HomeMy WebLinkAboutPermit PG13-131 - CAFFE LUCA COFFEE ROASTERS - ALTERATIONCAFFE LUCA
COFFEE ROASTERS
1025 INDUSTRY DR
PG13-131
•
City of Tukwila
•
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Inspection Request Line: 206-438-9350
Web site: http://www.TukwilaWA.gov
PLUMBING/GAS PIPING PERMIT
Parcel No: 2523049071 Permit Number: PG13-131
Address: 1025 INDUSTRY DR Issue Date: 5/13/2014
Permit Expires On: 11/9/2014
Project Name: CAFFE LUCA COFFEE ROASTERS
Owner:
Name: CWWA TUKWILA 1 LLC
Address: C/O EQUITY OFFICE MGMT LLC PO
BOX A-3879, CHICAGO, WA, 60690
Contact Person:
Name: JOSH MONDAU Phone: (253) 861-7965
Address: 885 INDUSTRY DR , TUKWILA, WA,
98188
Contractor:
Name: AFFIDAVIT - JOSH MONDAU Phone:
Address:
License No: Expiration Date:
Lender:
Name:
Address: , , ,
DESCRIPTION OF WORK:
SUBTYPE: NRES STATUS: APPROVEDDESCRIPTION: INSTALLATION OF NEW FIXTURES UPON EXISTING ROUGH -
IN PLUMBING. PREVIOUS TENANT REMOVED FIXTURES AND ALL PLUMBING IN PLACE, READY FOR
INSTALLATION.
Valuation of Work: $500.00
Water District: TUKWILA
Sewer District: TUKWILA SEWER SERVICE
Fees Collected: $110.63
Current Codes adopted by the City of Tukwila:
Internations Building Code Edition:
International Residential Code Edition:
International Mechanical Code Edition:
Uniform Plumbing Code Edition:
Permit Center Authorized Signature:
2012 International Fuel Gas Code:
2012 WA Cities Electrical Code:
2012 WA State Energy Code:
2012
2012
2012
2012
Date:
I hearby certify that I have read and examined this permit and know the same to be true and correct. All
provisions of law and ordinances governing this work will be complied with, whether specified herein or not.
The granting of this permit does not presume to give authority to violate or cancel the provisions of any other
state or local laws regulating cons uction or the performance of work. I am authorized to sign and obtain this
development per ae jthe conditions attached to this permit.
Signature:
Print Name:
Date: '22/14+
This permit shall become null and void if the work is not commenced within 180 days for the date of issuance, or
if the work is suspended or abandoned for a period of 180 days from the last inspection.
PERMIT CONDITIONS:
1: ***PLUMBING AND GAS PIPING***
2: No changes shall be made to applicable plans and specifications unless prior approval is obtained from the
Tukwila Building Division.
3: All permits, inspection records and applicable plans shall be maintained at the job and available to the
plumbing inspector.
4: All plumbing and gas piping systems shall be installed in compliance with the Uniform Plumbing Code and
the Fuel Gas Code.
5: No portion of any plumbing system or gas piping shall be concealed until inspected and approved.
6: All plumbing and gas piping systems shall be tested and approved as required by the Plumbing Code and
Fuel Gas Code. Tests shall be conducted in the presence of the Plumbing Inspector. It shall be the duty of
the holder of the permit to make sure that the work will stand the test prescribed before giving
notification that the work is ready for inspection.
7: No water, soil, or waste pipe shall be installed or permitted outside of a building or in an exterior wall
unless, adequate provision is made to protect such pipe from freezing. All hot and cold water pipes
installed outside the conditioned space shall be insulated to minimum R-3.
8: Plastic and copper piping running through framing members to within one (1) inch of the exposed framing
shall be protected by steel nail plates not less than 18 guage.
9: Piping through concrete or masonry walls shall not be subject to any load from building construction. No
plumbing piping shall be directly embedded in concrete or masonry.
10: All pipes penetrating floor/ceiling assemblies and fire -resistance rated walls or partitions shall be
protected in accordance with the requirements of the building code.
