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Home My WebLink AboutRALT-20-0309 --,',‘k° ` City of Arcadia, CA Permit NO RACY 20 0309 Development Services Department k Permit Type Residential Addition/Alteration 240 West Huntington Drive,Post Office Box 60021 3., : Work Classification Res-Accessory Dwelling Unit Arcadia,CA 91066-6021 .- r (626)574-5416 , o Permit Status Issued ARCADIA Issue Date:05/12/2020 I Expiration: 08/19/2020 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 32 W FOOTHILL BLVD B Arcadia, CA 91006-2338 5770008032 Contacts YUKAWA,RICHARD AND MU,YANG Owner 32 W Foothill Blvd,Arcadia,CA 91006-2338 (818)257-9578 Description:CONVERT EXISTING BEDROOM, BATH AND GAME Valuation: $ 9,628.20 ` Tenant RM INTO NEW ADU.(ATTACHED BY BREEZEWAY ) MEP INCLUDED Total Sq Feet: 724.00 Plan Check#20-0309 Plan#' Fees Amount Payments Amount Paid Building Issuing Fee $47.01 Total Fees $924.50 Building Permit Fees $237.25 Cash/Receipt#REC-04440-20 $442.83 Building Plan Review Fee $154.22 Cash/Receipt#REC-03933-20 $481.67 Cal Green Plan Check $15.43 Electrical Permit Issuance Fee $47.01 Amount Due: $0.00 Energy Plan Review Fee $47.45 Garbage Disposal Fee $13.21 Gas System(Outlets) $15.55 Green Building Standard $1.00 Kitchen Sink $13.21 Outlets-Receptacles&Switches $4.89 CALLS FOR INSPECTIONS Plumbing Permit Issuance Fee $47.01 Request for inspection by telephone at 626-574-5450. Leave a message Single Family Fire Plan Check $280.00 requesting the address,timeframe and what inspection item is needed. Strong Motion Inst.Program Res $1.26 Tota l: $924.50 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 12, 2020 Issued By: Date May 12,2020 Page 1 of 1 G~4 oFFC4dr PERMIT/PLAN REVIEW APPLICATION, /. je Development Services Department,240 West Huntington Drive,Post Office Box 60021 %on.„ow 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. 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 ElI 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 ❑ 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 IDI, 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. Name 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. 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 NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. 3 Z /',,/ 'v#/C( / d ✓ 100. Setbacks 210. Under fir/bldg.drain /��/F 101. Rough grade 211. Copper underslab 102. Figs.&forms 212. Rough plumbing ,‘/�%- /4Z 103. Pre-slab 213. Rough gas 104. Floor joists 214. Shower pan 105. Steel 215. Water heater 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service /5:1(&-Z /.57(// (Iiieyy��n� PL 109. Roof nailing 219. Final gas G, ,/ / ki7 110. Framing / ' / 220. Fixtures jSS 5,1. V/& 111. Occ./Area Sept.Wall 221. Final plumbing 77?Z/�7 to T-�� 112. Sound walls 222. Sewer cap/demo. r (J 113. T-bar'rid 114. Insulation-Flr. Pool Inspections Date °Insp. ? 115. Insulation-Wall 240. ExcavRough plum ingeel /,) �.�i �_Y �G��0s�74�� 116. Insulation-Ceil. 241. Rough plumbing �/�PCD!" r1' �? 