The URL can be used to link to this page

Home My WebLink AboutROOF-20-0020 • Cit of Arcadia, CA �� ,' PermrtNQ ROOF 20 0020. Development Services Department 1 L � ,' * v--. Permit Type Roof: i= 240 West Huntington Drive,Post Office Box 60021 r" � � �-� �,� e. > y �' t ,......„,r, Work Classification Reroof Residential Arcadia,CA 91066-60211 ( lgi t x .„(.._, (626)574-5416 Permit Status Issued, ARCADIA x Issue,Date 01/96/2020,1 Expiration: Addr NO.. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 763 FAIRVIEW AVE A-H Arcadia,CA 91007-9013 5783012029 Contacts GOLDEN FAIRVIEW TOWNHOMES HOA Agent for owner BENITEZ ROOFING &DEVELOPMENT, Contractor INC (626)642-1717 218 5 AVENUE 63,LOS ANGELES,CA 900423606 (323)907-8107 1017913 $_44 r 4, y. ...�. :'.4#44,L...s'.M...ti V.L'.S.m:a&(t a+..xztx^ -vr :.e. WM4fl♦_ '..":"..§..miYX i .ex',`.h ... "X.`...AN 'a.'ri. f ass..1"' '•* 4.% ..S:.r*, 'm`Y ,fl4'#.t�ti 44 . .. i Description:APPLY ENERGY COMPLIANT SEALANT,SURECOAT i Valuation: $ 22,000.00 Tenant SYSTEM OVER EXISTING ROOF (FLAT PORTION)COLOR:WHITE UNITS A-H VQ ? Total Sq Feet: 0.00 Plan Check# Plan# . Fees Amount payments Amount Paid Building Issuing Fee $47.01 Total Fees $490.91 Building Permit Fees $437.65 Cash/Receipt#REC-03503-20 $490.91 Solid Waste Management Fee $6.25 Amount Due: $0.00 Total: $490.91 1-3-2.c:' 'ARE —;pts '0,4 iva-c7-4.,,, is !vai V CoNFLrifo 7-7-z. MidA-L. 6A CALLS FOR INSPECTIONS r-' Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. • CARBON MONOXIDE AND SMOKE DE. �'1ECTORS > This permit/plan review expires by time limitation and becomes null and SHALL BE REQUIRED ' ' void if the work authorized by the permit is not commenced within 180 days P J'ASIJANT TO 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 CRC AND CBC 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 06, 2020 Issued By: Date January 06,2020 Page 1 of 1 of A Re �i PERMIT/PLAN REVIEW APPLICATION ,, :.., C 'E Development Services Department,240 West Huntington Drive,Post Office Box 60021 ommonItY nCI" 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 ereby 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 ofconsent to self-insure for workers' icense Class 0Zr/1 L• - se No. /0l"9-9/3Exp. Date g/So g •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 Contracto _.------ OWNER- — - i OWNER- 1II,1 'R D C�TION l have and will maintain workers'compensation insurance,as required by Section ❑ I hereby . , .nder 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 i issued.My workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Cggarrier S/7., k Co y,,,eevrSet fiat 7n v -r n ��„,-A demolish,or repair any structure,prior to its issuance,also required the applicant 'Li for such permit to file a signed statement that he or she is licensed pursuant to the Policy NumberP6 20/�Y 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 .0Iycertify that in the performance of the work for which this permit is issued,I shall Section 7031.5 by any applicant fora 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)) cottpensation Laws of California,and agree that if I should become subject to the wworkers'compensation provisions of Section 3700 of the Labor Code,I shall Elproperty, or my employees with wages as their sole orthwith comply with those provisions. I, as owner of thep y compensation,will do the work,and the structure is not intended or offered for 11111111111111 -- sale(Section 7044,Business and Professions Code:The Contractors License ?e - `ZtJ 2 v Signa ..--11111111111111 It jJ �" 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 WARN1N. adore 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. g"'am)-rr -t,.,,,. hi_ Title 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. F 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 .