11: All new plumbing fixtures installed in new construction and all remodeling involving replacement of
plumbing fixtures and fittings in all residential, hotel, motel, school, industrial, commercial use or other
occupancies that use significant quantities of water shall comply with Washington States Water Efficiency
and Conservation Standards in accordance with RCW 19.27.170 and the 2006 Uniform Plumbing Code
Section 402 of Washington State Amendments.
12: Piping in the ground shall be laid on a firm bed for its entire length. Trenches shall be backfilled in thin
layers to twelve inches above the top of the piping with clean earth, which shall not contain stones,
boulders, cinderfill, frozen earth, or construction debris.
13: The issuance of a permit or approval of plans and specifications shall not be construed to be a permit for,
or an approval of, any violation of any of the provisions of the Plumbing Code or Fuel Gas Code or any
other ordinance of the jurisdiction.
PERMIT INSPECTIONS REQUIRED
Permit Inspection Line: (206) 438-9350
1900 PLUMBING FINAL
8005 ROUGH -IN PLUMBING
CITY OF TUKWILA
Community Development Department
Permit Center
6300 Southcenter Blvd., Suite 100
Tukwila, WA 98188
http://www.TukwilaWA.gov
Plumbing/Gas Permit No.. to 1 31
Project No.
Date Application Accepted: �(� I (• 3
Date Application Expires: I ` 1
(For office use only)';
PLUMBING / GAS PIPING PERMIT APPLICATION
Applications and plans must -be -complete in order to -be -accepted for plan review.
Applications will not be accepted through the mail or by fax.
**Please Print**
King Co Assessor's Tax No.:
Site Address: /025 I 0,11 DLA GJ) PP 9e/
l e liit� ) Suite Number: Floor:
Tenant Name: C tAC-4 C457'EFA7-, New Tenant: Yes ❑..No
E (A)1 L.-4 L . t . C
PROPERTY OWNER Col p,( p ag. PIA -Fri ei
Name:/� �4-7'I bre
/F 1fD � L : LE -444— Avivi lA t4 -i t
Address:nn
Z coo 2
sti. KtVE?LitDE L.AZ-A t at
City: i41cot.,0 State: /i, Zip: 404:204,
CONTACT PERSON —person receiving all project
communication '
Name: jtivki M 614 D AKA
Address: pfbc2 1 vw_irAy pR1 J E__
City:,, M �W 1 U A' State: IA�� Zip: %
Phone:Fax:
253. 1 • 304c,
Email: •1 p`7vi ( col Cte I UCtA . CO nom)
PLUMBING CONTRACTOR INFORMATION
Company Name:
CG�t1W PIitAM%, "ic.,
Address:
100l tot., n -t MAc /4•e-na&t 5r.
City: ,T�G A- State: VD Zip:9
5
Phone: 2r 3.227) • 9-6 I t Fax:
Contr Reg No.: Exp Date:
el>sEwp*(P3Ga 3/tZ//5
Tukwila Business License No.:
Valuation of Project (contractor's bid price): $ ")00
Scope of Work (please provide detailed information): (i.(Gj— t e,pf.7.t pyo F 1 oi.'r•v JO .P.0-7 N Qty
Ext
47-1-16•1/41c., dot,, cA 4 t o-1 P "A Q , ,JL, . j7p-6.41 i c2AA TP— ter P -F_ -nn o -v
F txTu (2.-- of -c,,‘, A -t.. a.HM 'St,
i of �c.'3-'-E , gp._,a-v-7 F )0j A -i; wp 7-7 @„( .
