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HomeMy WebLinkAboutOld permits ... CITY OF ARCAA I • Development Services rtment PE. IiIT NO. BOO-007-521 WI �� 240 West Huntington Dry...-P.O. Box 60021 '• IMAM r' Arcadia,CA 91066-6021 Permit Type: Roofing ` .!{ (626)574-5416 PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 1llh! JI?lL1 8:42 10/2/2000 Issued PROJECT ADDRESS E ASSESSORS PARCEL NO. GEO CODE NFU 1124 Encino Ave 5780-016-012 OWNER MAILING ADDRESS Yew,Keng F And Lu Ching Hwa 1124 Encino Ave PHONE NO. Inspector#: 205 Arcadia,CA 91006 EMAIL ADDRESS: APPLICANT MAILING ADDRESS PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS YAN HOI TANG 3912 Vachon Dr PHONE NO. (818)288-1536 License No. 620138 Rosemead,CA 91770-1634 EMAIL ADDRESS: Type: C39,HIC Expires: 5/31/2001 TENANT MAILING ADDRESS PHONE NO. EMAIL ADDRESS: DESCRIPTION T/O&REROOF HOUSE&GARAGE(35SQS)30 YR COMP Construction Type UOM #of Units Value Construction Type UOM #of Units Value Value Value 8,000.00 $8,000.00 OCCUPANCY: Reroof TOTAL VALUATION: $8,000.00 OTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT Flat Bldg Issue Auto $40.25 $40.25 01-3104 each Bldg permit $203.85 $203.85 01-3104 /0,,.1 /� Totals for: 01-3104 $244.10 $244.10 ` yrL A /__ Flat SWMF Auto $6.25 $6.25 88-3027 /�.• 41 1(k— Totals for: 88-3027 $6.25 $6.25 le,5-60 4141 X44• thig4 nth. X ' Total Fees: $250.35 Total Amount Paid: $250.35 Paid Today: $250.35 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from the date of plan submittal. This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. CALLS FOR INSPECTION INSPECTORS OFFICE HOURS ARE Requests for inspection should be made at least Monday-Thursday Fridays one(1)business day in advance of the inspection 7:30 a.m.-9:00 a.m. 7:30 a.m.-9:00 a.m. by telephone at(626)574-5416 for onsite work. 4:00 p.m.-5:30 p.m. 4:00 p.m.-4:30 p.m. CLOSED ON ALTERNATE FRIDAYS DEVELOPMENT SERVICES DEPARTMENT•FORM#6600•ARCADIA PRINTING SERVICES City of Arcadia ,•��r, Development Services Department • % 240 West Huntington Drive - Post Office Box 60021 i ! Arcadia, CA 91066-6021 (626) 574-5416 `�'`• PERMIT / •LAN REVIEW APPLICATION LIP ENSED CONTRACTOR'S DECLARATION WO'KERS' COMPENSATION DECLARATION I ereby affirm under penalty of perjury that I am licensed under provisions of I h- eby 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. [) have and will maintain a certificate of consent to self-insure for icense Class 0 ),'7 License No. - /3 Exp.Date °s4a/ workers' compensation, as provided for by Section 3700 of the Labor 4.)r Code, for the performance of the work for which this permit is issued Signa e of Contractor. -- I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work OWNER - BUILDER DECLARATION for which this permit is issued. My worker's compensation insurance I hereby affirm under penalty of perjury that I am exempt from the carrier and policy number are: Contractors License Law for the following reason (Sec. 7031.5, Business and Carrier: 57-4-7-c7 tN Professions Code: Any city or county which requires a permi to construct, alter, improve, demolish, or repair any structure, prior to s issuance, also requires the applicant for such permit to file a signe• Policy Number: 60 N./,T u�pp lyf� statement that he or she is licensed pursuant to the provisions of the (This section need not be completed if the permit is for one hundred dollars or Contractors License Law (Chapter 9 (commencing with Section 7000) of (- Division 3 of the Business and Professions Code or that he or she is exempt there from and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant I certify tha in the performance of the work for which this permit is for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500): issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation 17 I, as owner of the property, or my employees with wages as their sole provisions of Section 3700 of the Labor Code, I shall forthwith comply compensation, will do the work, and the structure is not intended or with those provisions. offered for sale (Sec. 