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Ab336a04246e42a4bba7214749fcc687.aspx Development Permit Application

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BROWSE CITY OF LONG BEACH CALIFORNIA (CA) FORMS

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Page 1 of 8
(I/We) the undersigned declare, under penalty of perjury under the laws of the State of California, that (I am/we are) the owner(s)
or authorized representative(s) of the property in this application; that the information on all plans, drawings, and sketches
attached hereto and all the statements and answers contained herein are, in all respects, true and correct.
SIGNATURE
PRINT NAME
DATE
General Information
PROJECT NUMBER
Authorization
Plan Check Permit Tech
PROJECT ADDRESS (NOT MAILING ADDRESS) PROJECT NAME (IF ANY)
LEGAL DESCRIPTION (i.e. Lot, Block, Tract, APN, etc.)
DOING BUSINESS AS (DBA) SUBMITTAL DATE
APPLICANT LAST NAME, FIRST NAME OWNER DESIGN PROFESSIONAL
AGENT FOR LESSEE/TENANT
CONTRACTOR
APPLICANT MAILING ADDRESS EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
1) DESIGN PROFESSIONAL LAST NAME, FIRST NAME
ARCHITECT
CIVIL
STRUCTURAL
OTHER
DESIGN PROFESSIONAL MAILING ADDRESS DESIGN PROFESSIONAL EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
2) DESIGN PROFESSIONAL LAST NAME, FIRST NAME
ARCHITECT
CIVIL
STRUCTURAL
OTHER
DESIGN PROFESSIONAL MAILING ADDRESS DESIGN PROFESSIONAL EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
PROPERTY OWNER LAST NAME, FIRST NAME
PROPERTY OWNER MAILING ADDRESS EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
DESCRIPTION OF WORK
Development Permit Application
Development Services
Building and Safety Bureau
411 West Ocean Boulevard, 2nd Floor, Long Beach, CA 90802
562.570.PMIT (7648)
click to sign
signature
click to edit
Building
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
CONTRACTOR LAST NAME, FIRST NAME STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
PROJECT SCOPE (CHECK ALL BOXES THAT APPLY)
NEW CONSTRUCTION ALTERATION/REMODEL/TENANT IMPROVEMENT ADDITION CHANGE OF USE/OCCUPANCY
TYPE OF CONSTRUCTION PRESENT USE/OCCUPANCY PROPOSED USE/OCCUPANCY
# DWELLING UNITS # OF STORIES BUILDING HEIGHT CBC EDITION USED
FIRE SPRINKLERS
YES NO
FIRE ALARM
YES NO
FIRE STANDPIPES
YES NO
SMOKE CONTROL
YES NO
GRADING PERMIT (IN CUBIC YARDS)
CUT: __________ FILL: __________ EXPORT: __________ IMPORT: __________
Fire
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
CONTRACTOR LAST NAME, FIRST NAME STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
QTY
ITEM
QTY
ITEM
FIRE ALARM VALUATION: $____________________________ FIRE ALARM SYSTEM DEVICES
FIRE ACCESS UNDERGROUND STORAGE TANK
UNDERGROUND FIRE LINE UNDERGROUND STORAGE TANK PIPING (FT)
SPRINKLERS RISERS VAPOR RECOVERY SYSTEM
SPRINKLER HEADS ABOVEGROUND STORAGE
STANDPIPE SYSTEM HOSE VALVES ABOVEGROUND STORAGE TANK PIPING (FT)
SPECIAL FIRE EXT. SYSTEM NOZZLES OTHER___________________________________
Page 2 of 8
New
VALUATION COVERED BY APPLICATION
$
SQUARE FOOTAGE OF PROJECT:
OFFICE USE ONLY
RESIDENTIAL
Remodel/
Additions
NON-RESIDENTIAL
Demolition/
Removal
New
Construction
Remodel/
Additions
Demolition/
Removal Construction
Existing: ______________________________
New/Add/Remodel: _____________________
Demolition/Removal: ____________________
Health
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
HEALTH PROJECT NUMBER
Same as Building Project Number
CONTRACTOR LAST NAME, FIRST NAME STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
FOOD FACILITY
ITEM
ITEM
ITEM
RESTAURANT # OF SEATS _____
BED & BREAKFAST
GREASE TRAP
SCHOOL CAFETERIA
FOOD MRKT RETAIL (SQ. FT.)