Building Use (per Int'l Building Code): C OFF -F4— liA�.►�,�U 1d1
Occupancy (per Intl Building Code): F - I
Utility Purveyor: Water: C t r y o f T N if4N t LR Sewer C, i to K -W 1 t:., n
H:\ApplicationsWorms-Apphcauona On Lmc'2011 Applications\Plumbing Permit Application Revised 0-9-11.docx
Revised: August 2011
bh
Page 1 of 2
Indicate type of plumbing fixtures and/or gas piping outlets being installed and the quantity below:
Fixture Type
Qty
Bathtub or combination
bath/shower
Dishwasher, domestic with
independent drain
Shower, single head trap
Sinks
t
Rain water system — per
drain (inside building)
Grease interceptor for
commercial kitchen (>750
gallon capacity)
Each additional medical
gas inlets/outlets greater
than 5
Backflow protective device
other than atmospheric -
type vacuum breakers 2
inch (51 mm) diameter or
smaller
Atmospheric -type vacuum
breakers not included in
lawn sprinkler backflow
protections (1-5)
Atmospheric -type vacuum
breakers not included m
lawn sprinkler backflow
protections over 5
Fixture Type
Qty
Bidet
Drinking fountain or water
cooler (per head)
Lavatory
Urinal
Water heater and/or vent
Repair or alteration of
water piping and/or water
treatment equipment
Each lawn sprinkler
system on any one meter
including backflow
protection devices
Backflow protective device
other than atmospheric -
type vacuum breakers 2
inch (51 mm) diameter or
smaller
Backflow protective
device other than
atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
Atmospheric -type vacuum
breakers not included m
lawn sprinkler backflow
protections over 5
Gas piping outlets
Fixture Type
Qty
Clothes washer,
domestic
Food -waste grinder,
commercial
Wash fountain
Water closet
Industrial waste
treatment interceptor,
including trap and vent,
except for kitchen type
grease interceptors
Repair or alteration of
drainage or vent piping
Each lawn sprinkler
system on any one meter
including backflow
protection devices
Backflow protective
device other than
atmospheric -type
vacuum breakers over 2
inch (51 mm) diameter
Gas piping outlets
Fixture Type
Qty
Dental unit, cuspidor
Floor drain
Receptor, indirect waste
Building sewer and each
trailer park sewer
Each grease trap
(connected to not more
than 4 fixtures - <750
gallon capacity
Medical gas piping
system serving 1-5
inlets/outlets for a specific
gas
Each lawn sprinkler
system on any one meter
including backflow
protection devices
PERMIT APPLICATION NOTES
Value of Construction — In all cases, a value of construction amount should be entered by the applicant. This figure will be reviewed and is subject
to possible revision by the Permit Center to comply with current fee schedules.
Expiration of Plan Review — Applications for which no permit is issued within 180 days following the date of application shall expire by limitation.
The Building Official may grant one extension of time for an additional period not to exceed 180 days. The extension shall be requested in writing
and justifiable cause demonstrated. Section 103.4.3 International Plumbing Code (current edition).
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE UNDER
PENALTY OF PERJURY BY THE LAWS OF THE STATE OF WASHINGTON, AND I AM AUTHORIZED TO APPLY FOR THIS PERMIT.
BUILDING OWN �;,ir::tiff' ZED AGENT:
Signature:
Print Name:
Mailing Address: t'J G CD fti OL 4->-74—‘1DQ -
Date: (VicA/1*-2-)
Day Telephone: 2 77> ' c 6) 1 -
T-0, i? t-) 1(..-A (ADA e / t2,
n^,Applieations`rotms-Applications On Lincl2011 Applieatious'Plunrbin5 Permit Application Revised 5-7-11. docx
Revised: August 2011
bh
City State Zip
Page 2 of 2
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-43 1-3670
Fax: 206-431-3665
Web site: http://www.TukwilaWA.gov
RECEIPT
ParcelNo.: 2523049071 Permit Number: PG13-131
Address: 1025 INDUSTRY DR TUKW Status: PENDING
Suite No: Applied Date: 09/19/2013
Applicant: CAFE LUCA COFFEE ROASTERS Issue Date:
Receipt No.: R13-02684
Initials: WER
User ID: 1655
Payment Amount: $110.63
Payment Date: 09/19/2013 02:04 PM
Balance: $0.00
Payee: JOES GARAGE
TRANSACTION LIST:
Type Method Descriptio . Amount
Payment Check 1170 110.63
Authorization No.