„„ /�� Date P D elA2a y - FO .SGP 44v\ AFFIDAVIT SELF-CERTIFICATION FOR COMPLIANCE OF SMOKE ALARMS AND CARBON MONOXIDE ALARMS } l Property Address: �(y T Lr C r fri e.ii, 4-i40, 4e771- 4 1 ._ -,..c 1.0 Permit Number:A6;c 00 2a Brief Job Description: AoF /Q S t„.44_ /, 4 Number of smoke alarms_installed: 3 _ - _ __ _ _ _ _ Number of carbon monoxide alarms installed: When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created, Smoke alarms shall be installed in each sleeping room; and outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements and habitable attics as required by Section R314 of the 2016 California Residential Code (CRC) and California Health and Safety Code Section 13113.7. For dwellings or sleeping units containing fuel burning appliances or having attached garages, carbon monoxide alarms shall be installed outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements as required by Section 8315 of the of the 2016 California Residential Code (CRC). Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used. All alarms shall comply with requirements for listing and approval by the Office of the State Fire Marshal, htt.://osfm.fire.ca,•ovllicensin+listin•s/Iieenselistinv bml searchcotest.:hi. As owner of the above referenced property, I hereby certify that the smoke alarms and carbon monoxide alarms have been installed in accordance with the manufacturer'sinstructions and in compliance with the code sections referenced above. I declare under penalty of perjury that the foregoing is true and correct, and that this declaration was executed on (Date) at Arcadia, California. Owner's Name (printed/typed): 11s)c,.,<u r Signature of Owner: 1...d //� _.., ': , This affidavit must be returned to the City of Arcadia inspector prior to final inspection AK f*.', _A,; 11\7\I_%'"_IV'I.r'Ai len.OP U41,10)..V•.._MA-AriiViLDCAlagn .&.., , Guest Room rei IJO , Battill'OUn OM UI SlOrtige • • Fa ni IY ROOM 110111, a H • , Garage _ . . , ' - ......--------,---- , .... 44,Meariliga513"er626RMOditlaaillain FIRST FLOOR PLAN ,,,-, ;,!- w SMOKE AL A'''ft LI CARBON MONOXIDE ALARM 7r 111 ,., 1-- ,Irl" .:_ Wit • MStr _ 0' Master Bedroom ...a, _ _ ___ Dining Room 1 Kitchen - . ei - .., _ ._ - - - - --- - -- , _Hall , Closet _ G ij __ , Closet CO ,-0-0 ___ if ..._ Family Room frf. ow* _,....-__..--,-_, me 0 . mot 6 c, mom mum, aill mu- 1 d• ' Bedroom 0 room ,i, -:,---.... ---- ------ ----- _ :-- .. .__. -0=-L-__-,,___-:-.,. SECOND FLOOR PLAN ALARM , CARBON MONOXIDE ALARM \" iwrd - 7. s. Y 'srN t no!-. �.iiik ms� _ �FFI � IT sE9�FC ` lPilC `rl��i . �� (WLPL IJJCp-OF$ i� AL _ N1 `� i til OXIDE ALAR,..., 6yl� Property Address `7(P3. fc W,- ArFC Gl Cf\'.. I)7 is ,:-'-.'-,1''--,1''':.„':,,1.--'--,-:—'-'--',:-,'';:,:''^';1-.,,'---',--',.,'':'''..:-:-'''...7'.':.-1.--''',"-'-;-:.;'-''-.*'':.,.'',-.'.:..'-,'.".--,.'-''',--'',._:1.-1'',''.-.,„'.''.,,*.',.';A'i.'--,''','--'.:',r"'',t,,-'.`'':.''-.'.-.„:.•-'' ''Y,'--.:,---:r6„,',.,' ,1,'4,,'t,t'',',i-..M.;'7.-'-'i.-L-r--'M.:'.-.,'-.:.'t.„'„'.zI-; -:-.t',..:--''-:'*--.,..1..'.',1.,.”,._,,-,',..i?,r.;-k:;'-,,„';,'i:;'„.;,-:.'i,--,,.-":,::,-i',;-,';,,,.'„...k....,-..1-,..,..:'..-.i.,...-.,.--,, --,--,--:.„',-‘'-.'e:;,,„',-'-;-.,.-•-.,.--':.,'-',-,-,'lI--,7''.:,-71'i-1.'.;--.i1-':;,”.:.,:'-"..;.' ,,-.!:-,.-_”1I.",',,,--:,'•.,,,"„-,.-, -._:,'.,„,:.-,-,!-,.-..-T.,.:..-,.,-,,,-•-4--,.,,-7--4--.;...„-,_F.-.z,'•_'.1-'-4-,7,.,.'-.',.11-7_:'-,.-'..„-,i.-.:-.1,7.,•;':,",,,,,..',...,'r,,,..:,':--'!:,';.:,',,..'-„-:.,,:,,;,-:I.„'.,,;','I:;.1,7'.,'i',,-,-;'„4,.4,.,",';':;,-1.,s:,..,:-7A1-.s..0,.