FOOD PROCESSOR (SQ. FT.)
SATELLITE FACILITY/KIOSK
CATERER
CONSULTATION MENU CHANGE/EQUIPMENT
FOOD VEHICLE
WAREHOUSE/COMMISSARY
FOOD CART
SALVAGER
OTHER _____________________
BACKFLOW
FOOD FACILITY POOL & SPA OTHER_____________________
WATER SYSTEMS
CROSS CONNECTIONS /
RECYCLED WATER
NEW POOL REMODEL/REPLASTER – POOL
NEW SPA REMODEL/REPLASTER – SPA
SEWAGE DISPOSAL SYSTEM
MINOR REMODEL / EQUIP
CHANGE – POOL
MINOR REMODEL / EQUIP
CHANGE – SPA
BODY ART
TATTOO SHOP
OTHER _____________________
Page 3 of 8
LOW IMPACT DEV SYSTEM
WITH ONSITE WTR REUSE
LOW IMPACT DEV SYSTEM
WITHOUT ONSITE WTR REUSE
Electrical
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
CONTRACTOR LAST NAME, FIRST NAME Same as Building Cont STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
PROJECT SCOPE (CHECK ALL BOXES THAT APPLY)
NEW CONSTRUCTION ALTERATION/REMODEL/TENANT IMPROVEMENT ADDITION CHANGE OF USE/OCCUPANCY
TYPE OF CONSTRUCTION PRESENT USE/OCCUPANCY PROPOSED USE/OCCUPANCY
# DWELLING UNITS # OF STORIES BUILDING HEIGHT CEC EDITION USED
VALUATION COVERED BY APPLICATION
$
QTY
SERVICE
QTY
MOTORS, GENERATORS,
TRANSFORMERS & OTHER
APPARATUS
QTY BUSWAYS, POWER DUCTS
≤ 600 V SERVICE ≤ 200 AMPS
< 1 HP, KW, KVA
FEET OF BUSWAY ≤ 99 AMP
≤ 600 V SERVICE 201 – 400 AMP
1-10 HP, KW, KVA FEET OF BUSWAY 100-400 AMP
≤ 600 V SERVICE
401 – 1000 AMP
11-50 HP, KW, KVA FEET OF BUSWAY > 400 AMP
≤ 600 V SERVICE > 1000 AMP
51-100 HP, KW, KVA
QTY
SIGNS (NEW OR ALTERATION)
1
ST
SIGN AND SIGN CIRCUIT
> 600 V SERVICE > 100 HP, KW, KVA ADDITIONAL SIGN CIRCUIT(S)
1
ST
SB OR MCC ≤ 600 V
NEW RESIDENTIAL SQ. FOOTAGE
OF FLOOR AREA
ADDITIONAL SIGN(S)
1
ST
SB OR MCC > 600 V
QTY
OUTLETS AND FIXTURES
TEMPORARY POLE
WITH
PANEL (EXCLUDING SERVICE)
NUMBER OF OUTLETS/OPENINGS
ADDITIONAL METERS # BUILDING LIGHTING FIXTURES
1ST OUTLETS ≤ 50
ADDITIONAL SB OR MCC
≤ 600 V
MULTI-OUTLET/FIXTURE
ASSEMBLIES (EACH 5' OR PORTION
THEREOF)
TEMPORARY OUTLETS > 50
ADDITIONAL SB OR MCC > 600 V
QTY SPEC OUTLETS (INDIV CIRCUITS) QTY PHOTOVOLTAIC SYSTEMS
15-30 AMP RESIDENTIAL KILOWATTS
PANELS (SUBPANELS AND/OR
CONTROL PANELS)
31-50 AMP / EVC* COMMERCIAL KILOWATTS
# OUTSIDE/PARKING LIGHTING
STANDARDS
51-100 AMP
> 100 AMP
FOR OFFICE USE ONLY
# SQ FT FOR TITLE 24 REVIEW
* EVC – Electric Vehicle Charger / Application qualifies for expedited installation services.
