HomeMy WebLinkAboutSNEW-18-0669 City of Arcadia,CA
Permit No SNew 18 0669
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Development Services Department � � �� flJ $]csIficahon
240 Wesive,Post Office Box 60021 SF/New Accessory Dwelling* / 1
Arcadia ,, „i ,
(626)574-5416 7u4 1 w w~ Permit Status:Issued
ARCADIA c' Issue'Date 12 /O5/2018�'I Expiration. 06/03/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
268 W Le Roy AVE Arcadia,CA 5784019004 rt
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Contacts
HUNG HONG TAM Owner PDS STUDIO* Applicant
260 W LE ROY AVE 711 S FIRST AVE,ARCADIA,91006
(626)294-9402 pchan@pds-studio.com
Hung Hong Tam General Contractor(B)
260 W Leroy AVE,Arcadia,CA 91007
(626)524-6668
-, mommnimmm
Description:2 BED,2 BATH,LIVING,DINING,AND KITCHEN. . Valuation: $ 190.660.27 Tenant
WITH ATTACHED 2 CAR GARAGE.WITH EMP
°. Total Sq Feet: 1.200.00 Plan Check#18-669 Plan#32644
Fees Amount Payments Amount Paid
Bathtubs/or Combo $24.92 Total Fees $9,814.33
Building Issuing Fee $44.35 Cash/Receipt#REC-003063-2018 $7,839.83
Building Permit Fees $1,851.90 Cash/Receipt#REC-000998-2018 $1,974.50
Building Plan Review Fee $1,203.74
Cal Green Plan Check $120.38 Amount Due: $0.00
Clothes Washer $12.46 ���'`�
Compressor 3-5 Ton(3 to 15 hp) $34.29 ��'4L G-3-2-0
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Dishwasher $12.46 /^ ��
Electrical Permit Issuance Fee $44.35
Energy Plan Review Fee $370.38
Furnace or Burner‹=100,000 BTU $18.74 CALLS FOR INSPECTIONS
Garbage Disposal Fee $12.46 Request for inspection by telephone at 626-574-5450. Leave a message
Green Building Standard $8.00 requesting the address,timeframe and what inspection item is needed.
Install,Relocate Appliance Vent/Hood $9.38
Kitchen Sink $12.46
Laundry Trays $12.46 This permit/plan review expires by time limitation and becomes null and
Lavatories $24.92 void if the work authorized by the permit is not commenced within 180 days
Mechanical Permit Issuance Fee $44.35 from the date of issuance or if the permit is not obtained within 180 days
New Residential Elect.(sq ft area) $84.00 from the date of plan submittal.This permit expires and becomes null and
Parks&Recreation Fee(SFR) $3,420.00 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
Plumbing Permit Issuance Fee $44.35 Arcadia building inspector for a period of 180 consecutive days.
Total: $9,814.33
, • 121
COliparD
11411
/ "PrDecember 05, 2018
Issued By: Date
December 05,2018 Page 1 of 1
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4 PERMIT/PLAN REVIEW APPLICATION
I
4 jo Development Services Department,240 West Huntington Drive,Post Office Box 60021
...ny oto Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class\,:,
License No., j /31') Exp. 10� compensation, as provided for by Section 3700 of the Labor Code, for the
ignature of Contract. _.�� /A,/
performance of the work for which this permit is issued.
WNER-BUIL i R DECLARATION / ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I herebyaffirm under penaltyof perjury at I am exe t from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
p ry p is issued.My workers'compensation insurance carrier and policy numbers are:
License Law for the following reason(Section 7031.5,Business and Professions
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 ❑II certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that 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 comply with those 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
sale(Section 7044,Business and Professions Code:The Contractors License Date Sign
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 anemployer 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.
ame Miti ? GL Title ti U"
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.
Igree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Ar adia to enter upon the above-mentioned property for inspection purposes.
S gnature _ . Date (Z er
i
Z6v < <cga( 4ccE$fS121/ •PUE Ch
NOTES
Building Inspections Date Insp. • Plumbing Inspections Date Insp.
100. Setbacks 210. Under ft./bldg.drain /- -1f LEI A E' ��
101. Rough grade 211. Copper underslab 11.12'(1 $ YLVI Cr pA.,4ELt 0f Com/or
102. Figs.&forms (-2`t-11 2. Rough plumbing t 4) reCb S ,b
103. Pre-slab 3-63-(q 213. Rough gas 74-4L
104. Floor joists 214. Shower pan `/23-20 /?R�-54-�'6 Fog. 6A?_ 44F
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 7418 d1/0 217. Building sewer 1-749 it/.
