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HomeMy WebLinkAboutNew ADU 312 Sharon Rd City of Arcadia, CA PermitNO $New-18;-0417
f Development Services Department f'-"� '„`y w'�• � [' Permit Type:Single Family New-
240 West Huntington Drive,Post Office Box 60021 ' i e�1�rVc J Worlr Classification ;Accessory Dwelling,
Arcadia,CA 91066-6021 .1 J sem)
(6x6)574-5416 - - -
Permit Status Issued
ARCADIA - IssueDate:05/29/2018: Expiration: 11/25/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number I312 Sharon RD Arcadia,CA 5785007014
Contacts
KAI CHANG KYI AND ZHANG,XIAO H Owner R E T CONSTRUCTION CORP General Contractor(B)
310 SHARON RD 8035 LIN WALT ST,ROSEMEAD,CA 91770
(626)679-4013 KT5788@GMAIL.COM
Description:NEW ADU:1 BED,OFFICE,LIVING RM,KITCHEN,2 Valuation: 5 104.773.05 Tenant
BATHS,LAUNDRY RM.
Total sq Feet: 795.00 Plan Check#18-417 Plan#32522
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $6,728.02
Building Permit Fees $1,258.50 Cash/Receipt p REC-001269-2018 $5,576.48
Building Plan Review Fee $818.03 Cash/Receipt tr REC-000661-2018 $1,151.54
Cal Green Plan Check $81.81
Amount Due: $0.00
Energy Plan Review Fee $251.70
Green Building Standard $5.00
Parks&Recreation Fee(SFR) $2,265.75 -
Single Family/Condo/Townhome Impact $1,983.00
Fee
Solid Waste Management Fee $6.25
Strong Motion Inst.Program Res $13.63 CALLS FOR INSPECTIONS
Total: $6,728.02 Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
tis'231
I This permit/plan review expires by time limitation and becomes null and
P
4L 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
itrifrom 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 orif no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
Q
May 29, 2018
Is ued B . Date
May 29,2018 Page 1 of 1
. y
Si" PERMIT/PLAN REVIEW APPLICATION
Mtn' ie. ,..� rlia ':
ittt*H441Thw 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
ilLICENSED 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. 'Vt9. to Date/d�3�/;� compensation, as provided for by Section 3700 of the Labor Code, for the
1 performance of the work for which this permit is issued.
Signature of Contrac • �l
OWNER-BUILDER D ! - 'I•TION L:i I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penal of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions . is issued.My work�e i,corn• nation ------
demolish,
ation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, I]Cartier if _
demolish,or repair any structure,prior to its issuance,also required the applicant .r
Policy Nu ,:.-.
for such permit to file a signed statement that he or she is licensed pursuant to the •i
provision of the Contractors License Law(Chapter 9(commencing with Section , �('fhis section need not be - eted 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
exempt there from and the basis for the alleged exemption. Any violation of 4❑I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil I , knot employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
11. workers'compensation provisions of Section 3700 of the Labor Code,I shall
0 I, as owner of the property, ifor hwith mply with those provisions.
or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for t
r.
sale(Section 7044,Business and Professions Code:The Contractors License ` Dare C Sign.
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 penalties 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
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
-
contractors to construct the project(Section 7044, Business and Profession CONSTRUCTION LENDING AGENCY
Code:The Contractors License Law does not apply to an owner of property
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 Signature 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
•i)°` of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
Vfurther information.
Name 4'/yule r`? a/A6 Title t ,a C.
/' 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 duly authorized agent of the owner.
1
i I':agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
,i Arcadia to enter upon the above-mentioned . pection purposes.
:.Srgn. Date
5/2-eM
. . . 31t S/1,42o- i I- ui A,D.U',
, NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under fir/bldg.drain -26-(8 ' // ll
101. Rough grade 2(0 � (. 211. Copper underslab 39�9 C�'A S Rvtca e 4P,lr,
102. Figs.&forms CV 312. Rough plumbing jZ-2 -''//''I:,
103. Pre-slab 104-6,67'6213. Rough gas /.�-24'{I.'
104. Floor joists 214. Shower pan G') 2'22-t9 _
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
l
107. Shear nailing 12.418 ( 7V 217. Building sewer 348-1 ,
108. Diaph nailing �,I �111""_��11 218. Water service
109. Roof nailing /Z-4!q V N 219. Final gas 3-1$4, ,•
110. Framing 2-2 220. Fixtures /
111. Occikea Sept.Wall 221. Final plumbing q-23-17
112. Sound walls 222. Sewer cap/demo.
113. T-bar.rid „ _
114. Insulation-Flr. ..-(.q L Or
Pool Inspections Date Insp.
