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HomeMy WebLinkAboutUntitled lad 401,2".. PERMIT INSPECTED. REMARKS . POWER /6 /- t //,,,Ace.- . ,x 11/5.I1 if n 66 (-7 > FORMS - )1q0 /�✓/ 7 ( e..(!„,.5,;,/ , /i-f, 4 i}/ L-L' RO. PLUMB. /g( 7 / lt!Pl1 g • Z�.,.e.1.:d� _s./ . GAS /�'?_ pp I I >3 i. ,,," •116,A)- W,6eii �+. • SEWER �YV • ZD� 7-/z/' - / 4 /I \ /1 'URNACE /cP/ 7 '— ii/ ' & -v l..S f"? /!,Lt<! r I/a,.. .,,r=,C. rG , I Ji��r ti , i v RO. WIRE /l.J O Ll. /J-- "g 6,5 / CURB /7 314 v--Ifyi'•l�q _� ,„/_ . FRAME I• //3 j �j 0/grie/ "/d LATH ;iii ,/Y '1q ELEC. FIX. /4 S v 741 y"/ J [,g j.. PLUMB FIX. / P-1II f �/ A ELECTRIC 7til 9 )1>•- "9. A-12-%9 GAS y(?. 6 I LOCATION lig' /,��.Q ((//ict.„. — &'ti ? ,VALUE $ 0000 LOT�‘,0' 0y 2 I25" BLOCK TRACT 13s-S GOWNE ( ' c re Q (,' BUILDING �p e ^(� 1//y y7/(- /f9(I 2_ PLUMBING CrOyeV F 0Q A,VL 307,1 /1/21/46 18167 HEATING 0/ L( cf LI /8 /49 CEP STICPOOL R R 0 f /4 CO 2VOG/L9 6 GPS- WIRING ESS �e/f I /2.`Z774 8 /45-8 Z FIXTURES •I I L I !(j SB Z 39 0 / ELECTRIC 2/ (1io09) 7/49 GAS 2//99/4,9( 4j 19.4 PLAN No. TION /12i ✓� ( i�` iet' 1` L VALUE $ LOT fr ( BLOCK TRACT ! 3 (J , V-- OWNER ! E..s C L. BUILDING i rp '✓6vI7-162--e--�� �, i j / C PLUMBING �/CO�r'�." �Dc•:ec! iv J'"�-�',�� �<,,,,,,& �Er e."^.„--- HEATING * -.41,-"G�GT 7- M-16.4eri) r, IG t----.1j" . . CESSEGOL- l////! 1, 1 vk. �• / 7-12 s r e� WIRING ~/'1.141-1i60e4j) "KGs-e-'4 2/ G/ c-,C; .-.c..a✓ FIXTURES VIP IP .. ELECTRIC GAS PLAN No. • LOCATION i 12 I S. 50-i-174 r' 0 40E LOTj ( BLOCK i • TRACT 1 O n7 6, • /DD OWNER :: . `-. , ICQp J 7 t,U1.1(�,,1. PERMIT NO. • ) INSPECTED r BY CONTRACTOR .. i s 1-i 6..0,, a 6 g ,/-T E, CONTRACTOR a. F 3 0 w u Jour 6 I g - z - '%� -4'L bc. LENGTH FT. • a . • • . I JOB ADDRESS ,, I rNUMBER� STREET / _ APPLICATION FOR A /ell • ,I,e. BUILDING PERMIT j Vv- BUILDING&SAFETY DIVISION ' CITY OF ARCADIA,CALIFORNIA . OWNER f f rah' ` G€0 ('JA/ (5rr6f E- 1 TEL.NO. MAIL / DR€SS54/k' „—i 4/v//,�>! : ARCH. .1D J (v �C TEL.NO. - ENGR. CONTRACTOR p t, ig /y ey' STIAiT----5I O)'jr MAILING - S,. (,> e� r CITY AC. 1 CITY w3 G' / /A/4 i'3 -4., A� !i CONSTRU TION TEL.NO. LENDER DESCRIPTION OF WORK• f' NEW❑ ADD'N[D' ALTER❑ REPAIR 0 DEMOLISH❑ FLOOR AREA - GARAGES OR y TOTAL til MAIN BLDG CARPORTS / Ai I AREA NO.OF NO.OF DWELLING STORIES UNITS i ( PRESENT BLDG.USE PROPOSED BLDG. USE, DESCRIBE WORK `kms .i /..,TO BE DONE .. � / 4 h J�"3j.�"4" a !—��� . E ERIOR WALL MATE IA-L ROOF FRAMING MATERIAL PARTITIONING MATERIAL kOOF COVERING MATERIAL NOTE:Include Labor,Mat., J� sj VALUATION Wiring,Plumb.,Heat,Etc. t�[1L/ 3t? `P LOT BLOCK ! `li NO. NO. TRACT LOT LOT DIST.FACE OF i' WIDTH DEPTH CURB TO P.L. FT. NOTE:PROVIDE PLOT PLAN ON BACK SIDE OF ORIGINAL COPY ONLY INFORMATION BY BLDG.SECTION .- ii USE . / FIRE OCCU- =. Ij ZONE / ZONE PANCY REQ'D FRONT RIGHT SIDE LEFT SIDE REAR O l SET BACKS Q i TYPE OF SPECIAL ...•••••••••••‘------ Z ii0 CONSTR. t.a CASE NO. O f • PLAN NO. CHECKER'S APPROVAL PLAN CK.FEE I have carefully read and examined the above application and ,,J�-3 find the same to be true and correct.All provisions of the Lows PERMIT FEE and Ordinances governing building construction will be complied 4 ,e /, ," with whether specified herein or not.No person shall be employed g.(-C• /t in violation of the Labor Code of the State of California. I agree S.M.I.P. not to occupy or allow occupancy of any building authorized by this permit until final building inspection s been receive 4 ...6 Cl' TOT L FEE 3. IGNATURE OF OWNER 0 THORIZED AGENT il CONSTRUCTION PROHIBITED BETWEEN 7:00 P.M.AND 7:00 A:M. AND ON SUNDAYS AND HOLIDAYS AS PER ORD.