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Home My WebLink AboutH2011-0293 - Permits�W1�4 t+ r City of Newport Beach Building Division MECHANICAL Permit No: H2011-0293 m PO Box 1768 Newport Beach, California 92658-8915 Permit Counter Telephone (949)644-3288 Inspection Requests/Telephone (949)644-3255 n > Job Address: 2765 VISTA UMBROSA BIdg:1 Floor: Suite: Description of Work: MECH/R/R HVAC DUCTWORK InspectorArea:3 Code Edit: 2010 Legal Description: N TR 6905 LOT 40 Owner: GRIGORIAN ARMEN A Contractor: ALICIA AIR CONDITIONING Worker's Compensation Insurance - Address: 2765 VISTA UMBROSA Address: 26824 VISTA TERRACE Carrier: OAK RIVER INS NEWPORT BEACH, CA 92660 LAKE FOREST CA 92630 Policy No: 220021395111 Phone: 949-294-1128 Phone: 949-770-2495 Expire:08/0512012 Con State Lic: 525314 Issued Date:11/15/2011 Lic Expire: 02/29/2012 Bus Lic: BT20102054 Processed By: 1 Lic Exp Date: 09/30/2012 HVAC Items FEES Furnaces Boilers & Compressors Ventilation Misc 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 $0.0C Over 100K BTU/hr: 0 $0.00 > 3 HP to 15 HP: 0 $0.00 Exhaust Fan: 0 $0.00 Gas Line: 0 $0.00 $O.CO 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 $0.06 Down -Draft Fan: 0 $0.00 ICBO App. #: Record Mgmt Fos. $1.00 Up to 100K BTU/hr: 0 $0.00 >50 HP: 0 $0.00 Residential Hood: 0 $0.00 Investigation: $0.00 Over 500K BTU/hr: 0 $0.00 Air Handling Units Comm. Hood: 0 $0.00 Plan Check: $0.00 Up to 1 M BTU/hr: 0 $0.00 up to 10K CFM: 0 $0.00 Repair/Alter/Add: 1 $19.00 Issuance: $33.00 Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 TOTAL: $53.00 Plan Check Fee : $0.00 Fee Due at Permit Issuance: $53.00 PERMITS EXPIRE 180 DAYS AFTER ISSUANCE OR LAST VALID INSPECTION OWNER -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 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 l_) 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 legally 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 Profession e, a my license is in full force and effect. 1.- e License Class _ _ License No Date Contractor Signature WORKERS' COMPENSATION DECLARATION 'Vk^.NINC: FAILURE TO SEr URE WORKERS' COMPENSATION COVERAGE 15 UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE JJ�. LF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. ;wla;jy affirm under penalty of perjury one of the following declarations: 0 1 have and 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 thi dquhpance of the work for which this permit is issued. Policy No. - and w'!l 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' compensation )nsuY a carrier snd policy number are: .e cf Agent certify that in the performance , if I should Lecoma subject to) of Policy Number Date forwhich 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 compen ation provisions Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 9 Date CLARATION REGA061NG CONSTRUCTION LENDING AGENCY areby affirm under pefalt� of -perjury that ere 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 5elow, I certify to each of the folloul'ing: I am the property owner or authorized to act o 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 coun�ty/to�ente e-identif' property for inspection purposes. nature of Property Owner or Authorized Agent y-� Print Property Owner's or Authorized Agent's Name S�2 V�� e DATE BY DECLARATION OF COMPLIANCE WITH CODE OF FOR OFF CE USE ONLY ACTION FEDERAL REGULATIONS PART 61 OF TITLE 40 AND AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS N071FICATION TO: ❑ EPA ❑ AQMD PERMIT EXPIRED PERMIT CANCELLED PERMIT EXTENDED ❑ ASBESTOS NOTIHCA17ON IS NOT APPLICABLE TO PROPOSED DEMOLITION. SIGNATURE: PERMIT FINAL OZ/Z7/IZ CERTI FICATEOF n, 7 OCCUPANCYlSSUED