ACCOUNT ITEM LIST:
Description
Account Code Current Pmts
PLAN CHECK - NONRES
PLUMBING - NONRES
000.345.830 22.13
000.322.103.00.00 88.50
Total: $110.63
a,,..• oo,' inr_na
Printed• eq -1 Q-7111
::/
INSPECTION RECORD
Retain a copy with permit
INSPECTION NO. PERMIT NO.
CITY OF TUKWILA BUILDING DIVISION
(206) 431-3670
P6,5 -1g1
6300 Southcenter Blvd., #100, Tukwila. WA 98188
Permit Inspection Request Line (206) 431-2451
Project:
(rA r --E L2 &f k 0 Asiriv
Type of Inspection
1=1 IJ l -L-
Address: `
I 02S .�--t� `tl_S+ r �r'6 /
Date Called:
Special Instructions:
Date Wanted:
a.m.
Requester:
PzSl3 e6nt 7 h5
Approved per applicable codes. LJ Corrections required prior to approval.
COMMENTS:
-Pc,i /1 k. ( tAer'-
tas,�\or:
1
Date:
5 L(
n RE I SPECTION FEE REQUIRED. Prior to next inspection, fee must be
pa d)at 6300 Southcenter Blvd., Suite 100. Call to schedule reinspection.
RE: Building Division Review Memo
Date: October 11, 2013
Project Name: Caffe Luca Coffee Roasters
Permit #: PG13-131
Plan Review: Allen Johannessen, Plans Examiner
1. The daily business operations will include loading stacks of individual serve cups,
the required filters, ground coffee (roasted and ground off-site), and foil tops for sealing
the cups into a pneumatic machine for packaging. Cups will automatically drop onto a
moving conveyor, into properly sized holes, then filters will be placed into each cup, by
human hands, prior to the machine automatically filling and sealing the single serve cups.
Single serve cups of coffee will then be hand placed into 36 -count cartons, 6 cartons per
case, and the cases will be palletized for freight shipment.
The three -compartment sink is required by Washington State Department of
Agriculture regulations as Caffe Luca is a food -producing establishment. No items from
the packaging machine will be removable and thus not washed in the three -compartment
sink. Washable items will include stainless steel scoops and food safe plastic containers/
totes. Roasting coffee produces no grease and no grease will be present when packaging
coffee.
2. The required three -compartment sink will be installed upon existing fixtures as
well as utilize an existing floor sink. The air gap will allow proper disposal of wastewater
without risk of contaminating the wash station. Isometric drawings were not previously
submitted due to all installations upon existing plumbing fixtures.
3. Victoria Schaffer with the Washington State Department of Agriculture has been
our contact person as well as will facilitate licensing inspection. She informed us that
King County Health department will not require food handlers permits.
RECEIVED
CITY OF TUKWILA
OCT 14 2013
PERMIT CENTER
L �#RECTION r>��- G�
SEPARATE PERMIT
REQUIRED FOR:
B'Mechanic aI
Ertiectrical
0 Plumbing
P.' Sas Piping
-:y of Tukwila
F!-;;iS NG DIVISION
55 -6"
15'-2"
FILE COPY
Permit No. PG 1 t =J
Pian review approval is subject to errors and
..;:. ,al of construction documents does
or. •, jation of any adopted code • o
,proved Field
By
Date: -
Adjacent Suite
ASSUMED WALL THICKNESS (TYP.).
39'-0"
3- Com -PA P --r An nT _TIL
u9o/4 EX�hT-1/- I-HV)Ctr4 I V1
0" 1
'-11"
City Of lUkwlla
BUILDING DIVISION
WAREHOUSE
107'=11"
26'-3"
7711.e--'- W Ahrl4 I .J
u Pert Ex tet- 104 0-4
11'-5"
18'-0"
1025
15'-8"
OFFICE
REVIEWED FOR
CODE COMPLIANCE
APPROVED
OCT 21 2013
City of Tukwila
BUILDING DIVISION
27 -7"
18'-0"
DN
REVISIONS
No changes shall be made to the
scope
of work without
pr or approval of
I ".. "3 d ill Building
g Division.
;K7 i'Fv.y'd: additional
a new plan submittal
ditional plan review fees.
