HomeMy WebLinkAboutH2017-0176 - Permitspa��Fr City of Newport Beach - Building Division III III 1111111111111111p1p1111p111111111p11111
p 0 100 Civic Center Drive, Newport Beach, CA 92660 H 2 0 1 7 0 1 7 6
Per
F 'r Permit Counter Phone (949)644-3288
U
e s
�L1/IIR�
Job Address: 23 HARBOR POINTE BIdg:1 Floor: Suite:
Description of Work: MECH/CONDENSER & FAU C/O "TAMPER RESISANT CAP REX
Inspector Area:4
Legal Desc�p42r
Processed
to 100K
)r 100K
it Pumps 8. PadRa p
to 100K BTU/hr: 0
-r 500K BTU/hr: 0
to 1M BTU/hr:,,I
to 1.75M BTUAP. 4.
-r 1.75M BTU/hr: 0
&S
Code Edit: 2016
HARYW.ntractor: GREENSTAR If applicable:
ss- ?95t"AIN ST
CA92626 ORANGE CA92ff80%Cr i
-
Phone. 94:LLJJ
5 102
Con State Lic 5556 to N/hOril: —
�Lic Expire
Bus Lic: BT30056111
Lic.E Date,
PIKED
ressors Ventilation
$18.00 Upto 3HP0
Ptai5�:{i
nqHP a$O(work Uli)
$0.00 Air Handling
Units
$0.00 up to 1 OK CFM: 0
FEES
MECHANICAL Permit: H2O17-0176
Project No :
Inspection Requests Phone (949)644-3255
Worker's Conih Insurance -
Carrier : LIBE TY INS
PVI&UNh:�V 6315086310
Expire :10/01/ 017
S1lli3FCTTOFTFI-T)INQ' "I
REV1LW A;` '' At . '.OVAL
$0.00 j'''��hr Fen: 0 0 Me
rs: 0 $0.00
$33.00� E jau tF �:SC� 0 $0.00
$0.00 I�q� F $ a irep ace: 0 $0.00
$0.00 Down-f�SgF rrkttaPl) Record Mgt Fee: $0.00
$0.00 Reside is Hoo 0 $0.00 Additional Fee: $28.71
$0.00 VAV Box: 0 $0.00
Comm. Hood: 0 $0.00
Fee: $0.00 M;
—Insp. initials:
14ACXS-036
LENNOX
Other
$0.00
$0.00
Investigation: $0.00
Plan Check: $0.00
Issuance: $33.00
-- TO an LWeck Fee : Fee Due at Permit Issuance: $112.71
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.
fNER-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)
ction 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
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
fessions 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
more than five hundred dollars ($500).
I, 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,
iness 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
rovements 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 itwas not built or
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
ly 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).
J I am exempt from licensure u
Iy my signature below I acknowl' dge that, except for my personal residence in which I must have resided for at least one year prior to completion of the in
ell a structure that I have built a an oy(Oer- uilder if it has not been�cgql1lI��stryycctggS5�� i2n� sa entirety by licensed contractor sf# , d�l Ygcopy of the app.
'rofessions Code, is available u n re this applicabonrds�1Afi�*V,``l h following LN>H ��ro Rttp://wwW.l6g1a tabd.html.
;ignature of Property OwnerorA ithorized Agent
ICENSED CJNTRACTOR' DEC RA I N QOOIOr 1 /o re
hereby of iron under penalty, of p rjury- a a icensed under prov of pt 9 m FL=I"9tractor
on 3 of the Business and
nd effect.
ice,lse Class License No. Si nature
'ARNING: FAILL'R= TJ SECURE WOR
OFT OF COMPENSATION DAMAGES
hereby affirm under penalty of
y ttfff1ggqqqqve and wall maintain a
iJlnce of the wc-k for whi
hav and will maintain woI
�Sula a carrier aeJ policy nur
are:
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER
°CTION 37 7 LABOJ2 TEAdST, AND AITTORNEYS-
bllowl" declaraFio ns ''^^
m
compensation,. i
t4 ra
TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
of Industrial Relations as provided for by
insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this
Date
7044 of the Business and
and my license is in full force
DOLLARS ($100,000), IN ADDITION TO THE
3700 of the Labor Code; for
is issued. My workers'
der Policy Number • rat D16
ne of Agent h e
certify that, in the performancaa]]��of th or w Ich Is permit Is is ed, I shall not employ any person in any manner so as t be�epme fact to the workers' co' pensation laws of California, and
, if I should Deco rRa;rCfplPt, to Fje workers omp,(�rs18Rr ction 3700 of the Labor Code, I sh�ntfyl�® Tfj7 �FK� provisions.
lature of Applican !ll NL/L Date] -^
hereby affirm underlpenalty of p jutNit[1A Mere is a construction leodil nglpnQ4 f thep�1 of «•_ ^•��^�� n de).
Ender's Name Lender's Address
y my signature below, I certify to ach of the following: r1S �7. Itl i 1
I am the property owner or au prize o acton a prope owner's behalf.
I have read this application an
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 co ty t n th bove-identified property for inspection purposes. /^�
ignature of Property Owner or Authorized AgertS Print Property Owner's or Authorized Agent's Nam4K
ACTION
DATE
BY
DECLARATION OF COMPLIANCE IMTH CODE OF
FOR OFFICE EONLY
FEDERAL REGULATIONS PART 61 OFTITLE40 AND
AQMO RULE 1403.
PERMIT IXPIRED
0 0 L
❑ I SUBOTTEDASBESTOS NO77FICATIONTO:
❑ EPA
❑ AQMD
PERMITCANCELLED
PERMIT EXTENDED
❑ ASBESTOS N077RCAIIONIS NOT APPLICABLE TO
PROPOSED DEMOLITION.
PERMIT FINAL
CERTIFICATE OF
SIGNATURE:
OCCUPANCYISSUED
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