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HomeMy WebLinkAboutUntitled (3) '� BUILDING AND SAFETY DIVISION "- City of Arcadia ELEC./MECH./PLMBG. -.a 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT ....a / /-- ._. Building��� 6 I�l 1 No. Description (Additions, Commercial, Industrial) Fe—�% W Address ea:R(4 ,�t Services , 1/4f) Owner { (Size Jo L�p 3v1/u['1 Outlets )– '-- Loiling Address j_(x'/ 0 lcl ie.a 4C ii W (Receptacles, Lights, Switches) r� ,y / N Fixtures t,J city, Q It Zip Tel47::::;7(4.6/41 } Cl) Motors - Conhaetor' (H P each: ) GC Addref(, r Other V // (Specify: ) LJ ♦/v e cc Sq. Ft. Area New City p TeL y, A2) w/o+ Z� ed.? 7/J�_0 ?- Residential Bldg. State Lic•.YY 7ii5Y(r�� j L V ( city a a (_ w Sq. Ft. Area New a Clossif. �-"Z�' �" 1�--3�= CYO.2.3& w Res. Accessory Bldg. Lic. No. LICENSED CONTRACTeR'S DECLARA 101 Misc. cc I hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section ( I r r)of Division 3 of the Business and Professions Code,and my license is in full force and C effect. Wiring Pool ' ELECTRICAL FEE as. OWNER-BUILDER DECLARATION No. Description No. Description Fee 1 I hereby affirm that I am exempt from the Contractor's License Law for the following FAU to bnd includ. Boiler/Compressor reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a 2 100,000 BTU to and includ. 3 HP 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 W FAU over Boiler/Compressor pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with f•• Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt (n 100,000 BTU Over 3HP to 15 HP therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any • applicant for a permit.subjects the applicant to a civil penalty of not more than five hundred (r) Heat Wall/Susp•/Pool Air Handler to and dollars($500).'' Heaters includ. 10,000 cfm PI.as owner of the property,or my employees with wages as their sole compensation,will Q o Spray Booth / Air Handler 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 o V over 10,000 cfm of employees,who Vent. Fan n employees, Z Other: builds or improves thereon and who does such work himself or through his own 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 Q Duet 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 W construct the project."Sec.7044,Business and Professions Code:The Contractor's License 2 I t Law does not apply to an owner of property who builds or improves thereon,and who con- MECHANICAL FEE tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law.'' 1 _ 0 I am excempt under Sec. ,B.&P.C.for the reason _ No. Description No. Description Fee Bathtubs / Water Heaters 2_.COG' Date— Owner W Showers Garbage Disposals te WORKERS'COMPENSATION DECLARATION 1-- Wafer Closets Laundry Trays reby affirm that I have a certificate of consent to self-insure,or a certificate of Worker's Compens tion Insuraane or a certified copy thereof.(Sec.3800,Labor Code.) Lavatories Clothes Washers Policy No. 13-J'__:a_Company Tj2 r-L'�.D gCopy is filed a Certified copy is Ex/p.Date Kitchen Sinks Sewer Connections with the CERTIFICATE OF EXEMPTIONrFROM I G' 'S' I m Dishwashers Sewer Cap WORKERS'COMPENSATION INSURANCE c (This section need not be completed if the permit is for one hundred dollars($100)or less.) e Shower Pan Gas System Replacement (No.Outlets: ) 0 I certify that in the performance of the work for which this permit is issued,I shall not J Swim. Pool Solar employ any person in any manner so as to become subject to the Workers'Compensation Law a. , Pioina Installation of California. NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become Misc. PLUMBING FEE h c." 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 comp) with all city and county ordinances and state laws relating to building construction, nd hereby au file'representatives of this city to nter the above-mentioned property for i action pu o , �CjiGSignature of Appl;ean�. . ----._. TOTAL FEES if frO Mailing Address `City,State,Zip _ -- Processed Dote: By. of INSPECTOR COPY This is an electrical/mechanical/plumbing permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 120 days. INSPECTION RECORt .SPECTOR NOTES ..,. UNDERGROUND CONDUIT ROUGH WIRING NEW SERVICE FIXTURES FINAL ELEC. INSP. TEMP. POWER POLE OTHER OTHER ELEC. UTILITY CLRNCE. U. G. DUCTS/REFRIG. LINES RO. MECH. Ducts, Comb. Air, Supports, Vents FINAL MECH. FAU/AC Unit Vents, Shutoffs FOTHER _ ' I OTHER ' U.G./UNDER FLR. Soil, ater, Gas, Supports RO. PLMBG. Water, Gas, Vents, Supports,,Flashings GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM bv„ FINAL PLMBG. Fixtures, Valves, C Services WATER HTR. Vent, Valves, Press. Rel. Valve 0 SEWER/PRIV. DISP. SYSTEM OTHER OTHER GAS UTILITY CLRNCE. BONDING a U.G. CONDUIT ,GAS PIPING Material, Depth GAS TEST r HEATER Vent, Clearance, Location, Shut-off itni FINAL POOL ELEC. A FINAL POOL PLMBG. IV OTHER INSPECTION DATE INSP. SIGN. BUILDING AND SAFETY DIVISION City of Arcadia "0".. MISCELLAP�r +` US AND OFF-SITE . 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT Address Cj �`J �� MISCELLANEO F ECEIPT Address ;_'V" k �Yl,/ �-(py ////� Owner ; PLAN CHECK FEE FOR VAL��� `01 2- 6T ur, N Moiling �['' 0 CASH BOND FOR Address ( �G Cn ,� ���,�iii�A 01 it _Jx a , '7� 0 GRADING PLAN CHECK Contractor ,, L. � I ,il`� ll,f•� 0 GRADING PERMIT Address HOUSE MOVING City Zip Tel. 0 PARKS AND RECREATION FEE 0 ROUTE INSPECTION FEE Stole Lit. City 8 Clossif. Lit. No. t� LICENSED CONTRACTOR'S DECLARATION ( I I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 0 of Division 3 of the Business and Professions Code,and my license is in full force and effect. ___ 0�V "Alriri", 4: �I• ----- OWNER-BUILDER DECLARATION .. 0 I hereby affirm that I am exempt from the Contractor's License Law for the following TOTAL FEE r ;7715 rc noon:"Svc.7031.5.Business and Professions Codes.Ant vin or county which requires a IF prrm:t to con,neuct,alter,improve,demolish,or repair any structure,prior to its issuance f WARNING t 180 DAYS AND FEES. WHERE NO ACTION IS TAKEN also requires the applicant for such permit so file a signed statement that he is licensed FORFEITED IN TO-THE DAYS AND NO BUILDING PERMIT IS ISSUE Ds/fEES ARE pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with FORFEITED TO THE CITY. Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt three/rein,.and the bases for the alleged exemption.Any violation of Section 7031.5 by any SEWER PERMIT applicant fora permit,subjects the applicant to a civil penalty.of not more than five hundred dollars($.500)." PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTIONS AT I,as owner of the property,or my employees with wages as their sole compensation,will o the 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 on owner of property who LOT builds or lever,es thereon and who does such work himself or through his own employees, BLDCK TRACT provided that such improvements are not intended or offered for.sale. If, however, the LOCATION LATERAL building or improvement is sold within one year ojrlompletion,the ow•ne •builder will have SADDLE she burden of proving that he did not build at improve for the purpose of sale.'' SEWER PLAN NO. CESSPOOL FILL 0 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 Law does not apply to an owner of properly who builds or improves thereon,and who con- 1 tructs for r n such projects with a contractors)licensed pursuant to the Contractor's License Law $ ''' INSPECTED )98 0 I am excerpt under Sec. _. ,B.& P.C.for the reason TOTAL BY BY Date____ _____-____Owner ,, , ,1�•---• CURB AND SIDEWALK WORKERS'COMPENSATI D LA RATION CURB BREAK ❑ 1 hereby affirm that I have a certificate of consent to self-insure. or a certificate of REPLACE CURB FT. Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.) Policy No. ..._. Company_. DRIVEWAY APPROACH SIDEWALK FT. ('j Copy is filed j"-i Certified copy is Exp. Date I u with the City. 1 'hereby furnished. I INSPECTED TOTAL FEE CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE STREET CUT IThis section need not be completed if the permit is for one hundred dollars($100)or less.) E 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 of California. o /SO.FT, NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become ACTUAL SIZE-OF PATCH AMOUNT CHARGED subject to the Workers' Compensation provisions of the Labor Code,you must forthwith ( /SO.FT. comply with each provisions or this permit.shall be deemed revoked. AMOUNT REFUNDED 1 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 construction,and hereby authorize representatives of this city to enter the above-mentioned INSPECTION FEE property for inspection purposes. INSPECTED 198 BY Signature of Applicant Date___ _. PERMIT FEE Mailing Address City.State.Zip TOTAL FEES INSPECTOR COPY This is a miscellaneous and off—site permit when properly filled out,signed and vo/idoled, and is subject'to expiration if work thereunder is suspended for /10 days. 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, Industriol) Fee Building "`5 C')/� #/1.-11 ` /-) Services Address �� (,- �/ /'7 ✓�.J-- (Size: ) It 'N) ,�• 4 `!- ) 2 Outlets Mailing Lr'7�'/� �� N 1� t) y' / I W (Receptacles, Lights, Switches) Address .ILL' 6l p ice /lam '/_'J /0� N Fixtures !City `Tl, >''City I N Motors Controctot (H P each: ) �t G�/�/ f�ECr/i,f'i/U ��4 J Other t�'Q ) Address - (� /�{1, U (Specify: r 0'12/ .,` ,`�V' t Sq. Ft. Area New City 3 Zip Tel. �/"'/ , r Residential Bldg. r(i.���-le-i-t.d-s I 77" I" 2 W Sq.Ft. Area New State Lic. City /� 7 J Res. Accessory Bldg• 8 Clossif. t Cij, „3�' C_-"-D� Lic. No: / Z W Misc, LICENSED CONTRACTOR'S DECLARATION c I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section \ Pool of Division 3 of the Business and Professions Code,and my license is in full force and ELECTRICAL FEE effect. Wiring e OWNER-BUILDER DECLARATION No. Description No. Description Fee O I hereby affirm that I am exempt from the Contractor's License Law for the following FAU to b n d includ. Boiler/Compressor reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a 2 100,000 BTU to and includ. 3 HP permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance W FAU over Boiler/Compressor also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with I " 100,000 BTU over 3HP to 15 HP Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt CI) therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any )' Fir./Wall/Susp./Pool Air Handler to and applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred to Heaters includ. 10,000 cfm dollars($500).'' J Spray Booth / Air Handler 0 ExhaI,as owner of the property,or my employees with wages as their sole compensation,will the work,and the structure is not intended or offered for sale."Sec.7044,Business and U ust Hood over 10,000 cfm Professions Code:The Contractor's License Law does not apply to an owner of property who Vent. Fon Other: builds or improves thereon and who does such work himself or through his own employees, z 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 the burden of proving that he did not build or improve for the purpose of sale." = Misc. V OI, as owner of the property, am exclusively contracting with licensed contractor to W A - constructtheproject."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,'' No Description No. Description Fee 0 I am excempt under Sec. ,B.