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HomeMy WebLinkAboutOld permits N Development Services Departr- �It 240 West Huntington Drive,Pe. fice Box 60021 PERMIT . BOO-034-132 erty e, • City of Arcadia,CA 91066-6021 Permit Type: Plumbing Arcadia (626) 574-5416,Fax(626)447-9173 , PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 18241 2/24/2010 JB 12:27 2/24/2010 Issued ADDRESS No. Dir.Prfis Street Name Street Suffix Project ASSESSORS PARCEL NO. GEO CODE 710 Encino Dr 5780-016-045 OWNER MAILING ADDRESS Billy Huang 710 Encino Drive PHONE NO. Arcadia, CA 91006 EMAIL ADDRESS: Inspector#: CRIS Plan Chk#: APPLICANT MAILING ADDRESS Plan#• Fast Water Heater 12601 132nd Avenue Ne PHONE No. (425)636-7084 School Dist#: Kirkland, WA 98034 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Fast Water Heater Co 12601 132nd Avenue Ne 425-636-70 PHONE NO. (800)454-8955 FAX NO. Kirkland, WA 98034 EMAIL ADDRESS: License No. 877489 Type: C 36 Expires: 5/31/2010 12:00: TENANT MAILING ADDRESS PHONE NO. FAX NO. DESCRIPTION WATER HEATER CHANGE OUT(SAME SIZE,SAME LOCATION) Construction Type UOM X of Units Value Construction Type CMPL--E TValue I4L 3-41—(c) itk\ OCCUPANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT I Flat Plmbg Issue A 42.25 42.25 01-3105 I each Wtrhtr/vent 14.81 14.81 01-3105 I each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $58.06 Total Amount Paid: $58.06 Paid Today: $58.06 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Kecetpi R: 911574 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 01-3105 57.06 180 days from the plan application date. This permit expires and becomes null and void if any work 88-3027 1.00 authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by the City of Arcadia building inspector for a period of 180 consecutive days. CALLS FOR INSPECTION INSPECTORS' OFFICE HOURS Requests for inspection should be made at least Monday-Thursday Friday one(1)business day in advance of the inspection 7:30 a.m. to 8:30 a.m. 7:30 a.m. to 8:30 a.m. by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. (Closed on alternate Fridays) PER iIT/PLAN REVIEW 'PLICATION top, Development Services Department, 240 West Huntington Drive, Post Office Box 60021 Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS' COMPENSATION DECLARATION ❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: Chapter 9, commencing with Section 7000, of Division 3 of the Business and Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class License No. Exp.Date compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Contractor ❑ I have and will maintain workers' compensation insurance,as required by Section OWNER-BUILDER DECLARATION 3700 of the Labor Code,for the performance of the work for which this permit is ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors issued. My workers' compensation insurance carrier and policy number are: License Law for the following reason(Section 7031.5, Business and Professions Carrier Code: Any city or county which requires a permit to construct, alter, improve, demolish,or repair any structure,prior to its issuance,also requires the applicant Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less.) 7000)of Division 3 of the Business and Professions Code) or that he or she is ❑ I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption. Any violation of not employ any person in any manner so as to become subject to the workers' Section 7031.5 by any applicant for a permit subjects the applicant to a civil compensation laws of California,and agree that if I should become subject to the penalty of not more than five hundred dollars($500)): workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ❑ I, as owner of the property, or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for Date Applicant sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for WARNING: Failure to secure workers'compensation coverage is unlawful, sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalities and civil fines up to one completion,the owner—builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest,and attorneys fees. ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued(Section 3097,Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Owner Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required. The permittee may be entitled to reimbursement of the permit fees if the City fails to conduct an inspection of the permitted work within 60 days of the request for final inspection. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping, or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at (909)396-2000 for further information. Name Title PRINT NAME I certify that I have read this application and state that the above information is correct and that I am the owner or the duly authorized agent of the owner. I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter upon the above-mentioned property for inspection purposes. Signature Date 478936 I240 WEST HUNTINGTON 91007 DRIVE Cx �l ily �d' ARCADIA BUILDING SERVICES ARCADIA,CA 91007 (626)574-5416 ...OWNER-BUILDER DECLARATION"" Application is hereby made to the Pudding Official for a permit subject to the conditions I hereby affirm under penalty of perjury that I inn exempt front the Contractor's License Law for and restrictions net forth on this application. the following reason(Sec 7031.5 Business and Professions Code: Any city or county which -- — ---�— ----»- requires a permit to construct, alter, improve, demolish,or repair mry structure, prior to its WORKERS'COMPENSATION DECLARTION issuance,also requires the applicant for such permit to tile a signed statement that he or she is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9(commencing with I hereby affirm cruder penalty of perjury one of the following: (check appropriate IMO Section 7000)of Division 3 of the Business and Professions Code or that he or she it exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031 5 by any I have and will maintain a ceniflcate of consent m self insure for workers'compensation, applicant fora permit subjects the applicant to civil penalty of not more than five hundred dollars as provided for by Section 37011 of Me Labor Code,for the performance of the work for which (5500.00) this permit is issued. D I,as owner of the property,or my employees with wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Sec.7044 Business mid Professions X 1 have and will maintain workers'compensation insurance,as required by Section 