ASSUMED WALL THICKNESS (TYP.).
Adjacent Suite
PG 13
3
DN
RECEIVED
SEP, 2 4 2013
TUKWi W
PUBLIC WORKS
ea
a°
RECEIVED
CITY OF TUKWILA
SEP 1 9 2013
PERMIT CENTER
Project: C 1 0-26 1
0
L
0
0
u.
n
N
O
a
U
October 2, 2013
Josh Mondau
885 Industry Dr
Tukwila WA 98188
City of Tukwila
Jim Haggerton, Mayor
Department of Community Development Jack Pace, Director
RE: Correction Letter #1
Plumbing/Gas Piping Permit Application Number PG13-131
Caffe Luca Coffee Roasters —1025 Industry Dr
Dear Mr. Mondau,
This letter is to inform you of corrections that must be addressed before your plumbing/gas piping permit can be
approved. All correction requests from each department must be addressed at the same time and reflected on your
drawings. I have enclosed comments from the Building Department. At this time the Public Works Department
has no comments.
Building Department: Allen Johannessen at 206 433-7163 if you have any questions regarding the
attached memo.
Please address the attached comments in an itemized format with applicable revised plans, specifications, and/or
other documentation. The City requires that two (2) sets of revised plan pages, specifications and/or other
documentation be resubmitted with the appropriate revision block.
In order to better expedite your resubmittal, a `Revision Submittal Sheet' must accompany every resubmittal. I
have enclosed one for your convenience. Corrections/revisions must be made in person and will not be
accepted through the mail or by a messenger service.
If you have any questions, please contact me at (206) 431-3670.
Sincerely,
Jenn.
erm
enc
File: PG13-131
er Marshall
t Technician
W: IPermit CenterlCorrection Leuers120131PGI3-131 Correction Letter Nl.docx
6300 Southcenter Boulevard, Suite #100 • Tukwila, Washington 98188 • Phone 206-431-3670 • Fax 206-431-3665
Tukwila Building Division
Allen Johannessen, Plan Examiner
Building Division Review Memo
Date: October 1, 2013
Project Name: Caffe Luca Coffee Roasters
Permit #: PG13-131
Plan Review: Allen Johannessen, Plans Examiner
The Building Division conducted a plan review on the subject permit application. Please address the following
comments in an itemized format with revised plans, specifications and/or other applicable documentation.
(GENERAL NOTE)
PLAN SUBMITTALS: (Min. size 11x17 to maximum size of 24x36; all sheets shall be the same size. New
revised plan sheets shall be the same size sheets as those previously submitted.)
(If applicable) Structural Drawings and structural calculations sheets by a registered engineer shall have a current
signed stamp -seal. Architectural design sheets and documents by a registered architect shall also have a current
signed stamp -seal.
1. Please provide a narrative of the operation for this business explaining the basic process. In addition explain
specifically what the three -compartment sink shall be used for. Specify if any grease produced items shall be
washed into the sink. If so, a separate grease interceptor shall be required with manufactures specks and details
for connection to the drain waste system.
2. Food -preparation sinks, shall be indirectly connected to the drainage system by means of an air gap. Show an
indirect waste system for the three compartment sink. Provide a plumbing isometric diagram and plan view
diagram for new plumbing (i.e. indirect waste) identifying points of connections. Identify how or where drain
waste shall be vented. (2012 UPC 801.2.3).
3. Verify if a King County Health food handlers permit is required.
Should there be questions concerning the above requirements, contact the Building Division at 206-431-3670.
No further comments at this time.
Joanna Spencer
From: Han Kirkland
Sent: Thursday, September 26, 2013 7:24 AM
To: Joanna Spencer; Todd Reedy
Cc: Bryan Still
Subject: RE: Caffe Luca Coffee Roasters @ 1025 Industry Dr PG13-131
Joanna,
The (3) backflow assemblies for this address are all current for 2013.
8" DCDA for fire, 0.75" DCVA bypass and 1.5" RPBA for premise isolation were tested and passed on 08/21/2013.
