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BUt. ILDING AND SAFETY DIVISION BUILDING
Cityof Arcadia PERMIT
240 W. HUNTINGTON DR.,ARCADIA, CA 91006 •• TEL J(818)574-5416
�� 1
Bum ilding ;U.B.C, Type Occ.
Address C.j C...:3—Cr (Const. Group
Lot Block (Tract Occ. F.D.Appr. Date. H. D.Appr. Date
No. Load Required Required
Owner • "Use Zone Special Case No. . -
•
Mailing ,Homeowners Association Approval • Date
Address Lysq =ce
City
• a� Zip Tel. Lot
, • Size
Contractor Special • • .
Conditions
Address C ��as _ • _ NOTE: Include:
- 'VALUATION - Labor,Material, Plumbing, Etc. $
City Zip Tel. Misc. FEE
State Lic, - City i- 9Private •
&Classif, Lic.No. ,'• , Swimming Pool/Spa I I Public
Arch., Engr., _. Sign-Pole El Wall❑ .
Designer •
Address Tel. F Temporary❑ Projecting❑ .
City • • Zip State , -- Fee Based on Total Sq,Ft.
Lic.No.
Proposed S PLAN CHECKING FEE •
Construction ,F->i=ra,.j, eraa
S:M.I.R
TX' i -=-12 j et-[4 is-C_ - e
s Permit Fee
--1.' ,,,-; A/7/
Floor Main Accessory Total Processed by
Area TOTAL. /-I
New 0 Add.El Alter.❑ - Repair 0 Demolition El Permit No. Plan No. Date
LICENSED-CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ 1 hereby affirm that 1 am licensed under provisions of Chatter 9(commencing with Section
' El1 hereby affirm that I have a.certificate of consent to self-insure,or a certificate of
of Division 3.of the Business and Professions Code,and my license is in full force and Worker's Compensation Insurance,or a certified copy thereof:(Sec."3800,Labor Code.)
effect.
. Policy No.--__-- --Company .
❑
Copy is filed ❑Certified copy is Exp.Date
OWNER-BUILDER DECLARATION with the City. hereby furnished. - -I
ElI 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 sectionneed 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 .ElI certify that in the performance of the work for which this permit is issued,I shall not
. Section 70001.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:/f,after making this Certificate of Exemption you should become
dollars($500)." subject to the Workers'Compensation provisions of the Labor Code,you must forthwith
comply with each provisions or this permit shall be deemed revoked.
_ I,as owner of the property,or my employees with wages as their sole compensation,will CONSTRUCTION LENDING AGENCY
do the work,and the structure is not intended or offered for sale."Sec.7044,-Bof Property
s and •- I herebyaffirmthat there is a construction lending agency for the performance of the work
Z Professions Code:The Contractor's License Law does no;apply to an through owner
his
of property who for which this permit is issued.(Sec:30,97,Civil Code.) `
CP builds or improves thereon and who does such work himself orthroughhiown employees,
73 provided that such improvements are not intended or offered for sale.If, however, the .Name • -
fri building or improvement is sold within one year of completion,the owner-builder will have - '
Q the burden of provingthat he did not build or improve for the purpose of sale."- Lender's Address
—I ❑1,as owner of the property,am exclusively contracting with licensedcontractor to '
. 0 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
73 'Law does not apply to an owner of property who builds or improves thereon,and who con- agree to complywith 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 of this city to enter the above-mentioned`
0 property for inspection put •
-Q ❑ I am _, P.excempt under Sec._ — B.& C.for the
,� reason Signature of Applican .?.3/.i /.,� /-" Date_� ...qqq • -
-< - - Mailing Address
Date_____ Own /L/.l ��i'4 - - City,State,Zip
11 MANFAAIIM fiI" -,., • . . - - .-- 0
This is a building permit when properly fine. . , Signetl and validated, -
and is subject to expiration if work th -•• -der is suspended for 180 days. '11-02-87 1.CL7023 TOTAL` ' 0,.00 -
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4 it_szaezROBERT C. HARBICHT
r em.vauu 1 } ` L MAYOR PRO TEMPORE
tet',R
1�,' •';, M;;. • 1••7* ,i — ROGER CHANDLER
J ''�:;A7 ,ti 240 West Huntington Drive DENNIS A. LOJESKI
1.41 1 Arcadia, Califomia 9100.6.0060
, - �•:°•:v�� . -� � MARY YOUNG .
" �_l (818)574-5400 COUNCIL MEMBERS
GEORGE J.WATTS CHARLES E. GILB CHRISTINE VAN MAANEN
CITY MANAGER MAYOR CITY CLERK
•
Date Z3 OLTbFS g7
•
Re: • &1(i 5, SWM' AN►TA Ave.