3700 of Code:The Contractor's License Law does not apply to no owner of property who builds or the Labor Code,for the performance of the work for which this permit is issued. My workers' improves thereon, ar who does such work himself or herself or through his or her owit compensation insurance carrier and policy numbers are: employees,provided that such improvements are not intended or offered for sale If,however,the building or improvement is sold within one year of completion,the owner-builder will have the CamerTruck Insurance Fxcharnlicyo A09304455 burden ofproving that he or she did not build or improve for the purpose of sale). _t certify that in the pedonmance of the work for which tins permit is issued,I shall not C I,as owner of the property,am exclusively contracting with licensed contractors to construct employ any person m any manner no as to become subject to workers compensation Laws of the project(Sec.7044 Business and Professions Code:The Contractor's License Law does not California,and agree that if I should become subject to the workers'compensation provisions of apply to al owner of property who builds or improves thereon,anti who contracts for such Section 3700 of the Labor Code,I shall forthwith comply with those provisions. t( with a contracts)licensed pursuant to the Contractor's License Law). 0 1 mu exempt under Section 70.44,Business and Professicn's Code,for this reason Applicant WARNING Failure to secure workers compensation insurance is unlawful and shall subject an _ employer to criminal penalties and civil fines of up to one hundred thousand dollars(5100,000). in addition to the cost of compensation,damages as provided for in the Labor Code,interest and OWNER: DATE: attorney fees. ----- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I an licensed under provisions of Chapter 9 I certify that I have rend this application and state that the above information is correct and that I (commencing with Section 7000)of Division 3 of the Business and Professions Code,and my tun the owner or a duly authorized agent of the owner.I agree to comply with all city and state license is in full force and effect. laws relating to building construction and hereby authorize representatives of the City of Arcadia to enter upon the above-mentioned property for inspection purposes. License Number 931237 License Claus C36 _ -2z,,V..-. QP 2/12/10 Expiration Date of Contractor's License 4/30/11 Signature of owner,owner's agent or contractor Date PLUMBING PERMIT Building Owner• Contractor Address710 EJ4Ci1NO])•R UANG. BILLY FAST WATER HEATER COMPANY . Applicant Address City. : ' FAST WATER HEATER:COMPANY 12601 132ND AVE NE • t�SiRKL ND:-:,. Address City State Zip felephone'Nttmber 12601 132ND AVE NE KIRKLAND WA 98034 425-636-7084 State Zip - . Telephone Number Description Fee No. Amt. WA 98034 . I42�5-636 7084 Description Fee No. Amt. Complete water repipe(Fee is based on the valuation of the work.Please call/see staff) Plumbing fixture(s)on one trap* 11.30 ca. Lawn sprinkler system on one meter 17.00 Lads sewer connection on one property 28.25 1 to 5 atmospheric type vacuum breakers 14.10 Each sewer repair and/or replacement 28.25 Atmospheric type vacuum breakers over 5 2.80 ea. Each private sewage disposal system 84.75 Each backtlow protective device other than Each water heater and/or vent 14.10 1 14.10 the atmospheric or lawn sprinkler type: Each gas piping system,one to five outlets 14.10 • 2 inches and smaller 14.10 Each gas piping outlet over five,per outlet 2.80 • Over 2 inches 28.25 Rainwater system,per drain,within 14.10 Swimming pool and/or spa circulation 24.25 building Each kitchen grease trap 11.30 piping Each grease/industrial waste interceptor 22.65 Swimming pool"P"trap 9.85 Repair to drainage/vent piping.each fixture 11.30 Swimming pool and/or spa water heater 36.95 Repair and/or alteration to water piping 11.30 Sewer cap or cesspool abandonment 14.10 Full Description of Work: Miscellaneous Remove/Replace Gas Water Heater Solid Waste Management(SWMF)and 41.25 Processing fee Total fee,including Processing and SWMF 58 BB *Please itemizes by fixture type in description APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the specifications and plans herewith submitted for the erection of the building herein described. All provisions of the Building Ordinances and Zoning Ordi- nances shall be complied with in the erection of said building , whether specified or not. State License No / /® (Sign here) � / t City License No ! 7/7 Lot.lJY.����' .� G2 Block. Tract 456:7(3) 4. Zone Fire District d- Street Address 7 /0 A 1. Purpose of the Building te.,24_.-;17-1---.4-c--e'er 11 ' /T'.et'- -r%..z;. Number of Rooms Kind of Construction 2. Roof ....2`21- (�� ee7 • 3. Owner's name, /....f._. 2,1,(1.v • ( � sryu Telephone No./(/-4, 6 .% 9S"Z 4. Owner's address 5. Architect's name.../ . ei' -4-ar _ 6. Builder's name / � Telephone o ` 9 S7 7. Builder's address //'f''' 8. Estimated value of proposed improvements S.._/2..;'e 0 9. Will the building be erected on the front or rear of lot?.. a 10. Size of lot x Size of building x 11. Number of stories in height_.__ Floor Area /76' 12. Will there be a cellar or basement-_}L Q Size Dated Arcadia, California,... , 19 St�. 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I Jo. , .......■....■...... i ." ,0/ ...1 1 . / .,.., „.. , ....1 .., .....) .... , 1 ,. ,. ... I I I t I 1 ',4 4/ -, .....■..-..■-......-.... lin I/ L"\ rs..- r-, t, a ---- ----*. 14 . ,..r. —,.„... ,/, .._..........., .i . 1 BUILDING AND SAFETY DIVISION 44111. BUILDING City of Arcadia PERMIT 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 r 1 U.B.C. (Type Occ. Building 710 Encino Dr. Arcadia,Ca. Edition Const. Group Address Lot I Block (Tract Occ F. D. Appr. Date H. D.Appr.Date Load Required Required No.wner Special Case No. O Use Zone Bialy n.Y•Huang Homeowners Association Approval I Date Mailing 710 Encino Dr. Address (213 ) CityArcadia, Cali'?91006 1Te1. 4LI -2727 Size Special 0 Contractor Sierra-Pacific Design Conditions ns NOTE: Include: I— Address 2 210 Wilshire Blvd. #617 VALUATION Labor,Material, Plumbing, Etc. $ a cirySanta Monica Zip90403 Tel826-6660 Misc. FEE Santa City ❑Private �. State Lic.B_378037 Lic.No. 61 rj�?T Swimming Pool I Spa nPublic &Classif. Wall r Arch., Engr., Sign-Pole❑ ❑ owner Designer e r Address Tel. F Temporary❑ Projecting ❑ rT E City Zip State Fee Based on Total Sq.Ft. Lic. No. E •- Proposed Addition of two bedrooms S PLAN CHECKING FEE — Construction and bath , �© �-- 7i. S.M.I.P. 1 _ ) Permit Fee /..r (.,) Floor Main Accessory TotaQ4,50sq.ft . Processed by TOTAL Date` t�� Area U New❑ Add. Alter.