117. Drywall nailing /,"-LC%7 242. Light shell/bonding1-prehr- 7z %/J �j„y-�4( 118. Interior lath 243. Underground conduit "� 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test �% 121. Final building /7l��t! 246. Fence,gates&signs �� a 1/"t (S l�� /Uz 122. Final demo/lot clear 247. Pool heater 248. Final electric • 74e _ Cly/ Electrical Inspections Date Insp. 249. Final slumbins 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 270. Pre-reroof insp. 155. Water ground ` 271. Roof framing � 156. Rough electrical / ?Z/ 77 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. Eqpt.bonding Sign Inspections Date Insp. 160. Service panel ] L../'r* 280. Setback/overhang 161. Final electric Z-/- i 281. Footing 282. Conduitwirin. Mechanical Inspections Date Insp. 283. Disconnect _ 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rouch HVAC 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 .-41, 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 I r Property Line I ROUTING --ACTION r ^" Date and \P� o�P�P� ��°�5 *See Initials Checker ZO9 CP' �° Notes c,62' on Sheet# Planning jX '1i2bb VQ X 1 Eng. Building V �If Z — " ' Fire ;X�.)2c( - r �.. - PWS-Water_] WELO I Trees i I If.;M f."? '414.,ry 1.VG. .'y. .. 18' m n 4 PJr- 37' . .,kx`°'" -� � - * 18' v I -';" '.,.-1 Existing Dwelling A' itt AOC Unit(724 SQ.FT) • k EXISTING i MAIN HOME �/c(g/ 37' (1300 SQ.FT) -' f�d�' �:9• zd• `� /� �` 20' (Int 'ouietails and Covered Garage .C/r all wi dows and)doors 1 .-)-;.' "?r �(JW� of shown) r,. 6' ,l r Jo.lD• W -... 6Current Driveway 3• (Width ID•ID.) 32 W Foothill Blvd -1 14' Arcadia,CA 91006 r. ce c.i s g 2 0 lmtrwlde ` ,c o tC�N iL P vim' 1- l�X)c�i1 \/�til7�� ii'► 1 _ I ''l <J Gtctvar- VC°Art, 11/lir' pr A. a,. c ACAv-vY►S z ' , 2...... -u3 r-----Ali 21'6" -111 -P vats Bd0d J e wayl /'� JI U 11501, Property line(8D feet]-_ • H iti M� View 1 of 2 Sink Are• a of Kitchen StoveNent and Refrigerator Area of Kitchen 48 tall x 70"wide 80 - 46"tallx 48"wide "tall x 71 1/2"wide ';;;',!1'•.A.... ' 'C loset P .,y _ � #� 5} g L` 52 tall x 52 wide f. s pa, ; ry ' `° f' �. ;aa t _ °a+l✓ ' +.fir.w 'P 't %f y fig. p"x,.,., ,gya, M U :@ a .� tl-wa r k �, ��. ,�� I, "` Bathroom '° � j !?`. - , t ,� '.?' ^�`s z-1,1,:':::-;',',•-•:' ri . fi , `" �F' i -:':F..-.::,'....?-:;;;,:i.-,,,,....474.,4,,, s} 4 t.. F�S ,. �� -� �S, '� ��" � J"' �� ,.g�g . r'mo- f{ _ : K/k ltS rc. t S2F '� 'y.i. s t c< .:.'4..":„.:14.'.i,,!?-.:74 i.44,:�' t i / -::fall ft 5 ,......,,..,:f.'',.4.,...,01,..)1::::',::,:; ), x n ` w"� �,L fr E f� 3z 136"tall x 36'wide g _ �� Fri. �� V. -� { S';..; �: �,p .< �;� 35'tall Yx 35'wide • �; �,�� b , a � 35"tall x 35' wide :-;- ,„... ,, 4 ` . 20 tall x 19' wide a: tall x 35 wide ;� �. . `{ Main House 42 ° y , f, _ 4 i View2of2 E ' 1 tDe';;',.:::::::::::':..:..',':"'r ::-:''::-f:.'., ',,,.',:::‘..''':;:',.:.:-.-,',:::::,!':',:.,',...1::,...-,:'''::::''''',;-,:'.:1.-::::''',:,;'',.'1'..:. ::'..',.,',,...::,,,''':'":i:','-':;-';'-'2'1'''',:•-,:- '''.-.2:-.;,:':::::':',:''''''',,',.,::::'''-'::::...';'•''-'::::.'',.',.- i ,�� r 42"tall x35 wide 36"tall x 36"wide 4 � ; . ,; r RY Closet � .� a� �� ' �'��*, � �� f; - 5 fi.,-,,,,,,.,:--„,:,;:,,,,-,.7.,. .: oa, yq aA Bathroom. .-.(�ge,14,,;:',..: , FY � q� g �# ami T,1 d- ro.:- ,.:v.,..,,. .e x^"�s� + < ;.:., i a#+9 g �y,�4 1:z Main House 8 l3 i$ ff .° ' Wt R � '1r.. � 8' *'+a f HSTF+7 � �;1-.),,,-...,..r....•.--',":.,.:-.'-,.,",:!,-.`,..,- �4 F !E .t�,�,;�„r�, , ,.,- .a 4� - • .e°� ,�,.: 46 tall x 48"wide 20 tall x 19"wide 6� 80 tau x 71 1/2 wide Sink Area of . � ° Kitchen "`,, A; sem' , ®�- l '5, P`, " ,° r,� ,' a a � 35"tall x 35 wide n1,4:� ms �,� , � 3� �s ,�� . � � �a�� , �, 1, � . � � � P48"tallx70"wide E 35"tall x 35"wide ... .,I.:!,,,,,,!..;3,. a PSA�ag.. °° .., R 4% . „ . AD U i `� � � � Stove/Vent and Refrigerator I „wig4 Area of Kitchen s, �+s W�°': +� .