HomeMy WebLinkAboutH2019-0168 - Permits (3)4��llti�r City of Newport Beach - Building Division MECHANICAL Permit: H2O19-0168
100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 9 0 1 6 8 Project No
ti Permit Counter Phone (949)644-3288
u � �
Inspection Requests Phone (949)644-3255
Job Address: 188 HARTFORD DR BIdg:1 Floor: Suite:
Description of Work: MECH - R/R A/C CONDENSOR & FAU. TAMPER -RESISTANT CAP & TIMER REQ'D
InspectorArea:8 Code Edit: 2016
Legal Description: TR 11604 LOT 5 UNIT 113 OF PROJECT LOCATED ON AP 442-291-40's,_L `'•1
TOGETHER��_
Owner: BURKE SHEILA MARIE Contractor: OWNER/BLDR Worker's Comp Insurance- '
Nw `
Ar'c'm-,s: 11:8 HAFTFORD DR Address: BURKESHEILA Carrier: a :r
NEWPORT BEACH, CA 92660'^'
Policy No:
Phone: Phone: 949-244-5556 Expire
Con State Lic: O/B
IGc_od Date:03/22/2019 Lic Expire:
Bus Lic:
P,ocessed By:___ Lic Exp Date:
AC Items
FEES
•nacosBoilers & Compressors
Ventilation
Other
to 100K BTJ,/hr:
1
$19.00
Up to 3HP:
1 $19.00
Bathroom Fan:
0 $0.00
Fire Dampers:
0
$0.00
$0.00
:r 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
II/Floor Heaters:
0
$0.00
>15 HP to 30 HP:
0 $0.00
Attic Fan:
0 $0.00
Metal Fireplace:
0
$0.00
A 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:
$16.53
Investigation:
$0.00
=r 500K BTU/hr:
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Check:
$0.00
to 1M BTU/hr:
0
$0.00
up to 1OK CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
105ANA-30-AlssuanCe:
$35.00
to 1.75M BTU/hr:
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
BRYANT
:r 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$40.00
TOTAL: $129.53 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $129.53
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.
TIMER REQURRD) ON EQUIPMENT 30" WIDE X 36" DEPTH
- -- -- 4 �i. AND 7 A.M.
TIMER REQUIRED ON ECUIPMENT
REQUIRED FOR
A/C DISCONNECTS
DWNER-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 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 Cade) 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).
111, 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
im roved 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
p (o 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).
a exempt from licensure ndertheC
ontractors' State License Law for the following reason:
y my s g
nature below I acknowledge that, except for my personal residence in which I must have resided for at least one year prior to completion of [he improvements covered by this permit, I cannot legal
sell a st uctUu 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
fie ions Code, is available upon request when pfc t' n iS mi or at the following Web aits http://www.leg,nf0.Ca.gov/calaw.html. 2 2
Signature of Property Owner 0r Authorized Agent Date
LICENSED CONTRACTOR'S DECLARATI N
I hereby.affirm under penalty of perjury that I a licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and Professions ode, and my I�reflse-ig in full fcrcE
and effect.
License Class License No Date 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 ($100,000), IN ADDITION'0 xH
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:
111 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 '.he Labor Code, for r
performance of the work for which this permit is issued. Policy No.
❑I 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 compensati.l
linsurance carrier and policy number are: - -
arrer Policy Number Expiration Date
Agent
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
1, if I hould become suLbl!2t1 the orkers�'/��bmp�e/fps/anon provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provision
ure of Applicant / / B�n. ' // r 'L1r'� Date i I/
CLARATION REGARbING CONSTRUCTION LENDING AGENCY
maby 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).
Ider'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. Bit
r1��
I agree to comply with all applicable city and county ordinances and state laws relating to building construction. ---v e t lt�i
I authorize representatives of this city or county toiknfe� the agqggve-id ified roperty for inspection purposes.
nature of Prooertv Owner or Authorized Agent /IAA /l/1 .� Print Property Owner's or Authorized Agent's Name r Date
DATE
BY
DECLARATION OF COMPLIANCE WITH CODEOF
FOR OFFICE USE ONLY
ACTION
FEDERAL REGULATIONSPART 61 OF TITLE40AND
AQMD RULE 1403.
❑ I SUBMITTED ASBESTOS M071FICATION TO:
❑ EPA
❑ AQMD
.. ....
PERMdTEXPIRED
PERMITCANCELLED
PERMWEXTENDED
'
❑ ASBESTOS:NDDHCATIONIS NOT APPLICABLLE.TQ--
PROPOSED DEMOLITION.
SIGNATURE:
- - -
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