#1321.Ij I# 1C INSPECS.)NS I T E'M INS; CTOR DATE TRENCHES:WIDTH DEPTH Mt C?'_29 1st FLOOR JOIST FRAMING LATH FINAL PARTIAL OR MISC.INSPECTIONS UNSUCCESSFUL TRIPS ITEM INSP. DATE ITEM INSP. DATE SET BACKS • FRONT R.SIDE L.SIDE REAR INSP. DATE FIELD CHECKS TO APPLICANT:PLEASE DO NOT WRITE ABOVE THIS LINE PLOT / JVD nvv,.u., I UMBER STREET APPLICATION FOR A BUILDING PERMIT BUILDING & SAFETY DIVISION CITY OF ARCADIA, CALIFORNIA O N R i 4f �,t TEL.NO. 3: MAILING ADDRESS . �, 3^ ARCH. TEL.NO. , ENGR. CONTRACTOR STATE LIC.NO. MAILING ADDRESS CITY LIC.NO. CITY TEL.NO. I-' DESCRIPTION016 WORK H NEW 0 ADD'N 0 ALTER '' REPAIR 0 DEMOLISH 0 © FLOOR AREA NO.OF NO.OF DWELLING (SQ.FT.) STORIES UNITS Ui PRESENT BLDG.USE PROPOSED BLDG.USE DESCRIBE WORK �? TO BE DON �' �, to rn ,..0 NOTE: PRO OT PLAN ON BACK SIDE OF ORIGINAL COPY ONLY rxi U EXTERIOR WALL MATER! ROOF FRAMING MATERIAL . PARTITIONING MATERIA ROOF COVERING MATERIAL LOTAmb NO.OF EXISTING WIDTHH BLOGS.ON LOT19 JUI VALE: Include Labor, Mat., - � ✓ Plumb., Heat, Etc. 6� O LOT BLOCK 0 NO. N TRACT ,p INFORMATION P IND BY BLDG. SECTION an an { USE FIRE O U• SEC. - ZONE ZONE .54- Y SH. 777 co REQ'D FRONT RIGHT SID FT SIDE REAR Ce SET 0 BACKS u TYPE OF SPECIAL ce CONSTR. _CASE NO. GRADE Z 0 Approval&Information by Others u CITY ENGINEER EASEMENT DIST.FACE OF SEWER DRIVE CURB TO P. L. FT. AVAILABLE OVER PUBLIC SERVICE PLANNING PLAN CK.FEE WATER ELECTRIC PERMIT FEE PLAN NO. CHECKER'S APPROVAL I have carefully read and examined the above application and find the same to be true and correct.All provisions of the Laws and Ordinances �T^OTAL FEE governing building construction will be complied with whether speci- fied herein or not. No person shall be employed in violation of the Labor OD Code of the State of California.I agree not to occupy or allow occupancy of any building authorized by this permit until ficral building Inspection has been received yi e 1//,. :-/ ( 72C SIGNATUR,EA OWNER OR AUTHORIZED AGENT CONSTRUCTION PROHIBITED BETWEEN 7:00 P.M. AND 7:00 A.M. iNSPECTON RECORD BAW.1 INSPECTIONS - , .. ...., I T f.,'M INFr,'!„..0R ! , TRENCHES WIDTH ., DEPF,H i . . - . , I. FLOOR )olsr i . _ . . FRAMING . ... . . i LATH I _ . . . . ... . . FINAL. - • , . . .. PARTIAL OR MISC. INSPECT IONS . ... . i • - - i 1 . r •• , . 1 1 . ,..; ! 1 - 1.. . 1 I . I , ; . . . . 1 . . . .. . . .. 1 1 1 , . . . .._. UNSUCCESSFUL Trups M i 0,',P. 1 DA1E 1 f 7 .1:M I ;r•&Si.', ; DAY..i I i 1 1 . - ! . i . . „ , I I ' I I • 1 , , 1 . i SET EAcK.E ,,Rk--_,-NI , R. SIDE f ; sTE ! PEAR 7 !NSP. i =.',`AT:', 1: i 1 i i FIELD CHECK z ' I I TO APPL ICAN1': PLEASE CP".",t Nrr. ',61-::7F., ,?;.“:YvE iF.PS UNE • PLOT r-7-7-7—r---i--. . . i .--', 1 - y--- .---"1.---r" 1--"1 , i • 1 • 1 • 1 • .1 !, 1 . • ! I , I t 1. ....., .1, ...1. I 1 i • 1 . • 1, i I - i f I ..1 :,, ...: I i 1 I I 1 i I : • i I i ' 1 • I 1 I - I 1 i I ! t 1 l * _ I J i . I I I I I - I 4 , 1 1 I I - -- _i.. i • i 1 i i 1 . • i i / • t + — I i I Address / 5,, , . . . _ •,• . 1 .........._....... ._ ... . ..,.. . . , 1 ir I ' k I .• I . 1 , - , 1 , . I ,/- , (-•, " . .,/ // i ... . r)- i ? "—•,' ./. l' c-.....;. .•;- — / .....'- ,, I '') 'I,I 1' . I • ., _ 11 . , t . I - -• .-,.....--.---............-- --- ----, ' ,I. t • '.... - - - ' : .,: C.: *IL - .."....), ' / •-•',. t .''''