❑ Repair❑ Demolition El Permit No. Plan No. am. mommomaillqv LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION S '�c-, E I hereby affirm that I have a certificate of consent to self-insure,or a certificate of ,I 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section Worker's Compensation Insurance,or a certified copY�t he of.(Sec."3800, bor ode.) 7600)of Division 3 of the Business and Professions Code,and my license is in full force and ..yy��,,,,,�, �� )) rJ .urge andnsur. effect. Policy No.�d_IX.e/2.2_____ __Company Copy is filed ri Certified copy is I 2%zp.Date I OWNER-BUILDER DECLARATION with the City. hereby furnished. 85 ❑ I hereby affirm that I am exempt from the Contractor's License Law for the following CERTIFICATE OF EXEMPTION FROM reason:"Ser.7031.5.Business and Professions Codes.Any city or county which requires a WORKERS'COMPENSATION INSURANCE permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance (This section need not be completed if the permit is for one hundred dollars(3100)or less.) also requires the applicant for such permit to file a signed statement that he is licensed ❑ I certify that in the performance of the work for which this permit is issued.I shall not pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with employ any person in any manner so as to become subject to the Workers'Compensation Law Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt of California. therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for permit,subjects the applicant to a civil penalty of not more than five hundred NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become of f p PV p ry f f subject to the Workers' Compensation provisions of the Labor Code,you must forthwith dollars as owner comply with each provisions or this permit shall be deemed revoked. I,as owner of the property,or my employees with wages as their sole compensation,will CONSTRUCTION LENDING AGENCY o the work,and the structure is not intended or offered for sale."Sec.7044,Business and I hereby affirm that there is a construction lending agency for the performance of the work Professions Code:The Contractor's License Law does not apply to an owner of property who for which this permit is issued.(Sec.3097,Civil Code.) builds or improves thereon and who does such work himself or through his own employees, N is provided that such improvements are not intended or offered for sale.lf, however, the Lender's Name I'V a A.a building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale." Lender's Address ❑ I I, as owner of the property, am exclusively contracting with licensed contractor to certify that I have read this app. ' and sta ' at the above information is correct.I Law does the project. an owner of property and o builds dons Code: s thereon,and Contractor's ho con- agree to comply with all city-arf. co-'y •rdin• es and state laws relating to building Law does not apply to an owner of property who buil or improves thereon,a who con- construction,and hereby authorize rl'.se a'v of this city to enter the ab a-ment' ned tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law. property for inspection purposes • 1 am excempt under Sec. _-__,B.&P.C.for the reason f �! ❑ p -- Signature of Appl nt !l r -ter-i Date 2 ,� .i a I Mailing Addres — - `Date Owner City,State,Zip—__ ..... This is a building permit when properly filled out, signed and validated, INSPECTOR COPY and is subject to expiration if work thereunder is suspended for 180 days. -- INSPECTION RECORD -- FOUNDATION: (Gr. Certif. Comp. Tests, Set- r backs,Forms,Reinf.Steel,Excavation. Pz eg INSPECTION NOTES FLOOR SLAB/JSTS., GIRDERS: Mesh, Vap. Barrier,Blkg.,Spans,Access,Vents,Tr.Lmbr. , /'' MASONRY: Reinf., Mortar Jts., Grout Lifts, Clean-Outs,Bolts. ROOF SHTG.:Nailing,Diaph.Blocking,Material Grade and Thickness,Roof Drains. FRAMING:Walls,Raft.,Jsts.,Blocking,Bracing, /� Nailing,Backing,Diaphr.Draft Stops. l��i • • INSULATION: Thickness, R-Values, Piping, // A �/CJS� - (�µ/(�Q Y `��Q O/� - a�/� ?l/� Sound Caulking. _jLI O FIREWALLS: Material, Thickness, Dampers, r Doors,Closers,Fusible Links. INTERIOR:LATH/DRY WALL:Nailing,Supports, Laps,Joint Reinf. / i 41, EXTERIOR SID . c Mesh, Fasteners, Laps,Paper,Thic ness,Backing. FINAL INSPECTION: Finish Grading Certif., • Slope Plant., Energy Comp!. Card Posted, Pkg. Access, Fire Doors, Exit, Locking De- vices, Landings, House Numbers, Weather Stripping, PI./Engr. Clear. SWIMMING POOL/SPA EXCAV. REINF.SETBACKS:Radius Stl.,Bond- ing, Exp.Soil, Ramp Loc., Surcharge. FENCE/GATES: Height, Closers, Accessibility, • Latches,Stability. • FINAL INSPECTION: • • MISC. SIGNS: RE-ROOF: INSPECTION DATE INSP.SIGN. r r.. BUILDING AND SAFETY DIVISION City of Arcadia ELEC./MECH./PLMBG.240 W. HUNTINGTON DR., ARCADIA, CA 91006 •TEL. (213) 446-4471 PERMIT No. Description (Additions, Commercial, Industrial) Fee Building /�� )� `_ Services Address P �"L>��/ Owner j See Outlets �, W (Receptacles, Lights, Switches) Mailing ?/ I— ' Address „1, �-G Fixtures City / Tel �/ �(/'') •LI-rGG3 ea IZtp7/t)c∎C� /75 -772-7 U) / Motors tJ(�� Contractor �i I. , n N (H P each �1 /i e be r ea/re Ce /e1A Q Other 1 Address CC ///�J1 !r/'1 U (Specify: R•t /i7�4 £ e IJLZ/'7- /e./ Sq.Ft. Area New City /� _//// Zip /' Tel, e,� r IH Residential Bldg. .� / GU� ed I C�/�Gs(} �7/'— �JY Ui Sq.Ft. Areo New I State Lit. Q City •�/ J Res. Accessory Bldg• a Clossif. e 14 3 7 / Lit. No./� )c W Misc. LICENSED CONTRACTOR'S DECLARATION W ❑ I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Pool ELECTRICAL FEE �� 7000)of Division 3 of the Business and Professions Code,and my license is in full force and Poong sus effect. Fee 'A OWNER-BUILDER DECLARATION No. Description No. Description FAU to and includ. / Boiler/Compressor / �_— I hereby affirm that I exempt from the Contractor's License Law for the following 100,000 BTU to and includ• 3 HP 9 reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a 2 permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance Boiler/Compressor also requires the applicant for such permit to file a signed statement that he is licensed W over 3 HP to I S H pursuant 10 the provisions of the Contractor's License Law,Chapter 9(commencing with 1 FAU over o "' 100,000 BTU er Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt Flr./Wall/Susp./Po01 Air Handler to and therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any j applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred (1) Heaters includ. 