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;A:100 spa City of Arcadia, CA - Permit NO.SNew. 18-1585
't\((Y Development Services Department D {`n` [�1] Permi[Type Single Family New
\53 3 240 West A 9106 -6 Drive,Post Office Box 60021 ,' f"'} °7 (� 1 E -
Arcadia,CA 91066-6021 <<$ Work Oa sf cat pn:SF/New-Accessorywelling
i (626)574-5416 ' _. f _U
„rt :i'1,,t, Peimat Status issued
ARCADIA IssuetoateiO3/06/2019 I Expiration: 09/02/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1433 Oaklawn RD Arcadia,CA 5769019004
na=awl
Contacts
SERENA CHEN Owner Ctmax Development,Inc. Applicant
112 N Earle,San Gabriel,CA 91776
(626)285-3408
Jotek Development,Inc. Contractor
317 W Las Tunas#207,San Gabriel,CA 91776
(626)233-7810 923114
Description:ADU-2 BED,2 BATH,KITCHEN,ATTACHED 2-CAR Valuation: $ 64,423.71 Tenant
GARAGE
Total Sq Feet: 615.00 Plan Check#18-1585 Plan#32693
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $5,864.70
Building Permit Fees $931.75 Cash/Receipt#REC-002183-2018 $1,132.56
Building Plan Review Fee 5605.64 Cash/Receipt#REC-00595-19 $4,732.14
Cal Green Plan Check $60.57
Energy Plan Review Fee $186.35 Amount Due: $0.00
Green Building Standard $3.00
Parks&Recreation Fee(SFR) $1,752.75
Single Family Fire Plan Check $983.00 14 COMPLETED
Single Family/Condo/Townhome Impact $1,983.00
Fee
Solid Waste Management Fee 56.25 CALLS FOR INSPECTIONS
Strong Motion Inst.Program Res 58.38 Request for inspection by telephone at 626-574-5450. Leave a message
Total: $5,864.70 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 cornmenced 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.
I/
I
March 06, 2019
Issued By: Date
March 06,2019 Page 1 of 1
°,yFORyr,
PiaPERMIT/PLAN REVIEW APPLICATION ' r
•zatif, Development Services Department,240 West Huntington Drive, Post Office Box 60021
'�ao,N Arcadia, CA 91066-6021, (626) 574-5416,Fax(626) 447-9173
Dmp
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. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class License ta.2.3 C!C( Exp. Date/0"/9 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
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 ins ranee carver 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 Numb On- 71:1Sl2
for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code)or that he or she is
0 I certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of
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, forthwith comply 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 /
sale(Section 7044,Business and Professions Code:The Contractors License Date /p (r7 // / Si
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own -
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(I)year of 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),inaddition 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
j 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.
arae Yititit 044 a` fiTitle F � L/
.
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. /9
Sihnature — I Date �6 6 /1Se,l q
NOTES '
Building Inspections Date Insp. Plumbing Inspections . /Date Insp. X933 O4464/�
100. Setbacks 210. Under fir/bldg.drain i _ �-a
101. Rough grade 211. Copper underslab _
102. Fos.&forms .r�lq� 212. Roush slumbins
103. Pre-slab �.i - 213. Roush sac 4Ask. ww``/�/�� / %F/,,��/✓�����`���/
104. Floor joists 214. Shower san orsaviflt -, n � �JI�Ti..c�
105. Steel 215. Water heater e7 //4/g5
106. Grout lift 216. Roof drains/
�l�' �"
107. Shear nailine i/ 217. Buildins sewer w- %
108. Diaph nailing 218. Water service aryhip- . /sir Venia an/
109. Roof nailing eVee ' 219. Final gas //
110. Framing ` ?0r /*--1L 220. Fixtures _ _ _ ✓ • /' ,J // L A .'
111. oc./Area Sept.Wall 221. Final plumbing i 1 //A�1 cgO D i(ri / fl�
S
112. Sound walls ,222. Sewer cep/demo. L„{�/fj' /
113. T-bar grid
114. Insulation-Fir. Pool Inspections Date I 'Insp.
•! -I i ._ , CC ..7 -_ 11SE-TO
115. Insulation-Wall 'gni 240. Excavation/steel
116. Insulation-Ceil. f', ' y 241. Rough plumbing A4 d '
117. Drywall nailing , 242. Light shell/bonding
118. Interior lath 'Mani
243. Under.round conduit //
119. Exterior lath ���yt��' 244. P-Ua. ` ����L l��
120. Finish'rade 245. Gas line&test ii�!/�l ! i _
121. Final building r Aa 246. Fence,sales&si.ns /r. J f/-� i at,
248.