108. Diaph nailing 218. Water service INV f
109. Roof nailing 7-/-jfq 1/0V19. Final gas
110. Framing 4-f l`� 120. Fixtures
111. Occ./Area Sept.Wall 221. Final plumbing Sry72.a
ckl
112. Sound walls 222. Sewer cap/demo.
113. T-bar'rid
114. Insulation-Flr. Pool Inspections I Date Insp.
115. Insulation-Wall i7/f�.4a le 240. Excavation/steel
a
116. Insulation-Ceil. •li1 _ 41. Rough plumbing
117. Drywall nailing 12-a-t/c� / 42. Light shell/bonding
118. Interior lath I-I -Z,-4/4-,243.
Underground conduits
119. Exterior lath (2'/?-f9 244. P-trap
120. Finish grade 5. Gas line&test
121. Final building (03 ZO 246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final slumbin.
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 7 7-{q J VJ 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. El et.bondin. Sign Inspections Date I Insp.
160. Service panel 6,,,... �I/�� 80. Setback/overhang
161. Final electric 3ZS?.o '- 281. Footing -
282. Conduit/wirin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC 1-3-i? ,!I j 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. Commercial hood
190. Duct shaft Sewers&Offsite Insp. I Date I Insp.
191. Final mechanical s,-.27-24) 41.4‘ 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections • Date Insp. 302. Cess'ool 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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/' om.certificate of Occupancy L11':',St:r1..;*;,,rr.,!,,I',....)::::;,�. • City of Arcadia 5• I • -Development Services Department—Building Division �,i ,v ¢ w o ^ '•
N; CalifomwB ldngC do certify:g that at the nine ofusuance Nb Swcture was in y� cornplian¢wnh the various ordmmtas or:hc Ciy ogulwngbuilding mmwaion or use.<' Permit No. 18-0669' € »�
•
'`,";'7 ' ' Buadrng Address: 268 W.LE ROY AVE ARCADIA,CA 91007 • (1
Fi - Permit Type: SF NEW ADU ElrativeCoC 2016 C.R.C. l+. � ' '
Occupancy Code: R-3/U z rte code: R-I tpFe;,
,,'�d Final Bate: 6-3-2020 Type orcomo'onnn: TYPE VB SPRINKLERED M
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Certificate No.20121023-918
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.
Project Address/APN: 268 W. Le Roy Ave. , Arcadia, CA 91007
Number of Units in Project: One Plan Check Number: 18-669
[ ]* [X ]** [ ]**
Exempt: [ ]500 sq.ft.or less(residential addition/expansion/remodel) Residential Commercial/Industrial
[ ] Other: $3.20/sq.ft. $0.51/sq.ft.
Area in Sq.Ft.: 1 , 200 Receipt Number:
330439
Total Fee: $3, 8 4 0 .0 0 Check Number:
2026002808
Owner's Name:
Jie Bing Lin
Owner's Address: 260 W. Le Roy Ave. , Arcadia, CA 91007
Phone Number: Email:
626-329-8882 jieblin@lyahoo .com
Representative's Name& Contact Info(if appl.):
*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 pre.-nted above,this Certificate of Compliance is hereby executed.
Connie Chu
Senior Administrative Asst. 11/27/18
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.
> 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.
> 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 $100 administrative fee. The refund check will be issued in the name of the
owner/developer and mailed to the address of payee.
PURSUANT TO GOVERNMENT CODE§66020(d), OWNER/DEVELOPER HAS A PERIOD OF 90 DAYS FROM THE
DATE OF ISSUANCE OF THIS CERTIFICATE OF COMPLIANCE TO PROTEST THE IMPOSITION OF FEES
Applicant confirms that he/she is authorized to sign on behalf of the owner/developer and that the information he/she provided to the
District is true and accurate to the best of his/her knowledge.
it) ZVA)
Signature of Applicant: Nak. Name:
WHITE-City/County YELLOW—Fiscal Se ices PINK—Business Services GOLD—Applicant Certificate of Compliance(7-24-17)
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CALGREEN CONSULTANT LIST SHEET INDE •X"'" xm:"
E M1�L Aa nA.ORY REQUIREMENTS
HU HHOONG TARO ARCHITECTURAL — ��.�.��I. '
2016 CALGREEN CODE
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RESIDENTIAL MANDATORY REQUIREMENTSCHECKLSST 260 W LE ROY AVE ARCADIA,CA 91007 AD TITLE SHEET&SITE PLAN oo
I w Al FLOOR PLAN _ • c iii."'.- �L •+
nhrerc �.PtaeN `'�'covers IC. DESIGNGBI 332 ELEVATIONS/ARCHITECTURAL DETAILS /r•`m'°"�c'�" E.
