HomeMy WebLinkAboutRALT-20-1019 • City of Arcadia, CA Permit NO. RALT-20-1019
Development Services Department Permit Type:Residential Addition/Alteration
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Res-Addition/Alteration
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:01/07/2021 Expiration: 01/07/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
2200 HIGHLAND VISTA DR Arcadia,CA 91006-1532 5765029022
Contacts
GARY CHEN Owner GABRIEL CANEL Applicant
2200 HIGHLAND VISTA DR,Arcadia,CA 91006-1532
(818)314-0890 GARYGECHEN@YAHOO.COM (818)314-0890
GLADIATOR CONSTRUCTION INC* Contractor
17412 VENTURA BLVD 372,ENCINO,CA
(818)858-0087 1015248
Description:SECOND FLOOR ADDITION OF 2 BEDROOMS AND Valuation: $ 142,716.85 Tenant
2 BATHROOMS. REMODEL MASTER BATH AND CLOSET AREA.
WITH HOA APPROVAL.TOTAL 4 BED 4 BATH,includes MEP's Total Sq Feet: 924.00 Plan Check#20-1019 Plan# 7
Fees Amount Payments Amount Paid
Add/Alter Ducts $9.94 Total Fees $6,296.45
Bathtubs/or Combo $39.63 Cash/Receipt#REC-06470-21 $4,625.00
Building Issuing Fee $47.01 Cash/Receipt#REC-04899-20 $1,671.45
Building Permit Fees $1,520.70
Building Plan Review Fee $988.46 Amount Due: $0.00
Cal Green Plan Check $98.85
Electrical Permit Issuance Fee $47.01
Energy Plan Review Fee $304.14
Green Building Standard $6.00
Lavatories $52.84
Mechanical Permit Issuance Fee $47.01 CALLS FOR INSPECTIONS
New Residential Elect.(sq ft area) $73.92 Request for inspection by telephone at 626-574-5450. Leave a message
Parks&Recreation Fee(SFR) $2,633.40 requesting the address,timeframe and what inspection item is needed.
Plumbing Permit Issuance Fee $47.01
Shower $13.21
Single Family Fire Plan Check $280.00 This permit/plan review expires by time limitation and becomes null and
Solid Waste Management Fee $6.25 void if the work authorized by the permit is not commenced within 180 days
Solid Waste Management Fee 2 $1.00 from the date of issuance or if the permit is not obtained within 180 days
Solid Waste Management Fee 2 $1.00 from the date of plan submittal.This permit expires and becomes null and
Solid waste Management Fee 2 $1.00 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
Strong Motion Inst.Program Res $18.56 Arcadia building inspector for a period of 180 consecutive days.
Total: $6,296.45
VI C •
January 07, 2021
Issued By: Date
January 07,2021 Page 1 of 1
A•
4PERMIT/PLAN REVIEW APPLICATION
44ire Development Services Department,240 West Huntington Drive,Post Office Box 60021
(1.\......,„„(0°. 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. / 1:1I have and will maintain a certificate of consent to self-insure for workers'
License Class 13 ''Licen o. Io I52" Exp. Date 4" 9(24 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 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
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 Al)t I NSU K Ark)GE C6 M FAN/
demolish,or repair any structure,prior to its issuance,also required the applicant S I?G L o s 03 aZ 3 -i S
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 700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole orthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
to /ZOL l Signature
sale(Section 7044,Business and Professions Code:The Contractors License
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
0 I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
0 I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION ANI)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 AV 1 `l NItk(A rtle �4c.N€QA1- CbrNY7/2 T0R
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
A din to enter n th• above-mentioned property for inspection purposes.
1
S gnature Date 14/Z oz 1
STRUCTURAL OBSERVATION REPORT FORM ,��--•''�
STRUCTURAL OBSERVATION means the visual observation of the structural system, for general conformance to the
approved plans and specifications, at significant construction stages and at completion of the structural system. Structural
observation does not include or waive the responsibility for the inspections required by Section 108, 1704 or other sections of
the code.
Report No.