The above mentioned property has been inspected and is
in need of (repairs/analysis by a structural engineer)
due to damages caused by the earthquakes on October 1st &
4th of this year.
Please contact the Building and Safety Department regarding
this matter, (818) 574-5416 .
DAMAGE OBSERVED FALLING HAZARDS
EXTERIOR WALLS STAIRS PARAPET WALLS
FRAME GLASS ORNAMENTATION
ROOF MECH. EQUIP. CHIMNEY/S
INTERIOR WALLS PLUMBING CEILING
PARTITIONS ELECT. EQUIP. ROOF STRUCTURE
FLOORS FALLING HAZARDS
. io`'x!'Z/ coocacre f3LOC4 WALL kT IQEARZ of kp/42TMG'NT5 t5 Rosa-F
AfE Fr=MU1lE WALL.
Yours truly,
R. H. Franta
Building Official
RHF/aln .
JVD/11-JVRCJJ
616 S. Santa Anita
NUMBER STREET
i& APPLICATION FOR A
PLUMBING PERMIT ,
BUILDING& SAFETY DIVISION
CITY OF ARCADIA,CALIFORNIA
OWNER TEL. N
Sharon Armstrong / ` 287-1711
MAILING ADDRESS /
-' 6615 N. Vista , San Gabrie ,91775
(.-.. CONTRACTOR STATE LIC.NO.
u G-E-M Plumbing 111308
- CL4}
MAILING ADDRESS T II 3N0.
' 43 N. Baldwin b�11 �tff
�I_ CITY TEL. NO.
Sierra Madre, Ca. 91024 355-349E
ni FEE COMPUTATION
tz)
I-3 BATHTUBS FLOOR DRAINS
f--"' SHOWERS REPLACEMENT SHOWER PANS
WATER CLOSETS URINALS
LAVATORIES CLOTHES WASHER
SINKS DRINKING FOUNTAINS
GARBAGE DISPOSALS DENTAL UNITS
DISHWASHERS LAUNDRY TUBS
TOTAL NO. OF ABOVE FIXTURES @ 1.75 1
4-.---
4-.--
WATER HEATERS AND/OR VENTS @ 2.00 200
L_' WATER SYSTEMS @ 2.00
tr .
GAS SYSTEMS 5 OUTLET ADD. OUTLET
@ 1.75 @ .50 EACH
LAWN SPRINKLER SYSTEMS @ 2.00
SAND TRAPS @ 10.00
CLARIFIERS Ca 10.00
•
GREASE TRAPS @ 10.00
WATER SOFTENERS @ 2.25
I
SWIMMING POOL "P"TRAP @ 2.00
SEWER CAP @ 3.00
CESSPOOL FILL @ 3.00
SEWER CONNECTION ON PROPERTY @ 10.00
I have carefully read and examined the above PERMIT FEE 2;00
application and know the same to be true and
correct. All provisions of Laws and Ordinances INVESTIGATION
covering this type of construction will be cow• FEE
plied with whether specified herein or not. No �y
person shall be employed in violation of the TOTAL FEE 4. 10
Labor Code of the State of California,
0.22w----e,:,,___„„......i4,,,..._e
SIGNATURE OF CONTRACTOR OR AUTHO ZED AGENT 0L
CONSTRUCTION PROHIBITED BETWEEN 7:00 P.M. AND 7:00 A.
AND ON SUNDAYS AND HOLIDAYS AS PER ORD. #13 _....00111
City of Arcadia
Building and Safety Divilocl
CERTIFICATION RE: WORKMAN'S COMPENSATION .
COVERAGE
Job Address 616 S. Santa Anita
Owner Sharon Armstrong
Contractor G-E-M Plumbing,Inc.
Permit #(s) : Job Valuation
Building Elec.
Sw. Pool Plmbg.
Htg/A.C. Other
I certify that in the performance of
the work for which this permit is issued
I shall not employ any person in any
manner so as to become subject to the
Workman' s Compensation laws of California.
I certify that as the applicant I am
licensed under the provisions of the Con-
tractors License Law and further that my
License # 111308 in Classification
C-36 is in full force and effect.
I certify that I am exempt from the
"License Required" provisions of the
Contractors License Law. (State basis of
exemption) :
I hereby acknowledge that I have read -
this certification and state that the
above is correct and agree to comply with
all City Ordinances and State Laws regu-
lating building.