TrOi115. Insulation-Wall y 40. Excavation/steel
116. Insulation-Ceil. j- It'4q may✓ ,241. Rough plumbing
117. Drywall nailing r-/7-17 , 242. Light shelYbonding
118. Interior lath(3) 1.Z2•15 /,�(/�' 243. Underground conduit
119. Exterior lath (Z-' 1-bb/41 244. P-trap
120. Finish grade e� 45. Gas line&test
121. Final building G(-23-11 246. Fence,gates&signs
122. Final demollot dear 247. Pool heater
248. Final electric
Electrical Inspections Date :Insp. 249. Final.lumbin.
150. Power pole 250. Pool fina ■
151. Sates lo[lighting 251. Pool final
152. Under.round conduit
153. Underslab conduit Reroof Inspections Date I Insp. - --
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Roof framing
156. Rough electrical j224-18 ) 4 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E.It.bondin! Sign Inspections I Date I Insp.
160. Service panel 12-271' frk1_ 10. Setback/overhang ■ -
161. Final electric 'f-z5-(/ / 281. Footing
282. Conduit/whin.
Mechanical Inspections Date lnsp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rauch HVAC 122412L j Miscellaneous Insp. Date 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 them.
188. Compressor setback 295. Final
189. Commerdal hood
190. Duct shaft Sewers&Offsite Insp. I Date I Insp.
191. Final mechanical `1-23-1- 300. Lateral(main to P/L) ■
301. Saddlery
Block Wall Inspections ' Date Insp. 302. Cess...l filled
200. Footings 303. Sidewalk
201. Steelhebar 304. Driveway
202. Grout Iitt 305. Curb replacement
203. Final wall 306. Trash bin
Certificate No.20121023 -876
ARCADIA UNIFIED SCHOOL DISTRICT
150 South Third Avenue,Arcadia, CA 91006 • (626) 821-8300 Ext. 6732
Certificate of Compliance for Payment of Developer Fees
(Education Code §17620, et seq. & Government Code§65995, et seq.)
Effective July 24,2017
Current rate in effect applies at the time of imposition of fees/payment.
Project Address/APN: 312 Sharon Rd . , Arcadia, CA 91007
Number of Units in Project: One Plan Check Number:
18-417
[ ] [ X]** [ 1**
Exempt: [ ]500 sq.ft.or less(residential addition/expansion/remodel) Residential Commercial/Industrial
[ ]Other. _ $3.20/sq.ft. $0.51/sq.ft.
Area in Sq.Ft.: 795 Receipt Number: 324397
Total Fee: $2, 544 .00 Check Number: 3236
Owner's Name: Kai Chang Kyi
Owner's Address: 310 Sharon Rd. , Arcadia, CA 91007
Phone Number: 626-863-2200 Email: kaikyi@yahoo .com
Representative's Name& Contact Info (if appi.):
*The above-described development has been determined to be exempt from the developer fees of Education Code§17620, et seq.,
and Government Code§65995,et seq.,and a Building Permit may be issued therefore.
** All fees due to the Arcadia Unified School District, under provision of Education Code §17620, et seq., and Government Code
§65995, et seq., as a prerequisite to the issuance of a Building Permit by the Building Department of the City of Arcadia, City of
Monrovia,City of Sierra Madre, City of Temple City,and County of Los Angeles,Department of Public Works have been received.
Based on the information present above,this Certificate of Compliance is hereby executed.
Connie Chu
Senior Administrative Asst 5/29/18
Signature of District Representative Name/Title Date of Issuance
> 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 returned 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 formerly
issued on any type of development.
S. If 500 sq. ft. or less is the reason for exemption, any future additions,expansions, or remodels to the property that result in the
past aggregate square footage to exceed the allotted 500 sq. ft. will be subject to fees at the current rate for the entire square
footage of the development.