Page 4 of 8
Mechanical
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
MECH PROJECT NUMBER
CONTRACTOR LAST NAME, FIRST NAME Same as Building Cont STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
PROJECT SCOPE (CHECK ALL BOXES THAT APPLY)
NEW CONSTRUCTION ALTERATION/REMODEL/TENANT IMPROVEMENT ADDITION CHANGE OF USE/OCCUPANCY
TYPE OF CONSTRUCTION PRESENT USE/OCCUPANCY PROPOSED USE/OCCUPANCY
# DWELLING UNITS # OF STORIES BUILDING HEIGHT CMC EDITION USED
QTY ITEM QTY ITEM QTY ITEM
HEATING APPLIANCE
WOOD BURNING APPLIANCE
APPLIANCE/CHIMNEY/VENT
AIR INLET/OUTLET
SMOKE/FIRE DAMPER
SMOKE DETECTOR
AIR COND COMP
≤
25 HP
AIR COND COMP 26-50 HP
AIR COND COMP > 50 HP
GAS/STEAM FIRED AIR COND
UNIT
EVAPORATIVE COOLER OR MAKE
UP AIR UNIT
FAN COIL/AIR HANDLER*
COMMERCIAL HOOD
COMMERCIAL COOKING DUCT
PRODUCT CONVEY VENT**
COOLING TOWER
BATH/KITCHEN/DRYER DUCT
PIPING SYSTEM
REFRIGERATION COMP
≤
25 HP
REFRIGERATION COMP 26-50 HP
REFRIGERATION COMP > 50 HP
ABSORPTION UNIT
BOILER < 1,000K BTU
BOILER
≥
1,000K BTU
ALTER/ADD SYSTEM
TITLE 24 ENERGY REVIEW
OTHER _____________________
FOR OFFICE USE ONLY
# SQ FT FOR TITLE 24 REVIEW
*Requires 1 Piping System & Air Handler **Commercial/Industrial/Garage Exhaust
Note: Vav Box Is No Charge
Page 5 of 8
Plumbing
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
CONTRACTOR LAST NAME, FIRST NAME Same as Building Cont STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
PROJECT SCOPE (CHECK ALL BOXES THAT APPLY)
NEW CONSTRUCTION ALTERATION/REMODEL/TENANT IMPROVEMENT ADDITION CHANGE OF USE/OCCUPANCY
TYPE OF CONSTRUCTION PRESENT USE/OCCUPANCY PROPOSED USE/OCCUPANCY
# DWELLING UNITS # OF STORIES BUILDING HEIGHT CPC EDITION USED
QTY ITEM QTY ITEM QTY ITEM QTY ITEM
TOILETS BACKFLOW < 2"
GAS, DRAIN, VENT
ALTER/REPAIR
1.5" – 2” WATER LINE
SINKS BACKFLOW > 2"
GAS METER
RELOCATION
2.5" – 4” WATER LINE
BATHTUB BACKWATER VALVE
GAS PRESSURE
REGULATOR
≥ 5" WATER LINE
GARBAGE
DISPOSER
FIRE HOSE OULET GAS SYSTEM
DISABLED ACCESS
FIXTURES
AUTOMATIC
WASHER
HOSE BIBBS MED/HIGH GAS METER INDUSTRIAL WASTE
FLOOR DRAIN ON LOT SEWER
REPIPE GAS/WATER
FIXTURE
WET STANDPIPE
SHOWER
SPRINKER
(ANTISIPHON VALVE)
REPIPE WATER
SERVICE ONLY
MED PRESSURE GAS
SYSTEM
DISHWASHER SUMP PUMP AREA DRAIN COMBO WASTE/VENT
DRINKING
FOUNTAIN
TRAP PRIMERS ROOF DRAIN
2" FUEL GAS PIPING
SYSTEM
FLOOR SINK VACUUM BREAKERS PLANTER DRAIN
2.5" – 4" FUEL GAS
PIPING SYSTEM
LAVATORY WATER HEATER
GREASE
INTERCEPTOR
≥
5" FUEL GAS PIPING
SYSTEM
LAUNDRY TRAY
WATER PRESSURE
REGULATOR
SAND INTERCEPTOR MISC. FIXTURES
URINAL
TITLE 24 ENERGY
REVIEW
OTHER INTERCEPTOR OTHER _______________
FIXTURE
CHANGE OUT
Page 6 of 8
Landscape & Irrigation
SUBMITTAL TYPE
REGULAR EXPEDITED OTC NR
PLMB PROJECT NUMBER
CONTRACTOR LAST NAME, FIRST NAME STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
PROJECT SCOPE (CHECK ALL BOXES THAT APPLY)
RESIDENTIAL
NON-RESIDENTIAL
NEW INSTALLATION
REHABILITAITON
TOTAL LANDSCAPE AREA
SQ FT
SPECIAL LANDSCAPE AREA
SQ FT
TURF AREA
SQ FT
NON-TURF PLAN AREA
SQ FT
WATER TYPE:
LONG BEACH WATER OTHER:____________________________________________
WATER TYPE:
COMPLIANCE METHOD
POTABLE
WELL
RECYCLED
OTHER________________
PERFORMANCE PRESCRIPTIVE
ITEM
ITEM
ITEM
ITEM
RESIDENTIAL
PLAN CHECK
RESIDENTIAL
INSPECTION
NON-RESIDENTIAL
PLAN CHECK
NON-RESIDENTIAL
INSPECTION
Page 7 of 8
FOR DEPARTMENT USE ONLY
ZONE
HISTORIC APPROVAL REQ’D
YES NO
RELATED PLANNING CASE NO.
