CAPS REQUIRED & TIMERS PROHIBITED — Owner: KEITH BROWN Address : 319 DIAMOND AVE NEWPORT BEACH, CA 92662 Phone: Applicant: DEPENDABLE GRAHAM AC Address: 2952 CENTURY PLACE COSTA MESA, CA 92626 Phone : (714) 546-1653 Owner/Builder : Address Phone: Code Edition: 2022 Fire Hazard Zone Type of Construction Occupancy Groups: Building Setbacks : Front: 10, Side: 3, Side: 3, Rear: 5 Flood Zone : X; AO 1 Use Zone : R-BI - Two -Unit Residential, Balboa Island PROCESSED BY: 00 SPECIAL CONDITIONS: Contractor : DEPENDABLE GRAHAM AC Address: 2952 CENTURY PLACE COSTA MESA, CA 92626 Phone: (714)546-1653 Con State Lic : 472690 Lic Expire : 04/30/2026 Bus Lic : BT01013104 Bus Lic Expire:12/31/2024 Workers' Compensation Insurance Carrier : SERVICE AMERICAN INDEMNITY CO Policy No : SAMTWC0072801 W. C. Expire: 7/1/2025 NO Manufacturer: AIRTEMP Model# : GXH24-36MSK4DH TIMERS PROHIBITED ON HEAT PuMMs S`ynaturP of Proper:y Owner or Authorized Agent �2024Ll1 _A/!G-fi'�r'� Print Property Owner's or Authorized Ag ,CTION DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FEDERAL FOR OFFICE USE ONLY REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE P°RMIT EXPIRED 61403 I SUBMITTED ASBESTOS NOTIFICATION TO PERFHTCANCELLEG EIEPA Fz:'1.1:7EXTENDED QMD FE,t;l.'T FINAL D��` CASBESTOS NOTIFICATION 15 NOT APPLICABLE TO C64TIATE OF PROPOSED DEMOLITION PROPOSED OCCUP4NCYISSbcD SIGNATURE: OWNER -BUILDER DECLARATION 1 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). ❑ 1, 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). ❑ 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 improvements Covered by this permit, I cannot legally 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 applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web she:httpJhw .leginfo.ca.gov/celaw.html. 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 Profe ionsin full force and effect. License Class License No Date - 7- 1/ Contractor Signature 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.ND), IN At]DTION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37M OF THE LABOR CODE INTEREST, AND ATTORNEY-S FEES. I hereby affirm under penalty of perjury one of the following declarations: 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 IN performance 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 of Agent certify that, in the performance of the work for 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 if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply With those provisions. of Applicant Dale %— �;t-7 `_,2-y IECLARATION REGARDTNG CONSTRUCTION LENDING AGENCY hereby 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 Ender's Name Lenders Address ,y 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 provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize repn,ca:itatives of this city or County to enler„the abpve-idWtified property for inspection purposes. � 0 A/ (_ ' Civil Code).