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Home My WebLink AboutH2021-0357 - PermitsCity of Newport Beach - Building Division H2O21-0357 Y 100 Civic Center Drive, Newport Beach, CA 92660 Permit Counter Phone (949)644-3288 3 t�G iXilY�1~ Job Address: 17 DARTMOUTH BIdg:1 Floor: Suite: Description of Work: MECH NEW A/C UNIT *TAMPER PROOF CAP REQ* InspectorArea:4 Code Edit: 2019 Legal Description: N TR 15409 LOT 57 Owner: BENEHMED DANEIA SANADIKI Contractor: Address: 17 DARTMOUTH Address: NEWPORT BEACH, CA 92660 Phone: Phone: Can State Lic: Issued Date:06/07/2021 Lic Expire: Bus Lic: Processed By: Lic Exp Date: vrOrrI SEASIDE A/C AND HEAT ING 32959 CALLE PERFECTO UNIT C SAN JUAN CAPISTRANO CA 92675 949-496-3639 736214 08/3112022 BT30018420 01/31/2022 MECHANICAL Permit: H2021-0357 Project No : 2524-2019 Inspection Requests Phone (949)644-3255 Worker's Comp Insurance - Carrier : INS CO. OF THE WEST Policy No: WVE5049609 Expire :0712112021 HVAC Items FEES FurnacesBoilers & Compressors Ventilation Other Up to 100K BTU/hr: 0 $0.00 Up to 3HP: 1 $21.00 Bathroom Fan: 0 $0.00 Fire Dampers: 0 $0.00 $0.00 Over 100K BTU/hr: 0 $0.00 > 3 HP to 15 HP: 0 $0.00 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: $18.27 Up to 1M BTU/hr: 0 $0.00 up to 1OK CFM: 0 $0.00 Repair/Alter/Add: 0 $0.00 Model: CSA1BEIssuance: $37.00 Up to 1.75M BTU/hr: 0 $0.00 Over 10K CFM: 0 $0.00 Supplemental Fee: $0.00 Manufacturer: MAYTAG Over 1.75M BTU/hr: 0 $0.00 VAV Box: 0 $0.00 Zoning PC: $46.25 TOTAL: $122.52 Plan Check Fee : $0.00 Fee Due at Permit Issuance : $122.52 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. 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). I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature halow 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 :hat 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 Gode, is available upon request when this application is submitted or at the following Web site:http://www.leginfo.ca.gov/calaw.htmi. SignE'.Ure of Property Owner or Authorized Agent Date LICENSED COI4 i RACTOR'S DECLARATION i hereby affirm J. i6br penalty of perjury that I am licensed under provisions of Chapter 9 (commencing it action 7000) of Division 3 of the Business' n Pro assions Co and m license is in full force any effect. !.f mrse Class _ License No Date " L Contractor Signature LYCRKERS' COMPENSATION DECLARATION CARA,Ad: FAILURF TO :EJURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOY R T RIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUN RED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPE::SATIJN,. DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY's FEES. I hereh,, affirm under penalty of perjury one of the following declarations: I Lave and will mE:ntain 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 the oerformance of the work for which this permit is issued. Policy No. l(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' compensatior n rance carrier and policy number are: Policy Number of Agent Date I certify that, in the performance of the work for which th" er t is issued, I shall not employ any person in any manner so as to become subject to)he workers' compensation laws of California, and agree It, if I should beco bje t to the work s of Section 3700 of the Labor Code, shall forthwith comply with those pro" ro 'si ns. Inature of Applicant Date ' :CLARATION REGAR911413 CONSTRUCTION LENDING AGENCY ereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued ( ec on 3097, Civil Code). rider'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 co ty ordinances and state law elating to building construction. _ I authorize representatives of this cityor cou uj{�ol�nter the abo - e or inspection purposes. J// mature Of Property Owner or Authorized Acent Y O Print Pro ertv Owner's or Authorized Aoent's Name // / it TZI/C rl E/V v'CJ Date\ ACTION DATE I BY DE(2AHAIION OF COMPLIANCE VVI I LI COOL OF f FOR OFFICE USE ONLY v FEDERAL REGULATIONS PART 61 OF TIRE 40 AND PERMIT EXPIRED AQMD RULE 1403. ❑ I SUBMITTED ASBESTOS NOTIFICATION TO: PERMITCANCELLED ❑ EPA PERMfTEXTENDEO ❑ AQMD ❑ ASBES TOS NOTIFICATION IS NOT APPLICABLE TO PERMIT FINAL 8/I Z) aC+Gc. PROPOSED DEMOLITION. CERTIFICATEOF �wx SIGNATURE:. OCCUPANCYISSUED