HomeMy WebLinkAbout998 17TH ST - Building PermitsApplicanl to fill in all svaRs eieept those within neavY �ortler linas antl sign all aporopriate aeclarations.
PERMIT NO. ' TRACT NO. LOT NO. UNIT NO.
CITY OF COST�A C�VS RUC ON ERMIT ' �.� A.P.;f� zo�e .
�Project Address `1~�� 1 � . �S Main Building: Accessory Building:
Applicant'S Mail�p g AddreSi I r TVPE OF CONSTRUC ION NEW . ADD ALTERATION REPAIR- E , Z
1 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T F�ont �
Owner's Na �� �l -P one�+�. , DESC IPTION OF WOF{K/�1SE OF BLD ' B Rear ' N
Address i f�ar � H'V`-�i'/QYI A'� `� �R Q4tv A 1
Arch/Eng. License No. TVPE OF PERMIT GRADING FOUN ATION ❑ STRUCTV RAL I K Right G
Address ' , ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g� Left
I ❑ OTHER R
Contractor's Nam � S hp `'/ _ Ping. Ref. # Parking Req./Provided � E
Address�lmailing) S � (, , PROJECT DESCRIPTION SQ. FT. OCCUPANCV � p�anning Notes: � � M
/�`��/�.J� � CONSTRVCTIONTVPE V� VALUATION$ �_�^IC7
City LicenSE NO. L[`�k u/`Q ZONE GRADING CU.YDS. ACRES T
LICENSEO CONTRACTOR DECLARATION . S'
1 hereby affirm tM1at I am licensetl untler provisions ot Charter 9(commenUn9 Remarks: '
with 5ection 7000) oi Division 3 of the Business antl Protessions Cotle, antl �
my license is in twl fo � a L . ELECTRICAL FEES
Licens la s Lic nse No.
Date � Siqnature PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW �
WORKERS' COMPENSATION DECLARATION BarSink Show2f5 ConStruCtiOn POleSub. ❑ SO+KW
I hereby aifirm that I have a certificate of mnsent to selLinsure or a certiticate -
-' Workers' Compensation Insurance,_or.a ce ti tl copy }hereof (Se<tlon CookingUnit Meter ❑upto700amps, -
o, Lab.�y„2 !� 1(1 �I _•\ ���1 Backflow Preventer Service Sink , P
b'tJ _-} Com an J �{ Dishwasher Meter ❑over 100'am s
cy No. p y � Backflow Irrigation Sewer Cap
� Ce ietl <opy is hereby furnishetl. Dryers ❑Gas ❑EICct�ic Sub Panel �: ^
er if!�etl 's fiien witn tne city y�g Divisi�pn. (� /^ Bathtubs Sewer Connection
�ate �\� .aooi�cant �1A/..F�JIY..L1. 9.iL �9U-t/ Fan Motors �0.1 HP 01'h- 8
� EXEMPTION FROM WORKERS' COMPENSATION DEGLARATIO Cldflflel5 . SOIa! COIIeCtOfS
_ 1(This section neetl not be completetl ii the permit is for On¢ huntlretl ($ 00) o F.A.U. Inc. Solar 09-15 HP O 16-15+
tv iess) Dishwasher Solar Piping
_l I certify that in the performance ot tne work for which this perm�t is Issuetl I Fixtures
�l zhall not employ any petson in any manner so as to berome subject to t�e Drinking Fountains Solar Tank Microwave
� Workers' Compensation Laws ot Cali(ornia. .
� Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light �', '�
�NOTIGE: It, atte� making this tlecla�ation, you shOultl become subject to the OUtI¢t5 . �
Workers' Compensation provisions oT-the Labor Cotle, you must torthwith FIoo�Sinks Urinal Range '�j.
compty with such p�ovision5 or tltis pe�mit shall be tle¢metl r¢voketl.
CONSTRUCTION IENDING AGENCV � G25ServiCe OutlEts WaterCloset ' Switches � g�9�
1 hereby a((i�m that tnere is a mnstruttion lentling agency fo� the perfo�mdn<2 Garba ¢ Di5 OSdI
of th¢ wo�k fo� which Ihis pe�mlt is issuetl (Section 309� Civ. CJ Int2rc2pt0l5 Wdt¢r H¢dt¢� 9 P S[eOding $ECti0p5 �
Lentler's Name
Lentlet's Atltlre55 Kimhen Sink Water Service Generetor �0.5 KW �545 KW Trash Compactor
l. .
OWNER BUILDER DECLARATION , .
