HomeMy WebLinkAboutSNEW-19-0854 1'4 City of Arcadia, CA A Permit NO SNew 19 0854
x d Development Services
• Ix" o-4 Department
" ir1i PerTit Sngle Family
New 240 West Huntin on Drive,Post Office Box 60021 I
Arcadia,CA 91066-6021f ork Classlhcanon SF NewAccessor Dwellin atio•
, r
(626)574-5416 ' '
PermitStatus-Issued
ARCADIA Issue Date:12/19/20193I Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip ....Parcel Number
2718 Winthrop AVE Arcadia,CA 8586004011
Contacts
TRAN,LY MINH AND TRAN,BRIAN N Owner THINH NGUYEN Applicant
2716 WINTHROP AVE,910078435
(626)318-5168 (909)450-7371
Description:NEW ADU,ADD TO EXISTING DETACHED GARAGE, Valuation: $_117,490.56 Tenant.
2 BED,2 BATH, KITCHEN,LIVING,ATTACHED COVERED PATIO
Total Sq Feet: 812.00 Plan Check#19-854 Plan#195
Fees Amount payments Amount Paid
Building Issuing Fee $47.01 Total Fees $7,232.55
Building Permit Fees $1,348.20 Cash/Receipt#REC-03406-19 $5,718.94
Building Plan Review Fee $876.33 Cash/Receipt#REC-01145-19 $1,513.61
Cal Green Plan Check $87.64
Energy Plan Review Fee $269.64 Amount Due: $0.00
Green Building Standard $5.00
Parks&Recreation Fee(SFR) $2,314.20
Single Family Fire Plan Check $280.00 �n�NrL Z
Single Family/Condo/Townhome Impact $1,983.00
Fee
Solid Waste Management Fee $6.25 CALLS FOR INSPECTIONS
Strong Motion Inst.Program Res $15.28 Request for inspection by telephone at 626-574-5450. Leave a message
Total: $7,232.55 requesting the address,timeframe and what inspection item is needed.
trAi This permit/plan review expires by time limitation and becomes null and
COMP1E1void 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 19, 2019
Issued By: Date
December 19,2019 Page 1 of 1
OA oFF y ,
•
•Mm " PERMIT/PLAN REVIEW APPLICATION
co '4411,1 ` Development Services Department,240 West Huntington Drive,Post Office Box 60021
mmunItY.iIV 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
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 the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the - -
provisions of the Contractors License Law(Chapter 9(commencing with Section
(This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of 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
CIP
sale(Section 7044,Business and Professions Code:The Contractors License \Date LL-�l I/f 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 noarybuild or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
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
i-41111,
lDate 12/19 A ' 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. c
Name L .1 'T ti Title a LV�1i.
t 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 u n above-mentioned property for inspection purposes.
ignature Date l Z`l 9 /i CI
F - l.2.
o NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp. 27 I S I'll R6( deo 4.ati
100. Setbacks 210. Under flr./bldg.drain 1-13-Lb , - - , 6�
101. Rough grade 211. Copper underslab
102. Figs.&forms 212. Rough plumbing „4. /." 2 -27.-Lcs GASArAvicE NW.* lk
103. Pre-slab 213. Rough gas 2
104. Floor joists 214. Shower pan 2--'6-
.
105. Steel 215. Water heater
106. Grout lift 16. Roof drains
107. Shear nailing Z3'Z 217. Building sewer 3 2- - .
108. Diaph nailing18. Water service Z-f"-Zo
109. Roof nailing 2-3-Z€ 19. Final gas 2-Z4 2.. , j?'r
110. Framing -3--?..c:. 220. Fixtures -
111. Occ./Area Sept.Wall 221. Final plumbing 3-tn•to '
112. Sound walls 222. Sewer cap/demo.
113. T-bar grid
114. Insulation-Flr. Pool Inspections Date I Insp.
115. Insulation-Wall ‘,..24b Priff 240. Excavation/steel
116. Insulation-Ceil. ,�. r, 241. Rough plumbing -117. Drywall nailing 7..-1( Z0f, • 242. Light shell/bonding
118. Interior lath Z--.1Z--.1 -2-el.c� 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade 245. Gas line&test
121. Final building 3•Zr Zo ------ 246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final.lumbing
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Underground conduit
153. Underslab conduit Reroof Inspections I Date Insp.
154. UFER ground Z-3-Zb ��}0111111r 270. Pre-reroof insp.
155. Water ground Ai,I _ /71. Roof framing
156. Rough electrical Z3� Air
"�" 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E.it.bonding Sign Inspections ' Date I Insp.
