HomeMy WebLinkAboutRoof-20-1970 City of Arcadia, CA Permit NO. ROOF-20-1970
Development Services Department Permit Type:Roof
240 West Huntington Drive,Post Office Box 60021
Work Classification:Reroof- Residential
Arcadia,CA 91066-6021
(626)574-5416 Permit Status:Estimate
ARCADIA 1 Z-3-202„0 Issue Date: Expiration: 11/24/2021
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1522 S BALDWIN AVE Arcadia,CA 91007-7978 5785001077
Contacts
CHATEAU ARCADIA HOA Agent for owner DEPINHO ROOFING INC' Contractor
2832 N OLIVE AVE,ORANGE,CA 92865
(714)632-7663 683894
Description:T/0 AND REROOF FLAT PORTION OF Valuation: $45,000.00 Tenant
CONDOMINIUMS WITH SINGLE PLY TPO,WHITE CARLISLE
OVER EXISTING SHEATHING Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $796.01
Building Permit Fees $742.75 Cash/Receipt#REC-06212-20 $796.01
Solid Waste Management Fee $6.25
Amount Due: $0.00
Total: $796.01
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CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
o'I I PLED / requesting the address,timeframe and what inspection item is needed.
l�1 ,_ L5UL5
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.
L
Issued By: Date
December 03,2020 Page 1 of 1
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0,1110434,4
01101110,1 PERMIT/PLAN REVIEW APPLICATIO
44”' 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 ❑ 1 have and will maintain workers'compensation insurance,as required by Section
❑ I herebyaffirm under 3700 of the Labor Code,for the performance of the work for which this permit
penalty of perjury that I am exempt from the Contractors 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, 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
(This section need not be completed if the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
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
Alifel
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit: 1 )
Permit Number: ROOF-20-1970
Brief Job Description: T/0 and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 5
Number of carbon monoxide alarms installed: 4
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 2013
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 2010 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
Marshall. http://osfm.fire.ca.qov/licensinglistings/iicenselistinQ bmi 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 4/21/2021 at Arcadia, California.
Owner's Name (printed/typed): S i o MarqueA
Signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
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F-CERTIFICATION
FORAFFIDCOMP .• , ; , OF SMOKE ALARMS
AND CARE:, -`�': OXIDE ALARMS
Property Address: 1522 S . Baldwin ',,tii f r :itv1 j
Permit Number ROOF-20-1970 ,
Brief Job Description: T/0 and retool flat ,, •
.4. ------'- -
itP°rti‘ ,f condominiums with single-ply y
Number of smoke alarms installed: ik '
Number of carbon monoxide alarms installed: _itik2_
When alterations, repairs or additions requiring a perinit occur, or sleeping rooms are created,
Smoke alarms shall be installed In Bao *leaping room, and outside each separate
sleeping area in the immediate vicinity of itrii bedrooms, and on each additional story of the';
dwelling, including basements and habitable attics as required by Section R314 of the 2013
California Residential Code (CRC) and California Health and Safety Code Section 13113.7,
For dwellings or sleeping units containing fuel burning appiipnces 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 additionalstory of the
dwellir3g, including basements as required by `Set t}on R315 of the of the 2010 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 1 y the Office of the State Fr'
Marshall. http://Qsfm,fire.ca.govfjcensinolistincislligertseiistinQ bm1 searchcotest_pho
r
wner of the above referenced property, I hereby certify that the smoke alarms and carbon
xide alarms have been installed in accordance with the manufacturer's instructions and In
liance with the code sections referenced above.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) ` /(-' `) !i at Arcadia, California.
I I I/
Owner's Name (printed/typed): _ 4 1 L 1 to '
Signature of Owner: l L.!D.1.�- 4
This affidavit must be returned to the City of Arcadia inspector prior to final inspecti•„}
,
AFFIDAVIT SELF.CERTIFICATION
FOR COMPUANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Pr'opertyAddress: 1522 S. Baldwin Ave (unit; 1
Permit Number; ROOF-20-19'70
Brief Job Description: T/t+ raaffe*>t flat. portion of COndokihittal• With S1 gee-p1y 71,0
Number of smoke alarms installed: ,
Number of carbon monoxide alarms installed;
When alterations, repairs or additions requiring a permit occur, or sleeping rooms aro created,
Smoke alarms shall be installed in each sleeping room, and outskio each soperal
steeping area in the Immediate vicinity of the bedrooms, and on each additional story
lit *Melting, including basements and habitable attics as required by Section R314 of the 2
Calriemia Residential Code (CRC)and California Health and Safety Code Section 1311:
For dwellings or sleeping units eentaining fuel burning appliances or having attached
garages. carbon monoxide alarms shall bo instatted outside each separate steeple
area In (ho Immed►8te vidnity of the bedrooms, and on each additional story of the
dwetftng, including basements as required by Section R315 of the of the 2010Mil Galli
Residential Code (CRC).
