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Home My WebLink AboutH2017-0504 - PermitswN,.,, City of Newport Beach - Building Division 111111111111p11111111IN111111p1111111111111111 t? aTs 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 7 0 5 0 4 4 Permit Counter Phone (949)644-3288 �A Job Address: 3048 CORTE PORTOFINO Bldg:1 Floor: Suite: Description of Work: MECH/CHANGE OUT (1) AIC UNIT 435dB (MAYTAG; CSASE060K) Inspector Area:8 Code Edit: 2016 Legal Description: N TR 12271 LOT 129 Owner: HAY DOMINIQUE PDH/ Contractor: POLAR BEAR HTG & AIR Address: 3048 CORTE PORTOFINO Address: 23422 PERALTA DR#G NEWPORT BEACH, CA 92660 LAGUNA HILLS CA 92653 Phone: Phone: 949-388-9484 Con State Lic: 968411 Issued Date:09/01/2017 Lic Expire: 1213112017 Bus Lic: BT30060265 Processed By: f�✓ Lic Exp Date: 08/31/2018 MECHANICAL Permit: H2O17-0504 Project No : Inspection Requests Phone (949)644-3255 4 Worker's Comp Insurance - Carrier: MID-CENTURY INS Policy No: A09468247 5' Expire :1113012017 HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 0 $0.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Over 100K BTU/hr: 0 $0.00 > 3 HP to 15 HP: 1 $33.00 Exhaust Fan: 0 $0.00 Gas Line: 0 $0.00 $0.00 Wall/Floor Heaters: 0 $0.00 >15 HP to 30 HP: 0 $0.00 Attic Fan: 0 $0.00 Metal Fireplace: 0 $0.00 Heat Pumps & Package Units >30 HP to 50 HP 0 $0.00 Down -Draft Fan: 0 $0.00 Record Mgt Fee: $0.00 Up to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Additional Fee: $0.00 Investigation: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $28.71 Up to 1 M BTU/hr: 0 $0.00 up to 1OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: Issuance: $33.00 Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $37.50 TOTAL: $132.21 Plan Check Fee: $0.00 Fee Due at Permit Issuance : $132.21 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION Construction Hours: Monday - Friday7:00 a.m.to 6:30 p.m.and Saturday from 8:00 a.m. to 6:00 p.m. 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 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). ❑ I, 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). ❑ 1 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 legall sell a structure that I 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 Professions Code, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw. 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 Professions Code, and my license is in full force and effect. A License Class License No Da Contractor Signat�e�C WORKERS' COMPENSATION DECLARATION NARNING: 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 ($100,000(, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: I have and willaintain 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 grmance of thfor which this permit is issued. Policy No. have and will m 'nt* workers' comperys�tion insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' rance carrier and lialy number are: I ) I I Date of 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 agree t, if 1 should become ssject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. natureof ApplicantQ Q (�l CLARATION REGARD G CONSTRUCTION LENDING AGENCY ;reby 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, Civil Code). rder's Name Lender's Address 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 representatives of this city or county to ee,Amer the above -identified property for inspection purposes. // nature of Property Owner or Authorized Agent XC Print Property Owners or Authorized Agent's Narr]lf V A %1 t y'1.4 C l.S � D ACTION DATE BY DECLARATION OF COMPLIANCE W7TH CODE OF FOR OFFICE USE ONLY FEDERAL REGULATIONS PART 61 OF TITLE 40AND AOMD RULE 1403, PERMITEXPIRED ❑ ISUBMT,iEDASBESTOSNOTIFICATION TO: ❑ EFA - ❑ AQMD PERMITCANCELLED PERMITEXTENDED PROPOSED DEMOLITION. ASBESIOS P.ONIF NOTAPPLICABLE TO PERMIT FINAL 1 I/20 / S CERTIFICATE OF S;GNA7UPE., OCCUPANCYISSUED