Final demollot clear 247. Pool heater ■ j
248. Final electric ..&rt.
Electrical Inspections Date Insp. 249. Final slumbins
150. Power pole 250. Pool cover �
151. Sales lot lighting 251. Pool final freer/ 4/ee C__6' ? �s7/1
152. Under round conduit
153. Underslab conduit _ RendInspections I Date 1 Insp.
154. UFER ground # .-/ / 270. Pre-reroof insp. (. � ,)47 a /OC(. ' ' 0V-1155. Water ground 271. Roof framing
156. Rough electrical 9-by,r✓ 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. Es.t.bondin. Sign Inspections I Date I Insp.
160. Service panel MO 7- : 7. 280. Setback/overhang
161. Final electric 281. Footing
/
r.e i.. _' rFai-- / 282. ConduiNvirins
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/fiue 284. Final sign
181. Furnace/A.C.
182. Rauch HVAC TC 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 chem.
188. Compressor setback 295. Final
189. Commerdal hood
190. Duct shaft Sewers&Olfsite Insp. Date Insp.
191. Final mechanical tit del_ 300. Lateral(main to P4)
vv 301. SaddleN
Block Wall Inspections . Date Insp. 302. Gess..sl filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
Certificate No.20121023 -920
•
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.
ProjectAddress/APN: Accessory Dwelling Unit at 1427 Oaklawn Rd . , Arcadia,
('A Q10fl6 (Hnigr # TRT))
Number of Units in Project: One Plan Check Number: 18-1585
[ 1* [ ** [ ]**
Exempt: [ ]500 sq.ft.or less(residential addition/expansion/remodel) Residential CommercialIndustrial
[ ]Other: $3.20/sq.ft. $0.51/sq.ft.
Area in Sq.FL: 615 Receipt Number:
330441
Total Fee: $1 , 968 .00 Check Number: 125
Owner's Name: Shun Yao Guo
Owner's Address: 1427 Oaklawn Rd. , Arcadia, CA 91006
Phone Number: Email:
626-708-8920 997173817f@gq , com
Representative's Name& Contact Info(if appl.): Sam Chen 626-673-3526
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 prese d above,this Certificate of Compliance is hereby executed.
Connie Chu
Senior Administrative Asst . 11/30/18
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.
Si. 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 authorized to sign on behalf of the owner/developer and that the information he/she provided to the
District is true and accurate to the best of his/her knowledge.
Signature of Applicant: ® Name: r>ocknno.[-t
WHITE—City/County YELLOW—Fiscal Services PINK—Business Services GOLD—Applicant Certificate of Compliance(7-24-17)
VICINITY MAP NOTES PROJECT DESCRIPTION . SHEET INDEX
EMISIwG MUMPS SHALL BEDGWLISHEDUNDERLEPARAIEEERMSt PROJECT: ACCATORTEWELWCUxn PROJECT wPRE800P2)ampN :•UI.
1:p.4.4 I'A" PEmECTAEERSS: 1411OAEEAWx ROAD,ARCADL,CA MOS A.L2 atom.none
y 2.ELEVATION
RGOEONTDOGMAGEPIAH(OR RNSH ROOR PROJECT DECEPTION: TO CONVERT BODNOP'STP.GAPAGESTRUCNRETO pMIRRR cPPIu1N •
£2 ELEVAIAN ANOGRAOEfLEVAIIONS. AN ACCESSORY OWEIUNOUN1AND COWIPUCIA
3.SPARATEPERMIRSHALL BEOBTATEO FORFFNCEWALti.
NEW 3CAROARAGEIOIXU F]SUNO]RUCNPE ARO4TE N OE LS •••
nu.,.er r:...,.0 w+•." ANAUTOMATC REBOEHMIRTB-1 OENSAL NOTES.OFALS
REPRNYflSYETSMIN ACCORDANCE OWNER: — ___�
WITH NEPA IDE CR]KTTN R13.3 SHALL REINSTALLED IN ONEANE TWO AIN: 3769:019.4 �"
FAMILY OWERUNOI OR TOWNHOUSES INCLUDNGATIACHED GARAGES. PROP. .DESCEPMN TRACT NO ISI4 LOTS EA ROOFM.]INN
1E309.6.1131ST 631121 CODE DR 1060.COEC.CUC.CMC.CPC AND LOCAL AMENDMENT] TWWCESRP
.mm ADE EMOTINO WATER METER AND WATER SEVICECONMCT MIX BIC TYP EOF CONSTRUCTION: V-HI3 NOSPPINCLSSNT1EM T SS9R 113 N.m,rsl.STS.i
iw pr.,own.. Iw a WORK FOP PROPER WATS:SIZING. OCCUPANCY: 6.3 mon Xo u Df16Am R9We p�G�362T5 Vel®]JB
• r. - DP, GERTIRCATEOFOO.PUAN‘E E LOT SEE Mono'x ran=II.151 SE, ION ¢HIPVATE6EtuPW6 Fm�21.2BSYOJ
n,11Y1YeP LEGEND&ABBREVIATIONS PARuxc: 2CAEOARAGEWUX T PARKING SPACE FOR An
G1 Iia 110343) EPPING ELEVATION CM CONGEST BLOCK WALL BUADNGH anis HECHT TOR my Gny, surer
D -IED- IMMIXO GROUND CONTOUR UNE CONIC: CONCRETE �NS
J Q DIM-PIC CONCRETE BLOCK WALL WDPN
A: LWAY APPRON MNNHOISTFLOOR AREA 1478 5i.