Thanks,
Han
From: Joanna Spencer
Sent: Wednesday, September 25, 2013 2:02 PM
To: Todd Reedy
Cc: Bryan Still; Han Kirkland; Joanna Spencer
Subject: Caffe Luca Coffee Roasters @ 1025 Industry Dr PG13-131
Hi Todd,
Are they current on their backflows?
JJS
1
�C� i3 -iii
,ERMIT COORD COPY
PLAN REVIEW/ROUTING SLIP
ACTIVITY NUMBER: PG13-131 DATE: 09-19-13
PROJECT NAME: CAFFE LUCA COFFEE ROASTERS
SITE ADDRESS: 1025 INDUSTRY DR
X Original Plan Submittal -
Response to Correction Letter #
Response to Incomplete Letter #
Revision # After Permit Issued
DEPART ENTOS'::
Buiiltd�ng iMsion '
Pu lic Works
D
Fire Prevention
Structural
Planning Division
❑ Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete
Incomplete
DUE DATE: 09-24-13
Not Applicable
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg 0 Fire 0 Ping 0 PW 0 Staff Initials:
TUES/THURS ROUTING:
Please Route X Structural Review Required ❑ No further Review Required
REVIEWER'S INITIALS: DATE:
APPROVALS OR CORRECTIONS:
Approved
Notation:
n
Approved with Conditions
DUE DATE: 10-22-13
Not Approved (attach comments) n
REVIEWER'S INITIALS: DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections:
Documents/routing slip.doc
2-28-02
1UI02(1)
Bldg Fire 0 Ping 0 PW 0 Staff Initials:
• PERMIT COORD COPY
PLAN REVIEW/ROUTING SLIP
ACTIVITY NUMBER: PG13-131 DATE: 10/14/13
PROJECT NAME: CAFFE LUCA COFFEE ROASTERS
SITE ADDRESS: 2800 SOUTHCENTER MALL, K-9070
Original Plan Submittal
X Response to Correction Letter # 1
Response to Incomplete Letter #
Revision # after Permit Issued
DEPARTMENTS:
4edU v�3
Building Division
Public Works
Fire Prevention
Structural
Planning Division
Permit Coordinator
DETERMINATION OF COMPLETENESS: (Tues., Thurs.)
Complete Nq
Incomplete
n
DUE DATE: 10/15/13
Not Applicable
Comments:
Permit Center Use Only
INCOMPLETE LETTER MAILED: LETTER OF COMPLETENESS MAILED:
Departments determined incomplete: Bldg ❑ Fire ❑ Ping 0 PW 0 Staff Initials:
TUES/THURS ROUTING:
Please Route 1111
REVIEWER'S INITIALS: DATE:
Structural Review Required
No further Review Required ❑
APPROVALS OR CORRECTIONS:
Approved u Approved with Conditions zxt
Notation:
REVIEWER'S INITIALS:
DUE DATE: 11/12/13
Not Approved (attach comments) C
DATE:
Permit Center Use Only
CORRECTION LETTER MAILED:
Departments issued corrections: Bldg 0 Fire 0 Ping 0 PW ❑ Staff Initials:
City of Tukwila
Department of Community Development
6300 Southcenter Boulevard, Suite #100
Tukwila, Washington 98188
Phone: 206-431-3670
Web site: http://www.ci.tukwila.wa.us
REVISION
SUBMITTAL
Revision submittals must be submitted in person at the Permit Center. Revisions will not be accepted through
the mail, fax, etc.