&P.C.for the reason Bathtubs / Water Heaters rah Or..) Date Owner W Showers Garbage Disposals WORKERS'COMPENSATION DECLARATION N Water Closets Laundry Trays EaI 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 (r) Kitchen Sinks Sewer Connections flCopy is filed Certified copy is Exp.Date with the City. hereby furnished. I Z CERTIFICATE OF EXEMPTION FROM Dishwashers Sewer Cap WORKERS'COMPENSATION INSURANCE ma Pan Gas System (This section need not be completed if the permit is for one hundred dollars($100)or less.) = Replacement (No.Outlets: ) 0 I certify that in the performance of the work for which this permit is issued,I shall not J Swim. Pool Solar employ any person in any manner so as to become subject to the Workers'Compensation Law 0. Pialna - Installation r 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. I certify that I have read this application and state that the above information is correct.I ELEC.,MECH.,PLB G. ISSUANCE FEES -_...2._, ) , agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter the above-mentioned property for inspection purposes. '-"-"---• - I Signature of Applicant Date TOTAL FEES lal Mailing Address Protested Dote: ' City,State,Zip By: SO FIL�-OPY .s Is an elect. mechanlcal/plumbing permit when properly fills — t,signed and vaNdated, and Is subject to expiration If work thereunder is suspended for 120 days. BUILDING AND SAFETY DIVISION /h"■ City of Arcadia BUILDING :` 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT 4 , e„. Building s� . • U.B.C. Type Occ. 1 Address Old- ,v L L Edition Const. Group Lot Block Tract Occ. F. D.Appr. Date H. D.Appr. Date a• No. Load Required Required � Owner is. 4 4- Z e A. G ise e Use Zone Special Case No. 01 Mailing ,7 / Homeo.(11:0” �: .iat o *royal Date a.r.CO Address ' C, ac� ANC (1 Rift- � J�LL I, �• City Zip Tel. Lot T. 2 c�a d i� 91006 I y47-.;)(/77 Size -13 Contractor t Special L��. ti (m, Conditions Address n�-- ,�y NOTE: Include: `)�``l) etP' {4, VALUATION Labor,Material, Plumbing, Etc. $ /�O„ City h P ZiRTf Tel Misc. FEE F--, State Lic. City `�t Private U1 &Classif. 1- 7a l Lic. No./iO. I Swimming Pool I Spa E Public Arch., Engr., �a i'' . Designer . x„11 _ :Slgn Pole❑ Wall❑ N Address Tel Temporary El Projecting❑ City Zip State I Fee Based on Total Sq.Ft. Lic. No ®� r ,,,,t Proposed �,'PLAN CHECKING FEE Construction ire..—i-04 11g1 n It oR4.6- I� A4 T-. r „ C S k 14L 0.dcC �4V'''' S.M.I.R j o Permit Fee l!` Floor Main Accessory Total Processed by / Area TOTAL '! 'CO New❑ Add.❑ Alter.❑ Repairs Demolition❑ Permit No. Plan No. Date LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION S ❑ 1 hereby affirm that 1 am licensed under provisions of Chapter 9(commencing with Section reby affirm that I have a certificate of consent to self-insure,or a certificate of 70x0)of Division 3 of the Business and Professions Code,and my license is in full force and Worker's Compensation In ura a or a certified copy thereof.(Sec.'3800,La or Code.) effect. icy No. E re/7't.(In I-OWNER-BUILDER DECLARATION is filed Certified copy is Ex .Date the City. hereby furnished. _ ❑ I hereby affirm that I am exempt from the Contractor's License Law for the following CERTIFICATE OF EXEMPTION FROM 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 pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with ❑ I certify that in the performance of the work for which this permit is issued,I shall not Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt employ any person in any manner so as to become subject to the Workers'Compensation Law therefrom.and the basis for the alleged exemption.Any violation of Section 7031.5 by any of California. applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred NOTICE TO APPLICANT:!j,after making this Certificate of Exemption you should become dollars($500).'' subject to the Workers' Compensation provisions of the Labor Code,you must forthwith I,as owner of the property,or my employees with wages as their sole compensation,will comply with each provisions or this permit shall be deemed revoked. o the work,and the structure is not intended or offered for sale."Sec.7044,Business and CONSTRUCTION LENDING AGENCY Professions Code:The Contractor's License Law does not apply to an owner of property who I hereby affirm that there is a construction lending agency for the performance of the work builds or improves thereon and who does such work himself or through his own employees, for which this permit is issued.(Sec.3097.Civil Code.) 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 Lender's Name the b rden of proving that he did not build or improve for the purpose of sale." Lender's Address I.as owner of the property, urn exclusively contracting with licensed contractor to on ruct the project.''Sec.7044,Business and Professions Code:The Contractor's License I certify that I have read this application and state that the above information is correct.I Law does not apply to an owner of property who builds or improves thereon,and who con- agree to comply with all city and county ordinances and state laws relating to building tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law." construction,and hereby authorize representatives f this city to enter the a ove-mentioned //��77 ,,�eras'"e' il—s ' property for inspection pu os s. 1 am excempt under Sec 01/A___,B.&P.C.for the reason LS p Signature of Applicant f (/� Vl` ...re Date 4i..2,__ vMailing Address ...a e d 3, /V�� �( ` 4A KA- Date— _ _Owner City,State,Zip_ j 4 ' 16°‘ INSPECTOR COPY This is a building permit when properly filled out,signed and validated, and is subject to expiration if work thereunder is suspended for 120 days. INSPECTION RECORD FOUNDATION: (Gr. Certif. Comp. Tests, Set- INSPECTION NOTES backs,Forms,Reinf.Steel,Excavation. 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 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: .�1 RE-ROOF: �CJ " � °j#4 INSPECTION DATE INSP.SIGN. wrruttry ruvv Onrclt u vl0luiv '� .✓� �„� BUILDING City of Arcadia „7"../...- • 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT n j� Y 1 IT Building U.B.C. Type j Occ. 1 Address 'O O • 7, e g A i C 4 (?e( Edition ! , Const.�! l v Group �� Lot Block I Tract Occ. F. D.Appr. Date H. D.Appr. Dates,._. ,_, No. Load Required Required ,Qwr�r Use Zone t'2— Spe cial Case No.4. 1- Tv p riviV 6-igeci✓Mailing n Q / q p�ry� s ciation Approval D Address SO• old 1(ANC L PI V J�. G j aY • Zip Tel Lot ce ad to.. 9A1,6 14/7".7 Y7? Size - Contractor MA� Special _ LT/ X f 1)7, .x,%; r. Conditions Address NOTE: Include: .7._ $ t /dip-10 c VALUATION Labor,Material, Plumbing, Etc. $ City a.,Ai� 0 a_ Zip 7i`7 C-7 Tot., f:7e"£r Misc. FEE %NI). State Lic. �lC City �3 ❑Private } &Classif. / / :.i•-• 1 Lic. 4.I Swimming Pool/Spa ❑Public Arch., Engr., ll Sign-Pole❑ Wall ❑ Designer ®i[-�/ Address . Tel. F Temporary❑ Projecting ID� S . 