4 ,,P' _ -"'] EOM*BUBOWO MW: DRNEWA ART FLOOR AREA: 613S'.
0-4.14P- TESTING STREET LIGHT EC: TETRIOY IOTALIMNGA 2OP MAN HOUSE)N151ADY.3014 SF
O113 Cl FF: RASH ROOF EIEVATOH GARAGE ATEA: 435SF. CONSULTANTS
N (J ImTNGTEEM REMANIDPMETERI R: FLOW LINE ELEVATION SITE PLAN KEYNOTES
0 EP ELECTRO POLE IHV: INVERET ELEVATION r r� nummrx SSRUClURE ENGINEER
339530.10 TOPOFCUEBTEVATRIN PA: PROPBIYeOUNERYWE uK
13NMIPL FLOW WE FLLVAEON PVT: PAVOAENT nmx Dumpy GNNOITROFY'�W'
WM: WATER METER RW: RETAINING WALL Pm.••..•-"•,ulrwm
PM P LAW AREA. ]AY: MECHANICAL ENGINEER:
PM': P UM WALL SMI, SEWER MANHOLE
WF. WOOD FENCE in: TOP OF CM ELEVATION Dm.: mu553T
use:a PlAman0 to&.304 Drown By:
Checked By:
1 TOLIB m by Number:
27,-8 20•-6„
CONVERT REI NEW 2-CAR
52'-0"IE) GARAGE TO ADU GARAGEu 3 33'T REI 58L10"REI I I v.Mrmn:
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•
PL:228.9'
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SCALE: /SR"= Y 0' --R
„„,` County of Los Angeles
PUBLIO W. DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION
PUBLIC WORKS
"ter 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___! Po day of_ J .�1 _,2017_Page No.__1 __of_1_
Project Address: Structural Observer of Record (SOR): SOR Phone No.:
141 Oak(A vo h Rd, �"c'i a CA Hong Chuen Chao 909 680-2727
Building Permit No.: Structural Observation Observr Professional Lic./Reg. No:: Observer Phone No.:
SNew or performed by:Hong Chuen Chao C68688
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTION
OBSERVATION LOCATION
❑Footing, Stem Walls 0 Concrete 0 Steel Moment Frame 0 Concrete
❑ Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck
❑Caisson, Piles, 0 Wood , 0 Concrete Moment 0 Wood
Grade Beams Frame
❑Retaining Foundation 0 Others: 0 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 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.)
Gffold-dcw"y � Rpt 91.ectiti'," Den., t pbs-el , s
fI y t.onoc i4 eat h tri�y e ffe,i, t o 54, I e tri .ole r
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 PpFESS
REQUIREMENTS OF THE COUNTY OF LOS ANGELES. , N,9
QQ�
G CNUEcN e
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS 'c3$ , 2�
UNDER-MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT
7--
EACH
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN 0 rr'
uJ
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; N0. C-68868
Exp.09/30/1 9
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED - * *'
ABOVE;
sr civt\- �P
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY ite OF CAL\FOPS
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED.
'/1�/j ��� / o/2-0/ 9 (STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF STRUCTURAL OBSERVER DATE O
Version 1.0(2008 LACBC) Jen. 10 2008
------- ----- ---- ----------- - ----
111 -
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G3t1 s -., Ur r r^ r L-_1 "Crl lr Thl 111111
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III +I l +9 Los Angeles County Registrar-Recorder/County Clerk
si. LN\.< Fit
DEAN C.LOGAN
Registrar-Recorder/County Clerk
If this document contains any restriction based on race, color, religion, sex, gender, gender
identity, gender expression, sexual orientation, familial status, marital status, disability, genetic
information, national origin, source of income as defined in subdivision (p) of Section 12955, or
ancestry, that restriction violates state and federal fair housing laws and is void, and may be
removed pursuant to Section 12956.2 of the Government Code. Lawful restrictions under state
and federal law on the age of occupants in senior housing or housing for older persons shall
not be construed as restrictions based on familial status.