> Owner/developer may request a refund of fees paid to the District within 12 months of payment only in the event the Building
Permit expires or the project is canceled without commencement of construction in accordance with Education Code section
17624(all other requests for refunds must be made in accordance with the fee protest procedures set forth in Government Code
§66020). All refunds will be reduced by a $100 administrative fee. The refund check will be issued in the name of the
owner/developer and mailed to the address of payee.
PURSUANT TO GOVERNMENT CODE§66020(d), OWNER/DEVELOPER HAS A PERIOD OF 90 DAYS FROM THE
DATE OF ISSUANCE OF THIS CERTIFICATE OF COMPLIANCE TO PROTEST THE IMPOSITION OF FEES
Applicant confirms that he/she is prized to si n behalf of the owner/developer and that the information he/she provided to the
District is true and accurate t e best of his •nowledge.
Signature of Ap cant: _ _ �_sSt Name: —0/ 01-040 /
WHITE—Cit /County YELLO �scal Services Rusin/Services GOLD—Applicant Certificate of Compliance(7-24-17)
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\; County of Los Angeles
fp "-1p— DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION
,..kz__
`i.,. f' - Los Angeles Regional Uniform Code Program
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the
approved plans and specifications, at significant construction stages and at completion of the structural system.
Structural observation does not include or waive The responsibility for the inspections required by Section 108, 1704 or
other sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709)
n Report No. 7�
This report includes all construction work through �1 day of Qer.-em }C� .20_!8 Page No. < of(
ProjectAddress:VA/t /b tArr3-'l� . Structur I Observof Record (SOR): SOR,Ph�iNo,: e
340 F�rRv) bA, ( ( Ger 1
Building Permit No.: Structural Observation V , Observr P ofessioBnal Lic./Reg. No.: Observer Phone Nqo.:
performed by: �?APp l,� 6-6-31 f'-
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
ELEMENTS/CONNECTION
FOUNDATION WALL FRAMES FLOOR OBSERVATION LOCATION
�
❑Footing,Stem Walls 0 Concrete 0 Steel Moment Frame 0 Concrete INrmL1 (/J
❑Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck {U
0 Caisson,Piles, Wood ❑ Concrete-Moment ❑ Wood N ti-t0 i1 5
Grade Beams Frame
❑Retaining Foundation 0 Others: 0 Masonry Wall 0 Others:
Hillside Special Anchors Frame
❑Others: Others:1&Jera-0
NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general
conformance with the approved plans or in the load path: (A final report by the structural observer which states that
all observed deficiencies have been resolved is required before acceptance of the work by the building officials.)
—NB-a (3 leo D faintiy i i._— 7c_ te ,(�
Sa- TheIr-t� au
fr l• Ne 5-A-<-4-° -5 t° 1 u5-A-<-4- $ a -11"1.& (-I-c-
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE
REQUIREMENTS OF THE COUNTY OF LOS ANGELES. 0 ==%D
gE, �r `
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS W (OA
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT sf V ; '
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN L tr j �N ' \,.,
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; Tit I 24 •c `t
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED r>...,_?(—(q 1*
e' C(V T. `�, ,E
ABOVE;
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY -.` CA0i
• LOS- ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
•.r- TED/
(//Al/-�I �G 3 �g (STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF/.TRUCTURAL OBSERVER 0 E
Jan.10 2008
Version 1.0 008 LACBC)
•
•
.r:=- County of Los Angeles
p.C�-�A�
=r'�`" ,,,..4\I DEPARTMENT OF PUBLIC WORKS BUILDING& SAFETY DIVISION
ai .
:�-K�,�r �� Los Angeles Regional Uniform Code Program
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the
approved plans and specifications, at significant construction stages and at completion of the structural system.
Structural observation does not include or waive the responsibility for the inspections required by Section 108, 1704 or
other sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709)
__
Report- No.