Mutts-purpsae alarms (combination carbon monoxide and smoke alarms) may be used
Al! sienna shall empty with requirements for listing and approval by the Office of the St
Marstlall. x s, of i.u' .i 1 ;. i`'I n ! 1 = 1'St * .1 $1
As owner of the above refereneerl property, I hereby codify that rho smoke alarms and carbon
monoxide alarms have been installed m aced dance with the manufacturer's instructions and I
compliance with the code seetiens referenced above,
1 declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) .., '► f 'S 1 at Arcadia, California.
Name :
• mar's �P rinted/typed) .y..n_.�„
gnaturo of Owner:
affidavit Must be return to the City of Arcadia $nsp ctnr pncr to final inspection
•
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1=01
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit: 4 )
Permit Number: ROOF-20-1970
Brief Job Description: T/0 and reroof flat portion of condominiums with single-ply
Number of smoke alarms installed: 3
Number of carbon monoxide alarms installed: 1
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 2013
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 2010 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
Marshall. http://osfm.fire.ca.qov/llcensInolistings/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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) Apri1,26,2021 at Arcadia, California.
Owner's Name (prints yped): Janta Bhojwani
Signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
.1itry
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S . Baldwin Ave (unit :5 )
Permit Number: ROOF-20-1970
Brief Job Description: T/0 and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 3
Number of carbon monoxide alarms installed: 1
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 2013
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 2010 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
Marshall. http://osfm.fire.ca.qov/licensinglistings/Iicenseiistinq 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 4/21/21 at Arcadia, California.
Owner's Name (printed/typed): Michael Ong /Wei Yin Fang
Signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
P'd
.14
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit : )
Permit Number. ROOF-20-1970
Brief Job Description: TSO and reroof flat portion of condominiums with single-ply 'r
Number of smoke alarms installed:
Number of carbon monoxide alarms installed: 3
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 2013
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 2010 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 Fi
Marshall. httr :/(2sfm,fire,ca,AQvlllcenSIflQ 1stincsflicenselistinQ bmi s archcotest.Dha
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 forggoing is true and correct, and that this
declaration was executed on (Date) 041 I 2021 at Arcadia, California.
Owner's Name (printed/typed): KEVIN) `tat _
Signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
•
AFFIDAVIT SELF-CERTIFICATIO 1
FOR COMPLIANCE OF SM a ALARMS
AND CARBON MONOXIDE ALARMS
_ x
roperty Address: 1522 S . Baldwin Ave (unit: 7 )
SA
ermlt Number: ROOF-20-1970
f Job Description: TSO and rer•cof flat portion of condominiums -
with sira3le-ply
umber of smoke alarms installed: 44
mber of carbon monoxide alarms installed: /
hen alterations, repairs or additions requiring a permit occur, or sleeping moms 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 2013 •
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 sieepin'::.'
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 2010 Cal' _
Residential Code (CRC).
Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used fi
All alarms shall comply with requirements for listing and approval by the Office of the Sta
Marshall. tempt :/gym.fire.ria.aovfIicensIn illstines/(icenselstirq brrti searthcotest s ' . ..
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.
$ declare under penalty of perjury that the foregoing Is true and correct, and that this. >`
declaration was executed on (Date) --/D - p at Arcadia, Califorr
pwner`s Name (printed/typed): 00/ j3 ,47ppel aalt,4 1 L
signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final ins '
•
o
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S . Baldwin Ave (unit : )
Permit Number: ROOF-20-1970
Brief Job Description: T/O and reroot flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 3
Number of carbon monoxide alarms installed: 3
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 2013
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 2010 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
Marshall. http://osfm.fire.ca.qov/iicensinglistinas/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.
I declare under penalty of perjury that the foregoing is tr'ue and correct, and that this
declaration was executed on (Date) 4-110/7,11A at Arcadia, California.
Owner's Name (printed/typed): 1/4 C' Sa k/ar �
Signature of Owner: c5; L:/7iiP
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
poresips
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit : 9 )
Permit Number: ROOF-20-1970
Brief Job Description: Tho and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 5
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 2013
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 2010 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
Marshall. 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 04/23/2021 at Arcadia, California.
Owner's Name (printed/typed): Kaushlendra Misra
Signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
ArH')DAVIT •� 1 iATION
FOR ate!Of IMMtO 11 MSS
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. Of smelts awns insaaad: ._ .
of groan monoxide.lanns neta#ad:412 ,_,
eiteretions,repots or additions requiring a parnell occur.or sleepily rooms ere coated,
Smoke alarms shall be installed M each sleeping room, and outstda each separate
sleeping area M the Ynmadlats vloiMty of the bedrooms, and on teach additional story of the
dwalerig,including basements and habileble attics as required by Section 8314 of the 2013
California Residential Code (CRC)end California Health and Safety Code Sem 13113.7.
