HomeMy WebLinkAboutUntitled (2) It I
d ,,1rt . y,_ �, ,:
•
;{ + permit No. RALT 18 1686'
i City of Arcadia, CA 5 �� r ^ ,
{ Development Services Department i 'N j- + `1 ' "Pei`mit Type Residential Addition/Alteration
• ) 240 West Huntington Drive,Post Office Box 60021 i L ri 1 a1 c' S; I , . '
Arcadia,CA 91066-6021 x }t i work Cass; cation Res-Addition/Alteration'
(626)574-5416 = + ° - —
Permit Status Issued
ARCADIA a tissue9$! 11/0 /2018: Expiration: 04/30/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
228 W Palm �..... DR
Arcadia,CA 5787018015
.0 ,i ,
Contacts
ESTER&KEN FUNG Owner Shlomi Suliman Applicant
228 W PALM DR 2272 COLORADO BLVD 1200,LOS ANGELES,CA 90041
(626)823-9190 (323)989-2444
Description:ENLARGE KITCHEN BY ENCLOSING EXISTING Valuation: S 28,243.23 Tenant
PATIO.WITH EMP
Total Sq Feet:_ 137.00 Plan Check#18-1686 Nan N 32623
Fees Amount payments Amount Paid
Building Issuing Fee $44.35 Total Fees $1,988.99
Building Permit Fees $538.75 Cash/Receipt*/REC-002309-2018 $772.96
Building Plan Review Fee $350.19 Cash/Receipt U REC-002756-2018 $1,216.03
Cal Green Plan Check $35.02
Dishwasher $12.46 Amount Due: $0.00
Electrical Permit Issuance Fee $44.35
Energy Plan Review Fee $$12.75 cp '�/.
Garbage Disposal Fee $12.46 « t�- �b—�/.t 1 /�r/,t
Green Building Standard $2.00
Install,Relocate Appliance Vent/Hood $9.38
Kitchen Sink $12.46 CALLS FOR INSPECTIONS
Light Fixtures $20.02 Request for inspection by telephone at 626-574-5450. Leave a message
Mechanical Permit Issuance Fee $44.35 requesting the address,timeframe and what inspection item is needed.
Outlets-Receptacles&Switches $27.72 v
Parks&Recreation Fee(SFR) $390.45
Plumbing Permit Issuance Fee $44.35 This permit/plan review expires by time limitation and e u ,'{Iqr�ED
Single Family Fire Plan Check $280.00 void if the work authorized by the permit is not commenced within 'BIWtl
Solid Waste Management Fee $6.25 from the date of issuance or if the permit is not obtained within 180 days
Solid Waste Management Fee 2 $1.00 from the date of plan submittal.This permit expires and becomes null and
Solid Waste Management Fee 2 $1.00 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
Solid Waste Management Fee 2 $1.00 Arcadia building inspector for a period of 180 consecutive days.
Total: $1,988.99
d/
November 01,2018
Issued By: Date
November 01,2018 Page 1 of 1
o AR f )
•
PERMIT/PLAN REVIEW APPLICATION
r� *' •
Development Services Department,240 West Huntington Drive,Post Office Box 60021
m3/4a,,.-"° Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ 1 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 Bu 'ness and
Professions Co d my license is in fu I fierce acid effect. ��n G �q ❑ I have and will maintain a certificate of consent to self-insure for workers'
(
License Class License o. Y z7xp. Date } I I 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 DE LARATION have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty o erjury that I am exempt from the Contractors 700 of the Labor Cod ,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions s issued.My ers' nsati�ryc.re carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier 9^ V
demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number r)_0%\2 -
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 ❑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 ill 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 forthwithcomply w h 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 Date1 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 arenot 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 shallsubject 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).
0 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:
I. 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 1 _ (Title F.,29.-.11\--
" NT NAME
I certify that I ha ad 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 comp with City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter u on the ve-mentioned property for inspection purposes. 1
f(gignature (Date I) I I \ I
I OO
2Z' V F.401,1
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under fin/bldg.drain -.7-0 ,re