\:.-,',:-,';-,.-,-,'!,r*.-..'-.4-:--1'','4A----,.•-'-,„,;.,,--,-''-.-,.:'. ,-.,-"-,,',t.-,-,,,,,.-,,7J,--;,.—:-,':,--,'.”1,-)--,;„,.-i,1;,.s„,.c.,-,''..--.:,r--,.,'..,'t.:,-,',,-P,.,;i,i-..,,,--:,.-,-..,--,,.-.;.l.-.i..,:„,:i:;.... ..'----„-..,7..'..- Permit Number .,- mom¢ -,74a - 0e24 k 'Brief Job Description; (r, , k” , Res/4�, t` '",...,•:,,.„,.‘,...':111'.':-,,:,'..,,''„-., ) -:,.:.:.-,'- Nur)ber_of smQk�atarins_iiristalled �.� �.. --,,:-=.i..,;..-.'-.',,. , - "Number of carbo_ namonoxide alarms instailecl ' - `':. ,, i.':,,-., ','„.,.:.`,,:-'.,_.-;'... .,---:-,....:----.-,-.'-,'.'::,.-,:''.,',-.,:,.: ,,,-,.r:‘--_ -.c,--.-.'-L:•-•. When alters#ions=repairs or'addi#ions requiring a permit occur, or sleeping rooms are crewted,, Smoke alarms shad be;•installed in, each;sleeping room,.and outside'each; separate sleeping.area in<the :immedia#e tVicinity of the bedrooms, and on each additional story of he ,.dwelling,"including basements and habitable attics asrequired by Section 12314 of.t`he 20 fi. : , :'California Residential Code (Cl2C)and California Health and Safety Code Section 13113.7. Fier dwellings,or sleeping units;containing fuel burning appliances or F aving;attached -- ' '''''-441, ages, Carbon' monoxide 4aaarms shall be z installed, outside each separate sleeping '' 'area `in '"the immediate vicinity ofA,the bedroo ms, and orf `each radditional story of the -1a '„ ,:dwelling, including basements as required by Section X315."of :the of the 2016 California. `"Residential Code (CR+C) Multi purpose alarms (combination carbon mo ioxide andxsmoke alarms)maybe ised. - - . All alarms shall comply with,requirements for listing and approval by the Office of the State Firs Marshal hti 4i fn fico ca: e tlicens�n€listri jos d ceiaseiistir, bbl sesrchcotest i: h Ott As owner,of the above referenced property, I herebycertify that ;the smoke alarms and carbon mono tide alarms have Eiseni 'Istalled in>accordance”with"the manufacturer's`instructions and_.ii-i compliance with the code section referenced above. 'w ,i dec)a a under penal ef.pee;iir r#hat ifie egg tg is true incl 6qrrAct4„antthOtAPIs ieclatrer waseccrged fat Ot d - .. atrcdip.Cairfhta. } � ' Cwnee'a Name t''''''iffy sei )r . _ S -. . rgnat€ re ':. of owner 4 his affidavit must be returrbed to the City.,of Arcadia inspector prior to;final inspection 03, .;1184A•;ts Zargs AFFIDAVIT SELF-CERTIFICATION ,-- FOR COMPLIANCE OF SMOKE At-ARIVIS AND CARBON MONOCIDe ALARMS Property Address:, 41123 Friirvlativ Ave- Pliit*eYLdiø a 01 too Permit Nutnbtr. 4rA . Brief:job Description: Nurnber dismoke alarms-Installed: 2- Number of carbon mOrloxide_alarmsinstllsth - I Otiolii-parp.ge441,*(1 Mc4f"4C Cril*.e4414.11 When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created, Smoke aurins shall-be-installed in each sleeping'room, and outside_each separate sleeping area in the iimmediate vicinity of the bedrooms, and on each additional story-of the dwelling Including-basements and habitable attics as required by Section iRai 4 of the-2016 _ California Residential Code-,(CRC)and California Health and Sefety-CodeSection 131137. _ For dwellings or sleeping units containing fuel-burning appliandes-or.having attached -- garages carbon monoxide- slams Shall be installed outside each,separatesleeping area in the immediate vicinity of the bedrooms, and on each additional Story:of the inbluding basements as required by Section R1 of the of the'2016_California Residefitiel Code (CRQ)-. -Multi-purpose alarms(combination carbon monoxide and smoke alarms)may be-used. All alarm's shall comply with requirements for listing and-approval by the Office of the State Fire Marshal hit :. ,,,a/A)Almiljaige.tioviiic_ensin nselistin seace rdhcotest.gbp As owner of the above referenced preperty,-I hereby certify that the smOke alarrniand carbon monoxide alarms have been installed in accordance with the inanitfacturer'sinetructiOna-and-in compliance with the code sections referenced above, I deciaratindet penalty of perjury that the fdregoing is true and cot-rec-1i and that declaration was spouted on at Arcadia, California.