�e a s y g8 /� p z� e ✓` t�'a, r ,`152"tall x 52 wide ° &:. F. $ '. s em at L ti „';, *e .k m =a :� :,..1.::,42'"?'''-'” as b ° t ��aw" . _ _. ,' • CITY OF Al'CADIA DEVELOPEMNT SE'kVICES DEPARTMENT 240 WEST HUNTINGTON DR, ARCADIA, CA 91007 (626)574-5416 APPLICATION FO AN ADDRESS CHANGE ($753.26 FEE REQUIRED AT TIME OF APPLICATION) C 4 .7-d /!.( kCi_CQ)c* /Vr (c.a,- Voc kr' csJ Ce Applicant PP Property Owner 3 2 ) foot' A;(( /3(v.,4 2 Gel E o o-f k l ( / (v Address Property Address Ayr t ci (A er/,.4,0015 Mailing Address Mailing Address — 2s7 --9t 7R g18 - 2g- 7 -9s-76, Phone Number Phone Number REQUESTED PROPERTY ADDRESS: 3_2 £ ) F00-74A ,*(f S l v aP i •f. 1St Choice 211`1 Choice C / �i�i ,kms 21-'//202 D 0 ?s Signature Date F4R OFFICE USE ONLY DOCUMENTATION: Current Property Tax Bill: Recorded Grant Deed: FEE: $753.26 PAID: RECEIPT NO: APPROVED (Notification attached) Yes: No: DENIED (Reason): • ASSIGNED PROPERTY ADDRESS: By: Building Official *Note: Send notifications to all listed agencies upon approval of Building Official. . GAWA 4 galkip 4\ T. As'4 oe 1fY.oSj' AFFIDAVIT SELF-CERTIFICATION FOR'COMPLIANCE OF SMOKE ALARMS AND CARBON MONOXIDE ALARMS. Property Address• 32 W Foothill Blvd. Unit B, Arcadia, CA 91006 Permit Number: RALT-20-0309 Brief Job:Description: . Residential Accessory Dwelling Unit Number of smoke alarms installed: 2 Number of carbon'monoxide alarms installed: 1 When alterations, repairs or additions requiring a permit-occur, or sleeping rooms ate 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 2013 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 R31:5 of the of the 2010 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 Marshall.http:/losfm.fire.ca.qov/licensinglistings/licenselisting bml searchcotest:php 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) 05/12/2020 . at Arcadia; California.. Owner.'.s.Name (printed/typed): Richard Yukawa Richard Yukawa ,,m`o;�;;,° �°:�°""` Signature of:Ouvner: o ,�ao�,,,,-0,,o.�ar This.affidavit must be returned to the City of Arcadia inspector prior to final inspection t City of Arcadia, CA P nnitNO RALT 20 199. 5 k Development Services Department r PermitType•�Residential Addition/Alteration 240 West Huntington Drive,Post Office Box 60021 � p g k f` Work Classification, Res Additilon/;Alterat!on Arcadia, -5 91066 6021 i. • Y« � � -, , , [ (626)574-5416 ,- E `" Permit*ills:issued ARCA DIA Issue Date:11/30/2020_ Expiration: 11/30/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 32 W FOOTHILL BLVD Arcadia,CA 91006-2338 5770008032 - tem;,.__ _....,... ..e_,m.c. ._ -. d A. eac.. Contacts YUKAWA,RICHARD AND MU,YANG Owner R E T CONSTRUCTION CORP* Contractor 32 W Foothill Blvd,Arcadia,CA 91006-2338 8035 LINWALT ST,ROSEMEAD,CA 91770 (818)257-9578 (626)679-4013 1019820 Description:REMOVE TWO INTERIOR WINDOWS AND CREATE Valuation: $ 500.00 Tenant NEW WALL PARTITION. PROVIDE EGRESS WINDOW WHILE CREATING NEW PARTITION WALL. RELOCATE WATER HEATER Total Sq Feet: 0.00 Plan Check# Plan# TO EXTERIOR AND INSTALL 1 HVAC SYSTEM AT REAR PER ---- --- ----------- APPROVED PLANS.MEP FOR ADU.