SPECIAL SETBACKS
YES NO
PLANNING FEES REQ’D
YES NO
COASTAL FEE (CPCE) REQ’D
YES NO
SETBACKS
PLANNING REVIEW (PLAN CHECK) REQ’D
YES NO
PLANNING ENTITLEMENTS
INCOMPLETE (Not ready for Plan Check Submittal)
COMPLETE NOT REQUIRED
F
S
R
CF TO PL
ZONING CLEARANCE (INIT) & DATE
PLANNING APPR (INIT) & DATE
SUBMITTAL TYPE
REGULAR EXPRESS OTC NR
Planning
SUBMITTAL TYPE
REGULAR OTC NR
ITEM
ITEM
ITEM
ADMINISTR
ATIVE USE PERMIT (AUP)
SUBDIVISIO
N MAP
SITE PLAN REVIEW
(SPR) # OF FEET ____
CONDITIONA
L USE PERMIT (CUP)
LOT MERGER/LOT LINE
ADJUSTMENT
CONCEPTUAL ONLY
PRE-APPLICATION ONLY
WIRELESS TELECOM
STANDARDS VARIANCE (SV) CERTIFICATE OF COMPLIANCE
FENCE HEIGHT EXCEPTION (AUP or SV) CONDOMINIUM CONVERSION
MODIFIC
ATION OF APPROVED PERMIT
ZONING CHANGE AND/OR
AMENDMENT
CREATIVE SIGN
PERMIT
TIME EXTENSION
LOCAL COASTAL PROGRAM
AMENDMENT
SIGN PROGRAM
LOCAL COASTAL DEVELOPMENT PERMIT
GENERAL PLAN AMENDMENT
CONDO CONVERSION EXCLUSION
# OF UNITS ______
GENERAL PLAN CONFORMITY
FINDING
OTHER ________
Sign
SUBMITTAL TYPE
REGULAR OTC NR
SIGN PROJECT NUMBER
CONTRACTOR LAST NAME, FIRST NAME STATE LICENSE NO. & TYPE EXP. DATE
CONTRACTOR MAILING ADDRESS CONTRACTOR EMAIL ADDRESS
CITY STATE ZIP PHONE FAX
CITY BUSINESS LICENSE # (IF KNOWN) EXP. DATE TYPE OF BUSINESS CITY PIN
ELECTRICAL*
YES / NO
SIGN TYPE VALUE SQUARE FEET OVERALL HEIGHT ABOVE
GRADE
1
2
3
4
5
6
7
8
TOTAL VALUATION OF ALL SIGNS:
FOR DEPARTMENT USE ONLY
N = NEW E = EXISTING D = DEMOLISH/REMOVE A = ADD/EXPAND
PLANNING APPROVAL BY PLAN STAMPED YES NO DATE
*If signs require electrical hook-up, an electrical permit will also be required.
Page 8 of 8
City of Long Beach
411 W. Ocean Blvd., 3rd Floor
Long Beach, CA 90802
Visit us at longbeach.gov/lbds
LongBeachBuilds
This information is available in alternative format by request at 562.570.3807.
For an electronic version of this document. visit our website at longbeach.gov/lbds.
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Ab336a04246e42a4bba7214749fcc687.aspx Development Permit Application

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Completed 13 July 2020

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