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 Date: Applicant: her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one (1) year of completion, the owner - builder will WARNING:Failure to secure workers' coverage is uriawful,and have the burden of proving he or she did not build or improve for the compensation shell subject purpose of sale). an employer to criminal penalties and civi fines iP b One Hurried Thousand I, as owner of the pro a Dollars($100,000),n addition b the d compensation,damages as provided kiln p rty, am exclusively contracting with licensed contractors to Section 3706 of the Labor Code,interest and attorneys feea construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law). CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction U I am exempt under Sec. B.&P.C.for this reason: lending agency for the performance of the work for which this permit is issued(Sec. 3097, Civ.C.). 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.Construction activity is prohibited between the hours of 7:00 p.m. and 7:00 a.m. and on Sundays and Holidays. 2.The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 3. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildi s and structures. NA /A-NI N-0-1 I(-? TITLE: 0—eAl IP4C TT iq 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. DATE: a OWNER'S CERTIFICATION �, LOCAL STC. .M WATER POLLUTION PREVENTION PLAN � , Form _ "� FOR SITES UNDER 2 ACRES DISTURBED AREA ONLY OCI •Isturbed area less than 1/4 acre ,,z ❑ •' turbed area between 1/4 and 2 acres P)" BUILD! GIGRADING PERMIT NUMBER Project Name/ C A—) V n , c l �f / , ,_ _ .rtA Cv Project Location t \/ 1 Owner Name KEAC-7 TUAJ 4:7 Contractor Name / • NC- 774-A/0 Address I l- C/A/0 A'E Address 9/ ' I/40/VA/ Pe. ef � JJ,(/) %/77o Phone (1 ) � 6 —�ig yL Phone(6--6)-)J—/-4-3 FAX FAX The National Pollutant Discharge Elimination System (NPDES) is the portion of the Clean Water Act that applies to the protection of receiving waters. Under permits from the Los Angeles Regional Water Quality Control Board (RWQCB), certain activities are subject to RWQCB enforcement. To meet the requirements of the Los Angeles County Municipal Storm Water Permit (CAS614001), minimum requirements for sediment control, erosion control and construction activities must be implemented on each project site. Minimum requirements include: SEDIMENT CONTROL: Eroded sediments from areas disturbed by construction and from stockpiles of soil shall be retained on site to minimize sediment transport from the site to streets, drainage facilities or adjacent properties via runoff,vehicle tracking or wind. This will be accomplished by(check all that apply): ❑ Sand Bags 3 All work will be completed between ❑ Silt Fence a pril 16 and October 31 ❑Other (describe) -- -- CONSTRUCTION MATERIALS CONTROL: Construction related materials, wastes, spills or residues shall be retained on site to minimize transport from the site to streets, drainage facilities or adjoining properties by wind or runoff. Runoff from equipment and vehicle washing shall be contained at construction sites unless treated to remove sediment and pollutants. This will be accomplished by(check all that apply): '❑`Following the BMP pamphlets guidelines ❑ "Blueprint for a Cleaner Ocean" ❑Other (describe) Owners Certification I hereby certify that I have read, understand and will comply with the requirements indicated above: -.ry -- y Property Owner or Au orized Representative(signature) (printed) Title Date SITES WITH DISTURBED AREAS GREATER THAN % ACRE MUST SUBMIT A SITE PLAN SHOWING SIZE AND LOCATION OF BMP'S TO BE USED. ADDITIONAL INFORMATION MAY BE REQUIRED BASED UPON A REVIEW OF THE SUBMITTAL COLOR OF ORIGINAL DOCUMENT IS ORANGE BUILDING AND SAFETY DIVISION — BUILDING City of Arcadia PERMIT 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 Air ding U.B.C. 1Type Occ. Address 1 i�� Edition Const _ Grou. Lot I Block (Tract Occ. F. D.Appr. Date H. D.Appr. Date No. Load Required Required Owner Use Zone Special Case No. Mailing Homeowners Association Approval I Date Address ..-4-...0--0.-j4 City Zip I Tel. Lot Size Contra for, Special Conditions '' ..I 1 I" NOTE: Include: Cr A VALUATION Labor, Material, Plumbing, Etc. $ /0 5 V X /65 -, , City f Tel. Misc. FEE r, �v -6�a.:() r-)7 5 B ) °4-G/ t Cit �jl Private k.L. State Lic.&Classif. �f 3 ( 7 Licy. No.