For dwellings or sleeping unke containing fuel blaming applidnoos or arming coached
gem ss.cotton monoxide alarms shag be installed outside each separate sleeping
area in the immediate vicinity of the bedrooms, and on each additional story of the
daellIng, l l din Casements as � by Section R315 of the of the 2010 Cs!ltornla
it,- slurp$. urposs Warms(combination carbon mortmdde end smoke alarms)may be used
piAlt alarms shell comply with requirements for listing and approval by the Office of the State Fee
Mr 1.�4. .11•.�.,tnL. ••liJ.. , ,l , l •;., . .t.'.-.14.•-:1, . -.;.` .:,I+• •,/l: . , t''ad'.• .1, . • •
Its owner et the above referenced property, I hereby certify that the smoke*terms and carbon
IoriOalde alarms have been Irnetalied in accordance with the marwfaobwees Instructions end In
with the code sections referenced above.
under penalty of perjury that the'foregoing Is true and correct,and that this
was executed on (Date) if I 12. 1-41.2..- at Arcadia,California.
iwrier'sNfam.(prtntedltyped): t.S Li ke..i)1 (SAC A(1 W AR.Ary 1-51,kezm ' '° ”,4
lien*of Owner; -..—
This alln4siiii must be returned to the City of Arcadia inspector prior to final Inspection
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AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit: I )
Permit Number: ROOF-20-1970
Brief Job Description: T/O and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed:
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 2013
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 2010 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 try the Office of the State Fire
Marshall. httpJ/osfm.fire.ca.Qov/licensinallstings/licenselistinq bmi 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 4—/0 2.2-) at Arcadia, California.
Owner's Name (printed/typed): A /"2-K Rei/V1--
Signature
of Owner: I ,�Qlr/1/moi --
r tr
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
11
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AFFIDAVIT SELF-CERTIFICATION
FOR COMPUANCE OF SMOKE ALARMS
AND CARBON MONOXIDE AI.ARMS
Property Address: 1522 S. Baldwin Ave (unit: 12 )
Permit Number: ROOF-20-19/0
Brief Job T/O and raroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 3
Number of carbon monoxide alarms installed: 3
When alterations, repaba 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 2013
California Residential Code (CRC)and California Health and Safety Code Section 13113.7.
For dwetihgs 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 2010 California
Residential Code(CRC).
Multi-purpose alarms(combination carbon monoxide and smoke alarms)may be used.
Al alarms shall comply with requirements fru listing and approval by the Office of the State Fire'
Pfarsha& ( L•• i!...:111.1 l; •Vr .�:L .t ' 1 11, • i • . . ! :a l4�1.!`ll '•1
_c L+_.a.1. 1� •
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.
I declare under penalty of perjury that the foregoing Is true and correct,and that this
drolaration was executed on (Date) 04/21/2021 at Arcadia, California.
Owner's Name (printed/typed): Sheng Wang
Signatnra of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
ICATION
AFFIGIAVn St LF4Ein/FAL.AFthtS
FoR cOitPtIAPICE°F OKE .
AND COiteC*IM0NO)CDE AlAR/a8
PrOPertY Addr0144. ""Pg
Permit Number.
_ . .
Brief Jot)Description: IV 0 ari„.1 r e ,•• -
Number of smoke *isms istalled:
Nuieber of OW bon rrionoxide alarms Installed
When alterations. repairs or additions reoutring a permn Occur, or filaaf)ing r°°111111 are tj'eattld.
Smoke storms shati be installed in each eieoPing room, and °4.144dactl sel)24a14)
steet)ing area in the immediate vicinity of the bedrooms. and on **eh adder story of '
dvielbrig. including basements and tiabvtabie attics et regred by Section R314 of the 20/3 •
California Resitieritial Code (CRC)and Cehforilia Health and Safety Code Section 13113.
For dere or sieeptng units (x)nlaining fuel burning appliances or having attociled
garages, oarbon alarms sPia be instated outside each separate sleepi
area in the irrunediate3 vnity of the bedrooms, and on each additional story of the
dbveNing, including besemente es required by Section R15 of the of the 2010 CattfrYnia
Residential Code(CRC).,
kluity-pf.ittyase alarms (combo)ation cattx)fi rrnoxide and •smoice ntarins-} may be used
Ai swills siutd ooinpiy with reqtttriainents rot listing and aponIvel by Me Offir.e of fho fitaba 4,.*10!