This report includes all construction work through I day of 5eP 1 E it3efC 20 I R Page No. I of 7
Project Address:7t kt4& H,'U' RES. Stu ral Observer of Record (SOR): S Phone No.:
740 S IJ 12PM, CM7b4-, eA.gle'o C Lia .e . (P8 • 31 (-3
Building Permit No.: . Structural Observatio Observr Professional Lie/Reg. No.: 0 rver Phone No.:„7
performed by: t��7'O�i r- W” 3Q (-3.�(.>�lr
. OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS l
• ELEMENTS/CONNECTION
FOUNDATION WALL FRAMESFLOOR• OBSERVATION LOCATION
' noting,Stem Walls 0 Concrete ❑ Steel Moment Frame 0 Concrete chi•l L& €KCa4-0Or*)
❑Mat Foundation ❑Masonry 0 Steel Braced Frame 0 Steel Deck • 11
❑Caisson,Piles, 0 Wood ❑ Concrete Moment ❑Wood • (�C(5l� < (461.4)0 (d u
Grade Beams Frame
❑Retaining Foundation 0 Others: ❑'Masonry Wall 0 Others:
Hillside Special Anchors Frame
❑Others: 0 Others: '
NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general
conformance with the approved plans orin the load path: (A final report by the structural observer which states that
• all observed deficiencies have been resolved is required before acceptance of the work by the building officials.)
E L5 ' T' ' '
- -=711,--h-9 reirL. li --pU )
•
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE •
REQUIREMENTS OF THE COUNTY OF LOS ANGELES. ��0 p4hf:i5Jia'•.f
: 2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS \. y /2./4\,,
UNDER MY RESPONSIBLE CHARGE,HAS PERFORMED THE REQUIRED SITE VISITS AT 3 k-, , o-�;.
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN .. N sr t
• GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; ' a4jac , /45 •
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED 'I� L I
ABOVE; tb.fj c4. iv1-.i���,.
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY 1"#-, ,,,OF Ck1?
m1
OF LOS - e // WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE .-"'� "%• .-
CORRECTED /
yv��' $0 (STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF STRUCTU''•• OBSERVER• DA
Version 1.0(2008 LAS, ) . Jan.10 2008
. ,
BOUNDARY SURVEY ...
IN THE CITY ARCADIA, COUNTY OF LOS ANGELES
STATE OF CALIFORNIA
D. SPK ® BCto EL MONTE AVE
to 1 m PER R-3 _ T
N 11
^lo NOTHING FD. yr
410 NOTHING FD. NOTHING FD. ESTAB. PER R-4 SITE ADDRESS
'� .ESTAB. PER R-5 ESTAB. BY INT.
310 SHARON ROAD
E'LY UTNE LOT 5 OF R-5 ARCADIA, CA.
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Q 18.75 1 150.02' fid Q 1
0 11.75' z o'
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IES 8-Irn
i. m APN: 5785-007-014 m •
�a >_0o PREFERENCES
0 o m w 1
o°ii °' r 0 m=o' R-1 = LA. CO. PWFB 1527-935
�' rwn d1 J Z Z R-2 = LA. CO. PWFB 1527-342
I o w w z 0 R-3 = LA. CO. PWFB 1527-397
Z N M 1 R-4 = LA. CO. PWFB 1527-614
0 11.75' \ ,l J R-5 = M.B. 696/91-92
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= L` N 04'58'50" W 180.02'
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30 .1in 1Oi 0{ rnI.8 W I ��0
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NOTHING FD. w 1 XP 12/31/2019
w ESTAB. BY INT. z
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PER R-1 LEAD PER R-2\ k G`-e �� °rye) .44
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HOLLY AVE. (��� ��� °°Q� 1• = 50'
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LEGAL DESCRIPTION: ••.°..�°4,, a no.
LOT 12 OF TRACT No. 24140 AS PER Ne 2`ryc, . 18-76
RECORDED IN BOOK 696 PAGES 91 & 92 4$? Om•e• , 1 ��, 1 OF 1
OF MAPS, RECORDS OF LOS ANGELES COUNTYQ ,ter
BOUNDARY SURVEY
IN THE CITY ARCADIA, COUNTY OF LOS ANGELES
STATE OF CALIFORNIA
FD. ® 9G EL MONTE AVE
to I▪ W PER R-3 R- - .—f
PI S //'j
a o NOTHING FD. J '
410 NOTHING FD. NOTHING FD. ESTAB. PER R-4 SITE ADDRESS
rflUN
ESIAB. PER R-5 ESTAB. BY INT310 SHARON ROAD
E LOT 5 OF R-5 ARCADIA, CA.