specific.qn anon aP'x.am mmlgn` 711 STUDIO AVC A3 ROOF PLANT SECTIONS i o _/ • 0 ,
EagacEAmm,. ".. .... 7115.FIRST AVE,ARCADIA C49100fi -I
TEL 626.524.2901 I; / �:
arqulaE,mwT oIx ¢m.E..treSEx FAX:626.574.8693 STRUCTURAL �,,, d ��. H e
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EMAIL:PCHAN@ODs-STUDIO.com S-0 FOUNDATION PLAN - `v in .mgt
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.�,,, ,.•,•...•..-„-.,,,...w .., ,, STRUCTURAL ENGINEER. .. , .. _ a$
DAMAN CORP. SD-I STRUCTURAL DETAILS
.....r ”`M' ,,, 20540 VEJA0.RD WALNUT,CA 91759 SD-2 STRUCTURAL DETAILS "^ � E w(
.w..„ TEL:909 590.0858 tf
..,..,..m.�e.,m�....+o FAX:909590.8858 MECHANICAL s"^-..,_.M1 ',.1•.'•-•1••••,•
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1NERUY CALCULATION CONSULTANT. I;•'.+>�.-,�`M1 , I J - E..
PERFECT DESIGN&ENGINEERING INC. EN3 CF-1R8 MFd R,MANDATORY MEASURES IJ
....., .ewr..w.....re.�. .. " 2416 W.VALLEY BLVD.
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FALL 626.289.4913 _'
84444/44.4 •" •• EMAIL:PE4FECTPAA@AOL.COM ` -
,..... PROJECT INFO SCOPE OF WORK:
..., .- CONSTRUCT NEW 1-STORY ACCESSORY DWELLING UNIT '�"'
• _ PROJECT DESCRIPTION: SINGLE FAMILY HOME LOT SUMMARY
PROJECT ADDRESS' 260W LEROY AVE 1i� J'
e,,,, ARCADIA CA 81007 DAFuac uruDMEC �I, q SU
1, 4acm LOT 9ZE 62251 FOmTEONG ci MCCU
cDD,nosE lids L� I L,1 , si,®. all HINIIIHIIIII Illflll�''. 0
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v ....., w..r....__. .o .,. ACCESSOR PARCEL NUMBER: 5784-019U04 cl,POS aM I ® O
•�„ "+`^w`^^' .o. •u LOT(TRACT NO.: LOT:1.TRACT:951 TOM l+ncM.uorposExcavonaawvn Cll. ..s K4FAs '. 9kk r ' 'F"..`+� Q
MANG: R.1 J.,1�II- I�
. ...., NUMBER OF STORY: -(POSTING) ,..a.ri.t}:k"5ii,f Alf s,.i1,44 1,Xics -�,•
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„ , — •o. •„ E0STWG HOUSE LIVING AREA: 3.716 SF wBnne '^— - -- y-, r
••• OCLLPANCYGROUP. R3N PROFG1 1,105 1, Isla 0splw9 _ —- _.�__ _ '._ O 0<
WNSTRUCTON TYPE WB MINIM nngmmnMnrf.
FIRE SFR:NIGER: FULLY SPRINKLER SPACES I--• L.Li L..)
`•'Y �'w� RELEVANT CODES: REAMED I vw RGsv Srtn BEDROOM IWWI SPACES —I 4
^2016 CALIFORMA RESIDEMI0.ICRC) 4mOvmB9RO Q
]316 CALIFORNIA ELECTRICAL(CEC) FARfMCIuvoA' WI COVERAGE. TI
MI6 CALIFORNIA ENERGY CODE SJ a .,v=.�.,,".a��, .. _4 NEW 1 STORY ADU
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'MI6 CALIFORNIA MECNAENERGNCOD
^3316 CALIFORNIA PLUMBING(GPO) w.awvmu
:i...°;;;',•41,73713....,' "`' Q
916 CALIFORNIA FIRE CODE(CFC) - ,rw LLI
916
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916 ENERGY(ENS)MATH LOCALADDFMS 13
260 W LE ROY AVE, ARCADIA
916CPLFORNIA GREENBULDNG STANDARD GODS .au.,u •u..7„,.,, � ru
a.r�• - ,.,..r....r....n..rr .a, — AND CODES Wall LOCAL ADMENDMENIS
MAR AEMu dm
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EXISTING 2-STORY SINGLE
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MAIN BLDG:3,716 SF \\I '
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o } r- EXISTING BLDG SUMMARY
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•
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.
