HomeMy WebLinkAboutRALT-19-0046 ..•,+ City of Arcadia, CA ,.
Permit NO. RALT-19-0046
Development Services Department ' Permit Type:Residential Addition/Alteration
240 West Huntington Drive,Post Office Box 60021
M Arcadia,CA 91066-6021 Work Classification:Res-Remodel
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:06/26/2020 1 Expiration: 06/28/2021
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
r481 Workman AVE B Arcadia, CA 8586001008 k
i
Contacts
JEY&KATHY CHUNG Owner
481 WORKMAN AVE,ARCADIA,CA 91007
(626)487-4156
Description:CONVERT EXISTING POOL HOUSE INTO NEW Valuation: $ 34,631.68 Tenant
DETACHED ADU UNIT. WITH EMP
Total Sq Feet: 608.00 Plan Check#19-46 Plan#278
1
Fees Amount Payments Amount Paid
Add/Alter Ducts $9.38 Total Fees $1,969.86
Building Issuing Fee $47.01 Cash/Receipt#REC-00057-19 $912.96
Building Permit Fees 5615.25 Cash/Receipt#REC-04825-20 $1,056.90
Building Plan Review Fee $449.64
Cal Green Plan Check 544.97 Amount Due: $0.00
Clothes Washer $12.46 '
Dishwasher $12.46
Electrical Permit Issuance Fee $47.01
Energy Plan Review Fee $138.35
Garbage Disposal Fee $12.46
Gas System(Outlets) $15.55 CALLS FOR INSPECTIONS
Green Building Standard $2.00 Request for inspection by telephone at 626-574-5450. Leave a message
Kitchen Sink $12.46 requesting the address,timeframe and what inspection item is needed.
Lavatories $12.46
Light Fixtures $24.64
Mechanical Permit Issuance Fee $47.01 This permit/plan review expires by time limitation and becomes null and
Outlets-Receptacles&Switches $38.80 void if the work authorized by the permit is not commenced within 180 days
Plumbing Permit Issuance Fee $47.01 from the date of issuance or if the permit is not obtained within 180 days
Residential Services up to 400 amps $15.55 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
Sewer Connection on Property $31.16
consecutive days or if no progressive work has been verified by a City of
Shower $12.46 Arcadia building inspector for a period of 180 consecutive days.
Total: $1,969.86
OcOU J�[ Ei
/id;- ../0.•••
June 26, 2020
Issued By: Date
June 26,2020 Page 1 of 1
s •
ja1F°"N',e
•
PERMIT/PLAN REVIEW APPLICATION
too, Development Services Department,240 West Huntington Drive,Post Office Box 60021
of"° 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
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
1:1I 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
❑I, as owner of the property, or my employees with wages as their sole forthwith c ply ith those provisions.
compensation,will do the work,and the structure is not intended or offered for 6 b 6 'Lk) �
sale(Section 7044,Business and Professions Code:The Contractors License b•to 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
672.- 6720 fr°
)/ate Signature , Lender's Address
IORTANT: 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 'r J C �✓ C��C/ c/ Title a t ) Yt-e
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 V
LU
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp. 4l8 3 �Ri41,yArf
100. Setbacks 210. Under Br/bldg.drain
101. Rough grade 211. Copper underslab
102. Figs.&forms 212. Rough plumbing
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 tb-�i$'�4"�/
108. Diaph nailing 218. Water service !/
109. Roof nailing219. Final gas I-2/-1/
110. Framing 11-21.--2"a 220. Fixtures
111. 0cc.iArea Sept.Wall 221. Final plumbing 7-2-if Wr
112. Sound walls 222. Sewer cap/demo. ////
113. T-bar.rid
114. Insulation-Flr. Paul Inspections Date Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Ceil. Iycj 241. Rough plumbing -
117. Drywall nailing f 242. Light shell/bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade 45. Gas line&test
121. Final building -2-V( 246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final.lumbin.
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Under.round conduit
153. Underslab conduit Reroof Inspections Date Insp.
154. UFER ground 270. Pre-reroot insp.
155. Water ground 71. Roof framing
156. Rough electrical ( 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E.et.bondin. Sign Inspections Date Insp.
160. Service panel /r 80. Setbackoverhang
161. Final electric 2-Z-- -/ 6�c"", 281. Footing
282. Conduit/wirin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting,flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC -/Z-Z4, • i 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. Date I Insp.
191. Final mechanical 'Z Z"ZI ,/' 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Gess.,.1 filled
200. Footings 303. Sidewalk
201. Steelrebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
ELITE SPECIAL INSPECTIONS INC.
8616 Cleta St. Downey, CA, 90241
Bus. Cell / Message /Text (562) 413-8159
EliteSl1@mail.com
SPECIAL INSPECTORS TIME SHEET& REPORT
Date: 7/7/20 Job#: 070720
•
Building Permit# 11-20-0062 Permit Date 2/26/20 Jurisdiction Arcadia B&S •
Job Identification Skechers #1127 Address 400 S. Baldwin Ave. #T6 Arcadia, CA 91007
Contractor:General James M. Barb Construction Sub-
LDP:Architect Arcvisoin . Engineer Eclipse
Reinforced Concrete o ACI Grade 1-Tech 0 Prestressed Concrete 0 Masonry 0
Epoxyp Other El Tension Force Torque Testing
NOTE: Contractor assumes responsibilty for any and all work that is performed outside of stamped/approved plans
bearing the seal of the applicable enforcing agency of record. Contractor is informed thbt any and all work performed
prior to Building Department approval is performed at contractors own risk pending proper approval by the Building
Official.
