HomeMy WebLinkAboutRALT-18-1226 City of Arcadia, CA Permit NO. RALT-18-1226
Development Services Department Permit Type:Residential Addition/Alteration
240 West Huntington Drive,Post Office Box 60021 Work Classification:Res-Addition/Alteration
Arcadia,CA 91066-6021
(626)574-5416 Permit Status:Issued
:.A RCA I)I A Issue Date:11/05/2018 Expiration: 05/04/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
L610 Rosemarie DR Arcadia,CA 5787011027
Contacts
CYNTHIA HSIEH Owner LUIS CORTEZ Applicant
610 ROSEMARIE DR
(213)458-0682 (626)975-0137
Description:ENCLOSE COVERED PATIO TO HABITABLE SPACE . Valuation: S 124,846.48 Tenant
REMODEL KITCHEN,MASTER BED ROOM,BEDROOM,LAUNDRY
RM AND TWO BEDROOMS.OPEN UP EXISTING FIREPLACE. Total Sq Feet: 232.00 Plan Check#18-1226 Plan#32627
CREATE HALF BATH.6 NEW WINDOWS. -, l
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $3,687.35
Building Permit Fees $1,396.50 Cash/Receipt#REC-002800-2018 $2,129.54
Building Plan Review Fee $907.73 Cash/Receipt#REC-001701-2018 $1,557.81
Cal Green Plan Check $90.78 $0.00
Energy Plan Review Fee 5279.30
Amount Due:
Green Building Standard $5.00 `
Parks&Recreation Fee(SFR) $661.20
Single Family Fire Plan Check $280.00
Solid Waste Management Fee $6.25
Strong Motion Inst.Program Res $16.24
CALLS FOR INSPECTIONS
Total: $3,687.35 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
//-.�}} O r I p r Lj from the date of issuance or if the permit is not obtained within 180 days
i75
✓ wl�J���L, �iJ 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
Zb 2� irt7V Arcadia building inspector for a period of 180 consecutive days.
November 05, 2018
Issued By: Date
November 05,2018 Page 1 of 1
ii
.F •
4 ! PERMIT/PLAN REVIEW APPLICATION
.0' -.
e .0*. Development Services Department,240 West Huntington Drive, Post Office Box 60021
3/41.1t,ell 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 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.
WNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
0I 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 anystructure,prior to its issuance,also required the applicant
for such permit to filesigned statement that he or she is licensed pursuant to the Policy Number
i
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
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
d 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
Date 1
sale(Section 7044,Business and Professions Code:The Contractors License Signature /ikigs►/'
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 ofperjury 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 11 1 (A Signatu`// i�� Lender's Address
IMPORTANT: APPLICATION IS HE 1 BY 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 Cl `1 ) r 0 sPRICTI'
' 'Title 0 W Jv 0�
1 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.
i
�
//�// I1iL- 8-
jgnature i / Date
(o 1<css4‘1\40642/46-
Building
c46-Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under Hr./bldg.drain
101. Rough gradeX11. Copper lab
102. Figs.&forms -/2� 212. Rough plumbing 5--2Z
103. Pre-slab 213. Rough gas f7--y2-i?
104. Floor joists 214. Shower pan
105. Steel 215. Water heater 6-)sr-rt
106. ot lift �17. Roof drainsgs
107. Shear nailing -ZO-/c/� 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailing "219. Final gas
6-26-11 110. Framing 220. Fixtures
111. Occ.'Area Sept.Wall 221. Final plumbing
112. Sound walls 222. Sewer cap,demo. GG
113. T-bar grid
114. Insulation-Flr. Pool Inspections Date Insp.
115. Insulation-Wall kt'1' in 240. Excavationrsteel
116. Insulation-Ceil. 4i Ly` 241. Rough plumbing
117. Drywall nailing 7-311 (MJ 242. Light shell;bonding
118. Interior lath r "11 243. Underground conduit
119. Exterior lath 'Z7./y P-trap
120. Finish grade245. Gas line&test
121. Final building i- --( 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. Underground conduit
153. Underslab conduit Reroof Inspections Date Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 71. Roof framing
156. Rough electrical -Z-'q 1,(<-• -• 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E..t.bondin. Sign Inspections I Date Insp.
160. Service panel 280. Setback/overhang
161. Final electric 281. Footing
282. Conduit'wirin.
Mechanical Ins.ections Date Ins.. 283. Disconnect
180. Venting'flue 284. Final sign
181. Furnace-A.C.
182. Rouch HVAC 20-'/? Am 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 /-2d-2f 6/► / 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 Insp.