10/14
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:City Attorney - •20190046409
City of Arcadia •
P. 0.Box 60021
Arcadia, CA 91066-6021
COVENANT AND AGREEMENT
REGARDING ACCESSORY DWELLING UNIT
(1427.OAKLAWN ROAD, ARCADIA, CALIFORNIA)•
.
FOR GOOD,VALUABLE AND ADEQUATE CONSIDERATION, receipt of which is .. .
hereby acknowledged, . ,
SHUNYAO 6U0 ANDYONGHONG CHEN, .
HUSBAND AND WIFE, AS COMMUNITY PROPERTY WITH RIGHT OF
SURVIVORSHIP -
hereinafter referred to as "Covenantors", hereby declare that they are the owners of that
certain real property located at 1427 Oaklawn Road in the City of Arcadia, County of Los
Angeles, State of California, more particularly described as follows:
Lot4 of Tract No. 13544,in the City of Arcadia,.County of Los Angeles,State
of California, as per map recorded in the book 339; Page(s) 10 and 11 of
maps, in the office of the County Recorder of said county.
Covenantors hereby agree and covenant with the City ofArcadia, a Municipal Corporation
(hereinafter referredto as the "Covenantee") on behalf of and for the benefit of the
Covenantee's land;which is the public street and right-of-way adjacent and contiguous to
the Affected Land, and onbehalf of and for the benefit of the "Benefitted Land" which
consists of and includes all the publicand private land.'located within 500 feet of the '
Affected Land, as follows:
1. The Accessory Dwelling Unit shall conform to the plans shown on Site Plan
(Exhibit "A"). The Property owner shall occupy either:the primary residence or the
accessory dwelling unit. The Accessory Dwelling Unit shall not be rented for terms of less.
than 28 days or to more than one renter within any 28 day period, and the accessory
dwelling unit shall not be sold separately from the primary dwelling unit. No more than one
accessory dwelling unit shall be allowed on the property:The accessory dwelling unit shall
have two designated parking spaces. '
2. If this Covenant and Agreement is breached by Covenantorsor successors or
assigns, Covenantee is hereby authorized to bring an action in a court of competent
1
jurisdiction to enforce this Covenant and Agreement. In the event of such legal actions,
' Covenantor or their successors or assigns shall be liable for reasonable attorney fees of
Covenantee, if Covenantee is the prevailing party. In addition to other remedies available
by law to the Covenantee to enforce this Covenant and Agreement, if this Covenant and
Agreement is breached, the City of Arcadia solely at its option, may revoke this Covenant
and Agreement.
3. Covenantors agree to notify their assigns and successors in interest in
Affected Land of their Covenant and Agreement.
4. This Covenant and Agreement is for the benefit of the Covenantee and its
heirs, successors and assigns and is for the benefit of and shall inure to the benefit of all
the Benefitted Land and the heirs, successors and assigns of the owners of the Benefitted
Land, and this Covenant and Agreement shall be binding upon the heirs, successors and
assigns of the Covenantors, and may be released in writing by the Covenantee.
5. The City of Arcadia in its capacity as Covenantee and in its capacity as the
legal representative of the residents of the City of Arcadia and more particularly as the
legal representative of all the owners of the Benefitted Land is hereby authorized to
enforce the provisions of this Covenant and Agreement.
6. If any section, subsection, sentence, clause, phrase or portion of this
Covenant and Agreement is for any reason held to be invalid or unconstitutional by the
decision of any court of competent jurisdiction, such decisions shall not affect the validity of
the remaining portions of this Covenant and Agreement.
IN WITNESS WHEREOF, Covenantor has executed this instrument on the date
shown opposite their signature.
[SIGNATURES ON THE NEXT PAGE]
2
"COVENANTORS"
•
Dated: /.2--/2.??/ , 2018 %P Oho
Shunt' GAo
Dated: i.�/a8 2018 /a1y'kcg5 C 6411,
Yonghong Chen
"COVENANTEE°
Dated!SAavin 201 'G _-
Dominic Lazzare'
City Manager
APPROVED AS TO FORM:
Stephen P. Deitsch _
City Attorney
•
3
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1427 OAKLAWN ROAD, ARCADIA, CA 91006
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112 North Earle Street,
''fits. San Gabriel, CA 91775
„ TEL: 626.285.3408
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FAX 626.2.86.2037
, . _ ..