I hereby aftirm ihat I am exempt Trom the Cantractor's Li<ense �aw for the �avarories Auto-Wash
following reason (Section 7031.5 Business antl Prote55ional Coae: Any city or �
county wnicn requires a permit to construct, alter, improve, Cemolish or repair P-Trap L.aundry Trays � l •-� -
any 5[ructure, prior to its.issuance, also requires Ihe applicant for.such permit
to file a signetl statement that he/she Is IicenSed pu�suant to the p�ovi5ions Of Roof Drains �� ' �
the Contractor's License Law (Chapter 9(commencing with Section ]000) of .. '
Divizion 3 0( the Business antl Protessions Cotle) or that he/she is exempt � Rainspection Fee $15 la�e Fee
th^�efrom antl the basis tor the allegetl exemption. Any violation of Sectlon $ 3
" .5 by any applicant for a permit zubjects the applicant to a civil -
ty of not more than five huntlretl tlollars ($500). DEVELOPMENT SERVICES REQUIREMENTS:
1�.. � as owner of ttte Oroperty or my employees with wages as their sole ReinSpBction Fee $15 IsCue Pee $ 3 '
compensation, will Go the work, antl tne structure is not intenGetl or.otferetl Zaning Approved By Date
tor sale (Section 7044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES Building Approvad By 'Date���{
License Law tloes not apply to an owner of a property who bulltls or improves � e--G.r�i-L
ther¢on, antl who tloe5 such wo/k him5elf/M1e�selt or through his or he� own /�ppliCdtiO� ISSIIBd By net
employees, provitletl that sucn improvements are not intentletl or oiferetl ror Boiler Hood or Type I ❑ �
sale. If, nowever, the builtlin9 or improvement Is soltl within one year oi com- �nopy Type I I ❑ ' �. SU MARY F EES �
pletion, the owne� wlll have the burCen Ot p�oving h¢/She tlitl not builtl o� Im- DUCI - U(1dE� G�OU�d - ,�. �
provetorrnepurposeotsale). BUIL'DINGPERMIT $ — SMIP - $ ��
❑'I, as owner ot the property, am exclusively mntracting with Ilcensetl con- Duct- Structural Refrigeration System PLAN CHECK
tractorsto consVuct the project (Section �046, Business antl Profession5 Cotle: � � , $ PERMIT ��
The Contractor.'s Lio�nse i.aw does mt appty to an owner of oroperty who Duct - Ventilating ❑4100,000 BTU ❑100,000 BTU PLUMBING $ ISSUANCE � $
builtls or improves t ereon. antl who contracts for such oroiects wrth a ron- �
tractor(si Lcense pursuam m cne ConVattors License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration P�?N CHECK 25% $ ENERGV P.C. $��'
Droof of their Worker's Compensation Insurance shoultl be orovitletl to me. ELECTRICAL $ GRADING �$
❑ I am exempt untler�Section B. & P. C. (or thi5 reason Firepl/Fact. Blt. ICBO # Fir¢ Dampers
' ' . . PCANCHECK 50% $ MICROFILM ' $�. �
Date owner Heating System & Ducting Registers , �-'
I hereby certify that i have read mis appiication antl state that the above ❑0.100,OOOBTU �100,OOOBT MECHANICAL $ TOTALFyEE-}. $ ,
Information is correct. I agree to comply with all city antl county ortlinances ' PLAN CHECK 25%
antl state laws relatin9 to builtling mnstructlon, antl hereby authorize repre-
sentatives o thiz city to enter upon the above-mentionetl p op rty tor
Inspaction o roos �1 �0027327-Up027327 � 3'tl�3 ,5{7
s�eaat�re �`�lAl`�'.�0! � t�,i�_� o te � K9. UA7E: 03/Q1/�9 TII1E: 1I:I17
Drivers' License or 55 qk��� ��- �� Reinspection Fee $15 laua Fee $ 3
01 000273?b-DOU2?32b T7"�t'� ;d„�Q
�1 0865-46, rev. 5/88 White - Builtling; Canary - Appllcanq Pink - AccounUng; Goltlenrod - Assassor .�ATE: 03/D1/39 TZ(�F: 1!,Aj�3
�.l
CONSTRUCTION AND PLANNING '� POOL R� ^PA
APPROVALS Permit # Oate Inspector qppROVALS Per�,... # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd.� 54:� Forms .. �L
4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding
5. Steel Reinforcement , ' S6. Rough Plumbing & Pressure Test
6• Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation ' � 59. Gas Pipe, O Undrgrnd., Test
i
9. Water Pipe-Undrgrnd.. �' ' 60. Backwash Lines, P-Trap, � Undrgrnd. •
10. 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 EIBc[rical-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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing �- 73. Undergrnd. Storage Tank O Gas ❑ 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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
a< t1 sus
37. Final Factory Fireplace � 6
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. FINAL STRUCTURE & BUILDING � Z s <<
48. Special Requirements Completed
49. Electric Release to Edison - �
50. Gas Release to Southern California Gas Co -'
51. CERTIFICATE OF OCCUPANCY � ,
No. Date ,