- 1 ' I . '1 • •1',A /,I Li ) )". -.., \. .4 /i 1 „ • ' ' / . , ,• . 3 .,.. . • Y , _ . . 1 i,, ,.... -'-f- , . ....._ r •...• ' ... •, ' i . ,....,.., , . ,,, ., , ........ . l'• ;.‘• , .,..; . ..1 ,. i. . I ....:•' , , \ ;-: •.• , ,,,•-, \ 1 I *. I A<"' 1-r/7/ -->`i r --: • _ 1 i r .1) 6," — :I, — .,'63 F75,w-----;.),'..;1 ,;:: ---'>114i ; / V' I '.,..- •,.11.. .it / „/ '1 '', ,",' ' % 1 „.1. H i , 0 ri y y . it 1.-.,,,, r- BUILDING AND SAFETY DIVISION BUILDING = City of Arcadia ���M�T 240 W HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 . .. , 1 Building /� ,,", Address / ,' Glee//i // // Edition 6 I CU.B.C. onst. G o p Lot Block Tract Occ. F. D.Appr. Date H. D.Appr. Date No. . Load'-, Required Required Owner fe /�/ Use Zone Special Case No. Addres z;f, 3----- C X77, z #e, ".. Use Homeowners Association Approval Date lU City �� ,�i/ Zi / 9 TeW�622 ` Lot U; Size Ul Contractor ,� Special t �-1 Conditions CI; Address NOTE: Include: G� ��� �`�%/� /�f/% VALUATION Labor,Material, Plumbing, Etc. $ 5r6 k'�—" P1Ci Zi Tel Mise. FEE fe.zlr///�Fs t /OAC .. „,,,-,772 7,..:„, i'.i State Lic. City ❑Pvate Classif. Lic, No. Swimming Pool I Spa 1-1 Public Arch., Engr., _4 A Sign-Pole❑ Wall ❑ . ,.:,,,jDesigner ' Address Tel. Temporary❑ Projecting El Zip State E Fee Based on Total Sq.Ft. Lic. No. 1:11. . Proposed PLAN CHECKING FEE Construction�¢/�� 7C0 X/,‹7-9- �0-` S.M.LP. N.) 4-2e / ,...9.O0 /341 7-// OD Permit Fee 44 76- tp- Floor / Main Accessory Total Processed by ,�� 1 Area fc, , lel, TOTAL g/71 4 6— New ID Add Alter.p Rep.' I=1Demolition❑ Permit No. Plan No. -Date // ICENSED CONTRACTORS DE ARATION WORKERS'COMPENSATION DECLARATION S ., herf eby affirm t�at l a licensed under pro is ..f Chaptei 9(comma 1hg with Section III hereby affirm that I have a certificate of consent to self-insure,or a certificate of t II)of Division 3 •f ere : siness P. `' Code,a my license fin full force and of• /' Worker's Compensation Insurance,or a certified copy thereof.(Sec.'3800,Labor Code..) _. :. •, e-�' J Policy No._— Company OWNER-BUILDE' DECLARATION 1'—f Copyithisfiled Certified copy is Exp.Date j_J with the City. hereby furnished. r . I here•,affirm that I am exempt fro e Contractor's License Law for the following CERTIFICATE OF EXEMPTION FROM fl reason:"Sec.7031.5.Business and Professions Codes.Any city or county which requires a WORKERS'COMPENSATION INSURANCE permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance (This section need not be completed if the permit is for one hundred dollars($100)or less.) also requires the applicant for such permit to file a signed statement that he is licensed I certifythat in theperformance of the work for which this permit is issued,I shall not pursuant to the provisions of the Contractor's License Law,Chapter 9(commencing with ❑ 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 therefr. ,.nd the basis for the alleged exemption.Any violation of Section 7031.5 by any of California. ap.lt ' i.r 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 do 1.. (:. t0)." subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with each provisions or this permit shall be deemed revoked. oI,as owner of the property,or my employees with wages as their sole compensation,will CONSTRUCTION LENDING AGENCY 'o the work,and the structure is not intended or offered for sale."Sec.7044,Business and I hereby affirm that there is a construction lendin agency for theperformance of the work Professions Code:The Contractor's License Law does nos apply to an owner of property who g g y P for which this permit is issued.