1 City _ Zip State E Fee Based on Total Sq.Ft. Lic. No. E Proposed t+ , t� I‘) S PLAN CHECKING FEE s .._,,,� Construction EP . N S.M.I.P. / ' Permit Fee II r / a to Floor Main Accessory Total Processed by ,J Area TOTAL I. New El Add. Alter.❑ Repair❑ Demolition❑ Permit No. `. Plan No. Date , r r LICENSED CONTRACTOR'S DECLARATION WIT RS'COMPENSATION DECLARATION ❑ 1 hereby,affirm that I m licensed under provisions of Chapter 9(commencing with Section ❑ I hereby affirm T�I I have a certificate of consent to self-insure or a certificate of of Division 3 of thea Business and Professions Code,and my license is in full force and Worker's C p nsati. In rpgce,or a certified cop c." L b .) effect. Policy No _ Co.pan OWNER-BUILDER DECLARATION py is filed t'7 Certified copy is Ex .Date with the City. hereby furnished. ❑ I hereby affirm that I am exempt from the Contractor's License Law for the following CERTIFICATE 0 't EMPTION FROM 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 pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with El I certify that in the performance of the work for which this permit is issued,I shall not Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt employ any person in any manner so as to become subject to the Workers'Compensation Law therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any of California. applicant for a 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 dollars($500)." subject to the Workers' Compensation provisions of the Labor Code,you must forthwith 1,as owner of the property,or my employees with wages as their sole compensation,will comply with each provisions or this permit shall be deemed revoked. o the work,and the structure is not intended or offered for sale."Sec.7044,Business and CONSTRUCTION LENDING AGENCY Professions Code:The Contractor's License Law does not apply to an owner of property who I hereby affirm that there is a construction lending agency for the performance of the work builds or improves thereon and who does such work himself or through his own employees, for which this permit is issued.(Sec.3097,Civil Code.) 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 Lender's Name the burden of proving that he did not build or improve for the purpose of sale." ElLender's Address I, as owner of the property, am exclusively contracting with licensed contractor to construct the project."Sec.7044,Business and Professions Code:The Contractor's License I certify that I have read this application and state that the above information is correct.I Law does not apply to an owner of property who builds or improves thereon,and who con- agree to comply with all city and county ordinances and state laws relating to building tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law." construct' rand hereb a ,. -representatives of this city to enter the above-mentioned property for inspectio• �.. 0 . 1 am excempt under Sec._ ___,B.&P.C.for the reason '"" .. �,. Signature ofApplica;;;F _ - - //' Date ~". Mailing Address — Owner City,State,Zip INSPECTOR COPY This is a building permit when properly filled out,signed and validated, and is subject to expiration if work thereunder is suspended for 120 days. • oak.- INSPECTION. RECORD FOUNDATION: (Gr. Certif. Comp. Tests, Set- ',4 j4� ( INSPECTION NOTES backs,Forms,Reinf.Steel,Excavation. ��r 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,Rift.,Jsts.,Blocking,Bracing, Nailing,Backing,Diaphr. Draft Stops. INSULATION: Thickness, R-Values, Piping, — •Sound Caulking. //`S "o°L a‘..4" 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, L� Pkg. Access, Fire Doors, Exit, Locking De- vices, Landings, House Numbers, Weather �V5 7C:C fO-' t1 Stripping,Pl./Engr.Clear. ,1 2&(704-7` 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 City of Arcadia ELEC./MECH./PLMBG. 240 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT Building No. Description (Additions, Commercial, Industrial) Fee yam• Address #A `©/ o ► f Services ' / . fill Owner (Size / •!I • ) 7 MI r a VIE... ; 1 t...-- . Outlets Moiling W (Receptacles, Lights, Switches) Address .5' ..C) ,S, 67• �/$4.)' r4 Fixtures ■ City Zip Tel. Address c.I. 1 — Controctor U_ • Other 1111 City 5 ') LW O it S V Cit Zip Tel. StatY Lic• "Lr� City J C et Clossif. / n •2 Lic. No.f 3 W LICENSED CONTRACTOR'S DECLARATION Q1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 0)of Division 3 o ,mess and Prose ' ode,and my licens s t ull force and Pool t! effect. r(� �. __— =.�i `^j, _ Wiring OWNER-BUILDER DECLARATION •' • Description Fee ❑ l hereby affirm that I am exempt from the Contractor's License Law for the following PAU to iand includ. Boiler/Compressor reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a 2 •• see to and includ• 3 HP 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 W FAU over Boiler/Compressor pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with I— 100,000 BTU over 3 HP to 15 HP Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt to therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any )' Air Handler to and applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred U) Heaters induct. 10,000 cfm dollars($500)." I.as owner of the property,or my employees with wages as their sole compensation,will J Air Handler do the work,and the structure is not intended or offered for sale."Sec.7044,Business and V Exhaust Hood •Oover 10,000 cfm Professions Code:The Contractor's License Law does not apply to an owner of property who Other: builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If. however, the ex Duct building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he did not build or improve for the purpose of sale." =I 0 I, as owner of the property, am exclusively contracting with licensed contractor to W construct the project."Sec.7044,Business and Professions Code:The Contractor's License x Law does not apply to an owner of property who builds or improves thereon,and who con- tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License Law." . IIII am excempt under Sec. ,B.