This report includes all construction work through day of ``grRc-N , 20 Page No. of
Project Address Structural Observer of Record(SOR): Phone No.of SOR:
t,c.
Building Permit No. Structural Observation performed by: Professional LiclReg.No of Observer. Phone No.of Observer:
72ft,1Sc) TEiLcLco (�G1 ' 513
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAME FLOOR ELEMENT:CONNECTION
OBSERVATION LOCATION
El Footing,Stem Walls, Piers ❑Concrete ❑Steel Moment Frame ❑Concrete
❑Modulus of Elasticity*
Mat Foundation
❑ Concrete Shear Walls uSteel Braced Frame ❑Steel Deck
❑Caisson. Piles. Grade
Beams ❑Masonry ❑Concrete Moment Frame [Wood
❑Retaining Foundation ❑Modulus of Elasticity'
Special Anchors LWood DOthers:
Hillside S
P Seismic Moment Frames
0 Others: DOthers: DOthers:
For concrete buildings more than 160 feet in Structural Height: Concrete mix meets the modulus of elasticity
requirements in design for seismic force resisting systems.
NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general conformance
with the approved plans or in the load path: (A final report by the structural observer which states that all observed
deficiencies have been resolved is required before acceptance of the work by the building officials.)
NONE OSSs "i-_g UK C. ' r_L
UKlvo-rr WE. 4-41
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS CSS ,
OF THE CITY OF LOS ANGELES. <QQaQ` '
2. I,OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER TFf,
MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH
SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL No C87383
CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS;
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED
ABOVE; F�� cil L\\
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITY OF LOS
ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE CORRECTED.
SIGNATURE OF STRUCTURAL OBSERVER DATE STAMP OF STRUCTURAL ORSF RVrR
IN,Fam JS;Part 1)(Rev.0609'17;
rers------
C..-' G )
STRUCTURAL OBSERVATION REPORT FORM
STRUCTURAL OBSERVATION means the visual observation of the structural system. for general conformance to the
approved plans and specifications,at significant construction stages and at completion of the structural system. Structural
observation does not include or waive the responsibility for the inspections required by Section 108. 1704 or other sections of
the code.
I •
iReport No.
This report includes all construction work through g ,day of F6 , 20 2.1 Page No. of
Project Address: Structural Observer of Record(SOR): Phone N of SOR: .
2-:2--00 14t(C)HLA Ji) i1 i D1tA✓�-/ q,g.cAD,R 61(2.6-,15.,i-)-n-tt210 go,"") 4(61=(-18E%3
Building Permit No.• StruclurarObservation performed by: Professional Lic.lReg.No of Observer: Phone No.of Observer: ,
C.712�-r-c s�3 .-11-=_12,,0 C��303 3 /.
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAME FLOOR ELEMENT!CONNECTION
OBSERVATION LOCATION
et ,)Footing.Stem Walls.Piers ❑Concrete ❑Steel Moment Frame ❑Concrete
r
Mat Foundation
DModulus of Elasticity' tr
:er ❑ ❑Steel Braced Frame ❑Steel Deck
Concrete Shear Walls
ng ❑Caisson.Piles.Grade
❑Masonr )
61 Beams Y ❑Concrete Moment Frame ❑Wood
I(
)GI 0 Retaining FoundationWoad ['Modulus of Elasticity* J
Hillside Special Anchors ❑ ❑Others
rIa t Seismic Moment Frames
tia 1['Others: DOthers: ['Others: I
est
• For concrete buildings more than 160 feet in Structural Height: Concrete mix meets the modulus of elasticity )i
requirements in design for seismic force resisting systems.
NOTED DEFICIENCIES with the proposed corresponding corrective actions with respect to general conformance
with the approved plans or in the load path:(A final report by the structural observer which states that all observea
deficiencies have been resolved is required before acceptance of the work by the building officials.)
\I0iac ) ''E Lue0 ).. 'To
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
1. I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE REQUIREMENTS
OF THE CITY OF LOS ANGELES. ,,,;N.._ )Sj�
2. I,OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS UNDER ����Al'ill \\
i
MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT EACH �6 - \,.