I (We) agree to save, indemnify, defend
and keep harmless the City of Arcadia,
its City Council, Redevelopment Agency,
and their employees and agents against
liabilities, judgments, costs and expenses
which may in any way accrue against said
City in consequence of the granting of
this permit.
SIGNATURE i4ei40_,
Date .�JQ�P.• � /�f'
• Location 6/4- Z. SANTA ANITA A 1(E •
7-7-57 Sewer Permit No. 95g, Co. No.
Lot 3 Blk.4,bl� Tract S q 11 1v Ali in I Legend `�.,L ,
Owner I,Fj/ P p.5 W 1 I Length Date Insp.
Contractor 6 (:;', 0 o 14 S 8, . I i I g i -s'7 14,E
-
i
4j
'y-a.
y^P4. s- I 1
Pipe & Jointq\I C---•'P 1 ;"�._I .
itreet Location d' S
1 3G y, 4
ADDRESS t O. o &Tr VY1 1 Qp NNER O �Y•JS-�1.1.)-1±
l /D
STRUCTURE `1 F ?ts•�r C°al r is ort's CONTRACTOR euuol r IA�I r, 1,
DA PERMIT I INSPECTED REMARKS PLAN NO.it,�•
POWER..POLE I
FORMS .2.Z� L? �O-�_3 , , S /..LUL .t x.Gj^_(Yk.�9- -J G'•s5
-7' ,
RO. PLUMB. 329 8-7 I - Q---•r.I /�� //I/ / '"72.0_3 7�
1 ! JJ (1 Y' (✓'J 76)TO STREET/1./2- 7,
"GAS 3�.9 b /� j;Z. -Z�-•'7, �IN BLDG./2--/i-•"'
SEWER q..5-1 ID q-1?-5) W.C.
FURNACE 3ZC/`Q1 /2-43-6-7 DROUGH VENTq--/) )
RO. WIRE - bd C.-/2-T (S) f!
CURB _ -'A/s ' .!;/�I_/�- 4L& -
FRAME f-2-0 --5 7 /1
LATH / a I s• -S_ -/
ELEC. FIX. /6 Z-7 `�
. -7 ,/C l .
11l.U�•Q/!/1
PLUMB FIX. .� 77 /;L-- -5-1 V
ELECTRIC / I -S-cf) GAS //II - / //'-- I
SUB-CONTRACTORS _.,iG 7 rot
ADDRESS(0I6 Sp®. �!Alia VII •Iuc NER N 1 � J_
STRUCTURE I'L" Q ®� C� S ONTRACTOR,+�utl�I 11A �O hSFr Co.
^,P
DA -2 -SERMIT I INSPECTED _ REMARKS PLAN NO. I' .
POWER POLE fI I `� �
FORMS 221 CAff
6) Jjr i t!J -�6- 5-7 . 1/11/ 1fJ
!7 ('-2f- 7eg
RO. PLUMB. 0 n q--` e J 7 (5) G,VV, '1 O'dS7C)
GAS Z / IN BLDG. TO STREET
SEWER 1 W.C.
FURNACE Z ROUGH VENT
RO. WIRE Gt g 6
CURB
FRAME
LATH
ELEC. FIX. 94-e
PLUMB FIX. 2.907 p
ELECTRIC / J/7l I p -SY GAS
SUB-CONTRACTORS
ADDRESS (0l�Qn� �+0 eta\7Yt110WNER r ( 1� Ui 1A (�
DDASTRUCTURE 'LI�_ �'S• a‘C-. 13 . :Mb. 1\ u o 1 Y.Nn`�.`� `Ol
5-2q.�r7PERMIT INSPECTED REMARKS PLAN NO.L1l5�•
POWER POLE'
FORMS 2%1 7 �rrr---��. (/:�' +J�'-i- 7(C)) / p
RO. PLUMB. 3 Z�D / -/- _ 3-7 1% t.I.VV i L) - 7
GAS IN BLDG. TO STREET
SEWER W.C.
FURNACE ROUGH VENT
RO. WIRE
CURB
FRAME
LATH
ELEC. FIX. 94t`-'�-'
PLUMB FIX. 3z D �J /�Q
ELECTRIC / .S / I/p -5_0 GAS 9f-roP ' /-/e`J O
SUB-CONTRACTORS
ADDRESS(0(I V0.OI�.�vil-ai vtitAu OWNER 1 �v� `rs COSTRUCTURE '1 N_� `� S CONTRACTOR vU `
DDs--29-47 PERM IT � INSPECTED REMARKS PLAN NO.II,
POWER POLE
FORMS Z2.-(4.)Z t n— i 7 i' ) .l
+�J .y
RO. PLUMB. Z O q 3`-._0 l'�)7 cr.tA_• �r2.