160. Service panel 280. Setback/overhang '
161. Final electric g•t')'?.o - 281. Footing
282. Conduit/wiring
Mechanical Inspections Date Insp. 283. Disconnect -
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC -ZO �� 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. Date I Insp.
191. Final mechanical 3-t`) -to `L- 300. Lateral(main to P/L)
301. Saddle/Y __
Block Wall Inspections • Date Insp. 302. Gess sod 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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_
OWNER: PROPOSED SITE PLAN
LY TRAN SCALE: N.T.S.
2716 WINTHROP AVE.ARCADIA,CA 91007
(626)318-5168
APN:8586-004-011 ,
OCCUPANCY GROUP: R-1
TYPE OF CONSTRUCTION: VB
NUMBER OF STORIES: ONE
FIRE SPRINKLER: NO
18,_2„
'f 1
(N)PATIO COVER
(E)GARAGE r
31'-0"
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13'-4" I 5'-10" 12-10"
12 (N)3020 SW(TEMP.) (N)5350 SH
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U BATH#1 mI N
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F N O (N)LIVING® (N)BED#2 2 0-rcLG III
30'x30'ATTIC ACCESS
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(N)2880 « °
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2'-8° 13'-0" 5'-10" 12'-10"
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34,-4" 3'X7'LANDING
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OWNER:
LY TRAN
2716 WINTHROP AVE.ARCADIA,CA 91007
PROPOSED FLOOR PLAN - ADU
(626)318-5168
SCALE: 1/4" = 1'-0" APN:8586-004-011
OCCUPANCY GROUP: R-1
TYPE OF CONSTRUCTION: VB
NUMBER OF STORIES: ONE
FIRE SPRINKLER: NO
10/18/2019
PY //ll'llh//ih//ih//ih//ih///////I////i//I//III//III//i///iii !
RECORDING REQUESTED BY AND 20191114429'
•WHEN RECORDED MAIL TO:
City Attorney Has not been compared with original.
City of Arcadia Originals will be returned when processing
P. O. Box 60021 has been completed.
Arcadia, CA 91066-6021 LOS ANGELES COUNTY REGISTRAR RECORDER
COVENANT AND AGREEMENT
REGARDING ACCESSORY DWELLING UNIT
2716 WINTHROP AVENUE (2718 WINTHROP AVENUE — NEW ADDRESS FOR
ACCESSORY DWELLING UNIT), ARCADIA, CALIFORNIA •
•
FOR GOOD, VALUABLE AND ADEQUATE CONSIDERATION, receipt of which is
hereby acknowledged,
LY MINH TRAN,
A SINGLE WOMAN, AND BRIAN NHA TRAN, A MARRIED MAN, AS HIS SOLE AND
SEPARATE PROPERTY AS JOINT TENANTS
hereinafter referred to as "Covenantors", hereby declare that they are the owners of that
certain real property located at 2716 Winthrop Avenue (2718 Winthrop Avenue — new
address for accessory dwelling unit), in the City of Arcadia, County of Los Angeles, State of
California, more particularly described as follows:
Lot 25 of Tract No. 12676, in the•City of Arcadia, County of Los Angeles,
State of California, as per map recorded in the book 241, Page 20 of Maps,
in the office of the County Recorder of said county. '
Covenantors hereby agree and covenant with the City of Arcadia, a Municipal Corporation
(hereinafter referred to 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 on behalf of and for the benefit of the "Benefitted Land" which
consists of and includes all the public and 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
and Floor 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.