Provided Visual Inspection for: . Plans Date: 1/12/20
Tension farce torque testing and installation of:
3/8"x 3" Hilti KB-TZ wedge/expansion anchors placed into clean 3/8"diameter 3-1/4"deep pre-drilled
holes for an effective embedment depth of 2-3/4"each minimum after all torques losses were achieved
w/ (1) per'T' leg and 'L' base plates per code and stamped/approved/perforated plans 4/1 w/note #3.
All holes pneumatically blown and free of standing dust and debris during anchor placement.
All anchor nuts top of plate received tightening torque to desired/required force per manufacturers
approved/printed installation instructions (ICC ESR-1917) of (25) foot pounds. -
Tightening torque verification performed with calibrated wrench S/N.#081523213,12/6/18 Cert. #1536-TR.
All material embed depths maintained during placement.
Workmanship good to excellent. No discrepancies to note.
Hours Billed # 4 Certificate of Compliance
Paid Check# I hereby certify that I have observed to the best of my knowledge all of the above reported work
INVOICE# 070720 unless otherwise noted. I have found this work to lie in compliance with the Approved Plans,
BALANCE: Specifications,and applicable sections of the Governing Building Codes.
All inspection is based on a 4 hour minimum,over 4 hours is an 8 hours minimum.After 8 is time and a half,respectively.In addition,any inspection
extending past noon hour will be an 8 hour minimum.All lab work necessary to complete inspections will be paid by owner,engineer or contractor.
Certified Special Inspector(Please Print): Randall A. Martinez ICC#: 8064363
Certified Special Inspector(Please Sign): City# 01772 LACDPW
•
Owners Representative: Company: •
City of Arcadia, CA Permit No. Misc-20-1890
Development Services Department Permit Type:Misc
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Misc-Special Inspection
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date: 11/16/2020 Expiration: 11/16/2021
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
481 WORKMAN AVE Arcadia,CA 91007-8454 8586001008
Contacts
JEY&KATHY CHUNG Owner
481 WORKMAN AVE,ARCADIA,CA 91007
(626)487-4156
Description:RE INSPECTION FEE Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $114.21
Extra Inspection-Not ready/Hrs not $60.95 Cash/Receipt#REC-06041-20 $114.21
covered
Solid Waste Management Fee $6.25 Amount Due: $0.00
Total: $114.21 l
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.
°PUllel rue
November 16, 2020
Issued By: Date
November 16,2020 Page 1 of 1
t A.
0,1,IFORyiI I
41 PERMIT/PLAN REVIEW APPLICATION
°,><j°, Development Services Department,240 West Huntington Drive,Post Office Box 60021
° °t N° 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
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
IDI hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date 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 —3--- Y >Z 44 �i Li 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.
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•. City of Arcadia,CA Permit NO. M iSC-19-0047
Development Services Department Permit Type:Mist
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Misc-Address Change
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:01/09/2019 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
483 Workman AVE Arcadia,CA 8586001008
Contacts
JEY&KATHY CHUNG Owner
481 WORKMAN AVE,ARCADIA,CA 91007
(626)487-4156
Description:ASSIGN NEW ADDRESS FOR ADU 483 WORKMAN Valuation: $0.00 Tenant
AVE(LOCATED AT 481 WORKMAN)
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Address Change $500.00 Total Fees $553.26
Building Issuing Fee $47.01 Cash/Receipt#REC-00056-19 $553.26
Solid Waste Management Fee $6.25 Amount Due: $0,00
Total: $553.26
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.
January 09,2019
Issued By: Date
January 09,2019 Page 1 of 1
PERMIT/PLAN REVIEW APPLICATION
DCN elopment Services Department,240 West Huntington Drive,Post Office Box 60021
0•.„y or N° 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
❑ 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
0 I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
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).
0 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 3-E 4/9, C(-4 Title LJ )1 -e
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I ant 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.
VY(1'
Signature �" � Date
CITY OF ARCADIA
DEVELOPEMNT SERVICES DEPARTMENT
240 WEST HUNTINGTON DR,
ARCADIA, CA 91007
(626)574-5416
APPLICATION FOR AN ADDRESS CHANGE
($550.60 FEE REQUIRED AT TIME OF APPLICATION)
u V67
1 ( 1 /i CC-( U,V
Applicant Property Owner
( 0R 1<((//d/✓
Address Property Address
/ C1 'V l l , C/4) l lv c)
Mailing Address Mailing Address
X26— — u
Phone Numb.. Phone`Number 4
REQUESTED )PERTY ADDRESS: 4-a 3 .Io VOL A;/ 4 i7 -
1 st Choice
/Rcc/dv2 / Y °
,4e r, DCC 1Cec/ M' /
C
Owner's Signatu Date
FOR OFFICE USE ONLY
DOCUMENTATION: Current Property Tax Bill: Recorded Grant Deed:
FEE: $550.60 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.
of ARe
C.1 11111111.77 7
,. "`�5.1903 -1110 January 14, 2019
414.iy% Subject: Create new address at: 481 Workman Ave
C1 of Please be advised that the City of Arcadia has approved to create a second
i address for a newly created Accessory Dwelling Unit for the subject property.
Parcel Number: 8586-001-008. Please update your records as follows:
Arcadia
MAIN DWELLING ADDRESS ASSIGNMENT:
Development
Services 481 Workman Ave
Department Arcadia CA, 91007
Jason Kruckeberg NEW ACCESSORY DWELLING UNIT ASSIGNMENT:
Assistant City Manager/
Development Services 483 Workman 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 481
Workman Ave and the Accessory Dwelling Unit address is going to be 483
Workman Ave.
Should you have any question, please contact the City's Development Services
Department/Building and Safety office at(626) 574-5416.
Sincerely,
Kenneth iel.'�' :uildi g 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