HomeMy WebLinkAboutSOLR-21-0203 City of Arcadia, CA Permit NO.SOLR-21-0203
Development Services Department Permit Type:Solar
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Solar-Residential
(626)574-5416 Permit Status:Complete
ARCADIA Issue Date:02/09/2021 Expiration: 08/16/2021
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
523 W NORMAN AVE Arcadia,CA 91007-7918 5785002006
Contacts t
CHU,JENNY L Owner GKRW LLC dba ECOFORCE SOLUTIONS Contractor
523 W NORMAN AVE 2913 TECH CENTER DR,SANTA ANA,CA 92205
(949)229-5977 999669
Description:ROOF MOUNT PV SYSTEM, 20 MODULES/1 Valuation: $0.00 Tenant
INVERTER
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Plan Check Fee Residential $100.00 Total Fees $308.24
Electrical Permit Issuance Fee $47.01 Cash/Receipt#REC-06712-21 $308.24
Inverters $77.78
Panels $82.45 Amount Due: $0.00
Solid Waste Management Fee 2 $1.00
Total: $308.24
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
O f LCL,u
_1�n UJr ib u j consecutive days or if no progressive work has been verified by a City of
uJ Arcadia building inspector for a period of 180 consecutive days.
7—/7-2 cy�M
February 09, 2021
Issued By: Henry Kemick Date
February 18,2021 Page 1 of 1
F All
wpm PERMIT/PLAN REVIEW APPLICATIONIEEiM1
Mi•' r*
EIIi' 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. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION ❑ 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 Title
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature Date
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Structural Calculations for a Roof Mounted Solar Photovoltaic System for:
Chu Residence
523 W Norman Ave, .«9QROF.M/pN9l
Arcadia, CA 91007 co
No. C58724
Applicable Codes: Exp.3-31-21
s� CIVIC �'
TF OF C
2019 California Building Code, 2019 California Electric Code,
2019 California Mechanical Code, American Society of Civil Engineers
Standard ASCE 7-16 Minimum Design Loads for Buildings and Other
Structures, American Wood Council 2018 National Design Specification
for Wood Construction, Local Municipal Code, and all other codes which
are adopted by reference or enacted by law.
Assumed Design Parameters:
The existingstructure has been built under a buildi ��
��?: it ani is in its
original condition. The existing roof structure i ab of it\sobacte
required live load and the ability of the rook€trct_ r, , .sufpc #,1tve Ipads
L � 1 �yr �� �. �
has not been substantially reduced by the, es'frtactUte 'Iet i\tes or
mold, or unauthorized modifications to the existing; tfucti* St*st_nergy
Contractor shall make inspection of the exi,stiii ;roof,.f rn:r1 s'y�sten'i' prior
to installation of the roof mounted solar.\erie, y8ys-teetg. rify' hat the
existing roof is capable of supporting m! i �. liv .(o s.
Assumed Design Parameters: �,;,�,
All 2x members are grade Douglas Fir #2 m'ri titter
All 4x members are grade Douglas Fir #1 or'better
All Roof Connectors are Simpsons Strong-Tie or Equal
All Concrete Foundations are fc = 2500 psi or stronger
Original Structure was built to the Type-V Wood Framed Standards
of the Applicable Building Code at the time of Construction.
Sht # 1 of 7
2020-3789 Axis-Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224- 406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Note to Building Official:
Based upon a review of the proposed plans I am confident that the
existing roof framing system is capable of safely supporting the additional
loads caused by the solar photovoltaic energy system. The contractor
shall field verify that the existing roof structure is in its original permitted
condition and verify that it can support the normal code required roof live
loads. Attached in this package are several calculations showing that the
roof members can support the additional weight of the solar array.
Furthermore, an analysis of the solar array's support for wind forces and a
seismic analysis of the existing structure are also included.
Check 2x4 Rafters @ 24" O.C.*:
(Assume max rafter span = 6.9 ft.)