I NII I ESTAB. AT RECORD 'n
610' ANGLE PER R-5 n m 30' I^ rn N
Im ire n a
m n m t ai
up
I
I
n I I L SET L & TAG
LS 7552 LS 7552, ON WAL
CI 11j- N 00'58'50° W 180.02' 0 7
< \18.75' h 150.02' ie_ Q t
0 I 11.75' o1-= ,
te F-
I ¢• UN, <-•u_ I
• n 0o°
p N Ow1-
I
I _ a' APN: 5785-007-014 REFERENCES
ai m �a r -'
O ° I-0 m o' I R-1 = LA. CO. PWFB 1527-935
1 m b al r J Z Z I R-2 = LA. CO. PWFB 1527-342
• I o w La X 0 R-3 = LA. CO. PWFB 1527-397
ri M I R-4 = LA. CO. PWFB 1527-614
0 k____ 11.75 \ ,1 J I R-5 = M.B. 696/91-92
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LEGAL DESCRIPTION: Sv., n-t ND.
LOT 12 OF TRACT No. 24140 AS PER 0� ° -Pi) 18-76
vv 0 e 0a,t,.ti)/
sir: 1 OF 1
RECORDED IN BOOK 696 PAGES 91 & 92
OF MAPS, RECORDS OF LOS ANGELES COUNTY
312212016, ESUR2018001789
LosangelescountyCSSprod
./ Your plan application was submitted successfully.No fees are due at this time;we will review your
application,and we will be in touch with you shortly.
Plan Number: ESUR2018001789
Plan Details 0 I Tab Elements () I Main Menu ()
Type:
Corner Record
District:
SD-5
Applied Date:
08/22/2018
Status:
New-Online
Project Name:
Expiration Date: 'j% i 4z
Assigned To:
Rodgers,Brian
Completion Date:
Description:
httos://epicla.lacountv.aov/SelfService/#/plan/9ed553d8-0341-417a-bb39-e09104305acb7success 1/3
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SOLID WASTE MANAGEMENT COUNTY SANITATION DISTRICTS
OF LOS ANGELES COUNTY
1955 Workman MIR Road,Whither,CA 9 06 01-1400
Mailing Address:P.O.Box4998,Whittler,CA 90607-4998 Grace Robinson Hyde
Telephone:(562)699-7411,FAX:(562)699-5422 Chief Engineer and General Manager
www.lacsd.org
Counter Hours: 7:00 a.m.-4:00 p.m.Mon.-Thurs.
7:00 a.m.-3:00 p.m.Fri. Application No.: 5785007014-002
SEWERAGE SYSTEM CONNECTION FEE RECEIPT Date: October 15,2018
APN:5785 007 014 District No.: 15
Owner/Situs Address Applicant Information
ZHANG,XIAO H KAI CHANG KY!AND Kai Kyi Chang(owner)
310 SHARON RD Kevin Truong
ARCADIA,CA 91007 • 8035 Linwalt St.
Rosemead,CA 91770
Phone: (626)679-4013
• Facility Type Measure of Use Unit Rate Amount
Single Family Home T 1.00 DU
Connection Fee Due $0.00
Type Abbreviations
N-New or Additional;C-Change of Existing;E-Exisling to Remain;D-Demolition of Existing;T-Tenant Improvement of Existing;S-Septic to Sewer
(E)2,651 sq.ft.SFR&(N)761 sq.ft.ADU(new construction)@ 310 Sharon Rd.,Arcadia CA 91007-NO FEE REQ'D
Tenant improvement of 1.00 DU of existing Single Family Home
SANITATION DISTRICTS
Processor:Erika Ballesteros Approver: awn e gal anes
DC: APPROVED
f Payment'Received Check No: Amount!
Kevin Truong $0.00 GRACE ROBINSON HYDE
CHIEF ENGINEER&GEN.MG a
Valid Only When Stamped
DOC#4775749 THIS IS NOTA CONNECTION PERMIT.
A CONNECTION PERMIT IS REQUIRED BEFORE CONNECTING TO ANY SEWER.