(EA) iztissmarzsma Fees Amount Payments Amount Paid Building Issuing Fee $47.01 Total Fees $366.49 Building Permit Fees $40.65 Cash/Receipt#REC-06165-20 $366.49 Building Plan Review Fee $26.43 Cal Green Plan Check $2.65 Amount Due: $0.00 Clothes Washer $13.21 Compressor<3'Ton(up to 3 hp) $19.86 Electrical Permit Issuance Fee $47.01 Energy Plan Review Fee $8.13 Furnace or Burner<=100,000 BTU $19.86 Green Building Standard $1.00 Laundry Trays $13.21 CALLS FOR INSPECTIONS Light Fixtures $1.63 Request for inspection by telephone at 626-574-5450. Leave a message Mechanical Permit Issuance Fee $47.01 requesting the address,timeframe and what inspection item is needed. Outlets-Receptacles&Switches $6.52 Plumbing Permit Issuance Fee $47.01 Solid Waste Management Fee $6.25 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 Solid Waste Management Fee 2 $1.00 from the date of issuance or if the permit is not obtained within 180 days Solid Waste Management Fee 2 $1.00 from the date of plan submittal.This permit expires and becomes null and Strong Motion Inst.Program Res $0.50 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: $366.49 • - . ffNovember 30,2020 Issued By: Q • Date November 30,2020 Page 1 of 1 _' PERMIT/PLAN REVIEW APPLICATION • °ESV. Development Services Department,240 West Huntington Drive,Post Office Box 60021 �0m°altY°{�' 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 X 10 License No./? 'zv --- rate/O/'j0 4. compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Con performance of the work for which this permit is issued. OWNER-BUILDER DE A/RATION ❑ 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 �jC4- f474 h7 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 co ply 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�� ' v)a Signa 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 j employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date _Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for further information. • Name 1G(i/..--- (d� r16-1....-- --i1 f C/ (112 iti / e Chi 0 PRINT NAME certify that I have read this application and state that the above information is corn ct and that I am the owner or duly authorized agent of the owner. agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of rcadia to enter upon the above-mentioned propert s ion purposes. 11/ 1/2° , / Si a ::= _.......mow---............. ate 6`/ 1 2 1 U A This page is part of your document-DO NOT DISCARD A 20190853065 �� °s v: I ".1 Recorded/Fded in Official Records ix .t jr r California AUG 7 ") zoi9 � Recorder's aua/u.,e.aru County, CI FY (Y-7 At7CADIA cl FEES: 35.00 TAXES: 0.00 OTHER: 0.00 PAID: 35.00 UlOID I I IUl 11 NI11 I III 1 I lIUII 01 IU Ill I 11111 H lI 0 1111110 IlI LEADSHEET IlI 1111 llI ll I0 11I I I DIII Oil Oil Hifi II Il ll 1101111 II20 908233300064 0017049678 I 1011 1101111 Il lIHh111Illhllll 10111111111 010066501 01 DAR - Co er (Upfront Scan) 1011 I II OOI 1110111111111 IHIIOIIHIIIMIIH 11111 IlllIOIl1HOID - 1111111111]IIII1111IIIII1110IIIIIIAilll91111lllllI - 08123/2019 RECORDING REQUESTED BY AND 11 111 11 WHEN RECORDED MAIL TO: City Attorney *20190853065* City of Arcadia P. 