- Owners Name (printedityped):- -91_ kik"! 1444 Signature of Owner:, _ -41444,1- 414, - This affidavit must be returned to the City of Arcadia inspector prior to final inSpection APPIONitilreEtroCERVIICATIOI41 FOR CONIPUNICE,OF SMOKE ALARMS . Atto CARSON 1010,NOXiDE ALARM privoyAlicktom 109WIEWAVUNIMMAritivoi 54Tcaiif Pomtit !,..rtt&-er , sidoi jab etiorlitatol • • • •-• • • ---- Nalt **: tadditreatottiattalloct hirimSdrotitilbort morretide storms lotto:4k Whes elltattlOnst torralts or middiane tenotrog 4totniileitteat, istooprod monteato conated„ smoke ,ntarot dIIi ointrolle0 id cosh eltlebingi tees and euMkte testi seporeie ottimiottst:,,iit in Oro tonseiliode tleinifyd ttitt bdroom% arid em coat additltrial eitoy alto dtvlitool leetiahrig;tratertittals OM habitable otiio os tonoW by Poao*R414:0:040 18 Chlitenta Residente codetC3and Colbert%tieolitt cool SoilotteadaSixtbn 131-11:7:, • • For drimeihrtga or sloopitio tortiorologi hoof butsing UnGot cItmthort at lathed oaracht‘,crofts Momide- lOrms shrJ b instelled tout** fla0 SMarrit$ aapin MOffii 11101 framoditio-Wittily df Ma !bedrooms, MO sa sash addidoral itlery of Ins dweilltist 110010dres toot:et:0a utitetii b oction A315 oI mo Lio 2018 Gator thrillaitapositalommiiMatoblostine,monert orantoddo atter emokao.troggiWINIt 00.0d, Mogan:Ts:ORO tottObriNith tritiorritomettimidt tOIiE armtoopottal bytirs Oahe o hiter',Moto Fen- hietettot, 0'10 ....„ OfMittit olo atiyorrowortood pro1oo44, ,ftetotrynoility.throt therameto AM?, raid mi*stoma triaterbein MIIdtateeordenee with•the meoiffrosksaralnaiteetlorta and in conmitorms ittit line code attitnoo toramorted obsim. elOcioto ondiror tiny Mp4urEy thord tha'fottoe40,0 is tow,aad 1.tadittrat this deeitratiOn ws tame stad so; ,,stAtooditortehrollibt, Ourtrod, irtiaoarg hottiniedAydroop,„ ,„„ . , ittermlum trit*omen___ - lo itra Oily of At::-.;:tild iltpodatrootot to Wad loodettion • • 44 iE014� +gra. ) 1=u '; I4.. 5.msd n. AFFIDAVIT SELF-CERTIFICATION FOR COMPLIANCE OF SMOKE ALARMS AND CARBON MONOXIDE ALARMS Property Address: i b3 W V'vWvi � 40( I'Cv'�t,c��/� _ g 1007 1 Permit Number: 40r_ 24, -007 Brief Job Description: ,»L (e irt� )oma . . Number of smoke alarms.installed: __ _ __ Number of carbon monoxide alarms installed: 3 When alterations, repairs or additions requiring a permit occur; or sleeping rooms are created, Smoke alarms shall be:.installed in each sleeping room; and outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, includingbasements and habitable attics as required by Section R314 of the 2016 California Residential Code (CRC) and California Health and Safety Code Section 13113.7. For dwellings or sleeping units containing fuel burning appliances or having attached garages, carbon monoxide alarms shall be installed outside each separate sleeping area in the immediate vicinity of the bedrooms, and ori each additional story of the dwelling, including basements as required by Section R315 of the of-the 2016 California Residential Code (CRC). Multi-purpose alarms(combination carbon monoxide and smoke alarms) may be used. All alarms shall comply with requirements for listing and approval by the Office of the State Fire Marshal. httr:d/osfm.fire.ca.