191. Final mechanical /-20- .'11115r300. Lateral(main to P/L)
301. SaddlelY
Block Wall Inspections Date Insp. 302. Cess••ol filled
200. Footings 303. Sidewalk
201. Steel rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
.,+,. City of Arcadia, CA
Permit NO. RALT-18-1226
Development Services Department Permit Type:Residential Addition/Alteration
240 West Huntington Drive,Post Office Box 60021
1 Arcadia,CA 91066-6021 Work Classification:Res-Addition/Alteration
(626)5745416 Permit Status:Issued
A R(7A D IA Issue Date: 11/05/2018 Expiration: 11/05/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
610 Rosemarie DR Arcadia,CA 5787011027
Contacts ——
CYNTHIA HSIEH Owner LUIS CORTEZ Applicant
610 ROSEMARIE DR
Ls (213)458-0682 (626)975-0137
— Tenant
Description:ENCLOSE COVERED PATIO TO HABITABLE SPACE . Valuation: $ 124,846.48
REMODEL KITCHEN,MASTER BED ROOM,BEDROOM,LAUNDRY
RM AND TWO BEDROOMS.OPEN UP EXISTING FIREPLACE. is Total Sq Feet: 232.00 Plan Check#18-1226 Plan tt 32627
CREATE HALF BATH.6 NEW WINDOWS.
RENEWAL OF PERMIT 6-22-2020
-sr
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $4,013.66
Building Permit Fees $1,396.50 Cash/Receipt#REC-04754-20 $326.31
Building Plan Review Fee $907.73 Cash/Receipt q REC-002800-2018 $2,129.54
Cal Green Plan Check $90.78 Cash/Receipt N REC-001701-2018 $1,557.81
Energy Plan Review Fee $279.30
•
Amount Due: $0.00
Green Building Standard 55.00
Parks&Recreation Fee(SFR) 5661.20 ~
Renewal Fee $279.30
Single Family Fire Plan Check $280.00
Solid Waste Management Fee 56.25
Strong Motion Inst.Program Res $16.24 CALLS FOR INSPECTIONS
Supplemental Building Issuance $47.01 Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
Total: $4,013.66
-,
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.
() UVU JL5uE
R ,
6 2 -Z(
November 05, 2018
Date
Issued By: Da
June 22,2020 Page 1 of 1
Ieo '
'±!� 1� PERMIT/PLAN REVIEW APPLICATION
e r 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'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.
License Class License No. Exp. Date ❑ I have and will maintain a certificate of consent to self-insure for workers'
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 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
Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed if the
provisions of the Contractors License Law(Chapter 9(commencing with Section P permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑II certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the 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.
Name JIM 14 IA, �a V 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 Cit ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upo 1 , a 1 ove-m ntioned property for inspection purposes.
Signature Date ( 21— �" t z-*)
r
I
i
V
(N) 2X STUD
WALL @ 16" O.C. ��
2 X TOP PL.
(N) PLYWD. SHT'G. W/ 16d 6"
SEE PLAN FLR. PLYWD. •
, /
E.N. SHT'G.
„Z,
(N) 2X F.J. g 16"
O.G. SEE PLAN
2X BLK'G.
2X NAILER W/ 5/8"0
A.B.S @ 24" O.C. it
A35 g 16"
z ,. L..
(N) 6" CONC.
WALL
II1111
(N) 2 #4 1II
1IIII IIII
R.B. @ T$B
y, \L - - i
(N) #4 R.B. @ 24" O.G. I (E) GONG.
VERTICAL W/ SIMPSON I FTG.
i SET-XP IGC ESR# 2508 L - - - _ J
SETA _ ci
SCALE: N.T.S.
PROJECT ADDRESS: oQFEsso,
/"\, P I N6.y
INTERIOR REMODEL t,
No. 3 g * Z�
61 O ROSEMARIE DR. * Fxo.9- p c `
s #/
ARCADIA, CA. 91007 q�"of cap ie�P
i
rn I
' (
( __I
9\ ../ ' 4 t
‘1\71-
0� �4
t lq isivw
Pr
d 0,04 .
0+4 5:1 •
� I g , �
' _ (n
P7 :
.
.
...
4, -
il \ L_ a —
1 3 1 0., v (el -,;.
.. „
. . cp—
14 (N) 2 8 F.J.
16' O.G.
(E) FTG.L4%. o±R •..... (E) FTG
U z
i- ill 40
ZIP �' ..