Date: lcD/rr /i 7) Plan Check/Permit Number: G, / ,- 19D 1
0 Response to Incomplete Letter #
Response to Correction Letter # l itte ry
'
Ir
y ti °�vtA
121 Revision # after Permit is Issued
El Revision requested by a City Building Inspector or Plans Examiner 'Ir T 1 �. 2013
rERM1T CENTER
Project Name: CA -FF i_UG,q. (CIF -PE -E. a0..y-rL._R-,2D
Project Address: % 2-Fj /Avo..7 ne--tr IDR i v- / o / ?-6
Contact Person: `�jc�+ 4 Q� o, c'3 -N Phone Number: 2-c-29), Q?(o / • 79(0
Summary of Revision: rf tF'l--A'- a- Fs n 0 17 t r -f
P F.-SPG-elazrF.- 77) `/?f6 .t e>77`P-00C / "A 95-"1' PFS 4
1,6-P#48.71 e_ c•;,-04.ki a-9-4-7)41-7-7 c-7.1 aVl 07Q DA -ti / /0/-/r7.) , I"' i
3n rfn-Al nde37.1r_,%P7)I E
f,- e rf / raw �'(� , e Q- r 6-t>/►A h—T"(Lrc -)t
Pett P. -al -TF -9 61 M R- 304 mf p4
Sheet Number(s):
"Cloud" or highlight all a-'ieas'of revision incli?ditng dateof revision' —.
Received at the City of Tukwila Permit Center by: V'v `
0 Entered in Permits Plus on b 0 VI
H: Applications\Forms-Applications On Line\2010 Applications\7-2010 - Revision Submittal.doc
Created: 8-13-2004
Revised: 7-2010
•
CITY OF TUKWILA
Department of Community Development
6300 Southcenter Boulevard, Tukwila, WA 98188
Telephone: (206) 431-3670 FAX (206) 431-3665
Permit Center/Building Division
206 431-3670
Public Works Department
206 433-0179
Planning Division
206 431-3670
AFFIDAVIT IN LIEU OF CONTRACTOR REGISTRATION
PERMIT NO: v l'3 \ 3 I
STATE OF WASHINGTON)
) ss.
COUNTY OF KING
6-a D A -tit
, states as follows:
[please print name]
1. I have made application for a permit from the City of Tukwila, Washington.
2. I understand that state law requires that all building construction contractors be registered with the
State of Washington. The exceptions to this requirement are stated under Section 18.27.090 of the
Revised Code of Washington, a copy of which is printed on the reverse side of this Affidavit. I have
read or am familiar with RCW 18.27.090.
3. I understand that prior to issuance of a permit for work which is to be done by any contractor, the
City of Tukwila must verify either that the contractor is registered by the State of Washington, or that
one of the exemptions stated under RCW 18.27.090 applies.
4. In order to provide verification to the City of Tukwila of my compliance with this requirement, I
hereby attest that after reading the exemptions from the registration requirement of RCW 18.27.090,
I consider the work authorized under this permit to be exempt under number I 1 , and will therefore
not be performed by a registered contractor.
5. I understand that the licensing provision of RCW 19.28.161 through 19.28.271 shall not apply to
persons making electrical installations on their own property or to regularly employed employees
working on the premises of their employer. The proposed electrical work is not for the construction
of a new building for rent, sale or lease.
I understand that I may be waiving certain rights that I might of - 'se hav nder state law in any decision
to engage an unregistered contractor to perform constructio�;,�r
Aue%so
el
..
N�' h,��-19�1,) :
v~ =
/'0417t�OF WAS ~`
Owner/O 's Agent*
Signed and sworn to before me this
���day of 1 " 1Z V, 20 I Li.
t-- EAEJ--
NOTARY PUBLIC in and for the State of Washington
Residing at V , County
SName as commissioned: J KS b 1 "Y"QC
My commission expires: la- 11 ~ din S
18.27.090 Exemptions. The registration provisions of this chapter do not apply to:
1. An authorized representative of the United States
government, the state of Washington, or any incorporated
city, town, county, township, irrigation district, reclamation
district, or other municipal or political corporation or
subdivision of this state;
2. Officers of a court when they are acting within the scope
of their office;
3. Public utilities operating under the regulations of the
utilities and transportation commission in construction,
maintenance, or development work incidental to their own
business;
4. Any construction, repair, or operation incidental to the
discovering or producing of petroleum or gas, or the
drilling, testing, abandoning, or other operation of any
petroleum or gas well or any surface or underground mine
or mineral deposit when performed by an owner or lessee;
5. The sale of any finished products, materials, or articles of
merchandise that are not fabricated into and do not become
a part of a structure under the common law of fixtures;
6. Any construction, alteration, improvement, or repair of
personal property performed by the registered or legal
owner, or by a mobile/manufactured home retail dealer or
manufacturer licensed under chapter 46.70 RCW who shall
warranty service and repairs under chapter 46.70 RCW;
7. Any construction, alteration, improvement, or repair
carried on within the limits and boundaries of any site or
reservation under the legal jurisdiction of the federal
government;
8. Any person who only furnished materials, supplies, or
equipment without fabricating them into, or consuming
them in the performance of, the work of the contractor;
9. Any work or operation on one undertaking or project by
one or more contracts, the aggregate contract price of
which for labor and materials and all other items is less
than five hundred dollars, such work or operations being
considered as of a casual, minor, or inconsequential nature.