141
This report includes all construction work through Z•-' day of ,20 ter Page No. of
;Project Address: Structural Observer of Record (SOR): SOR Phone No.:
I 2-($ (AD_ C /toy /�v a• 4-ct-f-. .-cz& ��uT�aJ Gore (' 6'-6 3-2-'9 1 l 41
Building Permit No.: Structural Observation Observr Professional Lib./Reg. No.: Observer Phone No.:
performed by: 1::: •=reo .4")63- --4%/ v1.21- 1
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
•
ELEMENTS/CONNECTION
• FOUNDATION WALL FRAMES FLOOR OBSERVATION LOCATION
Footing, Stem Walls 0 Concrete 0 Steel Moment Frame 0 Concrete
Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck
E 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 1..D H 0 l/a
12 Others: I ,Others: !•.1 � Pt-2-ex-1 Vc-1--
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.)
el a - �-a o F r A.-i L'n! o
(•
''Iv e
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
REQUIREMENTS OF THE COUNTY OF LOS ANGELES.
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT - _' _•w'
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN -• 1
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; • .;
t,.; 1311(7 �!
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED 1.1= Dr :,
ABOVE;
I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED.
(STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF STRUCTURAL OBSERVER DATE
Jan. 10 2008
Version 1.0(2008 LACBC)
County of Los Angeles `�—�� �
�
PUBLIC WORKS! DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION
n"o 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 61-4-1\ day of J,w.,•vi ,20 ( 1 Page No. of_
!Project Address: Structural Observer of Record (SOR): SOR Phone No.:
In) j fz r �S„v-71+ , -Cr / co, _p * t o. 3 7 /1 4.1
Building Permit No.: tructural Observation Observr Professional Lic./Reg. No.: Observer Phone No.:
performed by: 2,6,,f,3-r,6_4..) C q -1 14-A 2 3 7 ( 14 1
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTION
OBSERVATION LOCATION
I❑ Footing, Stem Walls 0 Concrete ❑ Steel Moment Frame 0 Concrete
10 Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck
�❑ Caisson, Piles, 0 Wood ❑ Concrete Moment 0 Wood
I Grade Beams Frame
0 Retaining Foundation 0 Others: 0 Masonry Wall 0 Others:
Hillside Special Anchors Frame 0L�
.Others: 7 _ ❑ 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.)
ytJ9/.—� oy
azo
4.-e--4 t¢— c su-nz
I Ns i
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
REQUIREMENTS OF THE COUNTY OF LOS ANGELES.
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT •,ION i\
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN o'%'•a >�F'- j,C;
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; ,4670
N C� A2.01 f�
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED FBF
ABOVE; x CI\I\\,
T9iF OF ci\\`�`
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED.(EC
C\ RPA — (STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF STRUCTURAL OBSERVER DATE
Version 1.0(2008 LACBC) Jan. 10 2008
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_ s City of Arcadia, CA Permit NO. RACY 19 0164,
�t i�s -` Development Services Department 17r")) Perm/t Type Residential Addition/Alteration;I 240 West Huntington Drive,Post Office Box 6002 I 1` s ,qCr'� I Ork ClassificatlOn�IRes Addition/=Alteration'::
Arcadia,CA 91066-6021 ,•
_1 r (626)574-5416 � , . , Sat�
�..� Permit Statusissued
.ARCADIA N IssueDate 01/28/2019 Expiration: 07/27/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
260 W Le Roy AVE Arcadia,CA 5784019004
Contacts
HUNG HONG TAM Owner
260 W LE ROY AVE
Description:REMOVE EXISTING NON BEARING WALLS IN Valuation: $ 500.00 ', Tenant
ACCESSORY GYM HOUSE PER APPROVED PLANS.