//oa(-I Swimming Pool I Spa ❑9 Public , Arch., Engr., Sign-Pole❑ Wall ❑ s, Designer - — Address Tel. F Temporary❑ Projecting ❑ City Zip State E Fee Based on Total Sq.Ft. (� Lic. No. E �; Proposed S PLAN CHECKING FEE cp Construction , . Q S.M.I.P. 7:- y . Permit Fee 7 /0 !C r. i Floor Main -ccessory Total Processed by TOTAL e Area �j Permit No. Plan No. Date New❑ Add.❑ Alter.❑ Repair❑ Demolition❑ LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure,or a certificate of Lr �� [hereby affirm that I am licensed under provisions d Chapter 9(commencing with Section tirker's Com ion I �e7,r a certified copy t e Se .-3800, Code.) M t Pt of Division 3 of the Business and Professions Code,and my license is in full force and Q / effect. Policy No Company �J(Copy is filed ❑Certified copy is Exp.Date OWNER-BUILDER DECLARATION j[� with the City. hereby furnished. I 2-,/ ,�/,`1 ❑ 1 hereby affirm that I am exempt from the Contractor's License Law for the following / CERTIFICATE OF EXEMPTION FROM !S T reason:"Sec.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($100)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 NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred dollars($500)." subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with each provisions or this permit shall be deemed revoked. P1,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, 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 ap.Iication and state that the above information is correct.1 construct the project."Sec.7044,Business and Professions Code:The Contractor's License agree certify comply that with all d thi a p my ordinances and Sabo above information relation to build.I Law does not apply to an owner of property who builds or improves thereon,and who con- construction,and hereby. hot' -sentatives 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 a .ose /`I¢- ❑ I am ex-pt un er Se . B.&P.C.for the reason _ Signature of Applica Date fJ/ l—v Mailing Address 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- 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, PI./Engr. Clear. SWIMMING POOL/SPA EXCAV. REINF.SETBACKS:Radius Sti.,Bond- ing,Exp.Soil, Ramp Loc.,Surcharge. FENCE/GATES: Height, Closers, Accessibility, Latches,Stability. FINAL INSPECTION: MISC. SIGNS: RE-ROOF: A INSPECTION DATE INSP. SIGN. BUILDING AND SAFETY DIVISION ' City of Arcadia ELEC./MECH./PLMBG. 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL.(818)574-5416 PERMIT ilk Building No. Description (Additions, Commercial, Industrial) Fee Address 1124 Encino Avenue Services Owner 1 (Size: 10 0 AMP ) Blanton X Outlets Moiling W (Receptacles, Lights, Switches) Address 1124 Encino Avenue I— Fixtures City Zip I Tel. Arcadia 91006 445-1737 (f) Motors Contractor 1 (HP each: 31/2 H.P. ) /.5-AAA Conditioned Air, Inc. 4 Other Address V (Specify'. ) 10160 E. Valley Boulevard ac So. Ft. Area New City Zip Tel. V Residential Bldg. El Monte 91731 579-1800 W Sq.Ft. Area New State L ic. 3 8 516 3 CC 1U City -I Res. Accessory Bldg. Q B Classif. 293529 C20 Lic. No. 16984 W LICENSED CONTRACTOR'S DECLARATION Misc. In; 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section / I I I)of Division?oft sines and P lions Code.a d my license is in full force and Pool ELECTRICAL FEE /h `"j effect. n ���n �� Wiring OWNER-BUILDER DECLARATION No. Description No. Description Fee LiI hereby affirm that I am exempt from the Contractor's License Law for the following FAU to and includ, Boiler/Compressor ' reason: �� reason:"Sec 7031.5.Business and Professions Codes.Any city or county which requires a 1 100,000 BTU to and includ• 3 HP G?