WDL+LL -
w = 30.8 psf x 2 ft. = 61.6 plf Z
R1 R2
6.9'
Total load on rafter = 61.6 plf x 6.9 ft. = 425 lbs
i�oFEss/p,�, --\m
W No. C58724 g
* Exp.3-31-21 *
`5 ,7,.le-
OF AL F°vl ��\P
`Note: Contractor to Field Verify Framing
Sht # 2 of 7
2020-3789 Axis-Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Check 2x4 Rafters (& 24" O.C.:
P P P P
wLL 7 7 7 7 i
W DL /////////////////////////////A
W DL+LL = 30.8 psf x 2 ft. = 61.6 plf L 7
R1 R2
6.9'
6.6' 0.3'
Total load on rafter = 61.6plf x0.3ft. + 21.6plf x6.6ft. + ( 6' x1.65' x3psfx4 )
= 280 lbs < 425 lbs OK
Check attachment of Support to Existing Structure for Wind Uplift
CHECK SOLAR STRUCTURE ATTACHMENTS PER ASCE 7-16 WIND LOADS ON BUILDING
APPURTENANCES AND OTHER STRUCTURES Section 29.4.4 THEREFORE CHECK
ATTACHMENT FOR TYPICAL CRITICAL LOAD WHICH IS THE EDGE ZONE - ZONE 2.
NOTE: PER DEFINITION ON SHEETS 246 & 247 OF ASCE 7-16 EFFECTIVE WIND AREA:
"FOR ROOFTOP SOLAR ARRAYS, THE EFFECTIVE WIND AREA IN FIG. 29.4-7 IS
EQUAL TO THE TRIBUTARY AREA FOR THE STRUCTURAL ELEMENT BEING
CONSIDERED, EXCEPT THAT THE WIDTH OF THE EFFECTIVE WIND AREA NEED NOT
BE LESS THAN ONE-THIRD ITS LENGTH."
.<c9eOF ESS/o/y,4l
EFFECTIVE AREA = 15 SQ FTc') *()
No. C58724
* Exp.3-31-21
LP/;,,, CIV 1\- �Q
OF c AI.\ C)
Sht # 3 of 7
2020-3789 Axis- Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 TeI:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Check attachment of Support to Existing Structure for Wind Uplift - Cont'd
Tributary Area to Each Solar Mount = 6 ft. x 2.75 ft. = 16.5 sq. ft. ( Max )
Calculate Design Wind Pressure at each support (Wind Speed 130 mph Exposure C):
p=q/i(GCp)(yE)(ya) Eq'n 29.4-7 ASCE 7- 16
q/,=0.00256KZKZtKdKeV2 Eq'n 26.10- 1 ASCE 7- 16
Note:
KZ = velocity pressure coefficient, Section 26.10.1 ASCE 7- 16 �ookoFESS/p,�,,
KZ = 0.9 (Exposure C, Height = 20 ft or less)
Kzt = Topographical Factor = 1 .0 No. C58724
Kd = Wind Directionality Factor = 0.85 * Exp.3-31-21
Ke = Ground Elevation Factor = 1.0 `1%;f7,IV
FCA0o-�,��
V = 130 mph ; VAso= 101 mph Table 1609.3.1 2019 CBC
q = 0.00256 (0.9) (1.0) (0.85) (1.0) (101)2
q,1 = 20 psf
GC/, = -2.0 (Zone 2 ; Effective Area = 15 sq. ft. )
yF = Exposure Factor = 1 .5
y, = Solar Array Pressure Equalization Factor = 0.7 Fig. 29.4-8 ASCE 7- 16
p =q,,(GC,,)(7E)(yu)
p =20 psf (-2.0) (1 .5) (0.7) = -42 psf
Nominal (Unfactored) Uplift at each support = 42 psf x 16.5 sq. ft. = 693 lbs
Note: Section 2.4.1 of ASCE 7- 16, Basic Load Combinations for Allowable Stress
Design. Note: Applicable Load Combination #5 (D + 0.6W)
Design (Factored) Uplift at each support = 0.6 x 693 lbs = 416 lbs
Load per lag screw = 416 lbs / 1 = 416 lbs
Sht # 4 of 7
2020-3789 Axis-Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Check attachment of Support to Existing Structure for Wind Uplift - Cont'd
Determine allowable load per 5/16" lag screw w/ 2.5" embedment into wood below
according to the 2018 NDS.
W ' = W x Cd x Ct Table 10.3.1 2018 NDS
where:
W = 266 lbs / in. of embedment per Table 12.2A
Cd = 1.6 per Table 2.3.2 of 2018 NDS
Ct = 1.0 per Table 10.3.4 of 2018 NDS
W ' = 266 lbs/ in. x 2.5 in. x 1.6 x 1.0 = 1,064 lbs > 416 lbs OK
Use Support connected to 2x Min. Roof Member
w/ (1) 5/16" x 3" lag screw per connection minimum.
okoF ESSlO*,
. kNj
cc
g No. C58724
'AC Exp.3-31-21
lie'OF C A1.\0
Sht # 5 of 7
2020-3789 Axis-Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Check Seismic load due to added dead load of photovoltaic system.
