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Field Daily Report
Project# Job Name: (14X f 724 r A4r 7,494fnr // 12� 5
Report Date: 5 7 ze,j
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Job Address: 209 �� o4CCr -4 V L� _ f-//�-Cw9t1g •
Inspector: /�/_ /��Fl l en,"A-9 e.�0 / Client:
License# Y blK i/Exp Date:l� 6/2-17 y Contractor: O 'h.?� '
License Required for Inspection: V- (-al • Contact at Site: 5-C-7-- rT 7 -4199z.
Permit# etY).41%063Turisdiction P paii I
Offsite? ❑Yes Zkit Offsite Location:
TYPE OF WORK: /,(,,check one) ❑ Reinforced Concrete 111 Prestressed Concrete ❑ Masonry ❑ Welding
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Description of Work:
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Inspector Name: 1. ) f4 C (70Y , Signature:
Approved by: Signature:
(Print Name)
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Certificate No. 20121023 — 220
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 December 26,2012.
Any Developer Fee Worksheet brought in on or after this date will be charged at the new rate.
Address of Development: 209 E. Laurel Ave. , Arcadia, CA 91006
Number of Buildings in Project: one Plan Check Number: 13-376
[ 1 [ 11 [ ] [ ]
Exempt' (500 sq. ft.or less. Residential2 Commercialllndustrial Commercial/Industrial
Future additions chargeable $3.20/sq.ft. $0.51/sq. ft. Parking Structure
at regular rate) $0.26/sq.ft.
Area in Sq. Ft.: A developer may request refund of fees to the
970 District within twelve months of payment of fees,
in the event the Building Permit expires or the
Developer Fee: $ project is canceled. The refund will be reduced_by
3 , 104. 00 a $100 administrative fee. The refund check will
Receipt No. [[� 1 [ 1 N/A be issued in the name of the original payee and
�X310269mailed to the address of payee.
Owner: Laxmi Raj Kammari Developer:
Address: 209 E. Laurel Ave Address:
Arcadia, CA 91006
Home Phone: 626-348-8539 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 Department of the
Development Services 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 provide ein is true and accurate to the best of his/her knowledge.
Signature of Applicant:
District Approval: 1/� t te 1 �L Date: 4/15/1 4
WHITE—Applicant YELLOW—Accounting Dept. PINK—Business Services Certificate of Compliance(10-23-12)