ACCESSORY DWELLING UNIT PROJECT
1427 OAKLAWN ROAD, ARCADIA, CA 91006
•
•
NOTESPROJECT DESCRIPTION
__
1 AIL EXIDDIG STRUCTURES SHALLBE DDAOLISFIID UNDER SEPARATE PER6u1. PL'Ol[Ct, ACCC:UP+fYnEl LING OUT PRO/COT
PROJECT ADDRESS' _ 142/OILLA'NN ROAD.ARGdA.CA 91036
7 SEC APPROVED GRADNO AND ORANAGE PLANTOR r GISH FLOOR PROJECT OESCRPUGH' TO COI//CPIE/EIRtO Els I.I.GARAGE STRUCTURE TO
ELEVATION AND GRADE(IEVAUONS AJ1ACCESSOR/DWELL RAG win NO CONSTRUCT
NEW 2.CAR GARAGE 10 DC EXGUIG STRUCTURE
3 SEPARATE PERMITS SHALL BE OBTAINED TOR/DC(WAILS
—
4 AN AUTOMAIC REIDENTlAL ARL SPRNKLER 5YSILM IN ACCORDANCE OWNER:
WITH NFPA IOD OR SECTION R13_3 SHALL BE INSTALLED IN OIIE AND TWO AP J1• 5769019-004
FAA6RY DWELLNGS OR TOWNHOUSES ICLUDRG ATTACHED GARAGES. IRQ.GORY.DESCRIPTION' TRACTT:0 13:44 LOT 4
11309.6.8313.1..R31371
CODE. 2016 CBC.CGBC.CCC.CMC,CPC*IC LOCAL AMEla AFNT3 .
5. UPGRADE CASTING WATER/ALTER N.0 WAILR SERVICE.CONTACT PUBLIC TYPE Or CONSTRUCTION: V.8 WITH NO SPRINKLER SYSTEM
WORK FOR PROPER WATER SUING. (NO LIRE SPIl,1K,LER SYSTEIA I:EXISING MARL HOUSE]
OCCUPANCY: R.3
LEGEND & ABBREVIATIONS LOT SUL Loam 422850. 222.S1 SJ.
TONING: R•1
1403.43) CASTING ELEVATION OW: CONCRETE-BLOCK WALL PARERJG, 2-CAR GARAGE WIUI I PARKING SPACE TOR ADO
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EXITING IR,IOI+1 TO FUAAe1
DOSING CONCRETE BLOCK WAIL CUA: DRrvCYIAYAW RCH
MAUI HOLM ltOpR AREA 2.479 31.
EXISTING BTALDf1G D'RYY; D¢rv(vIAY
•
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GARAGE AREA: 6)2 I L(PEW A00111011 MCA 10 NEW AM
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(397,013)Fl FLOW UNE ELEVATION PVMT.: IAVU+LII IIwAns...es.•
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PM: PLANT WALL SMII: SEWERIAAFNEIOLE
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—
CTMAX DEVELOPMENT, INC._
• 112 North Earle Street,
San Gabriel, CA 91775
TEL: 626.2852408
cl, FAX: 6262862037
ACCESSORY DWELLING UNIT PROJECT `
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EXHIBIT PA"
�oeLEsco. LOS ANGELES COUNTY DEPARTMENT OF PUBLIC WORKS •
s5� �< BUILDING AND SAFETY DIVISION
l•gal
PUBLIC WORKS
SeNice SPECIAL INSPECTOR REPORT
'Iba�
Each inspector must complete this report and mail it to
the District Office where the permit was issued.
e+ DAILY 0 WEEKLY 0 FINAL
TOTAL TIME ON JOB (IN DAYS) BUILDING PERMIT NO.SNEW Ir( SRDISTRICT NO.
JOB ADDRESS 14- '- oCkkw n 1\d , , A ‘r-
GEI'IERAL CONTRACTOR 301-04
/ IO IV'4 /V C/I 01)% 4.
SIZE OF BUILDING NO. OF STORIES TYPE--OF WALL
TYPE OF WORK: 0 REINFORCED CONCRETE 0 MASONRY 0 HI-TENSILE BOLTING
• 0 PRESTRESSED CONCRETE 0 WELDING j 0 GYPSUM CONCRETE
OTHER . 1 1I / c
DESCRIPTION OF WORK INSPECTED -PY t 1 I to X es vIRIIAk kelt-s (h4-0
—2S4 s-1; v s I a 6 1• Y o• c a , c 1 •ea,,,, 1-e s whit `--
4 10 Weis w/ C c6ty +0 061),hsec-I- 1\J-e,W—.
