HomeMy WebLinkAboutROOF-19-0979 d City of Arcadia, CA Permit+NO ROOF 19 0979
4:,%, Development Services Department ,[3 \,r. q y:y x—^., N't, , _ Permit Type:Roof
r 240 West Huntington Drive,Post Office Box 60021 ,e-fl l I,, I t
8°` Arcadia,CA 91066-6021 • - Ca,k)l a r I i x 4 kl$rork`Clossificatfon:Reroof-Residential
Y X..-£- ..tee - 4 _."P. _ .,r _
( (626)574-5416 ' PermitStatus.Issued
ARCADIAIssue Date 05/23/2019 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
140 E Las Flores AVE Arcadia, CA 5789016007 1
Contacts 1
SAM KIM Agent for owner INTERCONTINENTAL TOY CO INC Owner
247 GRAND AVE,GLENDORA,CA 91741 DEANNA Y CHAN
(626)588-7255 140 LAS FLORES
(626)695-5493
Description:T.0 HOUSE/ATTACHED GARAGE WITH COMP Valuation: $ 12,000.00 Tenant
OWENS CORNING OAKRIDGE BROWNWOOD CLASS A.23 SQ
(PS) Total Sq Feet: 0.00 • Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $323.91
Building Permit Fees $270.65 Cash/Receipt#REC-01307-19 $323.91
Solid Waste Management Fee $6.25
_ Amount Due: $0.00
Total: $323.91
,tns_` mgverimi o COMPLETED
(w. ?at Ex12Sf 1 CALLS FOR INSPECTIONS
��r � _ I Request for inspection by telephone at 626-574-5450. Leave a message
I wry r 5`� ) a'V requesting the address,timeframe and what inspection item is needed.
tr4'—I This permit/plan review expires by time limitation and becomes null and
?14PISLO . I
�f,V. 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 23, 2019
Issued By: Date
May 23,2019 Page 1 of 1
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4 ;• 1 PERMIT/PLAN REVIEW APPLICATION
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.DI" Development Services Department,240 West Huntington Drive,Post Office Box 60021
'"m==„„orr ' 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
OWNER-BUILDER DECLARATION ❑ 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 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
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
exempt there from and the basis for the alleged exemption. Any violation of 1 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
I, as owner of the property, or my employees with wages as their sole forthwith comply with those provis'
compensation,will do the work,and the structure is not intended or offered for cS�Z3L al
sale(Section 7044,Business and Professions Code:The Contractors License Date Signa
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 thecost 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 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
1 Date 21-4 1y Si 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.
fame AA II:MM Title V N2Ar )Al(11 ' '
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
itrcadia to e l r .1 1 ii Ibi • :• •ntioned property for inspection purposes.
III
ignature _ Date
k nit i
op,Nunli, ft
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City of Arcadia • Building Division
240 West Huntington Drive,Arcadia CA 91007
Office: (626) 574-5416 Fax: (626) 447-9173 •
. When the permit application and the Owner-Builder Declaration have been executed by a person
other than the property owner, prior to issuing the permit, the following shall be completed by
the property owner and returned to the agency responsible for issuing the permit:
AUTHORIZA1FION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the NoticIe to Property Owner, the execution of which I understand is my personal
responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign,
and file the documents necessary to obtain an Owner-Builder Permit for my project.
' I declare under penalty of perjury that I am the property owner for the address listed above, and
I personally filled out the above information and certify its accuracy.
i
Property Owner's Signature. ' A r -6.,c_.��t„ Date: _c/ G //9
Pro.e Address: i b e- , ti. Flores I
Owner's Name:
Owner's Address: S7-7 S n T ikIrtit C 1i.k e'/vtt lei-et... t4R,
CO ci I y
Phone # (c3 6— (,., is- cc( e
Agent's Name: S o yi- Wit,..-t
Agent's Address: Zt-t2 C . Chrw,4 A • 6iehc(ore- `in H i
Agent's Phone #: 620 , SR•F • 1 2 55
Rew,ot 'eAs-f'tvtG co bit .V1x,c 0tJ(...\/
Scope of Work: F •Zh54z,11 Nett Corp rtooc o iv-) same Color .
NOTE: This autiwrizatiou must be NO IT ILIZba) or accompanied by a copy of the
homcower's current photo 1.9. (i.e., driver's license. passport or milit:u•y W.
with sig r attire), when presented for issuance of a permit.
r FOR,„ •\ .
r� n.udw' .�
AFFIDAVIT SELF-CERTIFICATION % ,
- ' FOR COMPLIANCE OF SMOKE ALARMS
• AND CARBON MONOXIDE ALARMS
Property Address: / V) C, Cid S rt d2 €5. QcA D/4 • : '`.. .`
.-Permit Number: rap -`` II - O Rl� ' "
Brief Job Description:7v j Rog
ft
-Number of smoke alarms installed:
Number of carbon monoxide alarms installed:7. - .
When alterations, 'repairs dr additions requiring a permit occur, or.sleeping rooms are created,
< Smoke alarms shall be installed in each sleeping room, and outside each separate
• sleeping area in the. immediate vicinity of the bedrooms, and on each additional story.of the
• dwelling, including basements and habitable attics"as required by Section R314 of the 2016
California Residential Code (CRC) and California Health and Safety Code Section 13113.7.
For dwellings Or sleeping units containngfuel burning appliances or'having attached
-garages,-carbon monoxide alarms shall..be_ installed` outside each separate sleeping
area in the immediate vicinity of the bedrooms, and on each additional story of the -
dwelling,_including basefnents as required by Section R315 of the of the 2016 California
Residential Code(CRC). ,
Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used. -
All alarms shall comply with requirementsfor listing and approval by the Office of the State.Firp
Marshal. http://osfm.fire.ca.qov/licensinglistings/licenselistine bml searchcotest.php
As owner of the above referenced prbperty, I hereby certify.that"the snioksealarms and carbon
monoxide alarms have been installed in accordance with!the-manufactu-er's;instructions and in .
compliance with the code sections referenced above. , .
I declare under penalty of perjury that the for?ing is true and correct, and that this
declaration was executed on (Date) // // ' at Arcadia, California. •
Owner's Name (printed/typed): Rebecca r4 vi✓� • `
Signature of Owner: AA"2,--6- ,
This affidavit must be returned to the City of Arcadia inspector-prior to final inspection
; .
SMOKE ALARM AND CARBON MONOXIDE ALARM LOCATIONS
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Guest Room
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Storage ..... .,
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3‘. ,
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RoomFamily •
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1 • . ''',,1 : Garage
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,. FIRST FLOOR PLAN ".
6= SMOKE ALARM I = CARBON MONOXIDE ALARM •• .
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Pi Master Bedroom,
Dining Rodm- Kitchen
- Bath
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Hall 0 0 ei"et . .
-,... ; Close
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Family Room — •
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— Bedroom Bedroom
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• SECOND FLOOR PLAN
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0=SMOKE ALARM I = CARBON MONOXIDE ALARM
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