Determine Seismic Weight of Existing Building:
Effective Existing Seismic Weight (main house)
Area of (E) Building = Approximately 2,800 sq. ft.
Approximate
Effective = 2,800 sq. ft. x 30 psf ave. = 84,000 LBS
Seismic Weight
DETERMINE BASE SHEAR
V = Cs W EQ'N 12.8-1 ASCE 7-16
Cs = SDS R EQ'N 12.8-2 ASCE 7-16
le
R = THE RESPONSE MODIFICATION FACTOR IN TABLE 12.2-1
R = 6.5 WOOD SHEAR WALLS
le = 1.0 IMPORTANCE FACTOR .�2
okoFESS/04,91
' M9
cooO 'P�
SDS = 2/3 x SMS EQ'N 11.4-3 ASCE 7-16 i No. C58724 t
SMS= FA x SS EQ'N 11.4-1 ASCE 7-16 * Exp.3-31-21 *
SMS= 1.2 x 1.5 = 1.8 sT9T '
FOFcA�\ °Q?
SDS = 2/3 x 1.8 = 1.2
1.2
Cs = 6 5 = 0.185 EQ'N 12.8-2 ASCE 7-16
1
Sht # 6 of 7
2020-3789 Axis- Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
EXISTING BASE SHEAR
V = 0.185 x 84,000 LBS = 15,540 LBS EQ'N 12.8-1 ASCE 7-10
DETERMINE NEW BASE SHEAR
Determine Seismic Weight of Building with Solar Array:
EXISTING
SEISMIC = 84,000 LBS
WEIGHT
NEW SOLAR
ARRAY = 3 PSF x 10 PANELS x 3.3' x 5.5' = 545 LBS
NEW
SEISMIC = 84,000 LBS + 545 LBS = 84,545 LBS
WEIGHT
THEREFORE NEW BASE SHEAR:
V = 0.185 x 84,545 = 15,641 LBS EQ'N 12.8-1 ASCE 7-10
15,641 LBS - 15,540 LBS
% CHANGE = x 100 = 0.6 % < 10% OK
15,540 LBS
Effective Existing Seismic Weight (garage)
Area of (E) Building = Approximately 600 sq. ft.
Approximate okoFESS/ov
Effective = 600 sq. ft. x 10 psf ave. = 6,000 LBS .(<5o 4-isle
Seismic Weight co c �\
No. C58724
* Exp.3-31-21
d>47 /
OF
CAt�Fod-
Sht # 6.1 of 7
2020-3789 Axis- Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
EXISTING BASE SHEAR
V = 0.185 x 6,000 LBS = 1,110 LBS EQ'N 12.8-1 ASCE 7-16
DETERMINE NEW BASE SHEAR
Determine Seismic Weight of Building with Solar Array:
EXISTING
SEISMIC = 6,000 LBS
WEIGHT
NEW SOLAR
ARRAY = 3 PSF x 10 PANELS x 3.3' x 5.5' = 545 LBS
NEW
SEISMIC = 6,000 LBS + 545 LBS = 6,545 LBS
WEIGHT
THEREFORE NEW BASE SHEAR:
V = 0.185 x 6,545 = 1 ,211 LBS EQ'N 12.8-1 ASCE 7-16
1 ,211 LBS - 1,110 LBS
% CHANGE = x 100 = 9.1 % < 10% OK
1,110 LBS
OK. PER ASCE 7-16 SECTION 11.B.3 ALTERATIONS
EXISTING LATERAL FORCE RESISTING SYSTEM IS EXEMPT
FROM ANALYSIS SINCE NEW SEISMIC FORCE IS
LESS THAN 10% GREATER THAN EXISTING SEISMIC FORCE.
;;PFESs704
"Alterations are permitted to be made to any structure without requiring theco �o �\\
existing structure to comply with this standard provided the alterations comply • ?,1
with the requirements for a new structure. Alterations that increase the No. C58724
seismic force in any existing structural element by more than 10 percent or * Exp.3-31-21 *
decrease the design strength of any existing structural element to resist ,
seismic forces by more than 10 percent shall not be permitted unless the T97F OF'C AL F°��\
entire seismic force-resisting system is determined to comply with this
standard for a new structure."