marshat Ifftla.k.tfkLgoiltsiftnitostrLaWisitillitii*IngLint#A4#A eivt-
thaltboiee refloat:09d inivarty, hartiby rattly that it* smoke atarrn.S and c.:111)0()
*ama have bean insigited/116c°°rtkan°111Wrill the marlufachirea Inetrtkion3 andtfl
the)code secbon4 reforenool attcnv,
cfsciani wideP.nattY of P.IlivrY that 0111, fojo1, tit* end ttethos*,and that this
oration was ontocuted on lOttte) ,z at Ai- 44‘dlity: confocrnia,
K4'
W$140elk Mani* (poneeditypedy
of Ow n4ff: •
...rtt000misse mist .ritturred to 040 040 invoctar 000, toot, inspeco
4
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AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S . Baldwin Ave (unit: 19)
Permit Number: ROOF-20-1970
Brief Job Description: Tio and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 3
Number of carbon monoxide alarms installed: I
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 2013
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 2010 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
Marshall. 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 0 44/ ./ / 7c) -/ at Arcadia, California.
Owner's Name (printed/typ • 1`Th}�
Signature of Owner: /
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
r'�410461,/�,-
> .
fi` ^not ..
r
N..-..s• •.-
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit:15 )
Permit Number. ROOF-20-1970
Brief Job Description: mio and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: ii
Number of carbon monoxide alarms installed: 2-
,
When -
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 2013
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 2010 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
Marshall. http://osfm.fire.ca.qovIlicensinglistinq$/lloenseiistinq 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) L4.1-2-51 z- I at Arcadia, California.
Owner's Name (printed/typed): awl e -rUoln
Signature of Owner: ________tagdg:4__ _
This affidavit must be returned to the City of Arcadia inspector prior to final Inspection
*'TJ1
2.1 gin
‘.6.4.,e1/7et H's
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit :16 )
Permit Number: ROOF-20-1970
Brief Job Description: T/o and reroof flat portion of condominiums with single-ply TPO
Number of smoke alarms installed: 4
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 2013
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 2010 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
Marshall. http://osfm.fire.ca.qov/Iicensinglistings/licenselistinq bmi 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.
I declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 04/22/2021 at Arcadia, California.
Owner's Name (printed/typed): Brian Xu & Cleo Xu
Signature of Owner: ele.e Xu
This affidavit must be returned to the City of Arcadia inspector prior to final inspection
AFFIDAVIT IELF•CERTIFICAT)ON
FOR COMPIlANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
PropertyAdd►MK 1532 Z. Saldala Ave (-alts 1'11
Permit Number; mODT-20-1170
Brief Job Dasa n: aro ea twat ties sense W Wallas vlM elate-ply We
Number of smoke alums knlntled• J (fr'.4ca
Number of carbon monoxide elan»installed: rZ (fc.ltvnncl
lin-(ir n•.•1 fr 1-(n-f:
When atteralbns,repairs or additbns requiring a permit occur,or aleepkp rooms art creased
Smoke alarms shall be Mslatfed in each Mewing room.and OUWIa each separate
sleeping area in the Immediate vicinity of the bedrooms.end on each additional.tory of the
dweling kxhrdtrg basorn rets end habitable attics as required by section R314 of We 2013
California Resident al Cods(CRC)and California Health and Safety Code Sedbn 13113 7.
For dwellings or sleeping units containing fuel burning appliances or having attached
garages,carbon monoxide alarms shall be Sullied outside each aaoanle sleepkg
area in the Inmadfate vicinity of the bedroom's,and on each eddRionat story of the
dwellilp,
Including basements es required by Section R315 of the of the 2010 CoMarnis
Residential Code(CRC).
Muhl c rpoao aterma(combination carbon monocdde and smoke alarms)may be used
Al*lames shalt comply with requkemww los Wing and approval by the Office of the Stale Fn
Marshall.Mtai/odm.Care.a.00MkwIlln00 trs cAknneerrstno bed .e 1 ttcotealptlp
As owner of the above referenced property,I hereby codify that the smoke alarms and carbon
monoxide alarms have been Instated In.cu,dance with the manufacturer's rer's nstructions and In
compliance with the code sections referenced above
!decker*under penalty of perjury that the fonyoin Is bus and correct end that this
declaration was executed on(Det.) •41ici2t=i at Arcadia,California.
Owner's Nam.(ed ntadhyped): 1l•(.+41111 x110.'1
J
Signature ofOwns r. �./��
`r
Thu affidavit must be returned to the Cllygf Marna MMpedor Worn filet inspection
vi.
1 .,°.
•w�w
IfpM 1.Mf
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: 1522 S. Baldwin Ave (unit : 18 )
Permit Number: ROOF-20-1970
Brief Job Description: T/0 and reroof flat portion of condominiums with single-ply TPO
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 2013
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 2010 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
Marshall. 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.
i declare under penalty of perjury that the foregoing is true and correct, and that this
declaration was executed on (Date) 4/24/2021 at Arcadia,
California.
Owner's Name (printed/ty ed): Kexin Xu
Signature of Owner:
This affidavit must be returned to the City of Arcadia inspector prior to final inspection