HomeMy WebLinkAbout326 19TH ST - Building Permits�
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CITv.oF COSTa MES CON T CTI PERMIT
Project Address
Applicant's Mailing Ad ress �
Owner's Name Phan
Address
Arch/Eng. License No. �
Address /�_ �/J�/�/��� b /�/�
ConVoctO••�Namw /� - /-�lA ���Phnnwll. /.V
Address (mA �'��� ` n
City License No. _�Q���
LICENSED CONTRACTOR DECLqqqTION
I hG/Cby aHirm lhat I am Iit¢nsetl untler prOvlsions of Chdrter 9(COmmencing
wlth sectlon ]000) of Divlsion 3 ot tha Business antl Professlon�s( �Co(tlje, antl
my Iicense Is in f W fp c antl eHe<i. ���� 04n�A
, LICOns C s 'p i iC n5
Oatc Si9naturc N
7
WORKE 5'C MPENSATION DECLARATION
-' hcreby aHirm �that I have a ccrtiticate o( consent to solMnsuro or a certjfiwte
workers'. Compensation Insuranre, or a certifioa copy t er f(Sectlon
00, l.zb. in)n /L(�� �—�•� �/ Company
PolicY Na. � tr UX 4_��� �—
�tiftetl coPY iz hletl withrthenc �y �ptlj{�9�i lon. � y��
Odte_��—APPllcanly ���lL( � � `� l/! '
EXEMVT ON F OM WORKERS' GbMPENSATION DECLARATION
(This SGction neetl mt be cample[Gtl If the 0¢�mit ii,fOr one huntlretl (5100) Or
less). •
I certlty that in [he perto�mante O1 (he wo�k tor whith this pe�m�t IS ISSu¢tl, I
shall m[ employ any pe�ion In any manner'so as lo becoma SubjeGt to the
Workers' Compensatlon Laws of California. �
Date Si9nature
� NOTICE: H,atter making't�ls tletlar��ipn, you shoultl Decomo sub�eci to�the
I Workers' Compensation provi5ioni of the Labor Cotle, You must for[hwitn
I comply wilh such proWSiOnS or Ih15 p¢rmi[ shall be tlacmOtl revoketl.
CONSTRUCTIpN LENOING AGfNCV
I hereby aftirm ihal [here Is a const�Uclion lentling agen<y for the Oe�fo�manC¢
ot tha work for whicn inls permit is Issuetl (Sectlon 309� CW. C.)
Lentler's Name
i LOOtlO!'S AtlEf855- �
IOWNER BUILDER OECLARATION
I hereby atflrm that I am axompt irom the Contractor's LI<ense Law�for the
r..u�wi�n reamn t�ction 7031.5 Biainess antl Professional COtle: AnY tlty or
O�vislon 3 of the Bu9ness ana rrbfesslons Coae)-or mai na/sne rs exemp�
^f�om and the basis far t�e allagetl ¢xemptVon. AnY violdtlon of Sectlon
..5 Ey any applicant (or a permit subjects Ne applicant to a civil
dty of,not more than five huntlretl tlollars ($500). •
L I, as owner ot the property or my employees with wages as their sole
compensation, will tlo the work, aqtl the structure is not Intentletl or offeretl
lor sale (Section 7044, _Business gntl Professional Cotle: The Contractor'S
License Law Coes not applY �o an o�y�er of a property who builtls or improves
thereon, ana wno Ooes such work pimself/herself or througb his or her own
employ eei, proviaetl that such improvemen[s are not in[entleC or offered tor
sale. If, howevar, tho builtling Or ir�p�ovement i5 Sold wllhin ona y¢ar Ot Com-
pletlOn, [ne awn¢r will hdve [ha burtlCn of proving he/Shn tlitl nol builtl or IT-
�fOvO �or thC pufpo50 OI SaIU).
I, as owner o1 the property, am oxclusivery contracting wilh 11<ensetl con-
[racrors to mnstruc[ the projoct (Section 7044, Businoss antl Professions Cotle:
Tho Contra<toYs License Law does not apply to an ownor of property who
builtls or Improves thereon; anG who contracts ror such projects wIN a con-
traCtO�(5) license pu�suant t0 tha Con[ractOr'S License Law). I am awa�e [hat
. proof of thelr Work¢r'S CompenSatiOn insurance shoultl Do prOvlGOtl t0 Te.
