HomeMy WebLinkAboutH2022-0091 - Permits,I,w•. rtrk City of Newport Beach - Building Division H2022- 0091 MECHANICAL Permit: H2O22-0091
100 Civic Center Drive, Newport Beach, CA 92660 PfOJBCY NO
r~ , Permit Counter Phone (949)644-3288
r:�carnu�'� Inspection Requests Phone (949)644-3255
Job Address: 27 SPLENDORE DR BIdg:1 Floor:
Suite:
Description of Work: MECH CHANGE OUT A/C UNIT *TAMPER PROOF CAP REQ* 122-0129
O/B FORM ATTACHED
Inspector Area:6 Code Edit: 2019
Legal Description: TRACT 14773 LOT 6 POR. AND
935-34
PORS. OF LOTS 7 AND G OF PROJECT
gg
✓ �� CR
1
Owner: HIRSCH MICHAEL
Contractor: OWNER/BLDR
Worker's Comp Insurance -
Address: 27 SPLENDORE
Address:
Carrier :
NEWPORT BEACH, CA 92657
Policy No: TIMER REQUIRED ON EQUIPMENT
Phone: 510-725-1304
Phone:
Expire :
Con State Lic: O/B
TO SHUT OFF BETWEEN 10 P.M. AND 7 A.M.
Issued Date:02/23/2022
Lic Expire:
Bus Lic:
Processed By:
Lic Exp Date:
HVAC Items
FEES
FurnacesBoilers & Compressors
Ventilation
Other
II
Up to 100K BTU/hr:
0
$0.00
Up to 3HP:
1 $22.00
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
' .
_
I�
Heat Pumps & Package
Units
>30 HP to 50 HP
0 $0.00
Down -Draft Fan:
0 $0.00
Record Mgt Fee:
$0.00
II
Up to 100K BTU/hr:
0
$0.00
>50 HP:
0 $0.00
Residential Hood:
0 $0.00
Additional Fee :
$0.00
Investigz_Von:
$22.00
Over 500K BTU/hr.
0
$0.00
Air Handling Units
Comm. Hood:
0 $0.00
Plan Chock..
" $19.14 II
Up to 1M BTU/hr:
0
$0.00
up to 10K CFM:
0 $0.00
Repair/Alter/Add:
0 $0.00
Model:
4TTR40481_1Issuance:
$38.00 "
Up to 1.75M BTU/hr.
0
$0.00
Over 10K CFM:
0 $0.00
Supplemental Fee:
$0.00
Manufacturer:
TRANE
: ` _
Over 1.75M BTU/hr:
0
$0.00
VAV Box:
0 $0.00
Zoning PC:
$52.00
TOTAL:
$153.14
Plan Check Fee
: $0.00
Fee Due at
Permit Issuance:
$153.14
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 items)
(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 require:, 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 Iicensure 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 (_) 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
elyply 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 Iicensure 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 Iegall
sell a structure that I have built as an owner -builder If't has not been construc " in s entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the B siness and
Professions Code, is available upon request when�t{t/s applica ub tt or a t followin Web site:http://www.leginfo.ca.gov/calaw.html. ,jNN/
Signature of Property Owner or Authorized Agent /� Dat;d :
LICENSED CONTRACTOR'S DECLARATI I %
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, nd my license is in full force
and effect. - - - -
LicensefClasg,. .. 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 ($100,0001, 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 urd- penalty of perjury one of the following declarations:
I have and wily ,raintain 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 th
pc.rc:r.iance of the wcr; 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' compensatio
insurance carrier and policy number are:
Carrier _ _ Policy Number Expiration Date
Islam= dt Agent Phone #
- I ca.tify that, ;n ;he performance of the work 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
tha', If I should becomes bject ttoo ff/queer works cc mmpe�nsatition provisions of Section 3700 of the Labor Code, I shall forthwith comply with those prov/-i ons. r
Signature of Appllcanr 7 Date/
DECLARATION Fi .IS l STRUCTION LENDING AGENCY —�
i.LroLy affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec ion 3097, Civil Code).
Lrr^-'s Name Lender's Address
By my signature uelow, 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 ordi nce., and stat laws relating to building construction.
I authorize representatives of this city or county to n't th 40 e-ice ified property for inspection purposes..ZZ
Signature of Property Owner or Authorized Agent // "�� Print Property Owner's or Authorized Agent's Nam ' -` �- R sc/4 Date 23 09,
ACTION DATE BY DECLARATION
OF COMPLIANCE N7TH CODE OF
FOR OFFICE USE ONLY
FEDERAL REGULATIONS PART 61 OF 77TLE40QND
AQMD RULE 1403.
PERMIT EXPIRED
❑ 1 SUBMITTED ASBESTOS NOTIFICATION TO:
❑ EPA
❑ AOMD
PERMfTCANCELLED
PERMIT EXTENDED
❑ ASBESTOS NORFiCQTION f5 NOT APPLICABLE TO
PROPOSED DEMOLITION.
SIGNATURE:
PERMIT FINAL
fbnm -
CERTIFICATEOF
�M
OCCUPANCY7SSUED
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