/ 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 (LI FAU over Boi ler/Compressor pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with 1 00,000 BTU 1 over 3 HP to I S H P / Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any Fla/Wall/SusD•/Pool Air Handler to and applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred N Heaters Air Ha ter to cfm dollars($300).'' — . I,as owner of the property,or my employees with wages as their sole compensation,will Q Spray Booth / Air Handler do the work,and the structure is not intended or offered for sale."Sec.7044,Business and Exhaust Hood over 10,000 cfm Professions Code:The Contractor's License Law does not apply to an owner of property who 0 builds or improves thereon and who does such work himself or through his own employees. — Vent. Fan Other; provided that such improvements are not intended or offered for sale. If, however, the 4 includ• Duct 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." = Misc. ❑ I, as owner of the property, am exclusively contracting with licensed contractor to U 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- X MECHANICAL FEE �� tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law" Ei1 am excempt under Sec. ,B.&P.C.for the reason _ No. Description No, Description Fee __ Bathtubs Water Heaters Date_—__—___—__--___Owner LLI Showers Garbage Disposals WORKERS'COMPENSATION DECLARATION N Water Closets Laundry Trays ElI 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. _442.5B6 __ Company State Fund ® Copy is filed ❑Certified copy is Exp.Date Kitchen Sinks Sewer Connections with the City. hereby furnished. I Z CERTIFICATE OF EXEMPTION FROM 3/86 I m Dishwashers Sewer Cap WORKERS'COMPENSATION INSURANCE Shower Pan Gas System (This section need not be completed if the permit is for one hundred dollars(f 100)or less.) _ = Replacement (No.Outlets'. 1 Z 0 I certify that in the performance of the work for which this permit is issued,I shall not J Swim. Pool Solor (J) employ any person in any manner so as to become subject to the Workers'Compensation Law a Pining Installation mmmeme of California. Misc. m NOTICE TO APPLICANT:IJ,after making this Certificate of Exemption you should become —PLUMBING FEE C7 subject to the Workers' Compensation provisions of the Labor Code,you must forthwith 1 — - -I comply with each provisions or this permit shall be deemed revoked. O I certify that I have read this application and state that the above information in correct.I ELEC.,MECH.,PLB G. ISSUANCE FEES .. /� 50 77 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize rr�t�sentativF his city to enter the above-mentioned 1 o property for Applicant purposes. �L o (s aie �D ) C TOTAL FEES O- Signature of Applicant David C'. ('.Y(7 S Due-Q/5i3 5 - -< Mailing Address 1 01 6 n R_ Va 11Py Bot,1 Pva rd Processed Date: `ity,State,Zip El Mon - ___Ca 1 j f 91731 By: 00 - 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. INSPECTION RECOR' PECTOR NOTES UNDERGROUND CONDUIT ROUGH WIRING NEW SERVICE fit FIXTURES ��NI FINAL ELEC. INSP. , TEMP. POWER POLE OTHER • OTHER ELEC. UTILITY CLRNCE. U. G. DUCTS/REFRIG. LINES RO. MECI i. ~ Ducts, Comb. Air, 2 _ Supports, Vents • FINAL MECH. FAU/AC Unit '! ,Z Vents, Shutoffs 9 OTHER OTHER U.G./UNDER FLR. Soil, Water, Gas, Supports RO. PLMBG. Water, Gas, Vents, -- — Supports,.Flashings GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM i FINAL PLMBG. Fixtures, Valves Services t WATER HTR. Vent, Valves, ` Press. Rel. Volvo Q SEWER/PRIV. DISP. SYSTEM OTHER —4 OTHER GAS UTILITY CLRNCE. • LBONDING to U.G. CONDUIT 3 GAS PIPING Material, Depth gGAS TEST •' HEATER vent, clearance, Location, Shut-off FINAL POOL ELEC. FINAL POOL PLMBG. �V I OTHER INSPECTION DATE INSP. SIGN. ELUDING AND SAFETY DIVISION ,.., MISCELLAh''`OUS AND OFF—SITE City of Arcadia 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT �eaVid'^g f� ./� /` MISCELLANEOUS FEE RECEIPT Address /yG/,y-.0 F7 f'-e- Owner ❑ # PLAN CHECK FEE FOR VAL. Moiling ❑ CASH BOND FOR ( Address. - - 1. City Zip Tel, ❑ GRADING PLAN CHECK t n " 46 f /Yee(/y Usi U. Contractor' / O s SOT/ !� �S' ❑ GRADING PERMIT__ Address C7 ❑ HOUSE MOVING C t Zipy Tel/` ❑ PARKS AND RECREATION FEE %r �y��`�A 9/d/ le T��' �/ ❑ ROUTE INSPECTION FEE Stole lit, City / 8 Clossif. Oe In� / 7e9/ Lic, No./3.2f I— ❑ f—� LICENSED CONTRACTOR'S DECLARATION ' plot I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section of Division 3 of the Business and Professions Code,and my license is in full force and ❑ effect. OWNER-BUILDER DECLARATION 1'. 