'O. Box 60021 Arcadia, CA 91066-6021 COVENANT AND AGREEMENT REGARDING ACCESSORY DWELLING UNIT 32 WEST FOOTHILL BOULEVARD,ARCADIA, CALIFORNIA FOR GOOD,VALUABLE AND ADEQUATE CONSIDERATION, receipt of which is hereby acknowledged, RICHARD YUKAWA AND YANG MU, HUSBAND AND WIFE, AS JOINT TENANTS hereinafter referred to as "Covenantors", hereby declare that they are the owners of that certain real property located at 32 West Foothill Boulevard in the City of Arcadia,County of Los Angeles, State of California, more particularly described as follows"Affected Land": Lot 35, of Tract No. 12374, in the City of Arcadia, County of Los Angeles, State of California, as per map recorded in book 232, page(s) 42 to 44 inclusive 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 behalfof 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 owners 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 one designated parking space. - 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, 1 • Covenantor or their successors or assigns shall be liable for reasonable attorneyfees 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 maybe 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, Covenantors have executed this instrument on the dates shown opposite their signature. [SIGNATURES ON THE NEXT PAGE] 2 "COVENANTORS" Dated: . .„ v 6 , 2019 Richard Yu raw.. Dated: 6 , 2019 Yang Mu "COVENANTEE” Dated: e:373,11.. , 2019 Dominic Lazzarett. City Manager APPROVED AS TO FORM: Stephen P. Deitsch City Attorney • 3 r-• ....... ..........,......... ...... ....... ..... ..... ..... ..... irtdc,ty -". • • . . • _.. . . . . • • • • . • • .Q,,•••. . • • • • • • • • • . • • . . • • coiiensi Mint; ..Dte Pork - • • i• • . • 37' • -_ . • • . - . . • r. - . Existing DWelling • -11-:Unit(724 SQ.FT) ' g . • I• • EXISTING • MAIN HOME • . 37' 29' 20 (1300 SQ.FT) • 20' (Interior details and. cuwe.d Dia'age all windows and doors not shown) • lir ." 20' • • 11. . , Driest DriveienY " . -3' • • (Width 10',101 32 W Foothill Blvd . . • Arcadia,CA 91006 "rj • • • • . • . . Icturwide Designated SPeice • • ke.Tca rt,le.a•I "A" EXHIBtT P.7,,,IP'S 3 . • . . . . . . • . . . . . . . . . _ . . ). • -._„ lb:____ ___A iz. _pi',• • :_, 124. i___.,._r_49. - __I's.. • • - i4-2.-- I4S.- i Jb4. . 16Y.. ibb• . _i rg• . Am: • . •rii" • . 19c) . - •_jut? _ Y-Vr.:.-*•.;.7• ".'.11-7%"' ---- - " - • - - • . . = -v.• 1 m.c..1 i• . . , , ,„,,.... -.,1,...,. ,."••,,,•••,,,,:i','..„. •- : ' . IC VAll'" ' • a'---1.1 : - 1 - -,:-,...,:., • .•..: _ • • . _ - .. 43"I I • I I . ID_P-_•.,I.' - I. . . - . - I ' ' - , ' ' • ' -.:-..._---1-...1-._-..-ag... • __...,.,...,t_.• i . . • . . . . - . _ . • . , 1 . .. • , . i 1 ,. . . . . . . . . . • • 1 114: ! . I . I .. . . .. - . . 1 . . . . .. . , --- .. .— i I 4:13i Port . 1 • • * • • • . - . • • .-, ' AB1 • IlAgr , 1 • - • I _ _I ' .'• • '..' ': --' - - EX:Igtirig-Niellitlg- __ __, I* ._.-,/ ' . . - I, 7--1 • 'Unit..-(724-SQ FT). • .13-, - • •• . - , . E• I . • • • , • , . ,-.. - . . - • - -,1 —,, %•• . I . b . • . • , _e_-.1 • . . . . .. . , ' . . -,::•- . . • i • : 1 . '• , E)USTING. .. • . . '. I ' '. •. , '•' : •!" • .• • ', • " 1 ' " I • - .. . iTMAIN• HOME • •-, ' : .''....._. 'I • . i'. . •20' I 20! . .. (1300-SQiFT) : . . . . I . . . .. • . . ._._ • • . . , - , i • Cuvert*J Garay': 1 (inteeiot:details!and 1 • • s• .. .i. • , • . . all Windows..arid doors . . .. . not shwn) _ \•____. - - i 6'., t- • . • oi : 1• . • . . , . . • . . .. i.-____..,....r... -..• ,... • , . • . . , . . _ . . . . • ,: : .OLIO ' '.--';:-.. - ' 2°' • . • - - . H. . , ,- . • • • i '••' 1 VI . , . ,..CUrtent:Dril!eibay..:i.tS•-!---: . '-'. . • . 3 — . Varkith'101101);' g •-•,32-AN Foo.thiti;SE:Vd-.7r.,:e."':::,--•il•-•-•-•-f--•:-.--7:-.:::.:-.---- 1 . ,-,----- . . . .. 14,. • • -- :Arcadia—CA-91:006 , . . •>. • • . 1 . . . • i . . . . . i . 'it ' I • . • . i . . . 1 . .. . . , • 1--- , . . . . I '' '.: . . • . . 