101. Rough grade /211. Copper underslab `1-�2-1y 6 r3Sa/.UEO Frc�Cy or Z
102. Figs.&forms z-fl-I`t �'Y 1212. Rough plumbing -7-17
VetAte-�-~0 cD S Fs2 .I-CPU 2
103. Pre-slab / 213. Rough gas /
104. Floor joists 3-S-t ,214. Shower pan lcsLO Potv/J,$ • �•-"/
105. Steel 215. Water heater 66
106. Grout lift216. Roof drains
107. Shear nailing 'j-l9-1.9 217. Building sewer 5-0"_/, fa��/1-6 11:72,
108. Diaph nailing 218. Water service �y �A'a-
109. Roof nailing . 219. Final gas
110. Framing Y-Z?-1p! *• 220. Fixtures2949 MrNI, bpP� �✓ T. do VOL
111. OccJNea Sept.Wall 221. Final plumbing 9-G2 C5 Fixtures -294
4 rc, "-✓/AovrI4 aptNWc^ 52"---
112. Sound walls 222. Sewer cap/demo.
113. T-bar rid
114. Insulation-Flr. 3p9 '( air P,iI I t I D.b
ii
115. Insulation-Wall
4.....`.../---
� ---e - 240. Rough plumbing 116. Insulation-Cell. y� �1.�/241. Rough plumbing
117. Drywall nailing PH7 : -«y 242. Light shell/bonding
118. Interior lath \/ 243. Underground conduit
119. Exterior lath c-1-111 t,1 C 2 . P-trap
120. Finish grade 245. Gas line&test
121. Final building 0 246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final•lumbin•
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Under•round conduit
153. Underslab conduit Reroof Inspections I Date I Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Root framing •
156. Rough electrical S141 272. Sheathing nailing
157. Fixtures 11 273. Final reroof
158. G.F.C.I.
159. E••Lbondin• Sign Inspections I Date I Insp.
160.1Final a pane81. Fooling erhang ■
161. Final electric jtr�-G`] �7 281. Footing
282. ConduiVwirin!
Mechanical Inspections Date lnsp." 283. Disconnect 1-
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC Miscellaneous Insp. I Date I 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 chem.
188. Compressor setback 295. Final
189. Commercial hood
190. Duct shaft Sewers&Offsite Insp. I Date I Insp.
191. Final mechanical 9-/2•-d9 W 300. Lateral(main to P/L)
301. SaddleN
Block Wall Inspections Date Insp. 302. Cesspool filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
REGISTERED DEPUTY BUILDING INSPECTOR'S
CITY OF: ARCADIA CERTIFICATE OF COMPLIANCE
DEPARTMENT OF BUILDING AND SAFETY
Address of
Building 228 W Palm ave Arcadia CA
Off-Bile
Fabricator
DATE OFTHIS CERTIFICATE
Permit
Number RALT-I8-1686 Year 05/19/19
TO THE SUPERINTENDENT OF BUILDING: CITY INSPECTOR
I hereby certify that the following portions of the work at the above address which required continuous inspection,and
which I was employed to inspect,were inspected by me and comply with the provisions of the Building Code applicable
thereto:
Type of inspection:
❑ Masonry ❑ Rebar Placement ❑ Concrete or Mixer
® Welding ❑ Concrete Placement ❑ Gunite
❑ Hi-Ten Bolts ❑ Tendon Placement 0 Methane Barrier
❑ Others DIA-Epoxy
Description and location of work completed:
Welding inspection of Wood's connection plates to saddle and saddle to saddle-per design plan and AWS D 1.1 code:
located at 2nd level of of(E)dwelling construction.
Welding process:SMAW,E7018-1/8"diameter;Welder:Daniel Tule-LA cert.# P015433.
Size of Structure lime Arrived 8:00am
No.of Stories Time Left Job I0:am
Cone.Mix Design No. PSI Swimming Pool
I had sufficient time to inspect all materials used and placed.
I was not employed by the contractor,subcontractor or material vendor.
SSW-504 I 349-1CC,SS W-P012253-LA.
Registration No.
Signature-Regist-red Deputy Building Inspector
Independent
ROBERTO APAZA-562 8799533:rccosiinspa yahoo.com
Print Full Name
DO NOT AMEND, ALTER, CHANGE, DELETE, OR APPEND ANY PRINTED PORTION OF THIS
CERTIFICATE AS IT WILL RENDER IT NULL AND VOID.
AI? EA
STRUCTURAL INSPECTION
AND TESTING INC.
1215 North Dominion Avenue • Pasadena, California 91104 • (626) 487-1488 •Area4Inc@aol.com
JOB NO: DATE: I- er2I- lei PERMIT NO:
PROJECT: /(�'O�<�.,Jc-x 4-”P ae,41rt or14 ❑CONCRETE 17]POST TENSION ❑MASONRY ❑OTHER
„L�
ADDRESS: 4,'�f�' �T, /atM eat, GEN. CONTRACTOR: PAIS S 4r44T e-i-ter,)
OWNER: SUB CONTRACTOR:
ARCHITECT: CONCRETE SUPPLIER:
ENGINEER: (1, pm�.erzef REINFORCEMENT SUPPLIER:
REINFORCEMENTINSPECRED DATE INSPECTED:
Locations of Work Inspected, Work Rejected, Problems, Progress, Remarks Etc:S-gnot &dten
vi /I gia i (int i /A /� t, 2-xz tec .msl -crn1 ,O-y±&t e&&n"(cc
cfiltheii, 9 yU.rG q Z�i-a1 r r 46 oj.rh Anew rif ifs V
c*4c [ -3,A -A1/trrr, ! or (o / v
5 osnr-/y 040C,1
htwn retea9<540` P fettled Ocif
.A156/1 cer; � rm
< i eio� r• �7/61 -teaU AM pm' �
Gtie
( /dad
•
•
LOCATION SAMPLED
DESIGN STRENGTH
MIX DESIGN
CEMENT TYPE
TICKET NO.