•ora/lioens n•listin•s/licenselistin• brnl searchcotest,r h• As owner of the above referenced property, I hereby certify that the smoke alarms and carbon monoxide alarms have been installed in accordance with the manufacturer's instructions and in compliance with the code sections referenced above. I declare under penalty of perjury that the fore ging is true and correct, and.tfat this declaration was executed on (Date) . //p 9-0,,1.0 • at Arcadia, California, Owner's Name (printed/typed): A ' .OA Wiyyll • Signature of Owner: , . / ,% This affidavit must be returned to the City o Arcadia inspector prior to final inspection ,, A aVEUMBAARLI) c.4 t t;i_CI. 1-40V ft_._, Thf ALABIILLOCAYIPSA, Guest Room foi i I. 0 1 i Ilailiroon Storage C - L II MI m I ty Rom] .. , _ ii Garage ; __ FIRST FLOOR PLAN 03 w MOI ALARM LI CAR O4 MONOXIDE ALARM ire le Mstr _ ilk Master Bedroom _ _ - - i -- DinKitchenng Room 11 40 .... Boil __ Li_ Cinset I ''''Close ---- -_-_•,....- _.-____-_—_----_----- . ' !loft'Room ---- NNW ---------.,-__ . • ---- IMO" • iiiiii 1 - - Bedroom Bedroom SECON* FLO R PLAN Ci .SMOKE ALARM [A. .' . CARSON MONOXIDE ALARM f.1;:;,... ... r\r\., • ' evo.raa•d 4\ 0�6' Qty op9G AFFIDAVIT SELF-C. ERTt FpCATI ON FOR COMPLIANCE OF SMOKE ALARMS S AND CARBON MONOXIDE ALARMS Property Address: .90 r vn� L� /J it` P c,. 077 q 9 Permit Number: 49 F 72—o p Ze Brief Job Description:_•Ap,Co V� fir;= Number of smoke alarms installed: 3 Number of carbon monoxide alarms installed: When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created, Smoke alarms shall be installed in each sleeping room, and outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements and habitable attics as required by Section R314 of the 2016 California Residential Code (CRC) and California Health and Safety Code Section 13113.7. For dwellings or sleeping units containing fuel burning appliances or having attached garages, carbon monoxide alarms shall be installed outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements as required by. Section R315 of the of the 2016 California Residential Code (CRC). Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used. All alarms shall comply with requirements for listing and approval by the Office of the State Fire Marshal. hrip://osfm.fire.ca.ao�a/licensinralistinQs/licenselisiing bml searchcotest flg As owner of the above referenced property, I hereby certify that the smoke alarms and carbon monoxide alarms have been installed in accordance with the manufacturer's instructions and in compliance with the code sections referenced above. I declare under penalty of perjury that the foregoing is true and correct, and that this declaration was executed on (Date) , at Arcadia, California. Owner's Name (printed/typed : � , _. Signature of Owner: ,r; - This affidavit must be returned to the City of Arcadia inspector prior to,final inspection gli igq, - 4 1 i IR.) iNo,j CARK,QK 4*V it,',MAMA/ t.,k 1,_•,. 1 - -TI 1 l, - Gue ,, st Room • - g le 0 , Bothroun - (.) Storage Iii 1 . • 1,8tolls. Room • Li. pi I I . _ FIRST FLOOR PLAN , C fg SMOKE ALARM LI CARBON MONOXIDE ALARM 111111111111111 • Msir •-•----'"' -.6---",'— Bath 0 Master Bedroom Dining Room K ilehon j 110 Linti i (.. , , I-1011 c, Ei closet 1 cioget nowt Pamify Room -- opow _—_,------_ ,-- , os• I J --- --- Iledroom I iledrooni - _--: 7,-......ii- :____:-: SECOND FLOOR PLAN ( tc,SM cKfa. ALARM CARBON MONOXIDE MAR.,' 4 t • t AFFIDAVIT SELF-CERTIFICATION FOR COMPLIANCEE OF SMOKE ALARMS AND CARBON MONOXIDE ALARMS Property Address: �. ,rv, w Ave 17t (� rgr(ke. , o Permit plumber: r1704,F— 70 - 007 e� Brief Job CDescription: era iLreo Number of smoke alarms installed: 