1 rrl . X • ..= • - . = • . . , ... • CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 6^3�yfr3 'Y'. • 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 LOS Mti lge,t45 On JU'e to , 20 M before me, JCiarnie, rOgQh ) NOtarki ?ubl(c, Date HereInsertName and Title of the Officer personally appeared _ ,lr�GCI I Wawa o ci )d L4 • Name(s)of Signer(s) 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 his/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: JEPAMIE BROGAN WITNESS my hand and off'1421. • 4. Notary public,California _ / • "� Los Angeles County E :r Commission N 2249717 My Comm.Expires Jul 14,2022 Signature Sig - ubt c Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Document Title or Type of Document: C,0\knartt. Document Date: June 10 200 Number of Pages: 5 Signer(s) Other Than Named Above: Capacity(ies) Clainrd by Si ner(s) • Signer's Name: -t C C4rL AV uMa Signer's Name: . yA u ❑Corporate Officer — Title(s): ❑Corporate Officer — Title(s): ❑Partner — ❑Limited ❑General ❑ Partner — El Limited ❑General Qlndividual ❑Attorney in Fact Q Individual El Attorney In Fact El Trustee 0 Guardian or Conservator El Trustee ❑Guardian or Conservator V.13 ther: �+��Y Cy'Other: 0 Witter. Signer Is Refresenting: Signer Is Representin ©2014 National Notary Association •www.NationalNotary.org• 1-800-US NOTARY(1-800-876-6827) Item#5907 %14*44'1 City of Arcadia, CA Permit NO. EIeC 20 2113:~ % Development Services Department 1 1 -,r q = ( i Permit-Type Electrical ##:ktp 240 West Huntington Drive,Post Office Box 60021 Arcadi4 _I, 1 ( Work Classification Elec Service Change a,CA 91066-6021 t (626)574-5416 �t�� "� �_� I ? :PermrtStgtus Issued.? ARCADIA. Issue Date'12/17/2020 Expiration: 12/17/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 32 W FOOTHILL BLVD B Arcadia,CA 91006-2338 5770008032 Contacts YUKAWA,RICHARD AND MU,YANG Owner R E T CONSTRUCTION CORP* Contractor 32 W Foothill Blvd,Arcadia,CA 91006-2338 8035 LINWALT ST, ROSEMEAD,CA 91770 (818)257-9578 (626)679-4013 1019820 Description:200 AMP SERVICE FOR ADU Valuation: $0.00 Tenant Total Sq Feet: 0.00 Plan Check# Plan# Fees Amount Payments Amount Paid Electrical Permit Issuance Fee $47.01 Total Fees $64.49 Residential Services up to 400 amps $16.48 Cash/Receipt#REC-06337-20 $64.49 Solid Waste Management Fee 2 $1.00 Amount Due: $0.00 Total: $64.49 , /-6'2/ rer4 .-A 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. COIv]PLETED December 17, 2020 Issued By: Date December 17,2020 Page 1 of 1 G~4v."FO , I ; PERMIT/PLAN REVIEW APPLICATION , I ' Development Services Department,240 West Huntington Drive,Post Office Box 60021 om.4OYi,y oc�°m� 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 ClassF 0 License No. 0iq, O - 3 ZAP% compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature o ontrac or 1��" OWNER-BUILDE' 1 ECLARATION ❑ 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 0 I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, 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. 0 I, as owner of the property, am exclusively contracting with licensed - contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for further information. are 1/1/ .24( / _ \Title CSC 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 Aca dia to enter upon the above-mentioned property for ins 1 ection purposes. S gnature _ Date ?"-/?