HomeMy WebLinkAboutRALT-21-0153 ,+. City of Arcadia, CA Permit NO. RALT-21-0153
Development Services Department Permit Type:Residential Addition/Alteration
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Res-Remodel
(626)574-5416 Permit Status:In Review
ARCADIA 2-2- D2.1 Issue Date: Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
l1927 BALBOA DR Arcadia,CA 91007-6404 5777019023
Contacts
MA,WEI LIN AND DOONG,CHYI JIA Owner
9073 Hermosa Dr,Temple City,CA 91780
(626)399-4948
moimilmmumumnimmi
Description:RELOCATE DOOR OFF POWDER RM/KITCHEN TO Valuation: $ 500.00 Tenant
ACCOMIDATE NEW SHOWER
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $124.49
Building Permit Fees $40.65 Cash/Receipt#REC-06636-21 $124.49
Building Plan Review Fee $26.43
Cal Green Plan Check $2.65 Amount Due: $0.00
Green Building Standard $1.00 -
Solid Waste Management Fee $6.25
Strong Motion Inst.Program Res $0.50
Total: $124.49
�/� CALLS FOR INSPECTIONS
2 •11• Z 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.
Issued By:Steven Roberts Date
February 02,2021 Page 1 of 1
,
1061,,•
PERMIT/PLAN REVIEW APPLICATION
• ®A, Development Services Department,240 West Huntington Drive, Post Office Box 60021
b°p�r°t"° 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
❑ 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 t 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 ction 700 of the Labor Code,I shall
forthwith comply with those visions.
❑I, as owner of the property, or my employees with wages as their sole / p yo
compensation,will do the work,and the structure is not intended or offered for 21 2/2 ( f
sale(Section 7044,Business and Professions Code:The Contractors License �� I/ Signature J1
Law does not apply to an owner of property who builds or improves thereon, ts
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 an Professions Code,for this reason:
Lender's Name
Date '3/2/Z/ 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 r`,Q1 L n 7/10
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.
224 /2_,
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City of Arcadia, CA Permit NO. MEP-21-0138
Development Services Department Permit Type:MEP
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:MEP-Residential
li (626)574-5416 Permit Status:Issued
ARCADIA Issue Date:02/01/2021 Expiration: 02/01/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
927 BALBOA DR Arcadia,CA 91007-6404 5777019023
Contacts
MA,WEI LIN AND DOONG,CHYI JIA Owner
9073 Hermosa Dr,Temple City,CA 91780
(626)399-4948
Nomummois
Description:ADD SHOWER TO EXISTING MUD ROOM Valuation: $ 0.00 Tenant
ADJACENT TO HALF BATH OFF KITCHEN
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Electrical Permit Issuance Fee $47.01 Total Fees $168.81
Mechanical Permit Issuance Fee $47.01 Cash/Receipt#REC-06618-21 $168.81
Outlets-Receptacles&Switches $1.63
Plumbing Permit Issuance Fee $47.01 Amount Due: $0.00
Shower $13.21
Solid Waste Management Fee 2 $1.00
Solid Waste Management Fee 2 $1.00
Solid Waste Management Fee 2 $1.00 rA compiETEDVentilation Fan(Single Duct) $9.94
Total: $168.81 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.
2 .1 1 2
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.
February 01, 2021
Issued By:Steven Roberts Date
February 01,2021 Page 1 of 1
..sniz„.
A • ;‘,Pir, .,..k PERMIT/PLAN REVIEW APPLICATION
Egli' Development Services Department,240 West Huntington Drive, Post Office Box 60021
\yao- 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
❑ 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 hich 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 t. become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that' I should become subject to the
workers'compensation provisions o' ection 00 of thg ajo e,I shall
❑I, as owner of the property, or my employees with wages as their sole f. with compl with those provisions. ��
compensation,will do the work,and the structure is not intended or offered for 1 2// 2 p 1/ �i —
sale(Section 7044,Business and Professions Code:The Contractors License •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 Professions Code,for this reason:
Lender's Name
Date ;/i/21)it Signature)rki -> 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 /NP i 2_10/ilk- Title
PRINT NAME
I certify that I h've 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 comp with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia enter n the above-mentioned property for inspection purposes.