sL �� ak--'a;
4.mite ' City of Arcadia, CA -ea =Permit Na MEP-19-0674
1{ ..: Development Services Department _ I -� PerrPrt Type:MEP
a 240 Wes[Huntington Drive,Post Office Box 60021 - CtWorkaClassrfication MEP Residential
Arcadia,CA 91066-6021 • �" ,_, - -
� 1 (626)574-5416 _ = Permitstatus:issued
ARCADIA ` Issue:Date'04/08/2019=1 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1433 Oaklawn RD Arcadia,CA 5769019004 I
Contacts
YONGHONG CHEN Owner JOTEK DEVELOPMENT INC* Contractor
1427 OAKLAWN RD 317 W Las Tunas#207,San Gabriel,CA 91776
(626)233-7810 923114
Description:FOR ADU 100 AMP.HOODS,HVAC SYSTEM PER Valuation: $ 0.00 Tenant
APPROVED PLANS. HERS REQUIRED FOR FINAL.
Total Sq Feet: _ 0.00 , Plan Check# Plan#
Fees Amount payments Amount Paid
Bathtubs/or Combo $26.42 Total Fees $510.79
Clothes Washer $13.21 Cash/Receipt#REC-00886-19 $510.79
Compressor<3 Ton(up to 3 hp) $19.86
Dishwasher $13.21 Amount Due: $0.00
Electrical Permit Issuance Fee $47.01
Furnace or Burner<=100,000 BTU $19.86
Garbage
sal Fee
Install,Relocate Appliance Vent/Hood $13.21
Gas System(Outlets) $31.10
J
$9.94 n COMPLETED
Kitchen Sink $13.21 �r
Laundry Trays $13.21 CALLS FOR INSPECTIONS
Lavatories $26.42 Request for inspection by telephone at 626-574-5450. Leave a message
Mechanical Permit Issuance Fee $47.01 requesting the address,timeframe and what inspection item is needed.
Motors,Generators<1 hp $8.07
New Residential Elect.(sq ft area) $49.20
Plumbing Permit Issuance Fee $47.01 This permit/plan review expires by time limitation and becomes null and
Residential Services up to 400 amps 516.48 void if the work authorized by the permit is not commenced within 180 days
Sewer Connection on Property $33.01 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: $510.79
1 6L
2'Z61'20 6/r
Ale
April 08, 2019
Issued By: Date
April 08,2019 Page 1 of 1
i AR
es PERMIT/PLAN REVIEW APPLICATION
li
0� J;; op •
`titter Development Services Department,240 West Huntington Drive,Post Office Box 60021 '
000om,y 0(0' Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0 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 13 License Not —It
4-/ Exp. Date t/r 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
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of he 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 0� /Q
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 f
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,
forthwith comply th those provisions.
❑ or my employees with wages as their sole �7 wp0 p ___.......----
compensation,
compensation,will do the work,and the structure is not intended or offered for I\ Date (Qb-// / Signa ri`���
sale(Section 7044,Business and Professions Code:The Contractors License
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended-or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year.of and shall subject an employer to criminal 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:
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,renova'on and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
Name ><V1.444/11
4H (12--e" Title L' L`— (?
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 buildin construction. I hereby authorize representatives of the City of
Adia to enter upon the above-mentioned.property for inspection purposes.
Si ature s, ate 11/251
City of Arcadia, CA i ! Permit No Misc 18 2374
Development Services Department 0 f f •J t'� -„,,, \ -gni' ' ,Permit Type`._MISC'
•
� 240 West Huntington Drive,Post Office Box 600211—'1, ( � g i & •
I r Arcadia,CA 91066-6021 { ' I 'Work Clossifcotlon..M -Address Change
(626)574-5416 �. __ - Permit Status issued
ARCADIA - isaLie Date 12/20/2018 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1433 Oaklawn RD Arcadia,CA 5769019004
Contacts ,
YONGHONG CHEN Owner
1427 OAKLAWN RD
Description:ADDRESS CREATION FOR ADU =1433 OAKLAWN Valuation: $0.00 Tenant
RD.MAIN HOUSE 1427 OAKLAWN RD.
Total sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Address Change $500.00 Total Fees $550.60
Building Issuing Fee $44.35 Cash/Receipt#REC-003215-2018 $550.60
Solid Waste Management Fee $6.25
Amount Due: $0.00
Total: $550.60 -,
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.
