HomeMy WebLinkAboutRoof-18-1872 (2) ` Development Services Department
t�h'I1 PERMIT NO. BOO-031-607
240 West Huntington Drive,Post Office Box 60021
Cityof Arcadia,CA 91066-6021 Permit Type: SF Add/Alt
Arcdia (626)574-5416,Fax (626)447-9173
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY P INT DATE PERMIT STATUS
18855 6/10/2009 CM 12:1 6/10/2009 Issued
PROJECT ADDRESS ASSESSORS PARCEL O. GEO CODE
1624 Watson Dr 5789-002-0 5
OWNER MAILING ADDRESS
Morales, Raymond T And Edna V 1624 WATSON Dr PHONE NO. Inspector#: JEFF
Arcadia,CA 91006 EMAIL ADDRESS:
Plan ChM: 09-73
APPLICANT MAILING ADDRESS
Edna Morales
Expi
581Ervo. Plan#: 29973
i. , }, School Dist#: 047
DDRESS:2t
CONTRACTOR/PROFESSIONAL MAILING ADORE }1 (s, r�•r �
Homeowner r �i - ENO. FAX NO.
EMAIL ADDRESS:
License No. Type: Expires:
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
SF ADD/ALT:ADD SECOND FLOOR;MASTER BED&BATH,MEDIA RM,2 WALK-IN CLOSETS,BALCONY,STAIRS TO NEW 2ND FLOOR,REMODEL
KITCHEN
Construction Type 110M Si of links Value Cooslruction Type UOAI #ofUoils Value
Air Conditioning Res sq fl 812.00 $3,280.48
Sprinkler System sq II 812.00 52,436.00
Type V Wood Frame Good sq 0 812.00 $93,786.00
Patio/Porch sq fl 46.00 S761.76
Remodel with Plum sq fl 165.00 $7,623.00
OCCUPANCY: Dwellings TOTAL VALUATION: $107,888.00
QTY UOM DESC AMT AMT PAID ACCT QTY IIOM DESC AMT AMT PAID ACCT
each Plan review 831.48 831.48 01-3103
each Energy p/c fee 255.84 255.84 01-3103
I Flat Bldg Issue Auto 40.25 40.25 01-3104
each Bldg permit 1,279.20 1,279.20 01-3104
I each SF/MF Fire Pkc 215.00 215.00 01-3109
812 fq-Il Park Rec SFR 08 2.31420 2.314.20 07-3509
SMIP Res 10.79 10.79 14-2207
fan bldg std 5.00 5.00 714-3117
1 Flat SWMF Auto 6.25 6.25 88-3027
'!,
Total Fees: $4,958.01 Total Amount Paid: $4,958.01 Paid Today: $3,655.69 4;
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt N: SSSti/
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 01-3104 1,319.45
180 days from the plan application date. This permit expires and becomes null and void if any work 07-3509 2,314.20
authorized by this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been 14-2207 10.79
verified by the City of Arcadia building inspector for a period of 180 consecutive days. 887 5.00
88--33002277 6,25
CALLS FOR INSPECTION INSPECTORS' OFFICE HOURS
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 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)
SFA•
or,
oar PERMIT/PLAN REVIEW APPLICATION
\ ;/ 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
LI 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 ,
U I have and will maintain workers'compensation insurance,as required by Section
I OWNER—BUILDER DECLARATION
/03700 of the Labor Code,for the performance of the work for which this permit is
1 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 Carrier
Code: Any city or county which requires a permit to construct, alter, improve,
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 (This section need not be completed if the permit is for one hundred dollars or less.)
provisions of the Contractors License Law(Chapter 9(commencing with Section
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.
U I, as owner othellproperty,the r my employees with wages as their sole 0Ii^� pp 7J
compensation,will do the work,and the structure is not intended or offered for Date O A titan[— (/
sale(Section 7044,Business and Professions Code:The Contractors License (,_.-.0 __j
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(I)year of I, 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
1, 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 pxt:mpt�uncle/Section 7044,Business and Professions Code,for this reason:
D hw1 0. Ir �� Lender's Name
Date (Q110)09 Gwn
k er v 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 E6-A Yerfoles Title O'/rY
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. (0110/09
� /�Q
rSi _ D
Signature-4414c 14c. 27 �a Date (7l J i O it l
L_
•
s.PiOEIPEAATfON.. A • " . ' 13J0uPERATION`". ,l NOTES •.