1
2. If this Covenant and Agreement is breached by Covenantors or successors or
assigns, Covenantee is hereby authorized to bring an action in a court of competent
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: /0/1,5 , 2019
Ly Minh -'ran
Dated: /0 /S , 2019
Brian Nha Tran
"COVENANTEE"
Dated: /0 • a , 2019 *..- nic - aretto
City Manager
APPROVED AS TO FORM:
isq.A....tue,/
Stephen P. Deitsch
City Attorney
3
J, .4
•
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 California
County of Lasnae.(t'S
J
On l�(nfla R flQ Lar'7_ I`r iv f u 1
�C+D�'�'C ��. �oi:� before me, J - h� C
(Insert name and title of the Officer) 1
personally appeared u • _ f. ' a " ria trt. i W.
who proved to me on the basis of satisfactory evidence to be the person(s) whose
name(s)-is/are subscribed to the within instrument and acknowledged to me that
he/she/they executed the same in his/her/their authorized capacity(ies), and that by
Itis/her/their signature(s) on the instrument the person(s), or the entity upon behalf of
which the person(s) 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.
LA DU
NotaryINDPublicRO -California
i,�$,7Los Angeles County z
z T .-
WITNESS my hand 'l / Commission Ile 2212889
and ficial seal. •
_ Mr Comm.Expires oct 4,2021E .
Signature J (Seal)
crry OF City of Arcadia
ARCADIA , 240 W. Huntington Drive, Arcadia, CA 91007
•••..phbne Vo.:(626) 574-5466 -
STRUCTURAL OBSERVATION REPORT
Report No. 2,
This report includes all construction work through 2 .day of MA_ .2-g , 20 2_0. Page No.2 of„L.
-
Project Address: Structural Observer of Record(SOR): Phone No.of SOR:
i 2716 WINTHROP AVE, ARCADIA, CA 91007
I - Truong Dong 714-204-2874 I
Phone No.of
1 Building Permit No.: Structural Observation performed by: Professional Lic./Reg.No.of Observer Observer:
Truong Doris C75466 714-204-2874
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
PORTION OBSERVED,
FOUNDATION WALL FRAME FLOOR IF NOT WHOLE
----
r.2 Footing,Stem Walls 0 Concrete 0 Steel Moment Frame 0 Concr.te %./Q 013A Fro"e.
0 lviat Foundation 0 Masonry ' 0 Steel Braced Frame 0 Ste; 'I 4.44 ,
1.--- ' I--
li Caisson, Piles,Grade i 0 Concrete Moment
Beams tkt Wood Frame 0 W od
----
, Retaining Foundation 0 Others: 0 Mason Wall Frame U 'others
Ei Others: 0 0 Others: 0
I r...1 Final:Structural Systems are complete and all observations as required by the approved Structural Observation Program have
been made
OBSERVED DEFICIENCIES(Use Additional Sheets at need):
ert4-€46 PE pi 0 r),Ecee,i6AfC i Ec
Re-observation of observed deficiency(ies) is/are:
( ) Required
( ) Not required but must be verified by City Inspector and/or Special Inspector. Vt'
,3— t‘cji,,(..7 6 e •
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY 10Y 0p "I'
KNOWLEDGE: Co
C ,, 6 %.
1. 1 AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE m
CHARGE FOR THE STRUCTURAL OBSERVATION ACCORDANCE WITH THE * EXR Ca31/2,9 ':'
REQUIREMENTS THE CITY OF ARCADIA ' *
2. I,OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS zi‘-..„
UNDER MY RESPONSIBLE CHARGE,HAS PERFORMED THE REQUIRED SITE VISITS AT uPCAU '
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS;
3. ALL DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED ABOVE:
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITY
OF ARCAD.BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE CORRECTED: ftaranirfiOn:ISrtirvii ur
octrtsaai°ndbsaneter r?rni Rre6pc°ortrdstegceupittefdor
interim reports for one or two story single family
f..4(441111. 04 r g • homes where an unlicensed person working under
the responsible charge of the registered or licensed
Signature d Date design professional,has produced such Interim
report..