•
OWNER'S CERTIFICATION :Form
For sites under 1 acre disturbed area'Ifs.2 LO.C't
To reduce storm water pollution from construction situs '—
Ptejcc:Nance XIANG HUAIjG RESI,DEN1E_ • •euRCINGIGRADING PCRMIT.NLMHER
Prticd ICcatien ARCADIA. CA • -
C•:.ner 4amo KAl KYI CHANCr_AN0 ZHANG,_XIAO H _ Ce-,La wr Name KEVIN TRUDNG -
;�.rt c 3�OSHARON ao Ca=91007. _ Mdress_ __ _.
s6{ _
Fnonc C. 18632T
200 _ ---- ?:one (626)679-:013 -- --- _
FAX _. _-. FAX_ -'
The National Petulant Discharge Elimination System (NPDES) is the portion of the Clean Water Act that applies
to the protection of receiving waters. Under permits from the Los Angeles Regional Water Quality Control Board
(RWQCB), certain activities are sub:act to RWQCB enforcement. To meet the requirements of the Los Angeles
County Munftipal Storm Water Permit (CASG04001), minimum requirements for sediment control, erosion control
and construction activities must be implemented on each project site. Minimum requirements include:
SEDIMENT CONTROL: Eroded sediments from areas disturbed by construction and from stockpiles of soil
shall be retained on site to minimize sediment transport from the site to streets, drainage facilities or adjacent
properties via runoff,vehicle trad<r.g or wind.
CONSTRUCTION MATERIALS CONTROL: Construction related materials, wastes, spills or residues shall be
retailed on site to minimize transport from the site to streets, drainage facilities cr adjoining properties by wind
cr runoff. Runoff from equipment and vehicle washing shall be conlared at construction sites unless Treated to
remove sediment and pollutants_
NON STORMWATER RUNOFF: Non stormwater runoff from equipment and vehicle washing and any other
activity shall be contained at the project site.
EROSION: Erosion from slopes and channels shall be controlled by implementing an effective combination of
BMPs (as approved in Regional Board Resolution No. 99-03), such as the limiting of grading scheduled during
the wet season; inspecting graded areas during rain events; planting and maintenance of vegetation on slopes;
and covering erosion susceptible slopes.
Nrnrmunr AMPs Include:(1)rn:l pi.e s rrc„t Op covered w'th Tarps or p'atic.(2)Leaking erwiyncnt rri:t he rer8:•ed I:nn•oatoly,(3)
F eyrie CO must be CC Sdudud anal/troth ct:ca br.S is, (4)Calci bast;roan(w,cetUedod whon nearby,(5)Vacuum el ma:rete
a.v Coning, (0)::ova•rain ccrue:e•,vu::cs in le the sLec:, (7)Keep tie sr:e dean.sw ep the Gutters at lie cod of eath xerarg cay or4
'carp a rearm recant ee en ad:.
O.wner's Certification
I hereby certify that I have ,.ad, understand and vrdl comply with the requirements indicated above:
_ _ 'd 2(-IRr C A4-0 ul 5 ;-2016 __..
Prnporty Owner or A,rtho• '�d Rop entotiva(srgnaturo) (Ramo printed) Titre Da to
But Management Practices implemented shall include those recommended in the pamphlets
describing Stormwater BMPs for construction situs, Blueprint for a Cleaner Ocean, and the
California Storm Water Best Management Practice Handbook (Construction Activity).
f 4 City of Arcadia, CA Permit NO Mist 18 0792J.
Development Services Department ft"`"r r x. Permit Type:Misc
I 240 West Huntington Drive,Post Office Box 60021 i� )�H t 3 l;�
�j { �, �'' Work Classification:Address Change
Arcadia,CA 91066-6021 1," �=1_.
(626)574-5416 - "`
� �_._ Peimit StatustJssued
ARCADIA Issue Dat 05/29/2018 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
312 Sharon RD Arcadia,CA 5785007014
Contacts
KAI CHANG KV!AND ZHANG,XIAO H Owner R E T CONSTRUCTION CORP* General Contractor(B)
310 SHARON RD 8035 LINWALT ST,ROSEMEAD,CA 91770
' (626)679-4013 KT5788@GMAIL.COM
Description:ADDRESS CREATION FOR ADU 312 SHARON. Valuation: $0.00 Tenant _ rtmt
MAIN DWELLING IS 310 SHARON RD
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Address Change $500.00 Total Fees $500.00
Total: $500.00 Cash/Receipt#REC-001273-2018 $500.00
Amount Due: $0.00
is COMPLETED
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
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.
