HomeMy WebLinkAboutTI-19-0666 City of Arcadia, CA
Permit NO TI-19-0666
; Development Services Department a°" t q w��� Permit Type Tenant Improvement
_:, ' 240 West Huntington Drive,Post Office Box 60021
• ; Arcadia,CA 91066-6021 .1 i :.) i i t (Work Classification Tenant Improvement
[74"—V-71
(626)574-5416 A Permit Status Issued
r , ,
ARCA I)IA 3 �:: issue Date 07/26/201p.1 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1133-135 E Huntington DR Arcadia,CA 5773010010
Contacts
Calvin Chao Owner DANIEL TAI Applicant
137 Huntington DR 322 E FOREST AVE,ARCADIA,CA 91006
(626)452-8988 (626)808-6560 USCA.COMPANY@YAHOO.COM
New Skyline Construction Inc. Contractor
21807 Oakwood WAY,Walnut,CA 91789
(909)569-9198 970096
Description:T.I.FOR OFFICE Valuation: $ 200,000.00 Tenant
Total Sq Feet: 0.00 Plan Check#19-666 Plan#90
ti
Fees Amount Payments Amount Paid
Accessibility Plan Check $186.62 Total Fees $4,640.59
Accessiblity Building Permit $191.40 Cash/Receipt#REC-00875-19 $2,217.93
Building Issuing Fee $47.01 Cash/Receipt#REC-01923-19 $2,422.66
Building Permit Fees $1,914.00
Building Plan Review Fee $1,244.10 Amount Due: $0.00
Cal Green Plan Check $124.41
C 7
Commercial T.I.Fire Plan Chk. $280.00
Energy Plan Review Fee $382.80 Vr- ;,#"P
Fire Final Occupancy Fee $200.00 f
LETED
Green Building Standard $8.00
Solid Waste Management Fee $6.25 CALLS FOR INSPECTIONS
Strong Motion Inst.Program Corn $56.00 Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
Total: $4,640.59
This permit/plan review expires by time limitation and becomes null and Nx` :to 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 26, 2019
Issued By: Date
July 26,2019 Page 1 of 1
OF„AvoRA
,
X „' .I. �I- PERMIT/PLAN REVIEW APPLICATION
4.• ,„ • 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
i,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 6
Signature of Contractor��License NOS 9b Exp. Date_ /Z-0o. P compensation, as provided for by Section 3700 of the Labor Code, for the
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 the Labor Code,for the performance of the work for which this permit
is issued.My w rsop nsation insurance carrier and policy numbers are:
License Law for the following reason(Section 7031.5,Business and Professions l Aco Kv
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 1 I 9 O / 132 ” I? .
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number b
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)
1 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 M 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'
compensation Laws of California,and agree that if I should become subject to the
penalty of not more than five hundred dollars($500)): l
)vorkers'compensation provisions of Section 3700 of the Labor Code,I shall
0 I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
06sale(Section 7044,Business and Professions Code:The Contractors License Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or.she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees. -
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for
further information.
Name ic tA6vie A CA PM Title g m O
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.
Il 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. /�
�- / C
Signature Date
7 /
/33-135 C
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp. 1 - 06.(4)
100. Setbacks 210. Under fir./bldg.drain •.Z6.1e3
101. Rough grade 211. Copper underslab
102. Figs.&forms 212. Rough plumbing 9. c.•
103. Pre slab 213. Rough gas r 3�/ f/ /N1171€ 1.944 Do i.� Cif
104. Floor joists 214. Shower pan //lam vcP )"=' �o vr:"- a"-
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailing 219. Final gas
110. Framing /o•Z6.1 220. Fixtures
111. Occ./Area Sept.Wall 221. Final plumbing r•e0'70
112. Sound walls 222. Sewer cap/demo.
113. T-bar•rid .g•/t 4..-
114. Insulation-Flr. Pool Inspections Date I 'Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Ceil. 241. Rough plumbing
117. Drywall nailing /0.I0•(9 242. Light shell/bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade 245. Gas line&test
121. Final building f•rp•gjp 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. Underground conduit
153. Underslab conduit Reroof Inspections Date Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Roof framing
156. Rough electrical /0.29.11 Q-- 272. Sheathing nailing
157. Fixtures /2.•9.19 4 - 273. Final reroof
158. G.F.C.I.
159. E••t.bondin• Sign Inspections I Date I Insp.
160. Service panel 280. Setback/overhang _
161. Final electric •ln.Zp 281. Footing
282. Conduit/wirin•
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC jp, - '\� Miscellaneo s asp I Date I Isp
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 (•(o 'Ao 300. Lateral(main to PI)
301. Saddle/Y
Block Wall Inspections • Date Insp. 302. Cess.001 filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
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Ya Certificate of Occupancy
City of Arcadia ,5
�si {; Development Services Department—Building Division s \,r�,y
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. •07-a--'K. ,g; ..)ty.--,'V,IX;
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i S This certificate issued pursuant to the requirements of the , f
1,26 W t California Building Code certifying that at the time of issuance this structure was in .''.,i' '¢ '
compliance with the various ordinances of the City regulating building construction or use.