The exemption prescribed in this subsection does not apply
in any instance wherein the work or construction is only a
part of a larger or major operation, whether undertaken by
the same or a different contractor, or in which a division of
the operation is made into contracts of amounts less than
five hundred dollars for the purpose of evasion of this
chapter or otherwise. The exemption prescribed in this
subsection does not apply to a person who advertises or
puts out any sign or card or other device which might
indicate to the public that he or she is a contractor, or that
he or she is qualified to engage in the business of
contractor;
10. Any construction or operation incidental to the
construction and repair of irrigation and drainage ditches
of regularly constituted irrigation districts or reclamation
districts; or to farming, dairying, agriculture, viticulture,
horticulture, or stock or poultry raising; or to clearing or
other work upon land in rural districts for fire prevention
purposes; except when any of the above work is performed
by a registered contractor;
11. An owner* who contracts for a project with a registered
contractor, except that this exemption shall not deprive the
owner of the protections of this chapter against registered
and unregistered contractors. The exemption prescribed in
this subsection does not apply to a person who performs
the activities of a contractor for the purpose of leasing or
selling improved property he or she has owned for less than
twelve months;
12.* Any person working on his or her own property,
whether occupied by him or her or not, and any person
working on his or her personal residence, whether owned
by him or her or not but this exemption shall not apply to
any person who performs the activities of a contractor on
his or her own property for the purpose of selling,
demolishing, or leasing the property;
13. An owner* who performs maintenance, repair, and
alteration work in or upon his or her own properties, or
who uses his or her own employees to do such work;
14. A licensed architect or civil or professional engineer
acting solely in his or her professional capacity, an
electrician certified under the laws of the state of
Washington, or a plumber certified under the laws of the
state of Washington or licensed by a political subdivision of
the state of Washington while operating within the
boundaries of such political subdivision. The exemption
provided in this subsection is applicable only when the
person certified is operating within the scope of his or her
certification;
15. Any person who engages in the activities herein
regulated as an employee of a registered contractor with
wages as his or her sole compensation or as an employee
with wages as his or her sole compensation;
16. Contractors on highway projects who have been
prequalified as required by RCW 47.28.070, with the
department of transportation to perform highway
construction, reconstruction, or maintenance work;
17. A mobile/manufactured home dealer or manufacturer
who subcontracts the installation, set-up, or repair work to
actively registered contractors. This exemption only applies
to the installation, set-up, or repair of the
mobile/manufactured homes that were manufactured or
sold by the mobile/manufactured home dealer or
manufacturer; ,� tl{fp;fd�irosror<F.�
18. An entity who holds avyand•electricalcc„ont�ractor's
license under chapter 19:28%RCW ti at,,einplo, s;a certified
journeyman electrician, a certified cesidentlal�specialty
electrician, or an electrical+trainee meetinhhe
requirements of chapter`19.28 RCW'to perform plumbing
work that is incidentalydirectly, and immediately
appropriate to the like-in=khid replacemei vofa'household
appliance or other small:fionsehold utilizationfequipment
that requires limited el'ecttieipowevr anda^mlted waste
and/or water connections.'Anelectr ca1,tr`ainee must be
supervised by a certified electrician while performing
plumbing work.
• Per Washington State Department of Labor and Industries lessee has
been interpreted to be equivalent to owner for purposes of exemptions.