---/0Z k k o .' City of Arcadia, CA $ Re'rrrmrtNo MISC ZU 0310 Development Services Department p j ). yX s Permit Type e Mis 240 West Huntington Drive,Post Office Box 60021 r ft_ Ati Arcadia,ca 91066-6oz1 Work Classrficotron IVlisc Address Assignment 1 (626)574-5416 M wk,„ ? Permit Status Issued ARCADIA issueFDate:02/21/2020 I Expiration: 02/22/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 32 W- FOOTHILL BLVD Arcadia,CA 91006-2338 5770008032 Contacts YUKAWA,RICHARD AND MU,YANG Owner R E T CONSTRUCTION CORP* Contractor 32 W Foothill Blvd,Arcadia,CA 91006-2338 8035 LINWALT ST,ROSEMEAD,CA 91770 (818)257-9578 (626)679-4013 1019820 Description:ADDRESS ASSIGNMENT FOR ADU CONVERSION 32 Valuation: $0.00 a Tenant W FOOTHILL BLVD,UNIT B LOCATED AT 32 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-06210-20 $753.26 Solid Waste Management Fee $6.25 Amount Due: $0.00 Total: $753.26 - ti 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 fora period of 180 consecutive days. CO11PLETED February 21, 2020 Issued By: Date December 03,2020 Page 1 of 1 U~4�F0,1F0/04 nv4cIA PERMIT/PLAN REVIEW APPLICATION otow 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 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. 1 ❑ 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 0 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 ❑ 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. 0 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature _ _ Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. . 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. N e I (.// .,1i A itle C/-C) PRINT NAME I c rtify that I have read this application and state that the above information is co ect and that I am the owner or duly authorized agent of the owner. I ree to comply with all City ordinances and State Laws relating to buildin construction. I hereby authorize representatives of the City of A dia to enter upon the above-mentioned property for inspection purposes. f S ue _ - ate / � �Z � yiti: fi iPERMIT/PLAN REVIEW APPLICATION 7 Development Services Department, 240 West Huntington Drive, Post Office Box 60021 t 1 Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173 ONLINE PERMIT/PLAN REVIEW APPLICATION MY of ARC I . Job Site Address: 32 W Foothill Blvd. Arcadia, CA 91006 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. 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. 'Stgnattre of Contractor OWNER-BUILDER DECLARATION 0 I have and will maintain workers'compensation insurance,as required by Section ❑l 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 ❑x I certify that in the performance of the work for which this pemtit 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 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 Date 05/12/2020 - •Richard Yukawa-- sale(Section 7044, Business and Professions Code:The Contractors License {Signature «� Law does not apply to an owner of property who builds or improves thereon, or who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. pi, 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). DI am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Stgoature ...__ 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 Richard YukawaTitle Owner 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. Digitally signed by Richard Yukawa Richard.,Yukawa DN n=R1 h dY k u Own r "- email=riy OS@y h m US -- - 05/12/2020 - (Signatuie,' -`'� a t 1. , ;nnne, Date