10,000 Cfm dollars($500), ' Air Handler J Spray Booth / �l ❑ I.as owner of the property,or my employees with wages as their sole compensation,will over 10,000 cfm {�1 do the work,and the structure is not intended or offered for sale."Sec.7044,Business and 4:1„, Exhaust Hood (`\; Professions Code:The Contractor's License Law does not apply to an owner of property who Vent. Fan Other: / , r•. f n builds or improves thereon and who does such work himself or through his own employees. 2 (C V 1 provided that such improvements are not intended or offered for sale. If, however, the Q t'„1 includ. Duct building or improvement is sold within one year of completion,the owner-builder will have = Misc. the burden of proving that he did nor build or improve for the purpose of sale." U 0 I, as owner of the property, am exclusively contracting with licensed contractor to W construct the project."Sec.7044,Business and Professions Code:The Contractor's License MECHANICAL FEE � O� 9LJ L� Law does not apply to an owner of property who builds or improves thereon,and who con- tracts for such projects with a contractors)licensed pursuant to the Contractor's License Law." r Description Fee I am ezcempt under Sec._- B.&P.C.for the reason -- No Description No. I Bathtubs Water Heaters WShowers Garbage Disposals Date Owner -- -- I` WORKERS'COMPENSATION DECLARATION N Water Closets Laundry Trot's ❑ I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.) N .. Lavatories Clothes Washers Policy No. Company_ - L7 Kitchen Sinks Sewer Connections OCopy the filed a Certified copy is Exp.Date Z with the City. hereby furnished. Dishwashers Sewer Cop CERTIFICATE OF EXEMPTION FROM I I m Gas System WORKERS'COMPENSATION INSURANCE 2 Shower Pan Y (This section need not be completed if the permit is for one hundred dollars($100)or less.) = Replacement (Na. Outlets; ) I certify that in the performance of the work for which this permit is issued,I shall not J Swim. Pool Solar P Pi Dino Inytallotion e lay any person in any manner so as to become subject to the Workers'Compensation Law d - ' of California. Misc. NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become 'PLUMBING FEE comply wto ith the each provisions Compensation this permit sl provisions be the Labor revoked.Code,you must forthwith 1 comply with each provisions or this permit shall be deemed revoked. I certify that I have read this a plicatiotn and state t ,( a above information is correct.I ELEC.,MECH.,PLB G. ISSUANCE FEES .-frti..:341. agree to comply with all city d unty ordinanc(.. Y sta a laws relating to building■ construction,and hereby auth ze presentative .1 city/.enter the abo -menu() d property for inspection pure es TOTAL FEES 1 /701,25-r Signature of Applicant �" yr� ate _Of_757 Mailing Address /a5 `A,,f�"• I k2P /-e' ' Processed Dote: ) 11/41Crity State,Zip ��"" �4 �� �` _ By This is a building permit when properly filled out, signed and validated, INSPECTOR COPY and is subject to expiration if work thereunder is suspended for 180 days. INSPECTION RECORD INSPECTOR NOTES UNDERGROUND CONDUIT ROUGH WIRING NEW SERVICE m FIXTURES — -- --- le FINAL ELEC. INSP. n — — -- TEMP. POWER POLE —_-- OTHER OTHER ELEC. UTILITY CLRNCE. U. G. DUCTS/REFRIG. LINES 3 Ducts, Comb. Air, ^" RO. MECH. Supports, Vents l� D FINAL MECH. FAU/AC unit ___ Vents,Vents, Shutoffs OTHER OTHER U.G./UNDER FLR. soil, Water, Gas, Supports RC). PLMBG. Water, Gas, Vents, Supports,.Flashings GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM FINAL PLMBG. Fixture:, Valves, — — CServices • WATER HTR. Vent, Valves, O Press. Rel. Valve O SEWER/PRIV. DISP. SYSTEM OTHER OTHER GAS UTILITY CLRNCE. BONDING • U.G. CONDUIT • GAS PIPING Material, Depth p GAS TEST J G HEATER Vent, Clearance, Location, Shutoff >' FINAL POOL ELEC. FINAL POOL PLMBG. OTHER I INSPECTION I DATE INSP. SIGN. BUILDING AND SAFETY DIVISION of City HUNTINGTON Arcadia ELEC./MECH./PLMBG. 240 W. NTINGTON DR., ARCADIA, CA 91006 •TEL. (213) 446-4471 PERMIT 4. No. Description (Additions, Commercial, Industrial I Fee Buildingn J/ f/� • A Services Address /(/ /'(/(J./�I(! fw'- �`� ) �i , Gr ^ /n5 f� / ' t'7// (Size dam ' � /��'� !/ r Owner gi //' / /1/ F• �(i a v/ ui /// Y ///f Outlets /., Moiling J �1• yn. ,p W r---/—, (Receptacles, Lights, Switches) ! Address 6;0 /(/ r -ia / l , e J y Fixtures City zi J� / Tel. ) Q S / ! ! 3 7/4-5-99-i74,9 , cn Motors i (HP each: Contractor /—L j Q $ -/e _jf/ c J F/ Q Other �jJ !� O /� V (Specify: 1 Address /" ' / Q �l / I /f�'• 5q• Cr Ft. Area New Cif zip !'�/� Tel, [`qG� fir' V Residential Bldg. , )QI7 �//1'iels I/// ✓) 7/L _J //'_/'��e/2 W Sq.Ft. Area New 1 State Lit. / City /�� ,//' J Res. Accessory Bldg• v &Clossif. C- ID i7 09(01 Lic. No. fL4r�� W :Xi LICENSED CONTRACT R'S DECLARATIOR Misc. kir li thereby affirm th .m licy. sed under provisions of Chapter 9(commencing with Section Pool ELECTRICAL FEE f''1 III)of Division 3 Bu ss and Professions .•de,an,' y license is in full force and A _ 170 1""' effect. "—. Wiring •JLtLLlsa. ' e 1 OWNER-BU.6ERDECLARATION No. Description No- Description Fee FAU to and includ. Boiler/Compressor I hereby affirm that I ne exempt and Professions from the Contractor's Codes.An s city or License Law for the following requires i a 100,000 BTU to and includ• 3 HP reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance W FAU over Boiler/Compressor Y'- also requires the applicant for such permit to file a signed statement that he is licensed over r!C to 15 HP pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with I— 100,000 BTU Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt Cl) Therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any Fir,/Wall/Bust•/Pool Air Handler to and applicant fora permit,subjects the applicant to a civil penalty of not more than five hundred (n Heaters includ. 10,000 cfm dollars($500). ' Ln J Spray Booth / Air Handler ❑ I,as owner of the property,or my employees with wages as their sole compensation,will over 10,000 cfm to. do the work,and the structure is not intended or offered for sale."Sec.7044.Business and Exhaust Hood Professions Code:The Contractor's License Law does not apply to an owner of property who I Vent. Fan Other: builds or improves thereon and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale. lf, however, the Q includ• Duct building or improvement is sold within one year of completion,the owner-builder will have I Misc. the burden of proving that he did not build or improve for the purpose of sale.'' V 0 I, as owner of the property, am exclusively contracting with licensed contractor to W I MECHANICAL FEE t construct the project."Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon,and who con- _ tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.'' No. Description No. Description Fee ❑ I urn excempt under Sec ,B.&P.C.for the reason Bathtubs Water Heaters Showers Garbage Disposals Date __Owner_ -- UJ WORKERS'COMPENSATION DECLARATION Water Closets Laundry Trot's ❑ I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Clothes Washers Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800.Labor Code.) Lavatories Policy No. Company (' Kitchen Sinks Sewer Connections ri Copy the filed Q Certified copy d Exp.Date Z with the City. hereby furnished. I ' Dishwashers Sewer Cap CERTIFICATE OF EXEMPTION FROM m Gas System WORKERS'COMPENSATION INSURANCE 2 Shower Pan Y (This section need not be completed if the permit is for one hundred dollars($100)or less.) = Replacement (No. Outlets: ) I certify that in the performance of the work for which this permit is issued,I shall not _J Swim. Pool Solar toy any person in any manner so as to become subject to the Workers'Compensation Law Q_ Pi Dina In3fallotion of California. Misc. 'PLUMBING FEE NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with each provisions or this permit shall be deemed revoked. _^/ 1 certify that I have read this application and state that the above information is correct.I ELEC.,MECH.,PLB G. ISSUANCE FEES A / 7� agree to comply with all city a d county ordinances and state laws relating to building _construction,and hereby a hor1 representatives of this city to enter the above-mentioned property for inspection os• Signature of Applicant Jam• {.,n"' Da a �D^ y TOTAL FEES I /�� 3 5 Mailing Address ��7�7�,- n ,�y�/ /��-r / ^ Processed B Date: \City.State,Zip,if%J/7 ///!"Q5 /j This is a building permit when properly filled out, signed and validated, INSPECTOR COPY and is subject to expiration if work thereunder is suspended for 180 days. INSPECTION RECORD INSPECTOR NOTES UNDERGROUND CONDUIT ROUGH WIRING =''A? /y'/ % NEW SERVICE bn FIXTURES FINAL ELEC. INSP. A D TEMP. POWER POLE — OTHER OTHER ELEC. UTILITY CLRNCE. U. G. DUCTS/REFRIG. LINES • RO. MECH. Ducts, Comb. Air, Supports, Vents Z FINAL MECH. FAU/AC Unit • Vents, Shutoffs F. OTHER OTHER U.G./UNDER FLR. soil, water, Gas, Supports RO. PLMBG. Water, Gas, Vents, Supports,.Fleshings GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM '° FINAL PLMBG. Fixtures, Valves, CServices 3 WATER HTR. Vent, Valves, Press. Rel. Valve 0 SEWER/PRIV. DISP. SYSTEM OTHER OTHER a — _ GAS UTILITY CLRNCE. BONDING U.G. CONDUIT GAS PIPING Material, Depth SGAS TEST _ r' HEATER Vent, Clearance, location, Shut-off FINAL POOL ELEC. A' FINAL POOL PLMBG. — JV OTHER INSPECTION DATE INSP. SIGN. AIM AMP BUILDING AND SAFETY DIVISION City of Arcadia ELEC./MECH./PLMBG. 240 W. HU NTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT eNo. Description (Additions, Commercial, Industrial) Fee Building Address 7/0 6/ ter,% )^ n•,l? , Services Address J[•o�- /�'u ,/�" ) ff/y '/ (Size= , CO Owner bl G t 7 4 1-/J!4 s e'f �'T•�9f' •(f l? Outlets Ii Moiling W (Receptacles, Lights, Switches) 0-i Address 9/o/Q .6.:44)07..,-,4„0 af. N Fixtures .-. City I Zip Tel. ! 7 >-Cv4-1)/ L 9/9/5'�7'Z N Motors • -rt r*t Contractor", (HP each: ) 4 /S %�Cf.�d�,f51��. Q Other ) !---x U (Specify Address 9 (1l Ptc), 6d v.02-6 Sq. Ft. Area New City IZip Tel. Residential Bldg. 0 yi 7 --; 5' /y� f� .f W 54•Ft. Area New 'J.- State Lic. City -�� W Res. Accessory Bldg• (.9 B Clossif. -� 7 Lic. No. Misc. LICENSED CONTRACTOR'S DECLARATION ❑ 1 hereby affirm that h Business sinessd under Professions Tess ores Code,d Chapter 9(commencing erase is full Section e a Pool ELECTRICAL FEE 7000)of Division 3 of the Business and Professions Code,and my license is in full force and Wiring effect. ,MINE111■I No. Description No. Description Fee 0 OWNER-BUILDER DECLARATION FAIL to and includ, Boiler/Compressor I hereby affirm that I am exempt from the Contractor's License Law for the following 100,000 BTU to and includ• 3 HP �.' reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a ,n permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance JJ.J FAU over Boiler/Compressor V I also requires the applicant for such permit to file a signed statement that he is licensed FAU over BTU over Boiler/Compressor to I S HP pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with I"" or" Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt (I) therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any Flr./Wall/Susp•/Pool Air Handler to and applicant fora permit,subjects the applicant to a civil penalty of not more than five hundred (I) Heaters includ. 10,000 cfm dollars($500)." _,J Spray Booth/ Air Handler PExhaI,as owner of the property,or my employees with wages as their sole compensation,will over 10,000 cfm the work,and the structure is not intended or offered for sale."Sec.7044.Business and V ust Hood Professions Code:The Contractor's License Law does not apply to an owner of property who Vent. Fan Other: builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If. however, the Q includ• Duct building or improvement is sold within one year of completion,the owner-builder will have = I Misc. the burden of proving that he did not build or improve for the purpose of sale." 0 ❑ I, as owner of the property, am exclusively contracting with licensed contractor to W construct the project."Sec.7044,Business and Professions Code:The Contractor's License MECHANICAL FEE Law does not apply to an owner of property who builds or improves thereon,and who con- tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law." I No. Description No, Description Fee ElI am excempt under Sec. ,B.