HomeMy WebLinkAbout617 BROOKVIEW WAY - Building PermitsApplicant to fili in all spaces except thosa within heavy bortler lines anG sign all appro0riate Oeclarations.
Ci7Y oF COSTa M���S�A COyN-7STR CTI,ION PE MIT
Project Address l(G! � /Jr�� [� �P�,(% V '
�
Applicant's Mailing Add/r-ess
Owner'sName ���'IQh �Q•r Phnno .S �
Addreu
Arch/Eng. License No.
Address
Contractor's Nam ,A^ � � � 1 one ��.
U Addresslm �I' 91 r„L/�r� �A.�—
p CitV Licencw Nn . (l /.� S �
� LICENSED CONTRACTOR OECLARATION ' �
I hereby afti�m that I am Ilcensetl untlei provision5 of Chdr[er 9(commencing
witn section 7000) ot Division 3 of the Business antl Professions Cotle, antl
t. my IicenSe is In (ull ntl effect.
License C ss 'cense
'`ale ' i9natu�e
JRKERS'COMPENSATION DECLARATION
.tereby aifirm that I have a tertificate oi consent to selt-insure or a certlflcate
� of Workers' Compensation Insurance, or a certifietl copy tne�eof (5¢<tlOn
3800, Lab. C� � . � j')„���� n
Policy No. / � Company ��1� ��
rtifietl copy Is hereby turnishetl.
er}�' letl�py with the city B' in ' ii� n
Date-y (�- y/--(yJ-�- � APplicant � _
EXEM TP ION'FROM WORKERS' COMPENSATION DEGLARATION
(This section neetl not be cOmpletetl if the permit is fo� one huntl�etl (SI00) or
Iess).
1 certify lhat in tbe periormance of the work tor which this perm�t is Issuetl I
shall not employ any person in any manner so as to become subjetl to t�e
workers' Comoensation laws ot Cali(omia.
Date � Signature —
NOTI[E: If,alter making tnis tleclaration, you shoultl become subject to the
Workers' Compensation orovisions of the� l2bor� Cotle, you must forthwitn
como�Y with such provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV '
I nereby affirm that tnara is a construction lentling agency for the performance
ot the work for whiCh 4M1I5 permit is issuetl -($ectlon 3097 Clv. C.)
Lentler's Name
lCI1dEY'S fiddlC55
OWNER BUILDER DECLARATION
I hereby aff7rm that I am exempt from the Gon[�actor's LiGense Law for Ihe
following reason (Section 7031.5 Business antl P�ofe55ional Cotle: Any tlty or
county which requires a pe�mit t0 const�ucl, a1Seq �mprove, tlemolish or r¢pair
any structu�e, priOr lo Its issuance, also �equirPlthe applicant t0� SUGh petmit
�io file a signetl stalement [hd[ he/she i5 licens�tl pursuant to th¢ prOviSlons of
,�the Contrac[or's Litense Law (Chap[er 9(corti encing with Sectlon 7000) of
-Oivision� 3 of t�e BuSiness antl Profe55ion5 Cotl¢) or that he/Sh¢ is ezemOt
titerefrom antl the basis tor the alle9e0 exemption. Any viola[ion ot Sectlon
7031.5 by any applicant tOr a permit sub]ecis Ihe applicant to a civil
�endlty of not mor¢ [han (ivG hund�etl tlollars (E500).
1, as owner o� tM1e p�operty or my employees with wage5 as [hei� sole
compensation, will tlo the work, antl th structure is not intentletl or oHeretl
for wle (Seclion 7044, Businesi antl �rotessional Cotle: The Contractor's
License Law tloes nol apO�Y to an owner of a property who builtls or improves
tnereon, antl who Coes such work himself/herselt or lhrou9h nis or her own
employees, provltletl that Sucn improvemenls are not intentlatl or offoretl for
sale. If, however, Ihe builtling cr improvement is Soltl wi[hln one yeat ot mm-
O�etion, the Owner will hav¢ lite burtlen of proving he/she tlitl not builtl or Im-
�ov¢ for the purpose of sale).