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'to Clie,:t[ ] Copy to EGL['1 Environmental GeotechnologY 1 ,boratary inc,by:
11819 Goldring Road,Suite A -,
• Arcadia,„CA 9 4Qfi
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From: truongdong@gmaii.com
Subject: 2716 Winthrop SO 200116
Date: Jan 17 2020 at 11:48:46 AM
To: tim nguyen tejj97@omail.com
Cc: anh.phan@dongengineering.com
Hi anh Tim,
Please find attached structural observation form for 2716 winthrop.
Best Regards,
Truong (Troy) Dong P.E.
Principal
Dong Engineering inc.
15751 Brookhurst St,#225 Wg§tglitigqr_.C6925§3,
Phone:(714)&17,75,979
Mobile:(7,14)20,4-247,4
truong.dong@dongengineering.com
truongdong@zmail.com
www.dongengineering.com
crrt OF City of Amato
12.A.1411A 240 W.ilundreatort Drive,Arcadia,CA 91307
Rho 4 Ito,(626) 574-6466
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OSSERVED STIMTURAL ELEMENTS ANO THEIR aONNEOTIONS
. 1-45—RTMISWRITE5—, 1
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13139 Harbor Boulevard, Garden Grove, CA 92843
Tel: (714)414-9215, Fax: (714) 537-7974, Email: Lanpham9(2Ihotmail.com
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:4c City of Arcadia, CA � ��
Permit No. MEP-20-0055
t;:::1-,1\41,:-...":
g �" Development Services Department P")gyp;-" w'- �`"-\ �� , tet; `.Permit Type::MEP
*� ' 240 West Huntington Drive,Post Office Box 60021 i
Arcadia,CA 91066-6021 �' s �.,,,._1,,,,,,,,,,,, r" 4,`i A (, tit, i'' Work Classficat�on:MEPC% Residential,;.
(626)574-5416 " i
�.�'`� , ° •.-F Permit Status'Issued
L2CA1)Il's< Issue Date:01/16/2640 1 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
ii
2718 WINTHROP AVE Arcadia,CA 91007-8435 8586004011
Contacts
-THINH NGUYEN Agent for owner TRAN,LY MINH AND TRAN,BRIAN N Owner
2716 WINTHROP AVE,910078435
(909)450-7371 (626)318-5168
Description:MEP FOR ADU.TPP, 200 AMP SERVICE.HVAC Valuation: $ 0.00 Tenant
SYSTEM PER APPROVED PLANS.HERS REQUIRED FOR FINAL.
Total Sq Feet: 0.00 Plan Check# Plan#
t.
Fees Amount Payments Amount Paid
Compressor<3 Ton(up to 3 hp) $19.86 Total Fees $514.13
Dishwasher $13.21 Cash/Receipt#REC-03610-20 $514.13
Electrical Permit Issuance Fee $47.01
Furnace or Burner<=100,000 BTU $19.86 Amount Due: $0.00
Garbage Disposal Fee $13.21
'Gas System(Outlets) $46.65
Hood Serviced by Mechanical Exhaust $14.96 JNA` 3.Zs--z-,0
Kitchen Sink $13.21
Lavatories • $26.42
Mechanical Permit Issuance Fee $47.01
New Residential Elect.(sq ft area) $64.96 CALLS FOR INSPECTIONS
Plumbing Permit Issuance Fee $47.01 Request for inspection by telephone at 626-574-5450. Leave a message
Residential Services up to 400 amps $16.48 requesting the address,timeframe and what inspection item is needed.
Shower $26.42
Solid Waste Management Fee 2 $1.00
Solid Waste Management Fee 2 .$1.00 This permit/plan review expires by time limitation and becomes null and
Solid Waste Management Fee 2 $1.00 void if the work authorized by the permit is not commenced within 180 days
Temporary Power Pole $33.01 from the date of issuance or if the permit is not obtained within 180 days
Ventilation Fan(Single Duct) $19.88 from the date of plan submittal.This permit expires and becomes null and
Water Closet $26.42 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
Water Heater and/or Vent $15.55 Arcadia building inspector for a period of 180 consecutive days.