Hudiiingdns ikons I .gate I rinse. .d'lumbing inspections • •/ .Nate / nlnsp.
100. Sema • ��v .z- IkA In • B0b-03 6b
101. Rough grade "RIer undersiab01-14--0
102. Fl•s.8Isums g-44117 r • 't 611205$ t '�° , `
103. Pre•steb i ir w - 218. Rou.h'as '2-19-10 5.5MW t
104. Float Joists � 214. Shower an • 1!i1f • 2-24-ID .
106. Steel
106. Omuta •216. � cL`�5 hWV._
107. ShearnaiGm • r Yi176 EOM 217. Buildht! wer p ` .r 046
1DB. Dlaph nStingtO-2Dt� Water service '
109. Root nelinp 2-19-1D'
•110. Framing 4.284- q.
• 111. Doc Area Sep.Wal 221. Final ' '
112. Sound walls
113. Thar pdd • g
114. Insulation•fir... I��7 rt��-a'rio1 ddsped'nns• ' .1 d e Insp. +.
115. initiation•Walii , 6:jrtinel !1. 240. Excavation/steal Sc
116. insulation•Dells EISfl_ 241. Rou!h 'biobfn. ' , ;: 'IE
117. D II
118. Interbr lith 7-I cr• 243. Unde rood conduit • ..II 118. Erderior lath . 1 Y/- p�• y - r
120. Fhish rade i
�4 r `i
245. Gas ens&lest . . . •- .• : . ' . .
121. Final bulld'm 246. Fence, stes&si s
1M. Final derralol clear 247. Pool heater
n_
245. Final electric
`ns .. 1 248. Fatal Plumbln
150. POW Die r
151. Sales lot li hen 251. Pool final -
x 9lcrool Ins Sections' I Male 1 _ins..
1.54. LIFER round 270. Pre•remol htsp:
155; Water round . 271. Root Ireminq I
272. Sheathing nailing
157. Fixtures ' 273.. Final rereoi
.159. EgpL bonding Si. 'Ins,nations . Mate Insp. ` ` •
160. Service panel 280. Setback/overhang
161. Final electric 281. Fooling .
• 282. CondulVwfdn.
T.lecltanical Inspections 1 -male Insp. : 253. Dlscormegl
180. VenllngNWe 284. Final sign
181. Furnace A.C. �- . I •
:r Routh WAG All DDSS Qlliscelian „
co Insp. 8 lOate I gasp. 1
' 153. Fue dampers 220..fire alarm '
IBA. Fumace com gement 291. Underground supply •
IBS Combustion alr . 292. Fire sprinklers - •
1E6. Smoke delecims, • 293. Monlor system •
•
1W. Metal F.P.rou 284. Hood dry chem.
185. COM Tessin setback 295. Final •
189, Commersisi hood .
h Tve!vers Lateral
main
to . male' Rail' > .
191; Final mechanical . 300.
•Elolik37a110nspecttons I date. grasp. ' 302. Cesspool Oiled .
200. Footings303. Sidewalk
2D1. Sleellrebar 304. Driveway
202. Grout Ill . 305. Curb replacement • -
203. Forel Wall • 305. Trash bin '
vti4 .F R�jyi 4
v ;.
76i,
i
co
°li'tyOf." B MEMORANDUM
Fire Department
DATE: January 20, 2011
TO: BUILDING DEPARTMENT
ATTN:: INSPECTOR Jeff Wang
FROM: FIRE DEPARTMENT - �V)����,,,,,,Q
:Q, ‘.. r
SUBJECT: FIELD INSPECTION +1 �'t
do>
ADDRESS: 1624 Watson:Drive
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION NATE/INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 1-11-2011 Jill Perumean
FIRE ALARMS
TANKS
HOOD & DUCT
KNOX BOX
OCCUPANCY 1-11-2011 Jill Perumean
COMMENTS:
Emailed Bldg.Dept. 1-20-2011 re
-l' t Development Services Department
'' It PERMIT NO. B00-034-336
240 West Huntington Drive,Post Office Box 60021
City of Arcadia,CA 91066-6021 Permit Type: EMP Combo
Arcadia (626)574-5416,Fax(626) 447-9173
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
18855 3/29/2010 CM 15:43 3/29/2010 Issued
ADDRESS No. Dir.Prps Street Name Suet Suffix Project ASSESSORS PARCEL NO. GEO CODE
1624 Watson Dr 5789-002-005
OWNER MAILING ADDRESS
Raymond&Edna Morales 1624 Watson Drive PHONE NO. (626)445-3476
Arcadia,CA 91006 EMAIL ADDRESS: Inspector/4: JEFF
Plan Chk#:
APPLICANT MAILING ADDRESS Plan#: W/29973
Raymond&Edna Morales 1624 Watson Drive PHONE NO. (626)445-3476 School Dist#:
Arcadia,CA 91007 EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
^"'-'�\
Owner ` at'E NO. FAX NO.