Total Sq Feet: 0.00 s, Plan Check# Plan#
Fees Amount payments Amount Paid
Building Issuing Fee $47.01 Total Fees $132.62
Building Permit Fees $40.65 Cash/Receipt#REC-00219-19 $132.62
Building Plan Review Fee $26.43
Cal Green Plan Check $2.65 Amount Due: $0.00
-
Energy Plan Review Fee $8.13
Green Building Standard $1.00
Solid Waste Management Fee $6.25 Q
.; Y F,-
Strong Motion Inst.Program Res $0.50 '
Total: $132.62 114
,
CALLS FOR INSPECT ONS
Request for inspection by telephone at 626-574-5450. Leave a message
hi-----lb
( requesting the address,timeframe and what inspection item is needed.
G"3-2"4G�'/
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.
//
/
January 28, 2019
Issued By: Date
Page 1 of 1
January 28,2019
pFc� ,9
~4F �rO ,
0. PERMIT/PLAN REVIEW APPLICATION
o 4 j` 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. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License �; 7(3' Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
Adv /`�i1'IJ / performance of the work for which this permit is issued.
Signature of Contractor
OWNER-BUILDER DECLARA ION ❑ 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 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 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 ../Allif
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
C e:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
ho 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. //��
ame :.L/ ..... r �i of(/C Title
PRINT N•
I certify that I have read this application and state that the above information is corr t 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.
ignature .v %' I ate
; City of Arcadia, CA "1 Permit Na MIsC 18 0777
Development Services Department ;, Aa , Permit TypeMisc'
� .‘f SJR a �� 2 ` i� f � � : ., r ;`4�v '�
240 West Huntington Drive,Post Office Box 60021 $
�r x n + 4c Work Classification•Address Change
( Arcadia,CA 91066-6021 ` r' y g • •
(626)574-5416 ��� Permit Status:Issued
ARCADIA Issue Date 05/10/2018±`1 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
268 W Le Roy AVE Arcadia,CA 5784019004
Contacts
HUNG HONG TAM Owner PDS STUDIO* Applicant
260 W LE ROY AVE 711 S FIRST AVE,ARCADIA,91006
(626)294-9402 al@pds-studio.com
Description:NEW ADDRESS FOR ADU WILL BE 268 W LE'ROY. Valuation: $0.00 N Tenant
CREATE NEW ADDRESS FOR ADU AT 260 W LE ROY. f f
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Address Change $500.00 Total Fees $500.00
Total: $500.00 Cash/Receipt#REC-001131-2018 $500.00
ti Amount Due: $0.00
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.
May 10,2018
Issued By: Date
May 10,2018 Page 1 of 1
OA 9 PERMIT/PLAN REVIEW APPLICATION
ARc
y.
igimu
E417' Development Services Department,240 West Huntington Drive,Post Office Box 60021
e0 I y of IV
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_ 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
El 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 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.
ame- J lrc rA i �0�1�1 Title ! -e kj)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 above-mentioned operty or inspection purposes.
)Signature /C. Ar\0.Ltt-1 -n Date Si 1° 01
8-
ti �Fc•
F
,,..7.777 •a
May 10, 2018
°In99rpory
Au�ue2 5.1903
Subject: Create new address at: 260 W. Le Roy 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: 5784-019-004. Please update your records as follows:
Arcadia
MAIN DWELLING ADDRESS ASSIGNMENT:
Development
Services 260 W. Le Roy Ave
Department Arcadia CA, 91007
Jason Kruckeberg NEW ACCESSORY DWELLING UNIT ASSIGNMENT:
Assistant City Manager/
Development Services 268 W. Le Roy Ave
Director
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 260
W. Le Roy Ave and the Accessory Dwelling Unit address is going to be 268 W.
Le Roy Ave.
Should you have any question, please contact the City's Development Services
Department/Building and Safety office at (626) 574-5416.
Sincerely,
fl
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, CA •a° �, Permit NO FIRE-19-0041..
\\0/1/ Develo mentServicesDe artmentp p �; PermitType. ire240 West Huntington Drive,Post Office Box 60021 ? f t ,Work Classifi•cation F•ire Sprinkler
\ Arcadia,CA 91066-6021 ���.�
(626)574-5416u
���PermitStattrs In Review-'
t,,7 , air p
L-�RCAD IA. � �� .4 ... ,.,
z � issue Date I Expiration: 07/08/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
268 W Le Roy AVE Arcadia,CA 5784019004
Contacts
HUNG HONG TAM Owner UNITED FIRE&SAFETY CO.* Fire Contractor(C-16)
260 W LE ROY AVE 2318 CHICO AVE,SOUTH EL MONTE,CA
(951)279-8208 621096
Description:FIRE SPRINKS FOR ADU 15 HEADS Valuation: $ 2,000.00 Tenant
Total Sq Feet: 0.00 Plan Check#19-41 Plan#
Fees Amount payments Amount Paid
Fire Issuance $47.01 Total Fees $851.66
Fire Permit Fees $103.65 Cash/Receipt#REC-00048-19 $700.00
Solid Waste Management Fee 2 $1.00 Cash/Receipt#REC-00546-19 $151.66
Sprinkler Heads $700.00
Amount Due: $0.00
Total: $851.66
cot ��jj�?r INSPECTIONS
Request for inspection �• L :26-574-5450. Leave a message
requesting the address,timeframe mwhat 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.