\ ' ---------- I
Signature Date P/f / C 2
•
•.z • , ;•nr..•-r....11.?.,•.'#-:,,i.Or r.ti..,:�.••iv �C� - ,.
0.1
;4'od, City of Arcadia,CA .% :..,,•o', ... 2:i a;y ,.t
1 Development SerNces Department i4,..„ v"-at 4.4..:N.t,,.�L• `t' U7� •.e.% nliehrhC
tf' 260 Weft Hundrtgtan Drive,Post Olfk Box 61)021 S A� [f
, '� MEPglsl�eMfal'
" \ %" Arradia,U930646021 �,'�. �
r (626)574-5416 ,.,;�,*''"1/C: �fr••v.'• vI. :Wt.':,?../.:7.-..1.f' Pgrmnsrorus Issued
ARCA D.1A ;.;•'t•,..aiueoateOatutt3018i }Expiration:01/28/2019
Addr NO. Dir Prefix Street Name Street Stdfbi Unit City,State,Zip Parcel Number
927 Balboa DR Arcadia,CA 5777019023 JJ
Contacts
WEI LIN MA Owner
(626)399-4948
awsmmiweeiseweisiiimescraunneowim
Description:NEW KO,POND IN RFAR YARD Valuation: S 0,00 Tenant
Total Sq Feet: 0.00 Plan Check a Plan a
Fees Amount payments Amount Pied
Eiectri al Permit Issuance tee $44.35 Total Fees $46.89
Outlets-Receptacles S Swnums $1.54 Cash/Receipt it REC-001895.2018 $46.89
Sad Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $46.89 ,
8-23 E.i COIIPLEIEB
f,,,f,..e/b.„-„, ,,. ,i,,,,
,1-11--a) CALLS FOR INSPECTIONS
Request fur inspection by telephone at 626.574-5450.Leave a message
6AA L DKclh�/n�l requesting the address,dmeframe and what Inspection item Is needed.
( This permit/plan review expires by lime limitation and becomes null and
void It the work authorized by the permit is not commenced within 180 days
horn 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
corsecutive days or If no progressive work has been verified by a City of
Arcadia building Inspector for a period of 180 consecutive days.
1
. August 01,2018
Issue w: Date
August 01,ton -- _— Page 1 of 1
.�.T;tyar ,
i ! It PERMIT/PLAN REVIEW APPLICATION
•1 .111_474 1sa
' i . Development Services Department,240 West Huntington Drive,Post Office Box 60021
z.......,41....--. Arcadia,CA 910666021,(626)574-5416,Fax(626)447-9173
City of
Arcadia •
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
D I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby atfum 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 is full force and effect. O I have and will maintain a certificate of consent to self insure for workers'
License Class License No Pap. fate compensation,as provided for by Section 3700 of the Labor Code,far the
Sittnuum
Contractor of the work for which this permit is issued.
AOWNER-BUILDER DECLARATION ❑I ham and win minutia wohtn'compensation nnrsoce,as tequhed by Section
)V�{hereby affirm under penalty of perjury that I am exempt from the Contractors ss 3700 of the Labor Code,for the performance of the work for which this permit
cense law for the following reason(Section 7731.5,Business and Professions isaue0.My workers'compensation iauranoe safer and polity nimbus aro:
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 Numbs _
for such pemsit to file a signed matemcm that he or abe a licensed pwn,frtt to the
provisiosn of the Contncm,lironv Law(Osapt e 9(commencing with Sccticu (T»screen meed not be completed lithe penult is for ono bathed sbacs or lam)
7000)of Division 3 of the Business and Professions Code)or that he or she it �y5 I thatin the
exempt theft from oral the bas's far the alleged exemptroe,Any vioI,ion of tr}tit,, yatp ar eof the work for which thin permit is issued,I shell
Section 7031.3 by any applicant for a permit subjects applies.,the applictoe civil not employ any person in any manner in n to became subject to the workers
penalty of not more than fire hundred dollars(5.5000: compeaution Laws of California,and age that if I should become subject to the
workers'compensation provisions of Se n 3700 of the Labor Code,I shall
Li I.as owner of the or mymforthwith ly with those"vi' V
property, employees with wage u their sole
compensation,will do the work,and the strucone is not intended or offered for 0.