&P.C.for the reason — No. Description • Fee IBathtubs Water Heaters /1 , (3 Owner w Showers Garbage Disposals 17�' WORKERS'COMPENSATION DECLARATION N C Water Closets 5 6() ',.�j I hereby a rm that I have a certi icate of consent to self-insure or a certificate of yG'lhker's Co —'at on s r�ce. rtified copyljle/yof.,�$e/ 90. p Code.) . ' Lavatories -.) 1� /policy No._ ►#/ 1 C y Used c (is rJ/ Sewer �/ Copy is filed O Certified copy is Ex Date Kitchen Sinks with the City. hereby furnished. _ Z CERTIFICATE OF EXEMPTION FROM Dishwashers Sewer Cap WORKERS'COMPENSATION INSURANCE Pan Gas System (This section need not be completed if the permit is for one hundred dollars($100)or less.) j 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 employ any person in any manner so as to become subject to the Workers'Compensation Law Q_ Piping Installation of California. Misc. Nf, OTICE TO APPLICANT:!f,after making this Certificate of Exemption you should become PLUMBING FEE 02 Lk) 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.,PUB G. ISSUANCE FEES I/O 90 agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize representatives of this city to enter the above-mentioned property for inspecti oses. Signature of App 7 r t- 1-- 1 $_ TOTAL FEES 91 al Mailing Address «— -.---ter› "O.' Processed Date: City,State,Zip „_ / . _ - By INSPECTOR COPY This is an electrical/mechanical/plumbing permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 120 days. INSPECTION RECORD ...SPECTOR NOTES UNDERGROUND CONDUIT ROUGH WIRING NEW SERVICE .FIXTURES vs FINAL ELEC. INSP. TEMP. POWER POLE OTHER OTHER ELEC. UTILITY CLRNCE. U. G. DUCTS/REFRIG. LINES mRO. MECH. Duch' Comb. Air, = Supports, Vents FINAL MECH. FAU/AC unit Vents, Shutoffs _ OTHER OTHER r , U.G./UNDER FLR. Soil, Water, Gas, Supports Water' Gas, Vents, RO. PLMBG. Supports,,Flashings GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM ✓ FINAL PLMBG. Fixtu erviresces J, Valves, S ph. ,,bs/ S • WATER HTR. Vent, Valves, _ Press. Rel. Valve n SEWER/PRIV. DISP. SYSTEM OTHER OTHER GAS UTILITY CLRNCE. BONDING U.G. CONDUIT 3 GAS PIPING Material, Depth a GAS TEST Vent, Clearance, • HEATER Location, Shut-off v FINAL POOL ELEC. FINAL POOL PLMBG. OTHER INSPECTION DATE INSP. SIGN. Op 61'cad�b '' PlikAg h 1! BUILDING & SAFETY DIVISION �� `� r roilti 240 West Huntington Drive ' Arcadia, California 91006-3104 rNQO RAT �� ( 818) 574 - 5416 I Page 1 of 1 500 S OLD RANCH RD 05/31/89 10: 10 Permit No : A8902546 Autoproj No : AU001402 Status : APPROVED Validated by : LB Inspector area: 206 This type : Electrical Project Applied : 05/31/89 Issued : 05/31/89 Parcel number Finaled . Group-occup/use: To Expire .• Owner : GREEN, ROBERT Applicant : GREEN, JUDY Applicant Addr : 500 S OLD RANCH RD ARCADIA, CA 91006 Job Address : 500 S OLD RANCH RD Phone number : 818-447-2479 Class code .• Valuation 0 Construction : OTH Permit to do : ELEC FOR GARAGE AND WORKSHOP Fee description Units Fee/Unit Ext fee Data Original Permit Issue Fee (YES/NO) 27 . 55 Y Residntl Sery to 600 volt/400 Amp> 1. 00 9 . 65 9 . 65 Additl Meters/Distribution Panels> 1. 00 9 . 65 9 . 65 Outlets 3105> 37 . 00 29 . 20 *** Fees Required *** *** Fees Collected & Credits *** Receipt No. Date Payment 05/31/89 76. 05 Fees: 76. 05 Adjustments: . 00 Total Credits: . 00 Total Fees: 76 . 05 Total Payments: 76. 05 Balance Due: . 00 CALL FOR INSPECTION DECLARATIONS Requests for inspections should be made at least In accordance with Health & Safety Code, Section Requests for hours inspections should by made at least st 19825,all required declarations on the reverse side of twenty-four ho A.M. -adv P.M. this form have been properly signed and dated by 574-5416, the permittee. f! 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'9 33 -n v �, m c Q. - c 7 n 3 3 w w cn p) c O Z o m C 0 Z m 3 m m n m R. 3 N —I H 7 a) * y 3 c7). .0 -. = , 7 r m A CA 5 n 4° `� f) g 3 cu = 10 m m t > m w a `� m 0 m0 m c0 4 m 3 co 'Oi o) f.. 7 _ Z 7 ro O y c -. z = z Z n Co 4- ■ 0 ° 0 0 m m m C. 24 m E E E '.'--7---i-i- . � - • -_ - . - _ - • —s -- • - — • - i - • . - ■ . 1 �, 3 c '�t`is z �4' p 0 � Z v Jac P. -43&k*,:.4 Development Services Depart PERPAIN NO. 240 West Huntington Drive,F Office Box 60021 BOO-036-761 City of Arcadia,CA 91066-6021 Permit Type: Electrical Arcadia (626)574-5416,Fax(626)447-9173 PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 12104 3/17/2011 CM 10:08 3/17/2011 Issued ADDRESS No. Dir.Prfix Street Name Street Suffix Project ASSESSORS PARCEL NO. GEO CODE 500 S Old Ranch p 77-027-004 OWNER MAILING ADDRESS ) ��� ii Robert&Judy Green 520 N Old Ranch 'oaI (626)447-2479 Inspector#: JEFF Arcadia,CA 91007 EMAIL ADDRESS: Plan Chk#: APPLICANT MAILING ADDRESS Plan#: Robert&Judy Green 500 S Old Ranch Road PHONE NO. (626)447-2479 School Dist#: Arcadia, CA 91006 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Owner PHONE NO. FAX NO. EMAIL ADDRESS: License No. Type: Expires: TENANT MAILING ADDRESS PHONE NO. FAX NO. DESCRIPTION ELECTRICAL UPGRADE TO 200 AMP SERVICE ----in - - - Construction Type UOM #of Units Value Construction Type UOM #of Units Value OCCUPANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT I flat Elec Issue Auto 42.25 42.25 01-3105 I each 0-400 Res Set 14.81 14.81 01-3105 ���I-y�� �+ (� / �j 1 each S WMF 2 Auto 1.00 1.00 88-3027 C:.L�• S e0 �c-.J /`"'�%�"'E `— — \I tiO, 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 I° 93593 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 t 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) t' k PERMIT/PLAN REVIEW At-PLICATION ,�,1 I jB,, Development Services Department,240 West Huntington Drive, Post Office Box 60021 °y""Y°`"` Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION b 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 ;dI 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 Code: Any city or county which requires a permit to construct, alter, improve, Carrier 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 