December 20, 2018
Issued By: Date
December 20,2018 Page 1 of 1
A.
iss PERMIT/PLAN REVIEW APPLICATION
Ir 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. 0 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
(This section need not be completed if the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code) or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of _F-1I 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,
forthwith comply 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
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(I)year of and shall subject an employer[dcriminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousanddollar ($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 3706,6f 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
n
Date 0- ignature /� %i !/.v Lender's Address
IMPORTANT: APPLICATION IS HERE I- 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. ,�,, �� yy�
Name / / _ _ LJA „I ,t_AS Title (FY'^' - W
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. l //
iignature11v , !rGl) p Date / Z/ 2v / 42
U~4 oFF avc9,,�
I�l� , 4., ojl December 26, 2018
°°mYrf%. Subject: Create new address at: 1427 Oaklawn Rd
City of Please be advised that the City of Arcadia has approved to create a second
1 address for a newly created Accessory Dwelling Unit for the subject property.
Arcadia Parcel Number: 5769-019-004. Please update your records as follows:
MAIN DWELLING ADDRESS ASSIGNMENT:
Development
Services 1427 Oaklawn Rd
Department Arcadia CA, 91006
Jason Kruckeberg NEW ACCESSORY DWELLING UNIT ASSIGNMENT:
Assistant City Manager/
Development Services 1433 Oaklawn Rd
Director
Arcadia CA, 91006
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 1427
Oaklawn Rd and the Accessory Dwelling Unit address is going to be 1433
Oaklawn Rd.
Should you have any question,please contact the City's Development Services
Department/Building and Safety office at (626) 574-5416.
Sincerely,5iar.
COM
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
DEVELOPEMNT SERVICES DEPARTMENT
240 WEST HUNTINGTON DR,
ARCADIA, CA 91007
(626)574-5416
APPLICATION FOR AN ADDRESS CHANGE
($550.60 FEE REQUIRED AT TIME OF APPLICATION)
slat,
yeo C—, u.v
Applicant Propert9 ?et
111427 decl,LCut k\ RD. cel q/oo7
Address Property Address
t f' -7 oa./LLawn AD A-VC:ark C.4 9/007
Mailing Address Mailing Address
& .L4 708 8q2-0
Phone Number Phone Number nh��
REQUESTED PROPERTY ADDRESS: if 3 3 e (a«,h C� .Ana ch Q 97,000
15`Choice
1 n
2nd Choice
a 'a
oyd g Owner's Signature Date
FOR OFFICE USE ONLY
DOCUMENTATION: Curren 'roperty Tax Bill: Recorded Grant Deed:
FEE: $550.60 PAID: RECEIPT NO:
APPROVED (Notification attached) Yes: No:
DENIED (Reason): �j �/
ASSIGNED PROPERTY ADDRESS: 433 C)avI,auI''
n Di By:
Building Official
*Note: Send notifications to all listed agencies upon approval of Building Official.
�y City Arcadia, CA i
Permit No FIRE-19-0822
Development Services Department �r ( '+ "� (—` `Ser: PermitType Fire
240 Weses t Huntington Drive,Post Office Box 60021 +t "' g -:.
i i; Work fldssrficahonaFire Sprinkler_
Arcadia,CA 91066-6021 i4..1
' (626)574-5416 ` `,. •Permit Status:Issued.
ARCADIA Issue Date:07/08/2019'1 Expiration: 10/29/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1433 Oaklawn RD Arcadia,CA 5769019004
Contacts
SERENA CHEN Owner SPECIALIZED FIRE PROTECTION,INC.* Contractor
18305 E Valley#H, La Puente,CA 91746
(626)416-9276 1005885 `
Description:PRINKS FOR NEW ADU Valuation: $ 3,000.00 Tenant
Total Sq Feet: 615.00 Plan Check#19-822 Plan#32693
Fees
Amount Payments Amount Paid
Fire Issuance $47.01 Total Fees $448.36
Fire Permit Fees $120.35 Cash/Receipt if REC-01109-19 $280.00
Solid Waste Management Fee 2 51.00 Cash/Receipt#REC-01759-19 $168.36
Sprinkler Heads $280.00
Amount Due: $0.00
Total: $448.36
o CQMPIETEO 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.
July 08, 2019
Issued By: Date
July 08,2019 Page 1 of 1
of AR
1111E1 ^-9 PERMIT/PLAN REVIEW APPLICATION
e:Tr 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 forceand effect. /J ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class (11 b License No. u bti 20 Exp. Date 7/zl 9 compensation, as provided for by Section 3700 of the Labor Code, for the
J 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 &ta C..