(Sec.3097,Civil Code.) builds or improves thereon and w(io does such work himself or through his own employees, provided t at such improvements are not intended or offered for sale.If, however, the Lender's Name buildi : . ' provement is sold within one year of completion,the owner-builder will have the•u ''.. ...roving that he did not build or improve for the purpose of sale." W s. Lender's Address LI ,as owner of the property, am exclusively contracting with licensed contractor to I certifythat I have read this application and state that the above information is correct.I cons ructtheproject.'"Sec.7044,Business and Professions Code:The Contractor's License pp Law does no a ply 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 o R3;. �ojects with a conrractor(sJTtce :d ursuartt to the Contractor's License Law." construction,and hereby authorize representatives of this city to enter the above-mentioned Pproperty for inspection purposes. Ei.'a.`cempt under Sec '7 B.& .C.for the reason Signature of Applicant- Date Mailing Address Date — Owner "' 60 a�.�.I� Z ' City,State,Zip -- 1, INSPECTOR COPY This is a building permit_ iperly 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- backs, Forms,Reinf.Steel, Excavation % �� FLOOR atzleS., STS.,ans GIRDERS:V Mesh, VapLmbr. . � _ • Barrier,Blkg.,Spans,Access,Vents,Tr.Lmb i/// 7„z 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, �i • • Nailing,Backing, Diaphr. Draft Stops. /� 3 i � • •• INSULATION: Thickness, R-Values, Piping, - Sound Caulking. �J Ohl, • 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. f 112....'O Qd.,zi FINAL INSPECTION: Finish Grading Certif., Slope Plant., Energy Compl. Card Posted, Pkg. Access, Fire Doors, Exit, Locking De- vices, Landings, House Numbers, Weather Stripping, PI./Engr.Clear. 9/1"* v``e J / 0/ SWIMMING POOL/SPA j J 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 I - INSP.SIGN. I 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 Address �,y�j 57 5if/%j / �' Services �5 OwnerG� / C/ /j t / (Size' ��'� 61‘11:".. 11y�/'�, ) -."------ It ' t -1(-315/ // �I �j' Outlets y Mailing ter— �e- - • i- (Receptacles, Lights, Switches) • Arrdr City/�¢j!�1 / 7-/,‘"e N Fixtures J 47e./7 /� C Tel �// ( Motors '� Contractor / L+ (HP each: ) NJ 4 Other Address V i U (Specify: ) tlr Sq.Ft. Area New EU City Zip Tel. V Residential Bldg. 0\ W Sq.Ft. Area New State Lic. City J C!5 a Classif. Res. Accessory Bldg. Lic. No. . W "t7 LICENSED CONTRACTOR'S DECLARATION Misc. • ('L • I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section I i i-t)of Division 3 of the Business and Professions Code,and my license is in full force and Pool ELECTRICAL FEE •.— - I-1 effect. Wiring cit OWNER-BUILDER DECLARATION No. Description No. Description Fee O frl I hereby affirm that I am exempt from the Contractor's License Law for the following FAU to Ond includ. Boiler/Compressor r' 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 1— 100,000 BTU over 3HP to 15 HP Section 7000)of Division 3 of the Business and Professions Code, or that he is exempt Cr) therefrom,and the basis for the alleged exemption.Any violation of Section 7031.5 by any Flr./Wall/Susp./Pool Air Handler to and applicant for a permit,subjects the applicant to a civil penalty of not more than five hundred U) dollars($500)." Heaters includ. 