sale(Section 71144,Business sad Professions Code:The Convectors License Date_.Q 1/1;
/� SiAsame
Law does not apply to an owner of propety who builds or improves thereon.
or who docs such work himself or herself or through his or her own
employees,provided that soda impruverta:ns are nor intended or offered for WARNING:Failure to same Workers'Compensation coverage is unlawful,
sale.if,however,the building or improseaenl is sold within one(I)year of and shall vmhjat en employer to criminal peoahies sad doll fines say to me
completion,the owner•buildcr will have the burden of proving that he or abe hundred thoasaod dollars 0I00001 In addition to the cost of campensapm,
dui not build or improve for the purposes of sale). damages as provided for in Section 3706 of the Labor Code,haunt.and
VI,as owner of the arsmey's fns. --
property,am ezclraiveby cootraaing with licemued
contractors to construct the project(Sana 7044,Business and Professions
Colics The Contractors License Law does cot apply to an owner of property CONSTRUCTION LENDING AGENCY
tubo Wilds or imprmas tbmeon,and who commas for such projects with a I hereby sTrm under penalty of perjury that there 1s a eonswction Detling agency
contractor(s)licensed pursuant to the Coet ansors License Law). for the peofotmanee of the work for which this permit is issued(Section 3097,
Civet Code).
I am t Business .. Ptofeasiou Ckade,for tide nxwn:
L! \. Lender's Mune
[Jane 8//" S � • Lender's AddressThi
RTANTI APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDIITONS AND
CTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
I. 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,snipping,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 -------- MiloI 1• read this appl cadoa and state that the above information fa correct and that I am the owner or duly authorized agent of the owner.
I coma s,with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
A din t, tc t• the above•meattoned property for Inspection purp�et
��
` � �8
ma -— _ Date
r' FILE NO. o�
DATE FILED /
APPLICATION FOR HOMEOWNER ASSOCIATION V�� 10
ARCHITECTURAL DESIGN REVIEW
9 (SHORT REVIEW PROCEDURE)
PROJECT ADDRESS: h10c1 Por. CG.14C (� �1+!d
PROPERTY OWNER'S NAME: 141P, h VIA
r A
ADDRESS(IF DIFFERENT):r �}(� \rQ(1� I` I l
TELEPHONE NO.: (62-1) 3 1 / T l i" E-MAIL ADDRESS: A (tr — A'i ShC; ,d4'+1-t-
-
APPLICANT NAME(IF DIFFERENT):
ADDRESS:
TELEPHONE NO.: E-MAIL ADDRESS:
DESCRIPTION OF PROJECT(Check applicable):
❑ Single-story remodel(includes window replacement)and/or addltton(s)
❑ Detached accessory structure(s)and/or Accessory Dwelling Units-new,additions to,and/or remodels
❑ Fences and/or walls in and/or facing(i.e.,visible from)front and street side yards
6 Hardscape,landscaping and structural elements in front and street side yards,Including without/imitation,
swimMing pools,spas,fountains and other water features
❑ Fences,lights,and other features related to tennis courts,sports courts or other significant paved features
❑ Mechanical equipment SANTA ANI TA V
Cer,iMtUNi Il•HOMEOWNER::
R
❑ Roofing I
A FROYED BY J'ga
RAT j T -LC -ILE i r aa3
ACTION&FINDINGS:
❑ Approved-Tho project is consistent with all applicable guidelines
XConditionally Approved-With the following • ,Worts,the •roj• will be cone!. ,with all
applicable guidelines 1r ' £ 'as • _I - w •e
rfja rcfA4fh o f pp. , eler rir i
O ����DpDDpenied-The project Is not consistent with the following guidelines)
By /SIA • . ARB Chairperson Date: ti
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•
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ROUTING ItVG Oats and
ACTION •�'"�a �� '&:
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onsneen
Planning I
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" I Qv' COMMUNITY HOMEOWNERS'ASS AIQN
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�', ."" APPROVED BY (J
NI-f\_. - pi1f� DATE 9-I�PILH �Z
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Arcd . CA /(107
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1;4, City of Arcadia,CA •
F A,_"s t;. N17.Pat'iO 484625,:
i1 Development Services Department + Pltrttr� 240 Wert Runtlngton Drive,Post Dfflce Boa 60021 ez(I Arcadia,CA 91066-6021 �' ..ti�
} (626)5)1-5436 -: {!tly'.• -Y , ntfitStuhp UUd:
A jCADIA tube Dati 09/oe/zoi8 Expiration:03/05/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
927 Balboa DR Arcadia,CA 5777019023
Contacts
WILLIAM MA Owner
927 BALBOA DR,ARCADIA CA,91007
(626)399.4948
ermiremansil
Description:OPEN DETACHED PATIO OVER KOl POND PER Valuation: $6.390,72 Tenant