R ' ADDRESS:
ii
License No. Type: Expires: �wYf7P5�ry^/tom\p1
TENANT MAILING ADD l`�
' PHONE NO. FAX NO.
DESCRIPTION
EMP FOR SF/ADD ALT(INCLUDES REROOF REMAINING PORTION OF RESIDENCE WITH 20 SQS OF 30-YEAR CLASS 'A' COMP OVER EXISTING
SHEATHING,RELOCATION OF SERVICE PANEL AND ADDITION OF TANKLESS WATER HEATER AT REAR OF GARAGE)
Construction Type UOM R of Units Value Construction Type UOM N of Units Value
Value Value 3,100.00 53,100.00
OCCUPANCY: Dwellings TOTAL VALUATION: $3,100.00
QTY UOM DESC MIT AMT PAID ACCT QTY UOM DESC MIT AMT PAID ACCT
1 flat Elec issue 42.25 42.25 01-3105
I Flat Mesh issue 42.25 42.25 01-3105
1 Flat Plmbg issuance 42.25 42.25 01-3105
1 each Bathtub 11.87 11.87 01-3105
I each Shower 11.87 11.87 01-3105
I each Water Closet 11.87 11.87 01-3105
2 each Lavatories 23.74 23.74 01-3105
I each 400+Res Ser 59.17 59.1701-3105
812 sq R New res elec 40.60 40.60 01-3105
1 Flat Add/Alter Ducts 8.93 8.93 01-3105
I each Wu htr/vent 14.81 14.81 01-3105
each Water Repipe 138.73 138.73 01-3105
1 Flat SWMF 2 1.00 1.00 88-3027
I Flat SWMF 2 1.00 1.00 88-3027
1 Flat SWMF2 1.00 1.00 88-3027
Total Fees: $451.34 Total Amount Paid: $451.34 Paid Today: $45134
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt a: 90819
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 01-3105 448.34
180 days from the plan application date. This permit expires and becomes null and void if any work 88-3027 3.00
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
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)
%c A.
4 J•LiOty 4:.•
El ;;. I' PERMIT/PLAN REVIEW APPLICATION
"z#�; ffice Box 60021
,a\ /.•
Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION 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
I hereby affirm under penalty of perjury that I am exempt from the Contractors - issued. My,workers'compensation insurance carrier and policy number are:
XL.
icense 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; ''
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 thei
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 IA t 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;ompl with those provisions.
0 1, as owner of the property, or my employees with wages as their soler/7ry�
compensation,will do the work,and the structure is not intended or offered for Date 3 2! / / .._c I • - "'
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 coverageisunlawful,
sale. If,however,the building or improvement is sold within one(I)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.
1, as owner of the property, am exclusively contracting with licensed
- -
X
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 them 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 p under Section 7044,Business and Professions Code,for this reason:
net'
� 7 ?net
�/� Lender's Name
Date 3 L-.7 Ill�Dwit r �Vj't!ti ? t4z etas' 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 Rim MoyoIes Title OV,/t(
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.
7. — n 312910
eater r4i /(��'�'" Date
't'•_ Development Services Department
:-' " B00-034-022
• 240 West Huntington Drive,Post Office Box 60021 PERMIT NO.
Arcadia,CA 91066-6021
City of Permit Type: Fire
Arcadia (626)574-5416,Fax(626)447-9173
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
18855 2242010 CM 12:03 2/24/2010 Issued
ADDRESS No. Dir.Prim Street Name Street Suffix Project ASSESSORS PARCEL NO. GEO CODE
1624 Watson Dr 5789-002-005
OWNER MAILING ADDRESS
Morales, Raymond 1624 Watson Drive PHONE NO.
Insneetor#: AFD
EMAIL ADDRESS:
Arcadia, CA 91006 Plan Chk#: 10-52
APPLICANT MAILING ADDRESS Plan/I: W/29973
Superior Fire Protection P.O. Box 93448 PHONE NO. (626)272-2902 School Distil:
City Of Indus '. •I .DE) DDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADO
Superior Fire Protection P.O. Box 9 ' tit; K' moi' "°,r No. (626)961-5896 FAX NO.