0 I hereby affirm that I am exempt from the Contractor's License Law for the following TOTAL FEE reason:"Sec.7031.5.Business and Professions Codes.Ant city or county which requires a $WARNINGI PLAN CHECK FEES. WHERE NO ACTION IS TAKEN BY THE ,^) puma so construct,alter,improve,demolish,or repair any structure,prior to its issuance APPLICANT IN 180 DAYS AND NO BUILDING PERMIT IS ISSUED,IFEES ARE v�•• also requires the applicant for such permit Ill file a signed statement that he is licensed FORFEITED TO-THE CITY. pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with C: Section 7000)of Poisson 3 of the Business and Professions Code, or that he is exempt SEWER PERMIT Otherefrom.and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for permit,subjects the applicant ma civil penalty of not more than five hundred PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTIONS AT dollars tS500)." 1 I.as owner of the property,or my employees with wages as their sole compensation.will Pale work,and the structure is not intended or offered for sale."Sec.7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who LOT BLOCK TRACT builds or tmprm es thereon and who dries such woe(himself or through his own employees, providid that such improvements are not intended or offered for sale. If. however, she LOCATION LATERAL building or improvement is sold within one year of rlontplction,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. s CESSPOOL FILL I. as owner of the property, am exclusively contracting with licensed contractor to $ 3.00 construct the project."Sec.7044,Business and Professions Code:The Contractor's License Last does not apply to an owner of property who builds or improves thereon,and who con- y trart.s for such projects with a rant ractmis)licensed pursuant to the Contractor's License Lass:" INSPECTED J98 $ 11 I am excempt under Sec. ___. ,B.& P.C.for the reason TOTAL BY BY 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-ins e, or a certificate of Worker's Cy in a Ii(ied cup e 0 n ( 1r� .�r it r1,4'P-;,i j DRIVEWAY APPROACH /�P-'9Se/,..-T SIDEWALK FT. Copy is did ❑hereby led rni • is Gate i `s /, TOTAL FEE lirib with the City. hereby furnished. � j INSPECTED i .. CERTIFICATE OF EXEMPTION FROM •����_ WORKERS'COMPENSATION INSURANC STREET CUT (This section need not be completed if the permit is for one hundred dollars(5100)or less.) 0 I certify that in she 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 so the R orkers'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 sublet t to the Workers' Compensation provisions of the Labor Code,you must forthwith _ ® /SO.FT. comply comp with each provisions 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 ordinances and state laws relating to building INSPECTION FEE construction,and hereby authorize representatives I is city to enter the above-mentioned property for inspection pat ,�sess...� Y / INSPECTED 198 BY Signature of Applicant !�6.' ..�-.0-�� '--- Date J�•�g_/_L PERMIT FEE Mailing Address /57 A" '1' ' "be �r A. ---- TOTAL FEES l Ctn.State.Zip ./a'.'O.i/lw�-r e. 41— ��'���a INSPECTOR COPY This is o miscellaneous and off-site permit when properly filled out,signed and validated, and is subject to expiration if work thereunder is suspended for 110 days. LOCATION ►tZ4 Encino 1ve., VALUE $ 11(100 bwQttibN% 4 Go.r-age LOT t t BLOCK TRACT t %24. t OWNER �O b,t nSC n "a r'os BUILDING s4 ` t - 30- St 2. I l I 1 d PLUMBING Meor I i n L . C�acl e S ' .--4.-5. 308'1` S HEATING Hairy % ,. 4./Fv-LsGoy.p. 1 -1- -. t a 104:4 SEWER W6.J?C�.c �` . 15-- -_s-‘ V,S 7- WIRING F. b me. tc.‘Y1Str l.. 5 -1-iZ PI grQ FIXTURES"' " IR ELECTRIC 1$36 z. (�1g.-Veo GAS &667 9-1Z.-.M PLAN NO.toot7 ADDRESS 1I ..`- E__nQ1yt Y/t�eh VC•O:•JN=R ` - rvso 1 B r W- elk STRUCTURE QW%Ltl ecONTRACTOR Sa."e. 411111k- DATE ,•AD� ERMIT IN ECTED REMARKS PLAN NO.10001 POWER POLE . FORMS al i t I - IS sZ , ` RO. PLUMB. IV O % - .SZ e-,g4., GAS anst IL, 7/AWNE ^'� DG. / � .10 TO STREET SEWER • S is -ii b , W.C. FURNACE .211 'O`` ,j •,1 '�J)�� VENT AL RO. WIRE "l 41 v , b .S(j (•�/7�J CURB �V FRAME o -4 a LATH SZ C .. , t ELEC. FIX. 141121 7Jf PLUMB FIX. � I! ( V) , r)-,g P ELECTRIC J-� !L I / "tom-SiO GAS 1667-- 7--/).......s.--6 SUB-CONTRACTORS....-0-34- -6 f' 1 r Location a E/YC INN A 1%` , S-q-S6 Sewer Permit No. $9.j,9... Co. No. Lot // Blk. Tract /?;Z q/ I Legend v v Owner l?p 6 n S C Yk h//a a I Length Date Insp. Contractor Iv Xe r 4', 14 7 I - Pipe & Jointc Street Location Jr/f,c$ L5 /3 C?