❑ I am exempt untler Sectlon � B. 6 P. C. lor thls reason
Data
owner
ISi9nature
Drivars' License or 55 �
CMF 0865-46, rev. 30/84 Whi[e - Bui�tling: Canary
ite tnat the aoove
county ortlinances
ry authorize r¢vre-
meC p�operty to�
e
witnin neavy Dortlar Iines ana sign all approoriato tleelarations.
iACT NO. LOT NO. UN1T NO.
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION jll REPAIR '
'❑� CONVERSION ❑ DEMOLISH � OTHER q,p, �'•
DESCRIPTION OF WORK/USE OP BLDG. � �
- /� S Main �uilJi
_ . 1 E
TVPEOFPERMIT GRAOING�UNDATION ' STRUCTURAL T FfOnt
❑ TENANT ❑ ELECTRICAL PWMBING ❑ MECHANICAL B Rear
O OTHER_. � p`
PRQIECTDESCRIPTION S�.FT. OCCVPANCV C Right
K Left
CONSTRUCTIONTVPE ' VAIUATION$ $
ZONE - GRADING CU.YDS. ACRE$ p�ng. ReL #
Remarks:, , � � Planning ND�es:
3ackflbw Irrigation
3athtubs
Clarifiers �
Dishwesher "
D�inking Fountains
Floor Drains� '
Floor Sinks '
3as Service OuUets
Interceptars '
Kitchen Sink - '
Lavatories ,
P—Trap •
Roof Drains
Reinspection Fee S15
Boiler
Duct - Under Ground
Duct � SVucturel
Duc[ - Veniilating
Exhaust System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,000
Reinspec[ion Fee � $15
Pink - qccoun[ing; Goleenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping .
Solar Tank
Swimming Pool w/Spa
Urinal
Water Heater �
e
Auco�Wash
Leundry Trays
i
Isue Fee
IANICAL
Hood or Typel ❑ '
Canopy Typell ❑
Refrigeration System '
❑P100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers �
Registers .
Issue Fee
Automatic Washer �
CanstructionPoleSub. _
Cooking�Unit • �
Dishwasher
Dryers ❑Gas ❑Electric
Fan + _ �
F.A.U.
FixWres
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor �0-5 KW �5�'
?�- I5� 9'/9-8(v
I Zone
Accessory Building: '
Parking Req.lProvided
ELECTRICAL .
Transformer ❑ 15-50 KW _
.O'S0+'KW
Meter �up to 100 amps
_ Meter ❑over 100 amps
Sub Panel ' �
Motors �0-1. HP � 7'F, - 8
Int. Solar �9-15 HP �16-15+
Miuowave
Pole Light
Standing Sections
KN1 Trash Compactor
5 3 '
Rainspection Fee $75 � Issue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Builtling Approvad By �
Applifation Issued By
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMARV OF FEES . - �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ —�— PERMIT �
PLUMBING � $ ,� ��UANCE� $
' PLAN�CHECK .25% $ ENERGY.P.C. $
ELECTRICAL $ GRADING $ -
' PLANCHECK 50°6 $ � .MICROFILM $ '
MECHANICAL $ � TOTALFEE $ ���
PLAN CHECK 25% $ �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector .
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steei Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �; •
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Preswre Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER;�GUNITE
7. Footings 58. Electrical Conduit-Undrgc d.
8. Foundation 59. Gas Pipe, O Undrgrnd., Ye'st
�.
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap,�iUndrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK +' �
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final�
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final .
16. Rough Electric Wiring � 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71 . Product Piping O Gas ❑ Oil -
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTankOGas ❑Oil '
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � Q�a' � �
34. Final Heating & Air Conditioning - _
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final -
42. Backflow Preventer ' � • ,
43. Backflow Irrigation - �
44. Landscape Irrigation System - , ,
45: Sound Attenuation � ' � �
46. Handicap Regulations � � � �
47. FINALSTRUCTURE&BUILDING . �
48. Special Requirements Completed ' ,
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co � r
51. CERTIFICATE OF OCCUPANCY :
No. Date