om 1 wi 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 3J1 I l 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 erformance of the work for which this p permit is issued(Section 3097,Civil Code). I am exempt n er Section 7044,Business and Professions Code,for this reason: I' Lender's Name Date 311[)i I ( Owner Catra7 g'4L/'----• 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 3 1 G-1'r.A.N. Title OvVftY 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 6Ilt s------ Date 3//q11 w•. Development Services Department •`-: t• 240 West Huntin ton Drive,�i�Office Box 60021 • • g f PER NO. B0�-�18-964 ; ' City of Arcadia,CA 91066-6021 Arcadia (626)574-5416,Fax (626)447-9173 Permit Type: Roofing PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 5/20/2004 JB 13:37 5/20/2004 Issued PROJECT ADDRESS ASSESSORS PARCEL NO. GEO CODE CRWRIEwrg 500 S Old Ranch Rd 5777-027-0 4 0 OWNER MAILING ADDRESS Green,Robert A And Judy A 520 N Old Ranch Rd PHONE NO. Inspector#• JOHN Arcadia,CA 91007 EMAIL ADDRESS: APPLICANT MAILING ADDRESS Sierra Pacific Roofing 1042 N Mountain Avenue B-383 PHONE NO. (909)949-7663 Upland, CA 91786 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Sierra Pacific Roofing 400 25th PHONE NO. (909)982-0611 FAX NO. Upland,CA 91784 EMAIL ADDRESS: License No. 627233 Type: C Expires: 8/31/2005 12:00: TENANT MAILING ADDRESS PHONE NO. FAX NO. DESCRIPTION T/O EXISTING CAL SHAKE AND REROOF HOUSE AND GARAGE WITH GERARD CANYON SHAKE(NER-423, COLOR: TIMBERWOOD, 1.4 PS,34 SQS)-HOA APPROVAL LETTER IN FILE Construction Type UOM #of Units Value Construction Type UOM #of Units Value Steel roof system-B square 34.00 $11,900.00 OCCUPANCY: Reroof TOTAL VALUATION: $11,900.00 QTY 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 $270.65 $270.65 01-3104 ;, ,�f Totals for: 01-3104 $310.90 $310.90 ✓ v 7 Flat SWMF Auto $6.25 $6.25 88-3027 �,J.�.e-%— Q�j�/ /�)p/�` Totals for: 88-3027 $6.25 $6.25 1. I l r'^" • v'- 1 6,0vv giv*-- bvwcaI t . Pie" 2)41,.-- Total Fees: $317.15 Total Amount Paid: $317.15 Paid Today: $317.15 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from the date of plan submittal. This permit expires and becomes null and void if any work authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS fr Requests for inspection should be made at least Monday—Thursday Friday one(1)business day in advance of the inspection 7:30 a.m.to 9:00 a.m. 7:30 a.m.to 9:00 a.m. by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. (Closed on alternate Fridays) P L PERM, f/PLAN REVIEW AI LICATION •-7 ;,t• r-„0 ,44II' Development Services Department, 240 West Huntington Drive, Post Office Box 60021 °`.... Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS' COMPENSATION DECLARATION 1$. 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 ylittj license is in full fo ce ride e6t�zz 406. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class Lic rise No. 4 74e xp.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'co sari n inrncier 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, 285UN8�2 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. ❑ 1, as owner of the property, or my employees with wages as their sole 5-20-04 1 ��, compensation,will do the work,and the structure is not intended or offered for Date Applicant �'r`3 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. A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 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 r / . ,�.�/Wrenn�r enn O•• Title (\^`t'-^' 't--f,_- PR 1, AME 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 , 20 Date May 22004 e1TY o FOR OFFICE USE CITY OF ARCADIA COMMUNITY DEVELOPMENT DEPARTMENT 111 AxcADIA � - BUILDING DIVISION COMPLETED 240 West Huntington Drive Arcadia, California 91007 'C�*FORATED. (818)574-5416 Page 1 of 1 500 S OLD RANCH RD 07/06/94 12 :51 Permit no. : A9401940 Autoproj No : AU012764 Status : APPROVED Validated by : GERI Inspector area: 206 This type : Mechanical Project Applied : 07/06/94 Issued : 07/06/94 Parcel number : 5777-027-004 Finaled . Group-occup/use: To Expire .• Owner : GREEN Applicant : O'KANE & SALES INC. Applicant Addr : 204 S ROSEMEAD BLVD PASADENA, CA 91107 Job Address : 500 S OLD RANCH RD Phone number : 818-795-4775 Class code . Valuation 0 Construction : ADD Permit to do : ADD A/C ONLY CONTRACTOR : O'KANE & SALES INC. Lic. C 157626 818-795-4775 Fee description Units Fee/Unit Ext fee Data Original Permit Issue Fee (YES/NO) 35 . 00 Y over 3 to 15 HP 3105> 1 27 . 05 27 . 05 Refuse Fee 3027> 1. 00 *** Fees Required *** *** Fees Collected & Credits *** Receipt No. Date Payment 07/06/94 63 . 05 i, Fees: 63 . 05 Adjustments: . 00 Total Credits: . 00 Total Fees: 63 . 05 Total Payments: 63 . 05 Balance Due: . 00 Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the Hazardous Materials Information Guide? ❑ YES ❑ NO Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? ❑ YES ❑ NO Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? SEE PERMITTING CHECKLIST FOR GUIDELINES. Q YES ❑ NO I have read the Hazardous Material Information Guide and the SCAQMD Permitting Checklist. I understand my • rnni iirmmeinic I inrinr+hn I nc Annnln• (`nl m+v (`nr+n Min ') r`h.,r,+r,r') on Qnr.+i.,r. ') on 1 n/)+L.....,..L, n nn 4 A n _...__ NO.OPERATION A PERATION �- NOTES Building Inspections I Date I Insp. Plumbing Inspections I Date I Insp. 100. Setbacks 210. Under fir/bldg.drain 101. Rough grade 211. Copper underslab 102. Ftgs.&forms 212. Rough plumbing 103. Pre-slab 213. Rough gas 104. Floor joists 214. Shower pan 105. Steel 215. Water heater 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer - 108. Diaph nailing 218. Water service 109. Roof nailing 219. Final gas 110. Framing 220. Fixtures 111. 