City Of lndu . ,fA'.' 7I EMAIL ADDRESS:
License No. 664427 Type: C16 Expires: 2/ /2011 12:00:
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION . /
SPRINKS FOR SF/ADD ALT"29 HEADS**
Construction Type UOIMI #of Units Value Construction Type UOM li of Units Value
Value l Value 2,500.00 $2,500.00
OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $2,500.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
29 each sprinkler pck 537.50 537.5001-3109
I Flat Fire Issue Auto 42.25 42.25 01-3112
each Fire Permit 120.35 120.35 01-3112
1 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $701.10 Total Amount Paid: $701.10 Paid Today: $163.60
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 90573
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 01-3112 162.60
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
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)
rA 'rtt' °1.1.
!e+ tlii,1 PERMIT/PLAN REVIEW APPLICATION
R r i. ` E.
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
O 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 y license is in full force and effect. A ❑ I have and will maintain a certificate of consent to self-insure for workers'
License ClassLicense No.�p.Date - fi compensation, as provided for by Section 3700 of the Labor Code, for the
,fre &op performance of the work for which this permit is issued.
Signature of Contractor _ d so- % •Jr- ,
❑ 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
O I 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 Carrier DariNea--
Code: Any city or county which requires a permit to construct, alter, improve,
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 a Labor Code, I shall
forthwith co ply wi9s 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 22( /e' 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 hundredthousand 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 AM)
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.
Namefri12/frt I-rO/ —71 " Title 7 '
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 abo tinned property for inspection purposes.
Signature Date _ 2'7:2C r'/d
Certificate No. 20081029- 047
ARCADIA UNIFIED SCHOOL DISTRICT
234 Campus Drive,Arcadia, CA 91007 • (626) 821-8300 Ext. 6732
(Certificate of Compliance with Fee Provisions of Government Code Section 65995)
This new Fee Schedule is effective October 29,2008.
Any Developer Fee Worksheet brought in on or after this date will be charged at the new rate.
Address of Development: 1624 Watson Drive, Arcadia, CA 91006
Number of Buildings in Project: One Plan Check Number: 09-73
[ ] Exempt' (500 Ex] [ 1 [ 1 [
sq. ft.or less. Future Residential2 Commercial/Ind2 Commercial/Ind2
Commercial/Ind:
additions chargeable $4.13/sq.ft. $0.47/sq. ft. Mini-Storage Parking
at regular rate.) $0.34/sq. ft. $0.24/sq.ft.
Area in Sq.Ft.: B 1 2 A developer may request refund of fees to the
District within twelve months of payment of fees,
in the event the Building Permit expires or the
Developer Fee: $ 3,353 56 project is canceled. The refund will be reduced by
a $100 administrative fee. The refund check will
Receipt No. [ 282918 1 1 N/A be issued in the name of the original payee and
mailed to the address of payee.
Owner: Raym o •d & Edna Morales Developer:
Address: 1624 Watson Drive Address:
Arcadia, CA 91006
Home Phone: ( 626) . 445-3476 Business Phone:
Pager/Cell Phone: Pager/Cell Phone:
'This is to certify that the above-described development has been determined to be exempt'from the developer fees
of Government Code Section 65995 and a Building Permit may be issued therefore.
2This is to certify that all fees due to the Arcadia Unified School District, under provision of Government Code
Section 65995, as a prerequisite to the issuance of a Building Permit by the Building and Safety Division of the
Planning Department, have been received. Based on the information presented above, this Certificate of
Compliance is hereby executed.
> The District charges a $100 fee to process reinstatement of the Developer Fee Certificate of Compliance
resulting from an "insufficient funds" check in addition to a $35 fee for the bounced check. Only cash or a
Cashier's Check will be accepted as payment thereafter.
•
> The District charges a $100 fee for any amendments to or cancellation of a Developer Fee Certificate of
Compliance issued on any type of development. Said request for refund of fees paid to the District must be
made within twelve months of payment of fees.
Applicant confirms that he/she is authorized to sign on behalf of the owner/developer and that
. the information he/she provided herein is true and accurate to the best of his/her knowledge.
Signature of Applican • i i ' y, �L� a Q2ai
District Approval: Date: 06/10/09
WHITE—Applicant YELLOW—Accounting Dept. PINK—Business Services Certificate of Compliance(10-29-05)