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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!
Inspectors office hours are: Verified by:
8:00-9:00 A.M.; 1:00- 1:30&4:30-5:00 P.M. S ature
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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
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�.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
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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-
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,,�� 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)? SEE PERMITTING CHECKLIST FOR
GUIDELINES.
❑ YES ❑ NO
I have read the Hazardous Material Information Guide and the SCAQMD Permitting Checklist. I understand my re-
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BUILDING & SAFETY DIVISION coM
41. 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)? SEE PERMITTING CHECKLIST FOR
GUIDELINES.
❑ YES ❑ NO
I have read the Hazardous Material Information Guide and the SCAQMD Permitting Checklist. I understand my re-
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