0cc/Area Sep.Wall 221. Final plumbing 112. Sound walls 222. Sewer cap/demo. 113. T-bar grid - 114. Insulation-flr. Pool Inspections I Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Ceil. 241. Rough plumbing 117. Drywall nailing 242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical Inspections I Date I Insp. 249. Final plumbing 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Underground conduit 153. Underslab conduit Reroof Inspections Date Insp. 154. UFER ground 270. Pre-reroof insp. 155. Water ground 271. Roof framing 156. Rough electrical 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. Eqpt.bonding Sign Inspections I Date Insp. 160. Service panel 280. Setback overhang 161. Final electric 281. Footing 282. Conduit/wiring Mechanical Inspections I Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rough HVAC Miscellaneous Insp. I Date I Insp. 183, Fire dampers 290. Fire alarm 184. Furnace compartment 291. Underground supply 185. Combustion air 292. Fire sprinklers - 186. Smoke detectors 293. Monitor system 187. Metal F.P.rough 294. Hood dry chem. 188. Compressor setback 295. Final 189. Commercial hood 190. Duct shaft Sewers&Offsite Insp. I Date I Insp. 191. Final mechanical 7.7.9y is 7 300. Lateral(main to P/L) 301. Saddle/Y Block Wall Inspections Date Insp. 302. Cesspool filled 200. Footings 303. Sidewalk -_, 201. Steel/rebar 304. Driveway 202. Grout lift 305. Curb replacement 208. Final wall 306. Trash bin t °� c ago o`o°o IVJI1I Hilt Hh ° So U �c w'-`°U a' \ /� U o m u`°i op 1.21111 jjj 3 Zi» ti "2 LLOdX �. O E -u''o`� 'Milo"' Z S�}" N Om -do . ' �E 8d E`c e m °D £ Etoo °oc'o- `J3 °' a E 5 oLoL�E 3 oy° -uau 2 io . E � 8 zaQ _o 10 _ mcm , m 2 mcm v Aoo 2c„2 p� ic nLSine ooE f5-!J m r m o I tTi>. ¢>O Fa d ¢O¢ti'' a"n c 2 S g T E- J O tm o o (n o-°p a °`o o t °U " o oa t -3 �3 O O I /g 0°a� m.E¢ 0 o 2 o jyro10 =maN.oE 3),§i;-;12., ` Oo m y 9 a Zm` 0 o c2.0-0 .2 °' at 2>$¢.0 NU doL - a.'a :41%L y.-m c t0 NaE ° �m t o Qj m n aWt E t E d a ny m'' ° c =' row' Q m 2 2wu-iU .o n S TD as U U ¢ - a c w o °,)a o Z e 9. U �o w f ' y ° 9 �¢O iii 21:3,..' O Q a, `(n �c L =m 0 8 ¢ o °� p �'cm 513 a '5 g2 _ _ m c O ra' o ` ma _ -'Z m >,-P, - E ;0 LUD a am�a mm t o 3,°n- � m a U'o °a mt� <m. � y= m2 m 91£ E-v k Q m °w I < maan oco t oa j_ cU y N N in.`I' i 2 !LE 0rn8 �.ITY QF FOR OFFICE USE CITY OF ARCADIA COMMUNITY DEVELOPMENT DEPARTMENT `'i -' .1 \„..- to BUILDING DIVISION ARCADIA ) 240 West Huntington Drive COMPLETED '4.C. �o° Arcadia, California 91007 °RpoRATE°' (818)574-5416 Page 1 of 1 500 S OLD RANCH RD 07/06/94 12 : 51 Permit NO. : A9401941 Autoproj No : AU012764 Status : APPROVED Validated by : GERI Inspector area: 206 This type : Electrical Project Applied : 07/06/94 Issued : 07/06/94 Parcel number : 5777-027-004 Finaled .• Group-occup/use: To Expire Owner : GREEN Applicant : O'KANE & SALES INC. • Applicant Addr 204 S ROSEMEAD BLVD PASADENA, CA 91107 Job Address : 500 S OLD RANCH RD Phone number : 818-795-4775 Class code . Valuation 0 Construction : ADD Permit to do : WIRING FOR A/C CONTRACTOR : O'KANE & SALES INC. Lic. C 157626 818-795-4775 Fee description Units Fee/Unit Ext fee Data Original Permit Issue Fee (YES/NO) 35. 00 Y over 1 to 10 HP,KW,KVA,KVAR > 1 12 . 25 12 . 25 Refuse Fee 3027> 1. 00 *** Fees Required *** *** Fees Collected & Credits *** Receipt No. Date Payment 07/06/94 48 . 25 Fees: 48 . 25 Adjustments: . 00 Total Credits: . 00 Total Fees: 48 . 25 Total Payments: 48 . 25 Balance Due: . 00 1 Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the Hazardous Materials Information Guide? ❑ YES ❑ NO Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? '' ❑ YES ❑ NO Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? SEE PERMITTING CHECKLIST FOR GUIDELINES. Q YES ❑ NO I have read the Hazardous Material Information Guide and the SCAQMD Permitting Checklist. I understand my • rani iiramante t mriar tha I ne Annalae (.ni int, rnrla Titic 9 rhantar 9 On Cartinn 0 7n 1 nn+kr,inh 7 on 1 An ..,,. NO.OPERATION i PERATION NOTES Building Inspections I Date I Insp. Plumbing Inspections I Date I Insp. 100. Setbacks 210. Under flr./bldg.drain 101. Rough grade 211. Copper underslab 102. Ftgs.&forms 212. Rough plumbing _ 103. Pre-slab 213. Rough gas 104. Floor joists 214. Shower pan 105. Steel 215. Water heater 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service 109. Roof nailing 219. Final gas 110. Framing 220. Fixtures 111. 0cc/Area Sep.Wall 221. Final plumbing 112. Sound walls 222. Sewer cap/demo. 113. T-bar grid 114. Insulation-flr. Pool Inspections I Date Insp. - 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Ceil. 241. Rough plumbing 117. Drywall nailing 242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric -- , Electrical Inspections I Date I Insp. 249. Final plumbing 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Underground conduit 153. Underslab conduit Reroof Inspections I Date Insp. 154. UFER ground 270. Pre-reroof insp. 155. Water ground 271. Roof framing 156. Rough electrical 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. Eqpt.bonding Sign Inspections Date Insp. 160. Service panel 280. Setback overhang 161. Final electric 77,Y /s T 281. Footing 282. Conduit/wiring Mechanical Ins.ections Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rough HVAC Miscellaneous Insp. Date I Insp. 183. Fire dampers 290. Fire alarm 184. Furnace compartment 291. Underground supply 185. Combustion air 292. Fire sprinklers 186. Smoke detectors 293. Monitor system 187. Metal F.P.rough 294. Hood dry chem. 188. Compressor setback 295. Final 189. Commercial hood 190. Duct shaft Sewers&Offsite Insp. Date Insp. 191. Final mechanical 300. Lateral(main to P/L) 301. Saddle/Y I. 1 . l I '. 1. • Ins.. 302. Cesspool filled 200. Footings 303. Sidewalk - 201. Steel/rebar 304, Driveway 202. Grout lift 305. Curb replacement 208. Final wall 306. Trash bin m f nEo oQ .m3E°' IHU! m` i o E= t III I ,ll E cmU m'- oQ5mrn, _ ,T_ x w _N of A L.• o m c N§L 8 2 8 m o Z m y c °n ooa 2 wNc_o 3Q- Q ti ao E N'� ° .--oa�Eto° f a°i oo 'O tO a m . - 5 '"tg tE 0 0"02 N _ Z �U HE o-N i m >.�bi° y c°mm E._u 2oa.