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?