3 Number of carbon monoxide alarms installed: When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created, Smoke alarms shall be installed in each sleeping room, and outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling,,including basements and habitable attics as required by Section R314 of the 2016 California'`Residential Code (CRC) and California Health and Safety Code Section 1.3113:7. For dwellings or sleeping unitscontaining fuel burning appliances or haying attached garages, carbon monoxide alarms shall be installed outside each separate sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements as required by Section 1315 of the of the 2016 California Residential: Code (CRC). Multi-purpose alarms (combination carbon monoxide and smoke alarms) may used. All:alarms.shall comply with requirements for listing and approval by the Office of the:State`Fire. Marshal. http: /ostin iitevc . vdii ens in lid ct iiicenselist nqa bmin,searchcotasi. ii As owner of the:above referenced property, I hereby certify that the smoke alarms and carbon monoxide alarms have been installed in accordance with the manufacturer's instructions and in compliance with the code sections referenced above. t declare under penalty of perjury that the foregoing is true and correct, and that this declaration was executed on (Date) . ' lo at Arcadia, California. Owner's Name (printed/typed): o ''.' i ' Signature of Owner: _r -- This affidavit must be returned to the City of Arcadia inspector prior to final inspection t { , „,-.—itfi &mss.. �: ., .art -•"°:-_,A.w AFFIDAVIT SELF-CERTIFICATION x FORCOMPLIANCE OF SMOKE ALARMS "; AND'CARBON MONOXIDE ALARMS Property Address: fi '�"° Permit Number W •, ‘7-r2,�2> '111.. ... Brief Job Description: Number of smoke alarms installed: � �` ¢- Number of carbon monoxide alarms Installed :::::;sil4 When alterations, repairs or additions requiring a permit occur,or sleeping rooms are created, Y Stroke alarms shall be installed in each sleeping room, and outside each separate P;".,-;_ , sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the dwelling, including basements and habitable attics as required by Section R314 of the 2016 California Residential Code (CRC)and California Health and Safety Code Section 13113.7. For dwellings or sleeping units containing fuel burning appliances or having attached ',,,-4,,44- garages, carbon monoxide alarms shall be installed outside each separate sleeping k4 ; areae in the immediate vicinity of the bedrooms, and on each. additional story of the "' - 'T. dwelling, including basements as required by Section R315 of the of the 2016 California Residential Code(CRC). multi-purpose alarms(combination carbon monoxide and smoke alarms)may be used, Atrtt All alarms shall comply with requirements for listing and approval by the Office of the State Fire A lvtars a#, t tt t .fiie,ca.•*viii =n initis in. liicerlselistin larrtiise rettcotest.ph Z As owner of the above referenced property' i hereby certify that the smoke alarms and carbon monoxide alarms have been installed in accordance with the manufacturer's instructions and in y 'compliance with the code sections referenced above. 7ve:i41:;,:::;:',i,--., I declare under penalty pr perjury that the fora • n. I true and correct.., and that this declaration was executed on (Date) r -'"' ,et Arcadia, atiforr la, � r'e Nom.(Pr t 1{t ci). , _. -- Signature of Owner: - - ..,... weep„.„4417, - joiv ____ „„ ,,,,,„ .-4,;,,,'!„i r '1t*c ' _ of Ar; ifa inspector prior to final insection 4 , f r, - tt ` ?*=wa "1j s t.4'.'''''4 3'3.35r.''..,Pgvin t''ilirt'it'134';' .;;:;'4**ki7.4*::e.ifivii.3$,:f,,--, ,;:,„ ; ; 3 33 M1 Y h ,+ ' f