LI I, as owner ot the prop£rty, am excluslvely contratting with Iicensetl con-
traciors to mnstruc[ tne Pro�ect (Section 7044, Business an� Professions Cotle:
Tne Contractor's License Law does nOt appty to an owner of property who
builds or improves thereon, antl who contracts for such project5 with a con-
tractor(s litense pursuant�to tbe Contractor's License Law). I am aware ihat
proof o� their WOrker's Compensation insurance shoultl be providetl to me.
❑ 1 am exemo� untler Sectlon B. & P. C. for this reason
Date Owner ��
I hereby certify that I have reatl tnis appll
inPormatlon is mrrect. I agree to comply wii
antl slate laws relating to bulltling construct
5entativBz of [lqs cjsy to enter upon the
Si9nature l A// v l
Drivers' License or 55 �
1 Stat¢ that tne above
antl county ortlinances
ereby authoriie r¢pr¢-
mtionetl orooertv for
TYPE OF CONSTRUCTION LJ NEW IJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTNER
DESCRIPTION OF WORK/USE OF BLDG. —
TVPE OF PERMIT LJ GRADING
❑ TENANT ❑ ELECTRICAL
❑ qTHER
PROJECT DESCRIPTION Sa. Fr._
ALTERATION Ll REPAIR
1 FOUNDATION LJ.STRVCTURAL
PLUMBING ❑ MECHANICAL
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.YDS. A(
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Jrinking Fountains
Floor Drains
Floor Sinks - -
3as Service Outlets
Interceptors
Kitchen Sink '
P-Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct- Struciural
Duct - Ventilating
ExhaustSys[em ❑ MWtiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑6100,000 BTU � 100,000
Reinspection Fee I $15
-
� CMF OBfiS-46, rev. G/84 White - BuilOing; Canary - ADP�icant; Pink - Acrouniing; Goltlenrotl - Assesso�
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000eTu ❑ioo,000aru
System Repair/Alteretion
FEES
A.P. #
S Main 8uildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #-
Planning Notes:
1169 9/30/B5 5,pr,
Zone
Accessory Building:
Z
O
N
I
- N
G
R
Parking Req./Provided E
Q
M
• T
S.
EIECTRICAL
Automatic Washer Transformer ❑ 15-SO KW
Construction Pole Sub. � 50 + KW
Cooking Unit Merer ❑up ro 100,amps
Dishwasher Merer ❑over100amps
Dryers ❑Gas ❑Elettric Sub Panel
Fan Motors �0.1 HP 07'h - B
F.A;U. InaSolar �9-15 HP 016-15+
Fixtures
Device Boxes
Outlets
SNIILCFICS
Garbage Dispoul
Generator �0.5 KW �5-15 KW
Pole Light
Range
Sign
Standing Sections
Trosh Compactor
$ 3
Reinspection Fee $75 Issue Fee
FEES
DEVELOPMEN7 SERVICES REQUIREMENTS:
Zoning Appraved By
Building Approved By ��
Issue Fee � $ 3
SUMMARV OF fEES
BUILDING PEPMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ � ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL g GRADING
PLAN CHECK 509G $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
$
FEES
$ 3
CONSTRUCTION AND PLANNING P06L & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1'. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd, 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings , 58. Electrical Conduit-Undrgrnd.
B. Foundation 59. Gas Pipe, O Undrqrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECIC
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 Electriral-Conduit 66. Solar System-Final •
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTEfiING
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. RoofFraming 73. Undergrnd.StorageTank�Gas ❑Oil
25. Roof Sheathing 74. OverhearJ 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: ?�'S -D'F L�iP7'� u120. �.,E.✓i
34. Final Heating & Air Conditi0ning 7-//P..�[� C
L Fii� 6ae"tt�. L;�-4 2: ! b'
35. Final Gas Pipe-Test _�,q.�.�,�,2�, �' pk,(t �.g U f�G, (,,,,�/� •/2- �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final `T
40. Gas Service-Final +'t'
41 . Solar pomestic-Final � � ,
42. Backflow Preventer "' �
r. .
43. Backflow Irrigation ' � .
�� .
44. Landscape Irrigation System�-•
45. Sound Attenuation
.:
�
46. Handicap Regulations 'c
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date