May 29, 2018
Issued By: - Date
May 29,2018 Page 1 of 1
.
A ,�yvoRy4<.
` PERMIT/PLAN REVIEW APPLICATION
•E4PDevelopment Services Department,240 West Huntington Drive,Post Office Box 60021
m.ar.,,�r 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
Signature of Contractor performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
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
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
0 I. as owner of the property, or my employees with wages as their sole forthwith comply with hose provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
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 penalties 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
attorney's 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 Signature_ _ 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 Title
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 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 Date
r
OFF Rm, -46r
-�" May15, 2018
•`.joe.
Auryaa .UO3
°°mm Y°t„om`' Subject: Create new address at: 310 Sharon Rd
City of Please be advised that the City of Arcadia has approved to create a second
address for a newly created Accessory Dwelling Unit for the subject property.
Arcadia Parcel Number: 5785-007-014. Please update your records as follows:
MAIN DWELLING ADDRESS ASSIGNMENT:
Development
Services 310 Sharon Rd
Department Arcadia CA, 91007
Jason Kruckeberg NEW ACCESSORY DWELLING UNIT ASSIGNMENT:
Assistant City Manager/
Development Services 312 Sharon Rd
Director
Arcadia CA, 91007
The City of Arcadia would like to bring to your attention that we are requesting
to create a new address for the Accessory Dwelling Unit and would request you
to modify the address in your records. The main dwelling unit address is 310
Sharon Rd and the Accessory Dwelling Unit address is going to be 312 Sharon
Rd.
Should you have any question, please contact the City's Development Services
Department/Building and Safety office at (626) 574-5416.
Sincerely,
di,.4
Don Stockham, Building Official
240 West Huntington Drive
Post Office Box 60021
Arcadia,CA 91066-6021
(626) 574-5415
(626)447-3309 Fax
www.ci.arcadia.ca.us
CITY OF ARCADIA
DEVELOPMENT SERVICES DEPARTMENT
240 NEST HUNTINGTON DRIVE,
ARCADLA, CA 91007
(626) 574-5416
APPLICATION FOR AN ADDRESS CHANGE
($500.00 FEE REQUIRED AT TIME OF APPLICATION)
t'_21,1 rg(tA-o f u1 ----,-
(Applicant) (Property Owner)
I o_ ska-ron 120‘.4j. Mitt , C!'} I /064-
(Address)
u6(Address) (Property Address)
(Wailing Address) (Mailing Address)
(Phone Number) - (Phone Number)
''
REQUESTED PROPERTY ADDRESS: 3 I. Sh cul'ort fto[ir . Airce g1g97
(1st. Choice)
(2nd. Choice)
- ,
Owner's Signatur: I Date
FOR OFFICE USE ONLY
DOCUMENTATION: C}urent Property Tax Bill: Recorded Grant Deed:
FEE: $500 PAID: / RECEIPT NO.:
APPROVED (Notification attached)*: Yes: " No:
DENIED(Reason):_
ASSIGNED PROPERTY ADDRESS: .342 $S, " By
— 0,7` r
Building Official Date
*Note:Send notifications to all listed agencies upon approval of Building Official.
City of Arcadia, CA :: Permit NO'EIec182255
G k Development Services Department ` . " '"'`" ` Permit Type Electrical''
240 West Huntington Drive,Post Office Box 60021 71
tC °; work Classification:_Flee Service Change '
` Arcadia,CA 91066-6021 1.-,J _. L ; -_ _
i' i (626)574-5416 _ . }t Permit Status.4Issued.