/'L�'y� �.v
—
SIGNIFICANT CONSTRUCTION STAGE TO VERIFY IF THE STRUCTURE IS IN GENERAL a :o C87383
CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; l"r )Kj
\ r
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED Cly!:� ///CZ-'
ABOVE; �\ F O
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE CITY OF LOS
AN/ ES BE ITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED. —
• ^'UCTURALOBSERVER DATE
STAMP OF STRUCTURAL OBSERVER
IN/F.//(Part I)(Rev 06/15/17)
SIGALA INSPECTION SERVICES INC.
OFFICE/CELL: (323) 630-9436 8990 KRISTIN DR DOWNEY CA
EMAIL: office@sigalainspection.com 90240 /�
INSPECTION DATE: �`/ //
REGISTERED SPECIAL/DEPUTY INSPECTOR - CERTIFICATE OF COMPLIANCE
PROJECT INFORMATION:
Pemtit#: —� go/71.- _e 'd / _/�j
)
Project Name: /-
Address: .,_ b;DUO th,14
/Li7yj //s -pe.
1
=__/
Owner Name: 7-
Address:
Phone&Fax: ' / C� e 17 •
Contractor: (- Y
Address: ""di
/
Phone&Fax: 67a,
! 44/4".- /' C y L/�//Ji7`
Engineer: (
Address:
Phone&Fax:
2
TYPE OF INSPECTION
Reinforced Concrete E.Shotcrete ❑ Gunite ❑ Rebar ❑- Weld' ❑
Structural Masonry El Prestress El Anchors Bolts ❑ Dowels Fireproofing 0
Post-Tension ❑ Framing ❑ Nailing Insp. ❑ Grading El Others s�v7407
Quality Control ❑
Cylinders Samples Core Panels Mortar Grout Masonry Prism
I HEREBY CERTIFY THAT THE FOLLOWING PORTION OF THE WORK AT ABOVE ADDRESS WHICH REQUIRED SPECIAL!
DEPUTY INSPECTION AND FOR WHICH I WAS EMPLOYED TO INSPECT BY ME AND COMPLY WITH THE APPLICABLE
PROVISIONS OF THE BUILDING CODES AND THE APPROVED DRAWINGS:
INSPECT!r N DESCRIPTION:- '
`/� � �
0 r//� ,/ _/- �- fro-7409Z G...•tel./ y -.._ /i -IZ i t"ii-
-/ ,aMb . i" ' a.0- 'sem--'
`� .
TIME IN TIME OUT REG.HOURS O.T.HOURS SAMPLES
Bae..9'7v~ G
-
NAME.' di , i /, . ALL INSPECTIONS ARE BASED ON MINIMUM OF 4 HOURS,ANY INSPECTION OVER 4
•___
HOURS WILL BE CHARGED AS 8 HOURS.ANY INSPECTION EXTENDING PAST NOON
WILL BE CHARGED AS 8 HOURS.SATURDAY ARE BILLED AS TIME AND A HALF.
' SUNDEY ARE BILLED AS DOUBLE TIME
SI '. - ERE'I :'ECTOR
/d !` SITE CONTACT: zt /, J
TY' LICEN NUMBER
i1111 !!
IFS . , •
•'° WATER DIVISION
•
ATTENTION:
DATE:
FROM: BUILDING DIVISION INSPECTOR: �11
ADDRESS: /Z
PERMIT NO.: PLAN NO.:
CONTRACTOR: . ,l PHONE NO.:
OWNER: PHONE NO.:
PLEASE INSPECT THE FOLLOWING ITEMS FOR CONFORMANCE WITH APPLICABLE DEPARTMENT
OF PUBLIC WORKS REQUIREMENTS.
Type of Inspection Date & Initial Date& Initial Final Approval
Meter Location
- 3 46p/2
Blackflow Devices
-Abg tsfa/ak 1,1 ioiz,
Irrigation System
Fire Sprinkler System tiI4a
'eiJ / (a. `b/Io/a 1
Meter Clear A.P.P.