APPROVED PLANS.HOA APPROVAL
Total Sq Feet: 288.00 Pian Check a Plan
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $361.24
Building Permit Fees $167,15 Cash/Receipt A REC-002234-2018 $361.24
Building Plan Review Fee $121.61
Green Building Standard $1 Amount Due: $0,00
.00
Solid Waste Management Fee $6.25
Strong Motion Inst Program Res $0.84
Total: $361.24
7-1(14g CALLS FOR INSPECTIONS
Request for mspection by telephone at 626374-5450.Leave a message
f�1�Sl.� tequesting the address,timeframe and what inspection item b needed.
V•
This permit/plan review expires by time imitation and becomes nut and
void H the work authorized by the permit Is not commenced within 180 days
from the date of Issuance or If the permit Is not ootained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void d any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building Inspector for a period of 180 consecutive days.
42
September 06,2018
Issued By: Date
September 06,2018 Page 1 of 1
Irl 1i PERMIT/PLAN REVIEW APPLICATION
, E t,, Development Services Department,240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021,(626)574.5416,Fax(626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPF?$ATION DECLARATION
❑I hereby a mi under penalty of perjury that I am licensed ander provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(couunencing with Section 7000.of Division 3 of the Botlness and
Professions Code.and my license is in full force and effect. .a]I have and will maintain a certificate of consent to self-insure for workers'
License Claw_-- I ireese No. Exp. Date commas lion.as provided foe by Section 3700 of the Labor Code,for the
Signature of Contractorperformance of the work for which this permit is issued.
0
R-BUILDER DECLARATION ❑I have and will maintain workers'compensation insurance,as Section
I I underesetnp! 3100 of tic Labor Code,for the performance of the wort for which this permit
License Law affirmr the �lty perjury that I am from the Contractors y workers'a aon insurance caller and
is issued.M
following (Section 7031.5,Business and Professions mhProsW� whey numbers ase:
Code.Any city or county which requires a permit to construct,alter,improve, Cartier
demolish,or repair any structure.prim to its issuuae,also required the applicant -_
for sods permit to file a signed swarms that he or she is lirented pursuant to the Policy Number
proswors of the Conuattus Lactase Law(Chapter 9(romsnenclag with smeda (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 be or she is
exempt them frau and the basis for the aieged exemption.Any vjolanon of t certify the in the performance of the work for which this permit is issued,I shall
Section 70315 by any applicant for a permit subjects the applicant to a civil am employ any person in any manner so as to became subject to the workers'
penalty of not more than hie hundred dollars(S500)), compensation Laws of California.and agree if I should became subject to the
workers'compensation provisions of t 3700 oflprE�bpr Code,I shall
d1,as owner of the property.or my employees with wages as Ones'sole for ' ply with those provisions. 6
compensation,will do the work,and the ssnaaure is not Intended or offered for Onesale(Section 7044.Business and Professions Code:The Contactors license Dace Signature
Law does not apply to an owner of property who builds Of thereon
,or
th , - -—
or whho does such work himself or,herself or through his or her own
employees.provided that such improvements are net intended or offered for i WARNINn Pajtre to wane Walsers'Conversation onstage is unlawful,
sale.If.however,the building or onprovcmcot is sold within ode(I)year of and shall subject an dyer to criminal penalties and civil Snot op to one
completion,the owner-builder will have the laden of proving the be or the hundred thousand dollars(S100.030),in eddadm to the cost of compensatiat
did not build or improve for the purpose of sale). damages as provided foe in Section 3706 of the Labor Code,Islam and
0 I.as owner of the property,am exclusively contracting with licensed rwnysfoes
ooaaactoes to construct the project(Section 7044,Business and Professions
Code The Contractors License Law does oat apply to at owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon.and who contract for such projects with a I hereby affirm under penalty of perjury that there it a conamsetlon lending agency
entuetar(s)licensed pennant to the Contractor)License Law). for the performance of the work for which this
permit is issued(Section 3097,
•
Civil Code).