&P.C.for the reason - -- Bathtubs Water Heaters /0 Date _ __Owner --- - W Showers Garbage Disposals WORKERS'COMPENSATION DECLARATION N / Woter Closets Laundry Trays G /0 ❑ I hereby affirm that I have a certificate of consent to self-insure, or a certificate of Clothes Washers Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800.Labor Code.) >"' I Lavatories — Policy No. Company— — - O Kitchen Sinks Sewer Connections ❑Copy the filed a Certified ropy is Exp.Date Z with the City. hereby furnished. I 1 Dishwashers Sewer Cop CERTIFICATE OF EXEMPTION FROM m Gos System WORKERS'COMPENSATION INSURANCE 2 Shower Pan Y (This section need not be completed if the permit is for one hundred dollars($100)or less.) = Replacement (No. Outlets: ) ar Al certify that in the performance of the work for which this permit is issued,I shall not J Sol Swim. Pool Solallotion loy any person in any manner so as to become subject to the Workers'Compensation Law a• Pioina 1 of California. Misc. NOTICE TO APPLICANT:lf,after making this Certificate of Exemption you should become 'PLUMBING FEE IS' 20 subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with each provisions or this permit shall be deemed revoked. �� I certify that I have read this application and state that the above information is correct.I ELEC.,MECH.,PLB G. ISSUANCE FEES agree to comply with all city and co my or• •s and state laws relating to building construction,and hereby auth ize a rat this city to enter the abov -mentioned. I I� property for inspection purpo s. TOTAL FEES Date /5VS GIP Signature of Applicant ,2 Mailing Address 0' /3 G k .2-‘, `� Proc �d/ Dote `City,State,Zip A: . .` ByC � Y// This is a building permit when properly filled out, signed and validated, INSPECTOR COPY and is subject to expiration if work thereunder is suspended for 180 days. INSPECTION RECORD INSPECTOR NOTES UNDERGROUND CONDUIT ROUGH WIRING NEW SERVICE -------- '' FIXTURES -------.____ n lo FINAL ELEC. INSP. n .— TEMP. POWER POLE — OTHER OTHER ------ ELEC. UTILITY CLRNCE. U. G. DUCTS/REFRIG. LINES in RO. MECH. Ducts' Comb. Air, Supports, Vents D FINAL MECH. FAU/AC Unit Vents, Shutoffs F. OTHER F. OTHER U.G./UNDER FLR. Soil, Water, /�,, Gas,Gas, Vents, � ?AO' RO. PLMBG. Water, Gas, Vents, /� Supports,.Flashings - GAS TEST • SEWER/PRIV. DISP. SYSTEM DIAGRAM 72 FINAL PLMBG. Fixtures, Valves, T Services WATER HTR. Vent, lv , Press. va Rel.es Volvo 6f SEWER/PRIV. DISP. SYSTEM OTHER OTHER GAS UTILITY CLRNCE. BONDING U.G. CONDUIT 3 GAS PIPING Material, Depth p GAS TEST HEATER Vent, Clearance, Location, Shut-off D FINAL POOL ELEC. FINAL POOL PLMBG. n' OTHER f' INSPECTION I DATE INSP. SIGN. BUILDING AND SAFETY DIVISION --- �. BUILDING City of Arcadia _ PERMIT 240 W. HUNTINGTON DR., ARCADIA, CA 91006 •TEL. (213) 446-4471 r ■ U.B.C. Occ. Building Edition 1Type Const. Group Address 71 ENCINO RIVE, ARC'ADTA O� F. D. Appr. Date H. D.Appr.Date Lot Block Tract Load _ Required Required No. Use Zone Special Case No. Owner R i 11 y Th i a n g Homeowners Association Approval 'Date Mailing Address As abov T Lot IZi Tel. city Zip 445-2727 Size - ' Contractor Special J.L.Shipley Roofing Co. Inc. Conditions NOTE: Include: Address 265 N.V inedo Ave. , VALUATION Labor, Material, Plumbing, Etc. $ City Zip Tel. Misc. FEE y Pasadena 91107 792-2437.7 ❑Private State Lic. City 6 0 L Swimming Pool I Spa ❑Public &Classif. 309178 C 3 9 Lic. No. 10 9 Wall ❑ Arch., Engr., Sign-Pole❑ Designer '' Address Tel. F Temporary❑ Projecting❑ . State E Fee Based on Total Sq.Ft. City Zip Lic. No. E Proposed PLAN CHECKING FEE Construction Remove existing roof -nail 1/30# , solid mop 2/15# and gravel. 1S.M.I.P. 50 Permit Fee 41 178 Floor Main Accessory Total Processed by j TOTAL 42 28 Area Permit No. Plan No. Date New❑ Add.❑ Alter.❑ Repair Demolition❑ LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION nI hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ❑ I hereby affirm that I have a certificate of consent to self-insure,or a certificate of 7d0O)of Division 3 of the Business and Professions Code,and my license is in full force and Worker's Compensation Insurance,or a certified copy thereof,.a( ec.'3800, abor Code.) effect. Policy No.Vi_-_,..0.2.-._0_1 J Company ",�u� Copy is fi led ❑Certified copy is Exp.Date OWNER-BUILDER DECLARATION with the City. hereby furnished. I-7^ `` I CERTIFICATE OF EXEMPTION FROM l / •? ❑ I hereby a70i31.that Bt I Business exempt and Professions from ion Codes.An s ity or c Law for equir s a WORKERS'COMPENSATION INSURANCE re rmit o co n true,a ter.im sr and mlih, Codes.Any city or re,prior which p s issuance s a (This section need not be completed if the permit is for one hundred dollars($100)or less.) permit to construct,alter,improve,demolish,or repair any structure,prior to its issua also requires the applicant for such permit to file a signed statement that he is licensed ❑ I certify that in the performance of the work for which this permit is issued,I shall not pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with employ any person in any manner so as to become subject to the Workers'Compensation Law Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt of California. therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any NOT/CE TO APPLICANT:If,after making this Certificate of Exemption you should become applicant permit,subjects the applicant to a civil penalty of not more than five hundred subject to the Workers' Compensation provisions of the Labor Code,you must forthwith dollaars s($50(5500))." comply with each provisions or this permit shall be deemed revoked. I,as owner of the property,or my employees with wages as their sole compensation,will CONSTRUCTION LENDING AGENCY do the work,and the structure is not intended or offered for sale."Sec.7044,Business and I hereby affirm that there is a construction lending agency for the performance of the work Professions Code:The Contractor's License Law does not apply to an owner of property who for which this permit is issued.(Sec.3097,Civil Code.) builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale.If, however, the Lender's Name — - - building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale." Lender's Address ❑ I, as owner of the property, am exclusively contracting with licensed contractor to I certify that I have read this application and state that the above information is correct.I construct the project."Sec.7044,Business and Professions Code:The Contractor's License agree certify comply that with all city hi and •ant an s state an. Sabo laws relation is correct. Law does not apply to an owner of property who builds or improves thereon,and who con- construction,and hereby authorize 1•res• to vex of thi n.ity to enter the above-mentioned tracts for such projects with a contractarfs)licensed pursuant to the Contractor's License Law." property for inspection purposes./ ❑ I am excempt under Sec._-----,B.&P.C.for the reason Signature of Applicant �f .. •C jail Iate/1,1_2,8_4.... - Mailing Address - v• Date 4-12-84owner ..