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 uoo '? 3)/ ct/
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 1:1I 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 th abor Code,I shall
❑I, as owner of the property, forthwith comply 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
sale(Section 7044,Business and Professions Code:The Contractors License Date 7/g/I1
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. FJ/
Name t (! 'vt' Title
PRI N 1E
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 f inspection purposes. �7 a
Signature l// Date / 6/1
v%4 OV
wos4 7
�o C MEMORANDUM
Fire Department
DATE: January 6, 2020
TO: BUILDING DEPARTMENT
INSPECTOR John Zurick
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 1433 Oa/dawn Road
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 12-30-2019 Jill Perumean
FIRE ALARMS
HOOD & DUCT
KNOX BOX
OCCUPANCY 12-30-2019 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 12-30-2019 Rita
T� v�,.4
0 ® r7
sz.°on,a WATER DIVISION
ATTENTION: DATE: A 7Z )
FROM: BUILDING DIVISION / INSPECTOR: 6 //
4
ADDRESS: .72/ Oc; / Itizfl e /9/) ti
PERMIT NO.: PLAN NO.:
CONTRACTOR: Ci/?,/� PHONE NO.: -73 5576
OWNER PHONE NO.:
PLEASE INSPECT THE FOLLOWING ITEMS FOR CONFORMANCE WITH APPLICABLE DEPARTMENT
OF PUBLIC WORKS REQUIREMENTS.
Type of Inspection Date& Initial Date&Initial Final Approval
Meter Location
Blackflow Devices 'WA
*AS 1/4/Qo
Irrigation System
Fire Sprinkler System AA
it 1/q/ o
Meter Clear A.P.P.
,V/A
Swimming Pool
NIA
DC
COMMENTS: \AA\WI .e. 35o 1 "I WASH 3953 (fire Sotpie�lo. ,) —
tack T1Uvse/IVor}h
1y1�1� OWNER'S CERTIFICATION FORM
MINIMUM BMPs FOR ®/1
I
ALL CONSTRUCTION SITES V
ARCADIA
•
Project NameACa-SSoRy t& l4UI tIX/T BUILDING/GRADING PERMIT NUMBER
Project Location /¢z7 °Al efrtly) RCM Al b//
Owner Name y-DAfC/tloA %i
.l�°� C / Contractor Name
Address 142 7 /MK/4Wi(/R/a MLAO/,q/4 2/0 r( Address
Phone 6z t( - • Phone
FAX/Email FAX/Email
•
The National Pollutant 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 subject to RWQCB enforcement. To meet the requirements of the Los Angeles County Municipal
Separate Storm Sewer System (MS4) Permit (R4-2012-0175), minimum requirements for sediment control, erosion
control and construction activities must be implemented on each project site. Minimum requirements indude: •
• EROSION: Erosion from slopes and channels shall be controlled by implementing an effective combination of BMPs,
such as the limiting of grading activities during the wet season;inspecting.graded areas during rain events; planting
and maintenance of vegetation on slopes; and covering erosion susceptible slopes.
• 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 and/or adjacent properties
via runoff, vehide tracking or wind.
• CONSTRUCTION MATERIALS CONTROL: Construction related materials, wastes, spills or residues shall be
retained on site to minimize transport from the site to streets, drainage facilities or adjoining properties by wind or
runoff. Runoff from equipment and vehicle washing shall be contained 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 AND SEDIMENT CONTROL PLAN (ESCP): Required for projects one acre or more. The ESCP must be
developed and certified by a Qualified SWPPP Developer(QSD).
• HILLSIDE: Construction upon slopes 25% or more requires the implementation of additional BMP5 to protect slopes
and prevent erosion and sediment runoff.
Minimum BMPs indude:(1)Soil piles must be covered with tarps or plastic,(2)leaking equipment must be repaired immediately,(3)refueling must be
conducted away from catch basins, (4) catch basins must be protected when working nearby, (5) vacuum all concrete saw cutting, (6) never wash
concrete waste into the street,(7)keep the site dean,sweep the gutters at the end of each working day and keep a trash receptadeon site.
As the engineer of record, I have selected appropriate BMPs to effectively minimize the negative impacts of this project's construction activities on
stormwater quality. The project owner and contractor are aware that the selected BMPs shall be installed, monitored, and maintained to ensure their
effectiveness. The BMPs not sel- -. or implementation ar- -:undant or deemed not applicable to the proposed construction activity.
paf
S ginger> • ..rd Name Engineer of Record Signature
('lGc%c��j/�
/ Title Date
I certify that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that
qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person(s)who manage the system or those
person(s) directly responsible for gathering the information, to the best of my knowledge and belief, the information submitted is true, accurate, and
complete. I am aware that submitting false and/or inaccurate information,failing to update the BMPs or ESCP to reflect conditions,or failing to properly
and/or adequately implement the BMPs may result in revocation of grading and/or other pe Its r other sanctions provided by law.
-YoNGW-foN&- .CHEM iltoNq rkn
Landowner or Agent Name La wnecaJAgent Signature
(94.4)h 2}^ to/b
Title to