10,000 cfm U'� ❑ I,as owner of the property,or my employees with wages as their sole compensation,will QJ Spray Booth/ Air Handler do the work,and the structure is not intended or offered for sale."Sec.7044,Business and U Exhaust Hood over 10,000 cfm • C) Professions Code:The Contractor's License Law does not apply to an owner of property who Vent. Fan Other: �. builds or improves thereon and ivho does such work himself or through his own employees, • 0 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 5,;.• the burden of proving that he did not build or improve for the purpose of sale." = Misc. 1 ❑ 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 Law.does not apply to an owner of property who builds or improves thereon,and wh n- MECHANICAL FEE tracts for such projects with a contractor(s)licensed pursuant to the Contractor's License-Lal ' E 1 am excempt under Sec._-- &P.C.for the reason No. Description No. Description Fee ,/ Bathtubs Water Heaters Date_____ �wnrr ��""'- ✓4 - .e.-4,-(4 .W Showers Garbage Disposals WORKERS'COMPEN ICON DECLARATION N Water Closets Laundry Trays ❑ I hereby affirm that I have a cert' tate of consent to self-insure,o a certificate of Worker's Compensation Insurance,or a certified copy thereof.(Sec. 0,Labor Code.) )'• Lavatories Clothes Washers Policy No._______________Company I—I Copy is filed Q Certified copy is Exp.Date CD Kitchen Sinks Sewer Connections L_J with the City, hereby furnished. Z CERTIFICATE OF EXEMPTION FROM m Dishwashers Sewer Cap WORKERS'COMPENSATION INSURANCE Shower Pan Gas System (This section need not be completed if the permit is for one hundred dollars($100)or less.) = Replacement (No.Outlets: ) 4'• 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 CLPioina Installation of California. Misc. NOTICE TO APPLICANT:If,after making this Certificate of Exemption you should become (PLUMBING FEE 1 subject to the Workers' Compensation provisions of the Labor Code,you must forthwith comply with each provisioas.o•_ us permit shall be deemed a- '.ked. I certify that I have read this a plication and state thatihe..ove information is correct.I ELEC. MECH. PLB G. ISSUANCE FEES agree to comp) 'with all city a d county ordinances an. tate laws relating to building t t tO r•.�.. construction, d hereby author - epresentat' tit.-c' • neer the above-mentioned property for'nspection put.,:es. Signature of /'�_. f I . _ )ate '' •e7 7- TOTAL FEES Mailing Address+•. r AV _ -Ji,L__ �.<!f.'"� ��/jam /`J} y. Zip _ ./ iw •-1.G/` • By cessed e Date 1�I i l 4 /J Cit State, . INSPECTOR COPY This is an electrical meth ni al _ permit when properly filled out,signed and validated, and is s elect expiration if work thereunder is suspended for 120 days. INSPECTION RECO! - -__ISPECTOR NOTES UNDERGROUND CONDUIT " ROUGH WIRING , �� NEW SERVICE fa FIXTURES ' xl FINAL ELEC. INSP. �� A2 4M P TEMP. POWER POLE OTHER OTHER ELEC. UTILITY CLRNCE. ) 4Y4f4i (i U. G. DUCTS/REFRIG. LINES RO. MECH, Ducts, Comb. Air, Supports, Vents I FINAL-MECH. FAU/AC Vents, Shutoffs • OTHER r• t OTHER U.G./UNDER FLR. Soil, ater, Gas, Supports Water, Gas, Vents, RO. PLMBG. Supports,.Flashings GAS TEST SEWER/PRIV. DISP. SYSTEM DIAGRAM' 'w FINALPLMBG. Fixtures, Valves, Ir. Services C WATER HTR. Vent, Valves, R$3 Press. Rel. Valve Z SEWER/PRIV. DISP. SYSTEM OTHER OTHER GAS UTILITY CLRNCE. - BONDING �, U.G. CONDUIT GAS PIPING Material, Depth ®; - GAS TEST ® HEATER Vent, Clearance, t f Location, Shut-off V. FINAL POOL ELEC. FINAL POOL PLMBG. - J 1 - ' OTHER INSPECTION INSP. SIGN. B) !LDJNG AND SAFETY DIVISION City` ofArcadia �IIISCELLAN -SUS AND OFFS= TE 40 W. HUNTINGTON DR., ARCADIA, CA 91006 • TEL. (213) 446-4471 PERMIT • I .I . 