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� k Permit No. TI-19-0666 1f a
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47 f, Building Address: 133-135 E.HUNTINGTON DR ARCADIA, CA 91006 r,o,
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i Permit Type: TENANT IMPROVEMENT Effective CBC: 2016 C.B.C. 4.0;,-,&
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; ,,Occupancy Code: B Zone Code: CBD ., � a7\
t Final Date: 1-6-2020 Type of Construction: TYPE VB SPRINKLERED 3, *1
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4' s 1" Owner: CALVIN CHAO Tenant:REMAX REALITY 4_ -F ,
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8gg41; . .- CITY OF ARCADIA L '
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le , DEPARTMENT OF BUILDING AND SAFETY
c0�''4+�ity oc' STRUCTURAL OBSERVATION REPORT FORM
REPORT NO. 2
THIS REPORT INCLUDES ALL CONSTRUCTION WORK THROUTH_9_DAY OF 25 ,2019
PROJECT ADDRESS: STRUCTRUAL OBSERVER STRUC.OBS.PHONE NO.
133 E Huntington Dr DAVID LI (626)-288-1216
OWNER LIC.OR REGISTRATION NO. BUILDING PERMIT NO.
C58075
LOCATION AND DATE
OBSERVED STRUCTRUAL ELEMENTS AND THEIR CONNECTIONS PORTIONS
p�O�F'jBLDG. /�
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OBSERVED
❑-
❑-
❑-
OBSERVED DEFICIENCIES: J v12.
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND
BELIEF:
1.I AM THE REGISTERED ENGINEER OR LICENSED ARCHITECT WHO HAS RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION
2.I,OR ANOTHER REGISTERED ENGINEER OR LICENSED ARCHITECT WHO HAVE DESIGNATED AND IS UNDER MY
RESPONSIBLE CHARGE,HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF
THE STRUCTURE IS IN GENERAL CONFORMANCE WITH THE APPROVED PLANS AND SPECIFICATIONS; CI DEFICIENCIES CONTINUED
3.ALL DEFICIENCIES WHICH I DOCUMENTED HAVE BEEN CORRECTED UNLESS OTHERWISE INDICATED ABOVE, ON ATTACHED FORM(B&S 261 A)
4.I UNDERSTAND THAT FINAL ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE DEPARTMENT OF BULIDING AND SATETY CANNOT
OCCUR WITHOUT THE CORRECTION OF ALL OBSERVED DEFICIENCIES;
5.I AM RESPONSIBLE FOR THE SUBMISSION OF THE ORIGINAL OF THIS REPORT TO THE DEPARTMENT OF BUILDING AND SAFETY, Q,OFESSIO
CITY OF LOS ANGELES. 9///,��NG DA 1- 4
6.I HAVE PROVIDED STRUCTURAL OBSERVATION ACCORDANCE WITH THE REQUIREMENTS OF THE CITY OF LOS ANGELES. ,
NO, 058075
I 1'
a
SIGNED ' , OF 'r..-_-Ti', ,,2019 AT' Acadia CA ��,�� CIVI\'�4�:
DAY MO'' Y AR `r `CITY] OF CAS
„., ,
x-,-
. • _,, . ', EXPIRE DATE:06/30/2020
WET SIGNATURE OR REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT y``„ STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED
EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL
OBSERVER'S RECORD AND DISTRIBUTIONS.(B&S 261 R.12/95)
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�4 1 iFOR4.1'''d
�,ti _- ,,7 7 os pµCCI ES Recr0.,
t ` CITY OF ARCADIA
LAUCP .
I�?',..-1,:4;:-1�I,
r DEPARTMENT OF BUILDING AND SAFETY L"--.R. c�u p.oaWP�
N°'°pity Of STRUCTURAL OBSERVATION REPORT FORM
REPORT NO. 2
THIS REPORT INCLUDES ALL CONSTRUCTION WORK THROUTH_10_DAY OF 9 ,2019
PROJECT ADDRESS: STRUCTRUAL OBSERVER STRUC.OBS.PHONE NO.
133 E Huntington Dr DAVID LI (626)-288-1216
OWNER LIC.OR REGISTRATION NO. BUILDING PERMIT NO.