P I am ei tempt ... . 7044,Business and Professions Code,for this mason
I Lender's Nano
q/77(g �`
Sigraaoe W' � Lender's Address —-
L a't- .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:
I. 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 m 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_►Y t�(s 04.)ia ache V I'Mr
PAINT NAME --
I certify that I 'e read this application and state that the above information in correct and that I am the owner or duly authorised agent of the owner.
I agree I. eon.1, with all City ordinances and State l,wa relating to building construction. I hereby authorize representatives of the City of
Arcadia t\erne 1 -r.the above-menrtoncd property for inspection purposes.
1 Signature_... l <-------- 47/(— re
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9 7 ��/ COMMUNITYHOMEOWN 'S'ASS.d
Qo� �� APPROVED BY % �u• •
DATE . : - LE .V
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FILE No. /a 2-
DATE FILED p�
APPLICATION FOR HOMEOWNER ASSOCIATION 17—3I /o
ARCHITECTURAL DESIGN REVIEW
Q ()(SHORT REVIEW PROCEDURE) C�
PROJECT ADDRESS: 1� e��L/L4��,,lwA. perp ,4�CLott X CG,, ? �d
PROPERTY OWNER'S NAME: LtL' GIN A Yv\C\
ADDRESS(IF DIFFERENT): Q r
TELEPHONE NO.: (l/ ti
24) 3 1 ] T 1 E-MAIL ADDRESS: a Ili — Cl/She; d b4n•
APPLICANT NAME(IF DIFFERENT):
ADDRESS:
TELEPHONE NO.: E-MAIL ADDRESS:
DESCRIPTION OF PROJECT(Check applicable):
❑ Single-story remodel(includes window replacement)endfor addition(s)
❑ Detached accessory stru lures)and/or Accessory Dwelling Units—new,additions to,and/or remodels
❑ Fences and/or walls in and/or facing(Le.,visible from)front and street side yards
6 Hardscape,landscaping and structural elements in front and street side yards,Including without limitaton,
swimming pods,spas,fountains and other water features
❑ Fences,lights,and other features related to tennis courts,sponte courts or other significant paved features
❑ Mechanical equipment SANTA ANITA V'
COMMUNITY HOPfECWNERLL
❑ Roofing
APPROVED t3Ygt/j1)LwA/ i
ACTION&FINDINGS:
❑ Approved—The project is consistent with all applicable guidelines
X Conditionally Approved With the following • ,itions,the • • • will be cone • with el
applicable guidelines ■1 ' / ':.a_ • _I - „ •e
rey4P /i ce
ci p-�fh of p{i. eler rcv
O Denied—The project Is not consistent with the following guidellne(s)
ByAl,1212,¢ /--Iyyrya.lry-rL ARB Chairperson Date:..'(1—.3/-7 1 p
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��f C0MMUNITY HOMEOWNERS'k390�1kfIQ�Nyy Qp j�
(. Nc" -' , APPROVED BY,IA.4-"tJ`� i= -
-NI T` �r,Wivr "— DATE R 9-(Sit.aa (2.2g
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