Swimming Pool -66 %/a/?,1
COMMENTS: fitk to l " Rp V `[i ■ . i r i •
. e
Aft OV ARQA,
° 111161Pritli 7
Olt 4.AuN. , 90]
4,4
MEMORANDUM
Fire Department
DATE: July 28, 2021
TO: BUILDING DEPARTMENT
INSPECTOR Steven Roberts
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 2200 Highland Vista Drive
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS (PC# 21-0305) 7-28-2021 Jill Perumean
FIRE ALARMS
HOOD & DUCT
KNOX BOX
OCCUPANCY (PC# 20-1019) _ 7-28-2021 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 7-28-2021 Rita
City of Arcadia, CA Permit NO. FIRE-21-0305
Development Services Department Permit Type:Fire
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:03/11/2021 Expiration: 03/11/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
2200 HIGHLAND VISTA DR Arcadia,CA 91006-1532 5765029022
Contacts
GARY CHEN Owner INFINITY FIRE PROTECTION INC* Contractor
2200 HIGHLAND VISTA DR,Arcadia,CA 91006-1532 13400 SATICOY ST 20,N HOLLYWOOD,CA 91605
(818)314-0890 GARYGECHEN@YAHOO.COM (818)762-0314 811322
Description:FIRE SPRINKERS FOR SF 32 HEADS Valuation: $ 6,000.00 Tenant
Total Sq Feet: 0.00 Plan Check#21-305 Plan#
Fees Amount Payments Amount Paid
Fire Issuance $47.01 Total Fees $918.46
Fire Permit Fees $170.45 Cash/Receipt#REC-06839-21 $700.00
Solid waste Management Fee 2 $1.00 Cash/Receipt#REC-07020-21 $218.46
Sprinkler Heads $700.00
Amount Due: $0.00
Total: $918.46 ,
II V u r
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
COMPLETED
March 11, 2021
Issued By:Steven Roberts Date
March 11,2021 Page 1 of 1
A'
PERMIT/PLAN REVIEW APPLICATION
to.b, 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,andmylicense is in full force and e' ct. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class C. l 7 License No. ...0_,* I. . • compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor � ��
10performanceof the work for which this permit is issued.
11- _
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑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(
l\ OffSignature\ `�, °��/
sale(Section 7044,Business and Professions Code:The Contractors LicenseLaw 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).
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 VA" dIL111116
�f►. � I L. Title O(
TAN--
PRI 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.
l
Signature Ce04111110 � 10 Date \' �\
111 City of Arcadia, CA Permit NO. ROOF-21-0654
Development Services Department Permit Type:Roof
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Reroof- Residential
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:04/12/2021 Expiration: 04/12/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
2200 HIGHLAND VISTA DR Arcadia,CA 91006-1532 5765029022
Contacts
AVI YECHIZIKA Owner CERTIFIED ROOFING SPECIALISTS Contractor
9281 Larkspur DR,Westminster,CA 92683
(714)668-0757 (714)315-6504 956843
Description:T/0 AND REROOF HOUSE AND ATTACHED GARAGE Valuation: $25,000.00 Tenant
WITH BORAL SAXONY SHAKE 600,CLASS A,CHARCOAL BROWN
BLEND OVER NEW SHEATHING Total Sq Feet: 0.00 Plan Check# Plan#
ws
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $541.01
Building Permit Fees $487.75 Cash/Receipt#REC-07290-21 $541.01
Solid Waste Management Fee $6.25 Amount Due: $0.00
Total: $541.01
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
1?1 COMPLETED
April 12, 2021
Issued By:Steven Roberts Date
April 12,2021 Page 1 of 1
4 PERMIT/PLAN REVIEW APPLICATICON
1144,
441*, 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
❑ I have and will maintain workers'compensation insurance,as required by Section
OWNER-BUILDER DECLARATION
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
0 I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑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
" 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
crry or
ARCADIA Job Site Address: 2200 Highland Vista Dr.
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0 I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class C-39 License No. 956843 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 wLLUU
OWNER-BUILDER DECLARATION uy
❑X 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 State National Insurance Company Inc.
demolish,or repair any structure,prior to its issuance.also required the applicant 1949902
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 he 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
❑ 1 certify that in the performance of the work for which this permit is issued.]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(5500)): compensation Laws of California.and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code.I shall
ElI, as owner of the property. or my employees with wages as their sole forthwith comply with those provisions. ,/
compensation,will do the work,and the structure is not intended or offered for 4/12/2021 v 1
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(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.