SLUMP
AGE TO BE TESTED: @ 7 DAYS, @28 DAYS, @ DAYS, OTHER:
INSPECTOR'S NAME: 4'r e.9 {ran-7 #OM 677 SIGNATURE: ir
TSN..:30 DAYS-ALL REPORTS WILL BEHELD UNTIL ACCOUNT IS MD W FULL SERVICES BILLED AT 4 AND B HOUR MINIMUMS.WITH A HOUR CHAISE FOR CANS/LIMNS AND
TWE MO A HALF FOR SATURDAYS SHOULD AREA 4WC BE REWIRED 70 W57TME LEGAL ACTON FOR THE COLLECTKW OF A DEBT INCURRED AS A RESULT OF YOUR ACCEP-
UI CE OF THIS REPORT:AREA A WG WILL BE ENTRLED TD ATTORNEY FEES ANO COSTS INCURRED IN SC SUR THIS RECD REPORT PRESENTS A SUMMARY OF OBSERVATIONS AND
TESDNO DYARE4 4 WC PE'RSOA'VEL OUR WORK DOES NOT L CUIOE SUPERVISION Oft DIRECTION OF THE ACTUAL TURK OF THE CONTRACTOR HIS EMPLOYEES OR AGENTS THE
CONTRACTOR SHOULD BE INFORMED THAT NETHER THE PRESENCE OF OUR FIELD REPRESENTATIVE NOR THE OBSERVATION AND TESTING BY OUR FIM(SHALL EXCUSE HIM IN ANY
WAY FOR DEFECTS BIscovgnED W HIS WORKJT I5 UNDERSTWO INC OUR P7RM WILL NOT BE RESPONSISLEFOR JOB OR SITE SAFETY ON THIS PROJECT. ..
NO. OF HOURS REGULAR: OVERTIME: AUTHORIZED BY:
CIEL
CONSTRUCTION COMPANY
2272 COLORADO BLVD#1200
LOS ANGELES, CA 90041
(800)897-3114
LIC#983179
TO: CITY BUSINESS LICENSE/BUILDING &SAFETY/PLANNING DIVISION
I,SHLOMI SULIMAN , AUTHORIZE VERED NISSAN, NIRIT SHARAFI AND OR NOAM
LEVISOHN TO PULL PERMITS, OBTAIN CITY LICENSE AND SIGN DOCUMENTS ON
BEHALF OF MY COMPANY.'
SINCERELY,
Li
SHLOMI SU�`M �n 8_ fJ
RMO (,e Gl 1'
•
ACKNOWLEDGMENT
A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of Califoyhia
County of 4 05 /al Ct 4&-S )
On 3 /1 1 J a '-/ 30 it before me, .-.1 0 �' r billakfro 4/1m cf Gib /I C
J SAL (in ed name and/ title of the officer) P
personally appeared > `] I- &in t 5 U �C..! n-i g,
who proved to me on the basis of satisfactory evidence to be the person()whose name() is/eFe-
subscribed to the within instrument and acknowledged to me that he/she#hey executed the same in
his/her/their authorized capacity(jes), and that by his/her/their signatureM on the instrument the
person(7), or the entity upon behalf of which the person( acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.
,nom JOYCE E. LAWSON
WITNESS my hand and official seal. commission u 2124272
Notary Public •California M a
nl•,r
TJ Los Angeles County
My Comm.Expires Sep 17_2019 A
Signatu e dL cnC�� SWI(Seal)
b City of Arcadia, CA
_ PermiRNo Mech-19-0904
Development Services Department Q ;{-y r s -"t -+- �- -;Permit Type"Mechanical
240 West Huntington Drive,Post Office Box 60021 .( • , ill CE fi I l
l Arcadia,CA 91066-6021 � Work Classification*'HVAC New System,Residential
'u Sc
(626)574-5416
- ` - � ;'� - Permit Status Issued
ARCADIA Issue Date:o5/15/2019 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
228 W Palm DR Arcadia,CA 5787018015
Contacts
ESTER&KEN FLING Owner Cielo Construction Company Contractor
228 W PALM DR 2272 COLORADO BLVD 1200,LOS ANGELES,CA 90041
(626)823-9190 (323)989-2444 983179
Description:INSTALL NEW MINI SPLIT HVAC SYSTEM FOR Valuation: $ 0.00 Tenant
SFR/ADDITION
Total Sq Feet: 0.00 Plan Check It Plan#
Fees Amount Payments Amount Paid
Compressor<3 Ton(up to 3 hp) $19.86 Total Fees $87.73
Furnace or Burner a 100,000 BTU $19.86 Cash/Receipt#REC-01215-19 $87.73
Mechanical Permit Issuance Fee $47.01
Solid Waste Management Fee 2 $1.00 Amount Due: $0.00
Total: $87.73
F7Nn4.. #o-1-77
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 veri 'ed by a City of
Arcadia building inspector for a period of 180 consecu .