1 je 41-3" :ri,
‘L --.7._. 7 5,_5., .. .0, ,,_
s• O C.) IE
i W ! I
13
. _
OS\ '
L , _.,i4 �:::::: :•:::::::•::::::::::::::1•
L\
4 0 -(
-0
N_ 4-4 . 4, 1 N N
o
0
= z
n
P p 0
ET— x x N �
615 rn d
n -1 J cn
` / ox I I I Q (j) ex; . " v4
• I I9 - - - , (E)
?II ��
� , L _ _ _ _ 1 �1 X
r —
c
0 \ _ #
L \ _ O
7 IC° 0
. .
\ ,0 .÷
'4
1 _ _ L= 10'-6" \
rl
(N) 4X6 � -- -
,i HDR.
C1 � S�6 r
XI x I 1 4 CSN 7r
U1
C
rn _
(E) 2X G.J. _x0 I :1
7
0
6
rn O
CO 0
—1 ? I
1 e
H n �
z
1
-a Co 1
=1s -II N
JO # T ERfO
\ , ati { t i „
'� 9 J `'� C z
\ \ / (E) 2X R.R. V 49\G. ' �, � .�S,
\• -)) 1 ‘<l'O 0\ c:P.,/'
r
ii
13N3
/ U
/
LIN 111
s_ (019 .\-\• rn �� Z
le
I0NZ
. `.
�
il _ _
1 g_k)_.
_ ,.:.
.5._
()-N
T ,...-
T
City of Arcadia
SPECIAL INSPECTORS REPORT
ADDRESS: 610 Rosemarie Dr.
PROJECT NAME: LI Residence
BUILDING PERMIT NO:
This certifies that I performed special inspection on the following portion of the work at
the above address:
Located at rear east side addition foundation level, proper installation of 2- #4 horiz.T&B footing dowels two
locations and 15-#4 vertical dowels at stem. Installed with Simpson Set XP Epoxy ICC No. 2508.
All locations as per plan. Inspection Passed.
Based on rry pecsoneJ obsefvation and Olen repons of tis mic i nE nTijud itnt
Me fispecitoicwaspa4oar>edb ale best of rryIniedge n aozdancevath
the ag d plans,specirations,and lit appkaf>ie wpm*pisartsofthe
Govent9 Nil 'i
l
y 3/8/2019
°pecial Inspector's Signature Date
Ismael Cordero. 310-930-5515 ICC/LA City 1010614/P014491
Please Print Name Deputy Inspector Number
cc: Client/Owner
Architect/Engineer INTERNATIONAL
ENO CODE COUNCIL
P•.94.••.b•.R P.pl.S.44•SM.....w
.240 ITJdl^l?SO ; 019
I
__�00•►9 _11��__ �-..kr--
--
I i. .
s r Ai
.1-.£I .9-.LI .9-GC :: .
--
w
I Q •
WJII01.1 7,':.:',;..:.::::::1::::';;,, `P
•
O I i'L•IDG Y►tGI U
GU
\\ 1
1 .w '1J OG L6L ., ' 1 N
'20VJS 9NNIl
m ? 'ot aaza�nNm x
I .2201 Ls OLV.1 I•
b 1� f-. 3
1 \c,.. 1 4 1 1,_,
I
1 w
u 1 1 1 04
ypGpW 1d c.,G49
a 1 \ H u I s..\\
N
.9-.4 ..1-.41 .0-.41 .S-.01 .C-.1-1 /�..0-.9
PJ
b I
..o.E 1 u
I 1 N
L__ _ _ __ __J:
City of Arcadia,CA Permit NO. MEP-19-0069
Development Services Department Permit Type:MEP
240 West Huntington Drive,Post Office Box 60021 Work Classification:MEP Commercial
Arcadia,CA 91066-6021
(626)574-5416 Permit Status:Issued
A RCA I)I A Issue Date:01/10/2019 Expiration: 07/09/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
610 Rosemarie DR Arcadia,CA 5787011027
Contacts
CYNTHIA HSIEH Owner JOHN G FAN General Contractor(B)
610 ROSEMARIE DR 5740 OAK AVE,TEMPLE CITY,CA 91780
(213)458-0682 (626)825-8808 702434
Description:MEP FOR RESIDENTIAL ADD/ALT(RALT-18-1226) Valuation: $0.00 Tenant
LINKED
Total Sq Feet: 232.00 Plan Check#18-1226 Plan#32627
Fees Amount Payments Amount Paid
Add/Alter Ducts $28.14 Total Fees $361.60
Bathtubs/or Combo $12.46 Cash/Receipt#REC-00079-19 $361.60
Clothes Washer $12.46
Amount Due: $0.00
Dishwasher $12.46
Electrical Permit Issuance Fee $47.01
Garbage Disposal Fee $12.46
Gas System(Outlets) $15.55
Install,Relocate Appliance Vent/Hood $9.38
Kitchen Sink $12.46
Lavatories $24.92
Light Fixtures $30.80 CALLS FOR INSPECTIONS
Mechanical Permit Issuance Fee $47.01 Request for inspection by telephone at 626-574-5450. Leave a message
Outlets-Receptacles&Switches $24.64 requesting the address,timeframe and what inspection item is needed.