1 ti Addie t// / �L.le I mo./ MISCELLANEOUS FEE `REC I. �j Owner —�61 j� 101 ;• PLAN CHECK FEE FOR VAL. < J `7 /1 C(.:;2:# • V 1 Moilin - / Addressg �/ 5:/�f, 0/ :171 ❑ CASH BOND FOR • K) City e /f // Z �j/l�/ Te /�/�/Z 2 6/ ❑ GRADING PLAN CHECK Corr octor�[/�/ _ /�/�� ❑ GRADING PERMIT `t7 �J�//G✓ HOUSE MOVING i._1 Address 0 1"3 0 PARKS AND RECREATION FEE City Zip Tel. G ❑ ROUTE INSPECTION FEE -0 State Lic. City 8 Clossif, Lit. No. El r� LICENSED CONTRACTOR'S DECLARATION 1 I I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section El"Cit(!)of Division 3 of the Business and Professions Code,and my license is in full force and l i ,yl ! effect. El x. -.I 1 4 (--, OWNER-BUILDER DECLARATION 1I rC ~ 0 I hereby affirm that I am exempt from the Contractor's License Law for the following TOTAL FEE reason:"Ser.7031.5.Business and Professions Codes.Ani city or county which requires a I-WARNING t PLAN CHECK FEES. WHERE NO ACTION IS TAKEN BY THE pet ma to construct,alter.improve,demolish,or repair any structure,prior to its issuance APPLICANT IN'180 DAYS AND NO BUILDING PERMIT IS ISSUED,IFEES ARE ,.xy-' olio requires the applicant for such permit to file a signed statement that he is licensed FORFEITED TO-THE CITY, pursuant to the provisions of the Contractor's License Lou'.Chapter 9(commencing with 9.- Serum 7000)of Division 3 of the Business and Professions Code, or that he is exempt threc/rcov.and the basis for the alleged exemption.Any violation of Section 7031.5 by any SEWER PERMIT 1 applicant for a permit,subjects the applicant too civil penalty of not more than five hundred PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTIONS AT dollars 03001." PI.as owner of the property,or my employees with wages as their sole compensation,will u the work,and the structure is not intended or offered for sale."Sec.7044.Business and Professions Code:The Contractor's License Low does not apply to on owner of property who LOT BLOCK TRACT hutlds or:infirm es there on and who does such work himself or through his own employees. prortd.d that such improvements are not intended or offered for sale. If, however, the LOCATION LATERAL building or improvement is sold within one year ojrlontpletion,the owner-builder will have SADDLE the burden of proving that he did not build or improve for the purpose of sole." 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 Lao does not apply to an owner of propery who builds or improves thereon,and who con- runts for such projects with a contractorls)licensed pursuant to the Contractor's Lk nse Low." INSPECTED )9B $ TOTAL 0 I urn excempt under Sec.____ __ ___,B.& P.C.for the/reason BY B1' ti' or • Date /! / _ • , -r4' CURB AND SIDEWALK WORKERS'COMy NSATION DECLTRAT ! CURB BREAK REPLACE CURB FT. ❑ I hereby affirm that I have crtificate of consent to se f-insure, or a certificate of Worker's Compensation Insurance,or a certified copy thereof.(Ser.3800,Labor Code.) - Company DRIVEWAY APPROACH SIDEWALK FT. rI Copy is filed Certified copy is Exp.Date 1J with the City. hereby furnished. INSPECTED TOTAL FEE CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE STREET CUT (This section need not be completed if the permit is for one hundred dollars(5100)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 V.orkers'Compensation Law a /SO.FT, of California. 