-mo o 'tnmogg UmN E EU z' ws °.'' n o°'t ¢¢QO o °m°y mEa` _ a E°:�°y, tmi.NOE �V�'° t 2m °' Qa ° om c c : J3�p U 3,, ,,,-8-� a°oi °'oL c°c°imo°o.4m _NnE o. oiU m: 5 Op$ p .o N E y aua `-O7, »Fw _ ci _, F rna 2.2 acUm ,e !..E o t t =L n= E a° omm wZ ¢ / o. ' c°t E mHIh>. Z U n o tO L a u t U "c-? ¢moo a c d a 22Lr a� < N>mH1T! Ililfi r7Ot m �.cm w � 0° 6� d 22 mo-- E 2-4 ¢ °a� 3-8 ao V= I >, U° . °L°.gym_ �I! ra5o n 1 §-g n �UE.. ..oN \J ?� Y. 3,n m:m (5 P.9 Is t y mcoZ , I ,.... %Ty op .110....1'. 11.011,1 h 6fr(91,y6rxwii:et BUILDING & SAFETY DIVISION A I i W AD 240 West Huntington Drive Arcadia, California 91006-3104 nc�O\ATg'9'go ( 818 ) 574 - 5416 Page 1 of 1 500 S OLD RANCH RD 10/27/89 10:22 Permit No : A8905004 Autoproj No : AU003673 Status : APPROVED Validated by : CYN Inspector area: 205 This type : Miscellaneous Projects Applied : 10/27/89 Issued : 10/27/89 Parcel number : 5777-027-004 Finaled .• Group-occup/use: To Expire . Owner : GREEN Applicant : GREEN, ROBERT & JUDY Applicant Addr : 500 S OLD RANCH RD ARCADIA, CA 91007 Job Address : 500 S OLD RANCH RD Phone number : 818-447-2479 Class code . Valuation 1, 700 Construction : OTH Permit to do : SOLAR PANEL INSTALLATION FOR NEW POOL Fee description Units Fee/Unit Ext fee Data Enter Valuation Amount > 1700. 00 . 00 . 00 Enter Route Inspection Amount 3107> 61. 50 61. 50 *** Fees Required *** *** Fees Collected & Credits *** Receipt No. Date Payment 10/27/89 61. 50 Fees: 61. 50 Adjustments: . 00 Total Credits: . 00 Total Fees: 61. 50 Total Payments: 61. 50 Balance Due: . 00 \ J Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the Hazardous Materials Information Guide? ❑ YES ❑ NO Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? ❑ YES ❑ NO Will the intended use of the building by the applicant or future building occupant require a permit for construction or mod- ification from the South Coast Air Quality Management District (SCAQMD)? SEE PERMITTING CHECKLIST FOR GUIDELINES. Q YES ❑ NO I have read the Hazardous Material Information Guide and the SCAQMD Permitting Checklist. I understand my re- auirements under the Los Angeles Cnunty Coda Tltla 9 (Manta,- 9 9n cow+gin., 0 on Inn +►,.,,,,„t, n nn IAA - .�_ •T T. CIpZ any > ' g 700 3ca ❑0 4 0❑ O ❑ `^°`4A❑mEOk.❑__QOi 8m❑ n r ai❑ n ' 3 Pv,a^' o� n n � ��y n n3 3 m - ���- m4 � - m� m$ gg � m $- _ > �o = mxmii3. t. 4. m isIgq mp°cm ` $� 3 R ° wx� io.R -,3i.5� a-g Oi 1-414F �mv m, p;yZi8g4m n m 3m Roo @, '21 3 ? 0� o 2122 °73c71 oat4o$n�y�v g - s< mxQ4 .mod m, N -. p. ti me 3 3 > g o 3 m3-9-_, a-30 4$»o m m m - m T 0 1 g m R F v 8 g $ ' � q S o m o cD m v S g g P 3 n' a, bb.. Om 0= $Q°a S 5 ^ .-,- P1 n -3 o O_ n � -a�» �xm°-°.c $^ � 3 � .mJ.4m� c _ '° • zc;� MM o,$ zap' �m f� ° m o m �'�v°-_�`° d;: 3 m.im.`�»3_ w3 $il 3.°m g_3 m 3. y; n m > > 4 m p 3 O 3. y m o z m - A E . o g.j E R m o^ N i 4 m ° m n 5, n • RZQ Rn� g X01 §i, O3 ? 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Z co mom- • - i i - • - -• C_ r - - . , -. _ _ • Z 0 —4 m Cl) 6-jc . • •..11 03:11;1 ,,�� BUILDING & SAFETY DIVISION .� ,.ARCADIIA C J ri P L E ► L✓ 240 West Huntington Drive ,�\�jo� Arcadia, California 91006-3104 ORpoRATo', ( 818) 5 7 4 - 5 4 1 6 C Page 1 of 1 \ 500 S OLD RANCH RD 10/27/89 10:24 Permit No : A8905005 Autoproj No : AU003673 Status : APPROVED Validated by : CYN Inspector area: 205 This type : Plumbing Project Applied : 10/27/89 Issued : 10/27/89 Parcel number : 5777-027-004 Finaled . Group-occup/use: To Expire .• Owner : GREEN Applicant : GREEN, ROBERT & JUDY Applicant Addr : 500 S OLD RANCH RD ARCADIA, CA 91007 Job Address : 500 S OLD RANCH RD Phone number : 818-447-2479 Class code .• Valuation 0 Construction : OTH Permit to do : PLUMBING FOR SOLAR POOL INSTALLATION Fee description Units Fee/Unit Ext fee Data Original Permit Issue Fee (YES/NO) 27 . 55 Y Swim Pool Piping (Spas/Hot Tubs) > 1. 00 19 . 30 19 . 30 *** Fees Required *** *** Fees Collected & Credits *** Receipt No. Date Payment 10/27/89 46. 85 Fees: 46. 85 Adjustments: . 00 Total Credits: . 00 Total Fees: 46. 85 Total Payments: 46. 85 Balance Due: . 00 / Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the Hazardous Materials Information Guide? ❑ YES ❑ NO Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? ❑ YES ❑ NO Will the intended use of the building by the applicant or future building occupant require a permit for construction or mod- ification from the South Coast Air Quality Management District (SCAQMD)? 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ARCADI i 240 West Huntington Drive 1/� Arcadia, California 91006-3104 fhc°00RATE9-,0o ( 818) 574 - 5416 / Page 1 of 1 500 S OLD RANCH RD 09/28/89 10: 12 Permit No : A8904510 Autoproj No : AU003673 Status : APPROVED Validated by : CYN Inspector area: 205 This type : Pool/Spa Project Applied : 09/28/89 Issued : 09/28/89 Parcel number : 5777-027-004 Finaled • Group-occup/use: To Expire .• Owner : GREEN Applicant : CALIFORNIA POOLS Applicant Addr : 8806 E LAS TUNAS DR SAN GABRIEL, CA 91776 Job Address : 500 S OLD RANCH RD Phone number : 818-285-2261 Class code .• Valuation 16, 804 Construction : OTH Permit to do : POOL & SPA CONTRACTOR : CALIFORNIA POOLS & SPAS Lic. C 185102 818-285-2261 Assessor Book/Page > / Fee description Units Fee/Unit Ext fee Data Enter Perimeter Feet Pool/Spa > 102 . 00 . 00 . 00 Pool Fees 3104 242 . 55 Inhouse Plan Check (YES/NO) 3103> 121. 28 Y Electrical Wiring(YES/NO) 3105> 48 . 40 Y Piping(YES/NO) 3105> 19. 30 Y Heater(YES/NO) 3105> 29 . 10 Y P-Trap(YES/NO) 3105> 7 . 75 Y Issuance Fee 3104 55 . 10 *** Fees Required *** *** Fees Collected & Credits *** Receipt No. Date Paymcnt 09/28/89 523 . 48 Fees: 523 . 48 Adjustments: . 00 Total Credits: . 00 Total Fees: 523 . 48 Total Payments: 523 . 48 Balance Due: . 00 I • ., Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amounts specified on the Hazardous Materials Information Guide? ❑ YES ❑ NO Will the proposed building or modified facility be within 1000 feet of the outer boundary of a school? ❑ YES ❑ NO Will the intended use of the building by the applicant or future building occupant require a permit for construction or mod- ification from the South Coast Air Quality Management District (SCAQMD)? 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