Plumbing Permit Issuance Fee $47.01
Solid Waste Management Fee 2 $1.00
Solid Waste Management Fee 2 $1.00 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
Ventilation Fan(Single Duct) $9.38 from the date of issuance or if the permit is not obtained within 180 days
Water Closet $12.46 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
Total: $361.60 consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
fav Ful9 E-2 o-Z/
January 10, 2019
Issued By: Date
January 10,2019 Page 1 of 1
FA•
PERMIT/PLAN REVIEW APPLICATION
E41,*' Development Services Department,240 West Huntington Drive,Post Office Box 60021
c` , � 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, 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.76-1,43F Exp. Date I f d ( If 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 DE ARATION ❑ 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
is issued.My workers'compensation insurance carrier and policy numbers are:
License Law for the following reason(Section 7031.5,Business and Professions
Code.Any city or county which requires a permit to construct,alter,improve, Cam
-14,y.cA
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 Polic Number
Y f(
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be complet 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 S 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 t t d ! ( Signature
Law does not apply to an owner of property who builds or improves thereon, I //
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 JoA 611 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 u 9n W• above-mentioned property for inspection purposes.
Signature Date l `//
,, .. City of Arcadia, CA
Permit NO.FIRE-19-1124
Development Services Department Permit Type:Fire
j r 240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Fire Sprinkler
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:06/13/2019 I Expiration: 12/10/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
610 Rosemarie DR Arcadia,CA 5787011027
Contacts
CYNTHIA HSIEH Owner F&H Fire Protection* Contractor
610 ROSEMARIE DR 1119 Westminster AVE,Alhambra,CA 91803
(213)458-0682 (626)262-3876 584319
Description:FIRE SPRINKS FOR 8 HEADS Valuation: $ 1,000.00 Tenant
Total Sq Feet: 0.00 Plan Check# Olt, Plan tt
ti
Fees Amount Payments Amount Paid
Fire Issuance $47.01 Total Fees $389.66
Fire Permit Fees $61.65 Cash/Receipt#REC-01537-19 $389.66
Solid Waste Management Fee 2 $1.00
Sprinkler Heads $280.00 Amount Due: $0.00
Total: $389.66
CALLS FOR INSPECTIONS
//--►► ��rn1 Request for inspection by telephone at 626-574-5450. Leave a message
iJClINPLEu 1 u 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.
June 13, 2019
Issued By: Date
June 13,2019 Page 1 of 1
.
l PERMIT/PLAN REVIEW APPLICATION
04�o` o Development Services Department,240 West Huntington Drive,Post Office Box 60021
0m..h,.tN Arcadia,CA 91066-6021,(626)574-5416, Fax (626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
12I 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 m license is in full force and t. I have and will maintain a certificate of consent to self-insure for workers'
License Class
of Contractor/
ontractor License No. �F � = 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.
S
INNER-BUILDER DECLARATION al I have and will maintain workers'compensation insurance,as required by Section
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 700 of the Labor Code,for the performance of the work for which this permit
is issued
License Law for the following reason(Section 7031.5,Business and Professions . workers' ompensation insurance carrier and obey numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, arrier r Slnt' N.e -Ins t. c4 .
vp -Pr.,/
demolish,or repair any structure,prior to its issuance,also required the applicant H ' 2 '1 ,,V
for such permit to file a signed statement that he or she is licensed pursuant to the olicy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section is section need not be completed if the permit is for one tin.red 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 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 r `
sale(Section 7044,Business and Professions Code:The Contractors License Date i Ilj ( 7 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(I)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.
x
ame . ,4i ad A L _ Title 6. `'LJ
PRINT NAME
I
I ertify that I have read this application and state that th• above information is co rect 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 buildin, construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
ignature ( Date
‘X/C7
�s-OOFo ARO,
G t-1
7
4!
AIII
ary.t S,1901 `
•
44uaity°t84'
° MEMORANDUM
Fire Department
DATE: August 31, 2020
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemich
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 610 Rosemarie Drive
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS (PC# OTC) 8-27-2020 Jill Perumean
FIRE ALARMS
KNOX BOX
OCCUPANCY (PC# 18-1226) 8-27-2020 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 8-27-2020 Rita