May 15, 2019
Issued By: Date
May 15,2019 Page 1 of 1
ant
14 • p PERMIT/PLAN REVIEW APPLICATION
0- •_ „nr
Q37;' 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
r, ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0 hereby affirm under penalty of perjurythat 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,//ame�nd my license is in 11111 fforee and effect ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class /J License No. C 3l DateS1�� 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.
I have and willmaintain workers'compensation insurance,as required by Section
OWNER-BUILDER DECLARATION
❑ 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 perms:
License Law for the following mason(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 SW/Te CC9(1/P
demolish,or repair any structure,prior to its issuance,also required the applicant t q —Z O 312 2
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
1 workers'compensation provisions of Section 3711 :f the Labor Code,I shall
❑ as owner of the property, forthwith comply with those provisions.
I, or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered fort Date S��S��9 Ati.--
sale
sale(Section 7044,Business and Professions Code:The Contractors License Signature t
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..
0 I, as owner of the property, am exclusively contracting with licensed
contactors 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�/ -y-
if
( iact71 ! eV�SQ` `r/ -rife 1�19� /
PRINT NAME
Iti
Fill&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.
L4agree 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 thEe. ntioned
property for inspection purposes. ` / (j
Signature+�' Date 5-/(-s( �I
ROUTING TOTION
Date and , a=; ' `See
• ;! : `.,�� Notes
checferInitials of ;�Q� v,,F,¢ "c c}):, on on Sheet#
Planning T i��t /. I - ?J _f_ V -
Eng.
Building • —I-
Fire
PWS-Water i. •
WELO
Trees —
•
f it
coartedstok
frili
SST •
8 K
22,8 w Putirn 74 h4 9ifq
g ? City of Arcadia, CA Permit Na EIeC 19-0781
Development Services Department .b per Typef.'.Eleetrical
240 West Huntington Drive,Post Office Box 60021 I
Arcadia,CA 91066-6021ork Ciassi(uatlon:Elec Service Change
(626)574-5416 - Permit Status:Issued
ry .
ARCADIA Issue Date:;04/24/2019 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
228 W Palm DR Arcadia,CA 5787018015
Contacts
ESTER&KEN FUNG Owner A S I ELECTRIC INC* Contractor
228 W PALM DR 9250 RESEDA BLVD 234,NORTHRIDGE,CA 91324
(626)823-9190 (818)366-6476 807392
Description:200 AMP SERVICE UPGRADE Valuation: $ 0.00 Tenant -- -�
Total Sq Feet: 0.00 Plan Check U Plan U
Fees Amount ' Payments Amount Paid
Electrical Permit Issuance Fee $47.01 Total Fees $64.49
Residential Services up to 400 amps $16.48 Cash/Receipt N REC-01046-19 $64.49
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $64.49
NAL ia —`'tii_i!
(�( 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
frorn 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 consecu '• s.
le*/
April 24, 2019
Issued By: Date
April 24,2019 Page 1 of 1
N,.oagG
• PERMIT/PLAN REVIEW APPLICATION
fiii ".. r�
gg*' 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
❑ 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. 13I have and will maintain a certificate of consent to self-insure for workers'
License Class C �/o License No. PA-in-Exp. Date 20/-70 o compensation, as provided for by Section 3700 of the Labor Code, for the
te performance of the work for which this permit is issued.
ignature of Contractor .rgAt/1 ennt5k7
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
CII 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 mason(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 ,1 j22 7
demolish,or repair any structure,prior to its issuance,also required the applicant � Co 9 4'96-3for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number "gat,
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
❑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 y�i't 4 " Signature /llff/�C
sale(Section 7044,Business and Professions Code:The Contractors License Date /,
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 t
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:
I. 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.
jName /71ir'7C ../77-21°,7 Title 6�he�
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.
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et of plans and specifications must be kept ATduff.F of Wag°P��r
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he made except by the Building Division.
aping of this plan and specification shall not
o permit or to be an approval of the violation
'jrvisi s of any city ordinance or state law
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