❑1, 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).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name_.Date 4/12/2021 Signature 's Vgreg Lender's Address_
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BLAMING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS ANI)
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 Jose Vazquez Title Contractor
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 944 1/7114.8 Date 4/12/2021
Certificate No. 20200211-049
Business Services
150rc Southia, Third Avenue ‘A ,CA9.1/ \Arcadia,CA 91006
p 626 821 6631Unifed School Dstrict
f 626 821 6632
www.ausd.net Imagine • Inquire• Inspire
Certificate of Compliance for Payment of Developer Fees
(Education Code §17620, et seq. & Government Code §65995, et seq.)
Effective April 13, 2020
Current rate in effect applies at the time of imposition of fees/payment.
Project Address/APN: 2200 Highland Vista Dr., Arcadia, CA 91006
Number of Units: 1 Plan Check Number: 20-1019
❑ Exempt* ® Residential** ❑ Commercial/Industrial**
❑500 sq.ft.or less(residential addition/expansion) $4.08/sq. ft. $0.66/sq. ft.
❑Other: Sq.ft.of commercial tear-down greater than rebuild
Area in Sq. Ft.: 924 Receipt Number: 330597
Total Fee: $3,769.92 Check Number: 0976714786
Owner's Name: Gary Chen
Owner's Address: 2200 Highland Vista Dr., Arcadia, CA 91006
Phone Number: (626) 325-3254 Email: garygechen@yahoo.com
Representative's Name & Phone Number(if applicable): Gabriel Canel (818)314-0890
* The above-described development has been determined to be exempt from the developer fees of Education Code §17620, et
seq., and Government Code§65995, et seq., and a Building Permit may be issued therefore.
**All fees due to the Arcadia Unified School District, under provision of Education Code §17620, et seq., and Government Code
§65995, et seq., as a prerequisite to the issuance of a Building Permit by the Building Department of the City of Arcadia, City of
Monrovia, City of Sierra Madre, City of Temple City, and County of Los Angeles, Department of Public Works have been
received. :.sed on the informati. presented above,this Certificate of Compliance is hereby executed.
Connie Chu
111.1 Senior Administrative Assistant 1/7/2021
Signature of District Representative Name/Title Date of Issuance
The District charges a $100 fee to process reinstatement of the Developer Fee Certificate of Compliance resulting from an
"insufficient funds" check in addition to a $35 fee for the returned check. Only cash or a Cashier's Check will be accepted as
payment thereafter.
The District charges a $100 fee for any amendments to or cancellation of a Developer Fee Certificate of Compliance formerly
issued on any type of development.
If 500 sq. ft. or less is the reason for exemption, any future additions, expansions, or remodels to the property that result in the
past aggregate square footage to exceed the allotted 500 sq. ft. will be subject to fees at the current rate for the entire square
footage of the development.
Owner/developer may request a refund of fees paid to the District within 12 months of payment only in the event the Building
Permit expires or the project is canceled without commencement of construction in accordance with Education Code section
17624(all other requests for refunds must be made in accordance with the fee protest procedures set forth in Government Code
§66020). All refunds will be reduced by a $100 administrative fee. The refund check will be issued in the name of the
owner/developer and mailed to the address of payee.
PURSUANT TO GOVERNMENT CODE§66020(d), OWNER/DEVELOPER HAS A PERIOD OF 90 DAYS FROM THE DATE
OF ISSUANCE OF THIS CERTIFICATE OF COMPLIANCE TO PROTEST THE IMPOSITION OF FEES
Applicant confirms that he/she is authorized to sign on behalf of the owner/developer and that the information he/she provided
to the District istrue and accurate to the best of his/her knowledge.
6/A Int- CANES V1/202
Sign ure of Applicant Name Date
ORIGINAL-City/County COPIES-Business Services.Fiscal Services&Applicant Certificate of Compliance(4-13-20)