� - City,State.Zip— -.asadena,91107 -- lir This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. INSPECTOR COPY INSPECTION RECORD FOUNDATION: (Gr. Certif. Comp. Tests, Set- backs,Forms,Reinf.Steel,Excavation. INSPECTION NOTES FLOOR SLAB/JSTS., GIRDERS: Mesh, Vap. Barrier,Blkg.,Spans,Access,Vents,Tr.Lmbr. MASONRY: Reinf., Mortar Jts., Grout Lifts, Clean-Outs,Bolts. ROOF SHTG.:Nailing,Diaph.Blocking,Material Grade and Thickness,Roof Drains. FRAMING:Walls,Raft.,Jsts.,Blocking,Bracing, Nailing,Backing, Diaphr. Draft Stops. INSULATION: Thickness, R-Values, Piping, Sound Caulking. FIREWALLS: Material, Thickness, Dampers, Doors,Closers,Fusible Links. INTERIOR:LATH/DRY WALL:Nailing,Supports, Laps,Joint Reinf. EXTERIOR LATH/SIDING: Mesh, Fasteners, Laps,Paper,Thickness,Backing. FINAL INSPECTION: Finish Grading Certif., Slope Plant., Energy Compl. Card Posted, Pkg. Access, Fire Doors, Exit, Locking De- vices, Landings, House Numbers, Weather Stripping,Pl./Engr.Clear. SWIMMING POOL/SPA EXCAV.REINF.SETBACKS:Radius Stl.,Bond- ing,Exp.Soil, Ramp Loc.,Surcharge. FENCE/GATES: Height, Closers, Accessibility, Latches,Stability. FINAL INSPECTION: • • MISC. SIGNS: RE-ROOF: INSPECTION DATE INSP.SIGN. BUILDING AND SAFETY DIVISION AII-- BUILDING City of Arcadia PERMIT 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 r N l7M7A10 OR% U.B.C. Type Occ. Building ,.o pp A 4 vet pe Edition Const. Group Address /��`locr�� c Occ. F. D. Appr. Date H. D.Appr. Date Lot Block (Tract Load Required Required No. // ! A I l Use Zone Special Case No. (. Owner 8T L L y k1 ti , A-/t/AA 6 I Date Mailing 7 b L,vc/ 0 1 Homeowners Association Approval Address u ) Lot > A L City,0(AJ)/�A IGPIq/tDOf?ITe ,�)-71"7/6 Special ial \-' Contractor ©W 1 Conditions �V NOTE: Include: ..., Address VALUATION Labor, Material,Plumbin•, Etc. $ City Zip Tel. Misc. FEE �\- Cit ❑Private State Lic. P �r+/11� Lic No. Swimming Pool/Spa rj Public �, &Classif. Q Wall Arch., Engr., 1` �� Sign Pole❑ ❑ _Designer Address Tel. F Temporary❑ Projecting❑ gi E Fee Based on Total Sq.Ft. City y✓ �'g (ZIP State E Lic. No. Proposed S PLAN CHECKING FEE h ..— Construction jS.M.I.P. I'� 8 Permit Fee A 54 SD 1 • ii Processed b Q Floor Main Accessory Total y TOTAL f�,3 7 V Area Plan No. Date New❑ Add.� lter.❑ Repair❑ Demolition❑ Permit No. LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION nI hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section [II I hereby affirm that I have a certificate of consent to self-insure,or a certificate of 7600)of Division 3 of the Business and Professions Code,and my license is in full force and Worker's Compensation Insurance,or a certified copy thereof.(Sec."3800,Labor Code.) effect. Policy No.—____-----------Company ❑ Copy is filed 0 Certified copy is Exp.Date OWNER-BUILDER DECLARATION with the City. hereby furnished. I CERTIFICATE OF EXEMPTION FROM [II 1 hereby affirm that I am exempt from the Contractor's License Law for the following WORKERS'COMPENSATION INSURANCE reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a (This section need not be completed if the permit is for one hundred dollars($100)or less.) permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed ❑ I certify that in the performance of the work for which this permit is issued,I shall not pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with employ any person in any manner so as to become subject to the Workers'Compensation Law Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt of California. therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become applicant fora permit,subjects the applicant to a civil penalty of not more than five hundred subject to the Workers' Compensation provisions of the Labor Code,you must forthwith doll. s(5500/." comply with each provisions or this permit shall be deemed revoked. o o1,as owner of the property,or my employees with wages as their sole compensation,will CONSTRUCTION LENDING AGENCY. e work,and the structure is not intended or offered for sale."Sec.7044,Business and I hereby affirm that there is a construction lending agency for the performance of the work Professions Code:The Contractor's License Law does not apply to an owner of property who for which this permit is issued.(Sec.3097,Civil Code.) builds or improves thereon and who does such work himself or through his own employees. provided that such improvements are not intended or offered for sale.lf, however, the Lender's Name - — -- ---- building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale." Lender's Address — ❑ I, as owner of the property,am exclusively contracting with licensed contractor to I certify that I have read this application and state that the above information is correct.I construct the project."Sec.7044,Business and Professions Code:The Contractor's License agree certify comply that with all city and county ordinances that and state laws relating to correct.I Law does not apply to an owner of property who builds or improves thereon,and who con- construction,and hereby authorize representatives of this city to enter the above-mentioned ,,tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law." property for inspection purposes. I am excempt under Sec.____________-,B.&P.C.for the reason Signature of Applicant Date---_-------- �i _ Mailing Address — Date /: lLrl1L —_Owner i / w� City,State.Zip--... _ - -_— -_ —..-. . This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days INSPECTOR COPY Am. INSPECTION RECORD ,„,, FOUNDATION: (Gr. Certif. Comp. Tests, Set- backs,Forms,Reinf.Steel, Excavation. ,`I,� p/9/D.3 INSPECTION NOTES FLOOR SLAB/JSTS., GIRDERS: Mesh, Vap. /,/ !� Barrier,Blkg.,Spans,Access,Vents,Tr.Lmbr. MASONRY: Reinf., Mortar Jts., Grout Lifts, Clean-Outs,Bolts. ROOF SHTG.:Nailing,Diaph.Blocking,Material Grade and Thickness,Roof Drains. FRAMING:Walls,Raft.,Jsts.,Blocking,Bracing, • Nailing,Backing, Diaphr. Draft Stops. INSULATION: Thickness, R-Values, Piping, Sound Caulking. FIREWALLS: Material, Thickness, Dampers, Doors,Closers,Fusible Links. INTERIOR:LATH/DRY WALL:Nailing,Supports, Laps,Joint Reinf. EXTERIOR LATH/SIDING: Mesh, Fasteners, Laps,Paper,Thickness,Backing. FINAL INSPECTION: Finish Grading Certif., Slope Plant., Energy Compl. Card Posted, Pkg. Access, Fire Doors, Locking De- vices, Landings, House Numbers,ers, Weather Stripping,Pl./Engr.Clear. SWIMMING POOL/SPA EXCAV.REINF.SETBACKS:Radius Stl.,Bond- ing,Exp.Soil, Ramp Loc.,Surcharge. FENCE/GATES: Height, Closers, Accessibility, Latches,Stability. FINAL INSPECTION: MISC. SIGNS: RE-ROOF: INSPECTION DATE INSP.SIGN. BUILDING AND SAFETY DIVISION .. MISCELLAr4'OUS AND OFF-SITE City of Arcadia 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT • /Buildin g 7O L-Ai Ci A(/0 DX, MISCELLANEOUS FEE RECEIPT s( Address AC,e�, f)jA 7 C - 9/ (')v� /� /�/► t • li.. Owner ALL /T ��� A�,/� PLAN CHECK FEE FOR VAL. /�,��p"�,P(/ate //ge f J r r Ail/MA/6`G'• `', Moiling 7 / CASH BOND FOR - Address " !v �t:IA/a oR, 0 C= City Zip Tel. L. f3) 0 GRADING PLAN CHECK (_ ARC4 0 �A cA 90 v I i. -.2.7)7- 'Y GRADING PERMIT IN..) Connocta D U f/ 1�; 0 HOUSE MOVING Address va 0 PARKS AND RECREATION FEE C-3 City I Zip Tel 0 ROUTE INSPECTION FEE Slate Lic. City e7+ /1/'• ' lie /1 h B Clossif. Lit. No. Ivt ZN,�/�� �L r4 �� LICENSED CONTRACTOR'S DECLARATION J❑+ ` l V n 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section —__ �/�� 7PTK1)of Division 3 of the Business and Professions Code,and my license is in full force and W effect.