` O ' 7
GAS '7.-, IN BLDG. TO STREET
SEWER W.C.
FURNACE _ 2. b ROUGH VENT
RO. WIRE . 1 (2
CURB
FRAME
LATH
ELEC. FIX. - .
PLUMB FIX. 3 2. 01
ELECTRIC // /7 /-d--'---5-r i GAS al / /c
SUB-CONTRACTORS
( (1 So. ..-fl� o, •I A1Th fiat WNER I O�P V 5 Aii itt
ADDRESS {FJ�y A fO (�
�� STRUCTURE l ,r� �a rho r CONTRACTOR c &u Yj `�0ASAr. `C
S-2, S PERMIT j INSPECTED REMARKS PLAN NO.11 t,
POWER POLE I )) -
FORMS Z.2..-1(02_ 4--13 -.5 7 `�CC)
RO. PLUMB. . O X7_5_", 7 (6) G]w. 4,-'2O—j"76)
GAS • 0 1 IN BLDG. TO STREET
SEWER W.C.
FURNACE 3.2.:eDry, ROUGH VENT
RO. WIRE " _.ge
CURB
FRAME
LATH
ELEC. FIX.
PLUMB FIX. 17_
j /'
ELECTRIC /6 /7 I /-s GAS 9/f1- //c�J/'
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SUB-CONTRACTORS
ADDRESS �(6{�JC^�•.�v!•1111.C� 111111- YJWAER �Q e. 5
�2STRUCTURE ! „- i- r S CONTRACTOR la ,l LR
PERMIT I INSPECTED REMARKS PLAN NO. IIIA
POWER POLE
FORMS W.
RO. PLUMB. 3Z. '(9 � 9-S' 6-
7 5) (7VV. 6-ao'J 7057
`
GAS az_C Q IN BLDG. TO STREET
SEWER W.C.
FURNACE � Q 7 ROUGH VENT
RO. WIRE '1 .pR`
CURB 1
FRAME
LATH
ELEC. FIX.
PLUMB FIX. Z
ELECTRIC j / (J GAS LJ-7/[r"--"
SUB-CONTRACTORS
ADDRESS
�� b so•"iYy��t3 s`��W^NNER lQQ�\+��{r�..(]� V.^J�1 61../�
STRUCTURE artICONTRACTORNetAau JIY�I4/� `oN$1Y'• �__g
DA S. '7 PERMIT I INSPECTED REMARKS PLAN NO.111S� •�
POWER POLE I Z ?- I �
FORMS Z1 - --// ,
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RO. PLUMB. - 3 1-J S 1•ryc5) C7Y , (. -°'5 ?(s---_,)
GAS 2llr IN BLDG. TO STREET
SEWER W.C.
FURNACE _ 2." 1 ROUGH VENT
RO. WIRE
CURB
FRAME
LATH
ELEC. FIX. f '
PLUMB FIX. 3/z9 d
ELECTRIC 6S// I GAS Ff`-- /-/e"'-•S c
SUB-CONTRACTORS
Mee I-e9PCODRESS OUO S�1 iG YL�Q1n_1�OIL�� MEER r. t.\rs
'1�tZ__CL
STRUCTURE I'eyth 93TRUTOR eu.wiv,th n .�
DA 6-_7Q.jPERMIT I INSPECTED REMARKS PLAN NO.1115(0®
'POWER POLE
FORMS 2..-2Z-1 42.
,RO. PLUMB. 3 29 Q 7
GAS l / IN BLDG. TO STREET
SEWER W.C.
FURNACE ROUGH VENT
RO. WIRE 4• p
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CURB
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LATH
ELEC. FIX.
PLUMB FIX. p v `
ELECTRIC /`- i /_ Q r GAS /
SUB-CONTRACTORS
r(0 5 /� ,
LOCATION X01(o' f!!). �O&AA. LA�Itab�,/ALUE � 3 0o0
1 U r, t B e_rit 4 -v-V-o•.NetS_ "1
LOT 3 BLOCK to g 112. TRACT Y.,
OWNER Y'S �-}-I_
BUILDING Yl l- i L< LI i r L [1111sf. -Z9^-M71 2.2.1 (=,
PLUMBING 7, _jc,,, 1_,,,, C30,_ Z F- 3Z.°`b -
„
HEATING -}.
SEWER C. :P. aon,ztr. - • s
WIRING S ` �SL_C ` i . • (-D'O
FIXTURES
ELECTRIC /(DIS/7 I- --s---2 GAS 7/ gg /--/O__Fs PLAN NO.111s9
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