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 I certify that I have read this application and state that the above information is correct.I RECEIVED FROM STREET DEPT. agree to comply with all city and county ordinances and state laws relating to building INSPECTION FEE construction,and hereby authorize representatives of this city to enter the above-mentioned property for inspection purposes. INSPECTED 198 BY Signature of Applicant Date PERMIT FEE Mailing Address TOTAL FEES `City.State.Zip • INSPECTOR COPY This is a miscellaneous and off—site peri nproperly filled out,signed and validated,and is subject'to expiration if work thereunder is suspended for.A20 days. CITY COUNCIL O D.PELLEGRINO 0 v� 9,,,sz,e,4, DONALD MAYOR CHARLES E.GILB (' } MAYOR PRO TEMPORE ARCADIA 240 WEST HUNTINGTON DRIVE JEFFREY A. DRING r 9. RICHARD A.HALTOM RpaRATE. ARCADIA, CALIFORNIA 91006 JACx sAELro (213) 446-4471 • 681-0276 LYLE W.ALBERG CHRISTINE VAN MAANEN CITY MANAGER CITY CLERK Dear Property Owner: An application for a building permit has been submitted in your name listing your- self as the builder of the property improvements specified. For your protection you should be aware that as "owner-builder" you are the respon- sible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect your- - self from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the city or county. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection. If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200 or more for the entire pro- ject, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the state and federal government as an employer and you are subject to several obligations including state and federal income tax withholding, federal social security taxes, workers' compensation insur- ance, disability insurance costs, and unemployment compensation contributions. There may be financialrisks for you if you do not carry out these obligations, and these risks are especially serious with respect to workers' compensation insurance. 110 For more specific information about your obligations under federal law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Administration) . For more specific information about your obligations under state law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed con- tractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "owner-builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors State License Board in your community or 'at 1020 N Street, Sacramento, California 95814. Please complete and return the enclosed owner-builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF ARCADIA BUILDING DEPARTMENT 110 Attention Property Owner: An "owner-builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement (yes or no) �;�5 2. I (have/have not) /74/7i-, signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed con- struction: Name • Address \� City Phone Contractors License No. 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise and provide the major work: Name Address City 411 Phone Contractors License No. 5. I will provide some of the work but I have contracted (hired) the following per- _ sons to provide the work indicated:_ Name Address Phone Type•of Work Signed: �7- �j -- - '� • Property Owner //� ? -1y/ .7- -Z-e---11.c- Social C-c/r /,1 . Social Security C �mber„� Cx� e•-/eC) Date