Issued By: Date
March 04,2019 Page 1 of 1
U~4 oFry9�9
Al 1 PERMIT/PLAN REVIEW APPLICATION
fp leimg o „j� Development Services Department,240 West Huntington Drive,Post Office Box 60021
@.oily al 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 y license is in full orce ,ffect. 4 ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. _ 0 / Exp. Date Yl�D'1 ( compensation, as provided for by Section 3700 of the Labor Code, for the
�nn. _` performance of the work for which this permit is issued.
Signature of Contractor \M- ,I
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
El 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
�'com ensation insurance carrier and policy numbers are:Code.Any city or county which requires a permit to construct,alter,improve, Carrier 5 lZ% YAe 1'
demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number —0 "7i V w
� G DJ 33
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 ElI 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 40 of the Labor Code,I shall
ElI, 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 �µ—1 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: Fail 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 it�l...411111 Allita1111111iiikk Title 7:52f4
Pr ' 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 ,bove-mentioned property for inspection purposes.
—
Signature Date 03 -01( - r 7
of ARc
40,3,1FoRiv qtr.
PEP* 117
�".0'`y°ice MEMORANDUM
Fire Department
DATE: June 4; 2020
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemick
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 268 W. Le Roy Avenue
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS (PC# 19-41) . 5-20-2020 Jill Perumean
FIRE ALARMS
HOOD &
KNOX BOX
OCCUPANCY 5-20-2020 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 5-20-2020 Rita
�I
r'
SOLID WASTE MANAGEMENT COUNTY SANITATION DISTRICTS
OF LOS ANGELES COUNTY
1955 Workman Mill Road,Whittier,CA 90601-1400
Mailing Address:P.O.Box 4998,Whittler,CA 90607-4998 Grace Robinson Hyde
Telephone:(562)699-7411,FAX:(562)699-5422 Chief Engineer and General Manager
www.lacsd.org
Counter Hours: 7:00 a.m.-4:00 p.m.Mon.-Thurs.
7:00 a.m.-3:00 p.m.Fri. Application No.: 5784019004-002
SEWERAGE SYSTEM CONNECTION FEE RECEIPT Date: July 11,2019
r ,
APN:5784 019 004 District No.: 15
Owner/Situs Address Applicant,Information
HUNG H AND TAM Hung Hong Tam
260 LE ROY AVE 260 West LeRoy Avenue
ARCADIA,CA 91007 Arcadia,CA 91007
Phone:(626)524-6668
- • r " h
Facility Type Measure of Use Unit Rate Amount
Single Family Home C 1.00 DU
Multi-Unit Residential N 2.00 DU $2,526.00/DU $5,052.00
260-268 LE ROY AVE;ARCADIA
Base Line Credit 1.00 CUs $4,210.00/CUs ($4,210.00)
Connection Fee Due $842.00
Type Abbreviations
N-New or Additional;C-Change of Existing;E-Existing to Remain;D-Demolition of Existing;T-Tenant Improvement of Existing;S-Septic to Sewer
SFR(E)3716 sqft,Constructing 268 W.Le Roy Ave ADU(N)1200 sqft;
Changed use of 1.00 DU of existing Single Family Home to Multi-Unit Residential
•
•
•
Processor:Kimberly Gonzalez Approver:
dirn
D.C.: SANITATION DISTRICTS ks
Payment Received Check No..,. Amount! OF LOS ANGELES COUNTY
Hung Hong Tam $0.00 APPROVED .f 1
Jie Bing Lin and Hung Hong Tam 1192 $842 00 11:0
LaYf#iIi#lo�f �61�d4A§tljilS Ed
CHIEF ENGINEER&GEN.MGR.
DOC#5224331 THIS IS NOT A CONNECTION PERMIT.
A CONNECTION PERMIT IS REQUIRED BEFORE CONNECTING TO ANY SEWER.