End of Calculations
Sht # 7 of 7
2020-3789 Axis-Ecoforce Solar Chu Residence Date: January 19, 2021
Loyd W. Martin Professional Engineer, Inc.
9924 Universal Boulevard #224-406 Orlando, FL 32819 Te1:1 .310.464.1804
Email: loydwmartin@gmail.com www.loydwmartin.com
Determine Loading on Roof Rafters
.�OcoF ESS/04--
'</
SS/°N�l
Dead and Live Loads without Panels: ro -- M r,` ,
ti
Comp. Shingle Roofing = 4.0 psf No. C58724
1/2 Sheathing = 1.5 psf * Exp.3-31-21
Rafters @ 24" O.C. = 0.7 psf (9T4i. CIVIC o��P
5/8" Drywall = 3.1 psf °F caO
Misc. / Insul = 1.0 psf
Dead Load = 10.3 psf
w/ DL Corr. (1.05) = 10.8 psf
Live Load = 20.0 psf
Total Load = 30.8 psf
Dead Loads with Panels:
Comp. Shingle Roofing = 4.0 psf
1/2 Sheathing = 1.5 psf
Rafters @ 24" O.C. = 0.7 psf
5/8" Drywall = 3.1 psf
Misc. / Insul = 1.0 psf
Dead Load = 10.3 psf
w/ DL Corr. (1.05) = 10.8 psf
Total Load = 10.8 psf
Solar Array = 3.0 psf (Note: Solar Loads are point loads on members)
Total Load with Solar Array = 13.8 psf < 30.8 psf OK
Sht #R1
2020-3789 Axis- Ecoforce Solar Chu Residence Date: January 19, 2021
i
tl� :_- mss\
V . of
�ai[p of
AFFIDAVIT SELF-CERTIFICATION
FOR COMP IANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 523 b'-' /1/, 441/1,,,,, /,/,
Permit Number: Z (-0Z03
Brief Job Description: .) .,t4:1 '2_ ,,I sT A Pt A;X,A1
Number of smoke alarms installed: 2.
Number of carbon monoxide alarms installed: 2 ,
When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created,
Smoke alarms shall be installed in each sleeping room, and outside each separate
sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements and habitable attics as required by Section R314 of the 2016
California Residential Code (CRC) and California Health and Safety Code Section 13113.7.
For dwellings or sleeping units containing fuel burning appliances or having attached
garages, carbon monoxide alarms shall be installed outside each separate sleeping
area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements as required by Section R315 of the of the 2016 California
Residential Code (CRC).
Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used.
All alarms shall comply with requirements for listing and approval by the Office of the State Fire
Marshal. http://osfm.fire.ca.qov/licensinglistings/licenselistinq bml searchcotest.php
As owner of the above referenced property, I hereby certify that the smoke alarms and carbon
monoxide alarms have been installed in accordance with the manufacturer's instructions and in
compliance with the code sections referenced above.
1 declare under penalty of perjury that the fo egoing is true and correct, and that this
declaration was executed on (Date) v�_ j.l_ __ 2,3 __. aF Arcadia, California.
Owner's Name (printed/typed): ,1;`n R lJ, k
Signature of Owner: /-\./ J
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
.i
y PERMIT/PLAN REVIEW APPLICATION
Development Services Department, 240 West Huntington Drive, Post Office Box 60021
Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
ONLINE PERMIT/PLAN REVIEW APPLICATION
• t:rr e OF
ARCADIA Job Site Address: 523 W Norman, Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury that I ant 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 B icense No. 999669 Exp. Date 1/31/23 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 ❑X I have and will maintain workers'compensation insurance,as required by Section
Elhereby 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 State Compensation Insurance Fund of CA
demolish,or repair any structure,prior to its issuance.also required the applicant 9234071-20
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.1 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 1 should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code. I shall
❑1, 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 1/9/21
sale(Section 7044, Business and Professions Code: The Contractors License Date Signatu
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. lf, 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,'hnd
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 1 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).
rain ezertipt under-Section 7044;Business and Professions Code,for this reason:
Lender's Name
Date 2/9/21 SignatureLender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO TLIE BUILDING OFFICIAL. FOR A PERMIT St.BjECT TO THE CONDITIONS .AND
RESTRICTIONS SET FORTH ONTHIS 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 Johanna Lindgren Title Marketing&Operations
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 1/9/21 — —
%FA•
0 PERMIT/PLAN REVIEW APPLICATION
43 Ee 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. ❑ 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
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for
further information.
Name Title
PRINT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes.
Signature Date