Total: $514.13
v- COMPLETED .- _ ::•.. ... . (y .
•, .
,._ .. .
.._... ..,. . ,.. .• ..
. ...... .
. ... •_ •
... .
... . , ..
January 16, 2020
• Issued By: Date
January 16,2020 Page 1 of 1
vs40"oF 4R�9�9
u j F PERMIT/PLAN REVIEW APPLICATION
o 4.j` Development Services Department,240 West Huntington Drive,Post Office Box 60021
@Ynity ocs" 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. 13 I have and will maintain a certificate of consent to self-insure for workers'
License Class_ License No._ Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
IDI hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date /6.- 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. �y
[Name T:�/ / Z'C�'f�� Title ,,k, - ."1., ---
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 abo •-mentioned property for inspection purposes.
Signature Date OK lG-
mr Permit�NO .MI$C 19 2491:
;j City of Arcadia, CA ,
-i Development Department , ` '�
p p PermrtType Mise
240 West Huntington Drive,Post Office Box 60021 ' ' ! i F: a
t 4 Work Classification Misc ;Address Change,"
°i Arcadia,CA 91066-6021 �, �
I (626)574-5416 M� � Permit Status Issued
ARCADIA Issue nate si2/13/„20519 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
2716 WINTHROP AVE Arcadia,CA 91007-8435 8586004011
Contacts
TRAN,LY MINH AND TRAN,BRIAN N Owner
2716 WINTHROP AVE,910078435
(626)318-5168
Description:ADRESS CREATION FOR ADU 2718 WINTHROP. t Valuation: $ 0.00 Tenant
MAIN HOUSE 2716 WINTHROP AVE.
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Address Change $700.00 Total Fees $753.26
Building Issuing Fee $47.01 Cash/Receipt#REC-03349-19 $753.26
Solid Waste Management Fee $6.25
Amount Due: $0.00
Total: $753.26 -
o 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.
•
'/49
December 13, 2019
Issued By: Date
December 13,2019 Page 1 of 1
PERMIT/PLAN REVIEW APPLICATION
-tof Ape
;Y11A\�:
E4,,,' Development Services Department,240 West Huntington Drive,Post Office Box 60021
0\y% 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
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 the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of 0 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
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon, -
or who does such work himself or herself or through his or her own --- - - - -
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
1\
Name Title Q((/ih.P/_,
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature h i ,Date 1 L/1 II 1
ti 4 of
Rn'C`9�
C. mi
�If December 17, 2019
Augue[5 1903
°O s Subject: Create new address at: 2716 Winthrop Ave
unity of
Cl of Please be advised that the City of Arcadia has approved to create a second
address for a newly created Accessory Dwelling Unit for the subject property.
Parcel Number: 858-6004-011. Please update your records as follows:
Arcadia
MAIN DWELLING ADDRESS ASSIGNMENT:
Development
Services 2716 Winthrop Ave
Department Arcadia CA, 91007
Jason Kruckeberg NEW ACCESSORY DWELLING UNIT ASSIGNMENT:
Assistant City Manager/
Development Services
Director 2718 Winthrop Ave
Arcadia CA, 91007
The City of Arcadia would like to bring to your attention that we are requesting
to create a new address for the Accessory Dwelling Unit and would request you
to modify the address in your records. The Main Dwelling Unit address is 2716
Winthrop Ave and the Accessory Dwelling Unit address is going to be 2718
Winthrop Ave.
Should you have any question, please contact the City's Development Services
Department/Building and Safety office at (626) 574-5416.
Sincerely,
Kenne F'e.ds, B . lding Official
•
240 West Huntington Drive
Post Office Box 60021
Arcadia,CA 91066-6021
(626) 574-5415
(626)447-3309 Fax
www.ArcadiaCA.gov