C58075
LOCATION AND DATE
OBSERVED STRUCTRUAL ELEMENTS AND THEIR CONNECTIONS PORTIONS OF BLDG.
ri-m-lilAlrIATInAl fl-1A,AI I _I-1-.PPAM El-PI nnp tIQ kJ 6 (i. S13'VL
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❑-
❑-
❑-
OBSERVED DEFICIENCIES: 0 o&)Z-
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND
BELIEF:
1.I AM THE REGISTERED ENGINEER OR LICENSED ARCHITECT WHO HAS RESPONSIBLE CHARGE FOR THE STRUCTURAL OBSERVATION
2.I,OR ANOTHER REGISTERED ENGINEER OR LICENSED ARCHITECT WHO HAVE DESIGNATED AND IS UNDER MY
RESPONSIBLE CHARGE,HAS PERFORMED THE REQUIRED SITE VISITS AT EACH SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF
THE STRUCTURE IS IN GENERAL CONFORMANCE WITH THE APPROVED PLANS AND SPECIFICATIONS; ❑DEFICIENCIES CONTINUED
3.ALL DEFICIENCIES WHICH I DOCUMENTED HAVE BEEN CORRECTED UNLESS OTHERWISE INDICATED ABOVE, ON ATTACHED FORM(B&S 261 A)
4.I UNDERSTAND THAT FINAL ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE DEPARTMENT OF BULIDING AND SATETY CANNOT
OCCUR WITHOUT THE CORRECTION OF ALL OBSERVED DEFICIENCIES; ...,,l; p40FESS/OA
5.I AM RESPONSIBLE FOR THE SUBMISSION OF THE ORIGINAL OF THIS REPORT TO THE DEPARTMENT OF BUILDING AND SAFETY, 7O �,),S14G _ ,, '1'
CITY OF LOS ANGELES. / 40 Q�G 1 GAO 1.
6.I HAVE PROVIDED STRUCTURAL OBSERVATION ACCORDANCE WITH THE REQUIREMENTS OF THE CITY OF LOS ANGELES. )
. moo. C058•075
NC/IFIL ��� Z2
SIGNED OF ei 2019 ;AT '_Arcadia ;CA �Q'CALk,Fd� :I
DA `MONT YEARCITY
�L ).
X EXPIRE DATE:06/30/2020
WET SIGNATURE OR REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT ' STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED
EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTORS OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL
OBSERVERS RECORD AND DISTRIBUTIONS.(B&S 261 R.12/95)
A. City of Arcadia, CA ,
Permit NO FIRE-19-1910
Development Services Department i.� V d ",i, ter.. S ,," ,`) ."_ Permit Type Fire
7240 West Huntington Drive,Post Office Box 60021 , 1 a ! ,'
i�` i 6 +y Work Classification Fire Sprinkler
Arcadia,CA 91066-6021 a a G a
(626)574-5416 3 Fq fi'' ,, t q x y , Permit Status:Issued
ARCADIA Issue Date:11/15/2019"I Expiration: 03/17/2020
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 1133 E Huntington DR Arcadia, CA 5773010010
Contacts
Calvin Chao Owner F&H Fire Protection* Contractor
137 Huntington DR 1119 Westminster AVE,Alhambra,CA 91803
(626)452-8988 (626)262-3876 584319
Description:66 HEADS FOR TI Valuation: $ 7,000.00 Tenant
Total Sq Feet: 0.00 Plan Check#19-1910 Plan#
Fees Amount Payments Amount Paid
Fire Issuance $47.01 Total Fees $935.16
Fire Permit Fees $187.15 Cash/Receipt#REC-03109-19 $235.16
Solid Waste Management Fee 2 $1.00 Cash/Receipt#REC-02548-19 $700.00
Sprinkler Heads $700.00
Amount Due: $0.00
Total: $935.16
CALLS FOR INSPECTIONS
zif Request for inspection by telephone at 626-574-5450. Leave a message
Olirrequesting the address,timeframe and what inspection item is needed.
iCO1g? 7
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 fora period of 180 consecutive days.
I//
November 15, 2019
Issued By: Date
November 15,2019 Page 1 of 1
of ARe
:,* I PERMIT/PLAN REVIEW APPLICATION
o ,j` Development Services Department,240 West Huntington Drive,Post OfSce Box 60021
m4JonitY.11V Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
01
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, license is in full f rce and e 'ect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
/
License Class ' I 0 License No. l Exp. Date 4 f '2( compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor C.----- f performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION IMP
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. workers'igompensation insurance carrier and licy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, CarrierVp)r-Cg 'P Y.t,.,„) , ,..c.
demolish,or repair any structure,prior to its issuance,also required the applicant �( C pr� 7}�-
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number ' 1 (
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundreid 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 roe forthwith compl with ose provisions.
property,rty, or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for f( /
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
c______„_ _
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
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. ` I
Name
`'" Title r_ . `,.J
PRINT NAME
I certify that I have read this application and state that the above informatio s 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 \ -S -7-7'
Signature Date