•�) OWNER-BUILDER DECLARATION ���Qeq I hereby affirm that I am exempt from the Contractor's License Law for the following TOTAL FEE re axon:''Sec 7031.5.Business and Professions Codes.Am vin or courtly which requires a -It WARNING t PLAN CHECK FEES. WHERE NO ACTION IS TAKEN BY THE Ow prima to construct,alter.improve.demolish,or repair any structure,prior to its issuance APPLICANT IN 180 DAYS AND NO BUILDING PERMIT IS ISSUED,/FEES ARE also requires the applicant for such permit to file a signed statement that he is licensed FORFEITED TO-THE CITY, 1 pursuant to the provisions of the Contractor's License Lou', Chapter 9(commencing with Sertit,n 7000)of Division 3 of the Business and Professions Code, or Mar he is e.rempt SEWER PERMIT therefrom.and the bases for the alleged esemption.Any violation of Section 7031.5 by any applicant fora permit,subjects the upplicuni to a civil penalty of not more than five hundred PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTIONS AT dollars 15500)." PI.as owner of the property.or my employees with wages as their sole compensation.will u the work,and the structure is not intended or offered for sale."Sec.7044.Business and Professions Code:The Cunuactor's License Low does not apply to an owner of property who LOT BLOCK TRACT builds or improves thereon and who does such work himself or through his own employees. Y provided that such improvements are not intended or offered for sale. lf, however, the LOCATION LATERAL building or improvement is sold within one year oJtlompletion,the owner•builder will have SADDLE the burden of proving that he did not build or improve for the purpose of sale." SEWER PLAN NO. CESSPOOL FILL E I, us owner of the property, am exclusively contracting with licensed contractor to - $ 3.00 construct the project."Ser.7044,Business and Professions Code:The Contractor's License Low does nut apply to an owner of property who builds or improves thereon,and who con- tracts.for such projects with a((introcterr(s)licensed pursuant to the Contractor's License Law:. INSPECTED )98 TOTAL O I am excempt under Sec. ,B.& P.C.for the reason BY ay CURB AND SIDEWALK Date - ..___Owner _.. WORKERS'COMPENSATION DECLARATION CURB BREAK REPLACE CURB FT. ❑ I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Worker•s Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.) DRIVEWAY APPROACH SIDEWALK FT. Polo.).No. _._ _______Company_ f I-1 Copy is filed ❑Certified copy is Exp. Date TOTAL FEE I I,_1 with the City. hereby furnished. I l INSPECTED CERTIFICATE OF EXEMPTION FROM I WORKERS'COMPENSATION INSURANCE STREET CUT (This section need not be completed if the permit is for one hundred dollars($100)or less.) 0 I certify-that in the performance of the work for which this permit is issued,I shall not ESTIMATED SIZE OF PATCH AMOUNT OF DEPOSIT employ any person in any manner so as to become subject to the Workers'Compensation Law ® /SO.FT, of California. ACTUAL SIZE-OF PATCH AMOUNT CHARGED NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become subject JO the Workers' Compensation provisions of the Labor Code,you must forthwith ® /50.FT. comply with each protisions or this permit shall be deemed revoked, AMOUNT REFUNDED I certify that I have read this application and state that the above information is correct.I RECEIVED FROM STREET DEPT. agree to comply with all city and county ordi ances and state laws relating to building INSPECTION FEE construction,and hereby authorize represent t• sot this city to enter the above•mentioned property for inspection purp s , • INSPECTED 198 BY //�� PERMIT FEE Signature of Applicant �% a DateY_ - Mailing Address 1— •• ei� C TOTAL FEES s r \Ciis.State.Zip i '4�' �� INSPECTOR COPY This is a miscellaneous and off-site permit when properly 1,/led out,signed and validated,and is subject to expiration if work thereunder is suspended for 00 days. AIN Location I :ow g_.' - D Co. No. 6_4 3 4, Sewer Permit No. 903 Blk. Tract ?,4 At( Legend j Gt I Length Date Insp. le Owner / .el I Contractor M. # , co L • AI .z.4 . .D a 5 i.C,.-t- 3)) -a xx sc -2�Y -y .v), 13 c. La1rf0I .r∎f Pipe & Joints' ���� �' Street Location' W��y LOCATION 7 1 n a Y\c I D r` VALUE S I 1 t CT 0 Iu 1_ \ V\ l °ra\C0.4'� Tj -'t xD8 Por'ti o h (n LOCK TRACT 12 Z4 L—LOT M�pr '1 to kS OWNER 1 t N BUILDING Q r O kl `\ ` 1` 1 1 1 `e r lC- -s-"3 7 z_047..._ PLUMBING'Mr W1 �'1 u�v,nlr.)�\iu ,L G[-1Z-s2 39- 2-. HEATING�L1J IN/l�°r O e_a�\,AQ-L,242 RO.Igv1l 6-13-s$ 3' SEWER ahie. CCmVI�:11'\f. 0.0, Io-1q-58 I © oco _M WISING i A fl- -S 0 WIRING ". � FIXTURES .' I ELECTRIC k''ADgS 11-19'.8 OAS`1 0 2 11-\9_S8 PLAN NO.I92.4 .r tT 034, oho 0 � o • E v- o• �p 3r37 w o CA co cow ADDRESS 1 I 0 E nr un�o��,�t r. OWNER C %ar 1.P s Li c h STRUCTURE .. • .kai- fQ9 ONTRACTOR Narb ld R,N\Id1e_ - pq (PERMIT INS - ED ,J REMAR p PLAN NO.tJ-i POWER POL _ 1 O 5A WI iti .2',-L / 70 S^-p -//---5-42�'°� FORMS 2:M [Z.. l/'•�1 . �/� „�,,,,. l2� Z"tti.,„ RO. PLU 9't 7J�Z AY: ,a 'J! Da ¢G�Q� GAS D 31p2. ',Mr' IN BLDG.?-/8'-5 STREE�I � co,------. W.C. (c.,1,---- SEWER / �/OO� �fJ^ 2 1 - )ZrGi"� - FURNACE I i —qq. - O 'ROUGH VENT - ' -S1 RO. WIRE — j-/1 0 01 CURB SQ$Q 4,- a J.-5- r�1 ~ y, rr kb FRAME 7- 'i- d 4 41:i.�„V LATH 1C.-1.0-�/ 5 ©i 9' ELEC. FIX. —to I'-/P-5'sp 'C'_ PLUMB FIX. /• p(DZ' //--/V -. �Dj 0 J/ (� �p ELECTRIC /7c7 /f�9-! & GAS 97dQ "'/i/% -,f--3- SUB-CONTRACTORS -..-0•71 `//9 f8 rj 5-43 ; fro, $ `/� _ T d N J� Ib ly.-J irk Location 7/0 EN /t/p DR \ Sewer Permit No. /6 D p ,6" \ Co, No. Lot?t I Blk. Tract / $ �{I( / I Le (� / Owner HQ C`o/d I'/, /lam r I Length b �`� Date Insp. Contractor A b le ill, `,L s J`-. `5 H 3 O i z Y -- r Pipe & Joint /-K c P( i Street Location 17 J a jd C� rr-