ARCADIA Issae4a a 12/05/2018 Expiration: 06/03/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
310 Sharon RD Arcadia,CA 5785007014 1
Contacts -
(Al CHANG KYI AND ZHANG,XIAO H Owner RET CONSTRUCTION CORP' General Contractor(B)
310 Sharon RD,Arcadia,CA 91007 8035 LINWALT ST,ROSEMEAD,CA 91770
(626)832-2200 (626)679-4013 KT5788@GMAIL.COM
Description:200 AMP SERVICE FOR MAIN HOUSE Valuation: $0.00 Tenant
Total Sq Feet: 0.00 Plan Check N Plan N
Fees Amount payments Amount Paid
Electrical Permit Issuance Fee $44.35 Total Fees $60.90
Residential Services up to 400 amps $15.55 Cash/Receipt U REC-003061-2018 $60.90
Solid Waste Management Fee 2 $1.00 ,
Amount Due: $0.00
Total: $60.90
Zi Copq ��T CALLS FOR INSPECTIONS
IIS®®//ff// E DRequest for inspect on by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
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.
4
December 05,2018
Issued By: Date
December 05,2018 Page 1 of 1
:,.ueogp4 .
non
„Rs ::,0
PERMIT/PLAN REVIEW APPLICATION
4�% Development Services Department,240 West Huntington Drive, Pbst Office Box 60021
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,a d my license is in full force and effect. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. qi;i w p. Date Aid! compensation, as provided for by Section 3700 of the Labor Code, for the
rperformance of the work for which this permit is issued.
Signature of Contractor _ -.'
OWNER-BUILDER DELL•.ri•TION 0 I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance 'err and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier ON /L'/ (�e- '
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Numbe
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 co ted i s for one hundred dollars or less)
7000) of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑II certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Cod- .all
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date ��//5 Signatu+
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 ,'• ers'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 penalties and civil fines up to one
completion,the owner-builder will have theburden 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
attorney's 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
contractors)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 Signature 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. /
ame 14Fi v - �itle Ce
RINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances : d State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above- •• , •a property for inspection purposes. /S�
`Signature Date /2/ / �6
City of Arcadia, CA Permit NO RALT 18-0948'
f Development Services Department Perm rt Type Residential AddltlonlAlter ation
' • I 240 West Huntington Drive,Post Office Box 600215 A-) •a ,,si S i I'• r
1 Arcadia,CA 91066-6021 'i t ` 1r- + I•LWork Classnccanon Ralt-Window Change-Out
(626)574-5416 A £
Status:In Review
ARCADIA Issue Date:1 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
310 Sharon RD Arcadia,CA 5785007014
Contacts
KAI CHANG KYI AND ZHANG,XIAO H Owner R E T CONSTRUCTION CORP' General Contractor(B)
310 SHARON RD 8035 LINWALT ST,ROSEMEAD,CA 91770
pp (626)679-4013 KT5788@GMAIL.COM
Description:2 SKYLIGHTS. 1=12"&2=2'X4' PER APPROVED g Valuation: $ 500.00 Tenant
PLANS. r
g Total Sq Feet: 0.00 _ Plan Check N Plan it
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $129.96
Building Permit Fees $40.65 Cash/Receipt It REC-001368-2018 $129.96
Building Plan Review Fee $26.43
Cal Green Plan Check $2.65 Amount Due: $0.00
Energy Plan Review Fee $8.13
Green Building Standard - $1.00
Solid Waste Management Fee $6.25
Strong Motion Inst.Program Res $0.50
Total: $129.96
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
4 (fla
requesting the address,timeframe and what inspection item is needed.
s � This permit/plan review expires by time limitation and becomes null and
r�® 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.
Issued By: Date
June 06,2018 Page 1 of 1
0a.woxmy•
•�+ .; PERMIT/PLAN REVIEW APPLICATION
43:' Development Services Department,240 West Huntington Drive,Post Office Box 60021
e0uop orN 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 d my license is in full force and effect. CII have and will maintain a certificate of consent to self-insure for workers'
License Class License No. �d _ Date IC) 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 Con w J
OWNER-BUILDE' _t• • RATION ❑ I have and will maintain workers'compensation insurance,as required by Section
1:1I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance comer and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier __ -
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number 0/V G,'
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
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that ifI should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
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 penalties 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 tothe 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
attomey's 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 Signature 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. 7
(Name kec/w i (Tide
/—ktQytC L/4 C/
PRINT NAME
I certify that I have read this application and state that the above information is c ect and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to buildin construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentio .. • 'nspection purposes.
ignature Date 6767