HomeMy WebLinkAboutRALT-19-2463 i•4.• City of Arcadia, CA Permit NO. RALT-19-2463
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:08/11/2020 1 Expiration: 08/11/2021
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
111 W LE ROY AVE Arcadia,CA 91007-4070 5782008028
Contacts
YANG,HOWARD H AND AMANDA P Owner SAM ZHOU Applicant
111 W LE ROY AVE 320 W HOLLOW AVE,WEST COVINA,CA 91790
(626)622-1956 (626)632-4293 zigasinc@gmail.com
Charles H Niles Construction Contractor
601 E Dalton,Glendora,CA 91741
568389
Description:REMODEL ENTIRE HOUSE TO ADD BED RM#4, Valuation: $ 111,336.90 Tenant
BATH#3,LAUNDRY RM,ADDITION TO ENLARGE MASTER BED
RM,CONVERT PORTION OF FRONT ENTRY,MEP INCLUDED, Total Sq Feet: 58.00 Plan Check#19-2463 Plan#296
REWIRE HOUSE,ADD NEW RECESSED LIGHTING.
lREFRAME/RAISE ROOF,REPLACE WINDOWS, NEW A/C(ALL
WORK PER APPROVED PLANS)
11111111111111111111111111111161111111111601011110.
Fees Amount payments Amount Paid
Bathtubs/or Combo $39.63 Total Fees $3,396.08
Building Issuing Fee $47.01 Cash/Receipt#REC-05184-20 $2,200.35
Building Permit Fees $1,306.80 Cash/Receipt#REC-03302-19 $1,195.73
Building Plan Review Fee $849.42
Cal Green Plan Check 584.95 Amount Due: $0.00
•
Clothes Washer $13.21
Compressor 3-5 Ton(3 to 15 hp) $36.35
Dishwasher $13.21
Electrical Permit Issuance Fee $47.01
Energy Plan Review Fee $261.36
Furnace or Burner<=100,000 BTU $19.86 CALLS FOR INSPECTIONS
Garbage Disposal Fee $13.21 Request for inspection by telephone at 626-574-5450. Leave a message
Gas System(Outlets) $46.65 requesting the address,timeframe and what inspection item is needed.
•
Green Building Standard $5.00
Install,Relocate Appliance Vent/Hood $9.94
Kitchen Sink $26.42 This permit/plan review expires by time limitation and becomes null and
Laundry Trays $13.21 void if the work authorized by the permit is not commenced within 180 days
Lavatories $52.84 from the date of issuance or if the permit is not obtained within 180 days
Mechanical Permit Issuance Fee $47.01 from the date of plan submittal.This permit expires and becomes null and
New Residential Elect.(sq ft area) 5158.56 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
Parks&Recreation Fee(SFR) $165.30 Arcadia building inspector for a period of 180 consecutive days.
Total: $3,396.08
77
OCT] .iiiir r -?V Vii_:
August 11, 2020
Issued By: Date
August 11,2020 Page 1 of 1
4 PERMIT/PLAN REVIEW APPLICATION
i4, -.
o,1etEm 4w, Development Services Department,240 West Huntington Drive,Post Office Box 60021
0anl,Y°(‘" Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
I
hapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full or ei d e�. El have and will maintain a certificate of consent to self-insure for workers'
icense Classk ( L' .�. �+••• Date
ignature of Contras� compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
-.
OWNER-BUILDER DECLARATION ElI have and will maintain workers'compensation insurance,as required by Section
El 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 NFIL
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number l=
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 ElI 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 (� /(f _
sale(Section 7044,Business and Professions Code:The Contractors License / at�/ U "
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 infotion./ /� /� /,, {
amee C Cl►'l CM- K-S �/V t I`S Title �-/�'`�LLw—
I P NT NAME
N
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.
_ Si(/ 0
ignatur- Date /
NOTES
Building Inspections Date Insp. Plumbing Inspections Date /Inrsp: /r( /� r//
100. Setbacks 210. Under fir/bldg.drain 7-23-20 , ! �-G /la
101. Rough grade 211. Copper underslab
102. Figs.&forms „� - �• 212. Rough plumbing ' 'ZS _211.27_2t Ht;.rr ,ice
103. Pre-slab j-- / 213. Rough gas . _...---
104.
104. Floor joists 214. Shower pan 44-4 SbJcA. Gc`1C.oi-i/cr--keS
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 3-Z5-Z4 217. Building sewer
108. Diaph nailing 18. Water service
109. Roof nailing to .- - . 4.101 219. Final gas 23-2
110. Framing 3-2S---21 220. Fixtures ,�/
111. Occ.Area Sept.Wall 221. Final plumbing ;.--6-2/ t"--'/
112. Sound walls 222. Sewer caprdemo. 6'' I
113. T-bar grid
114. Insulation-Flr. Pool Inspections Date Insp.
115. Insulation-Wall S�Z I240. Excavation/steel
116. Insulation-Cell. l 41. Rough plumbing
117. Drywall nailing 3-3d- Fe
0242. Light shell bonding
118. Interior lath y-/6-2/ - 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade _ 45. Gas line&test
121. Final building g4-Z( 246. Fence.gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final.lumbin.
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Under.round conduit
153. Underslab conduit - Reroof Inspections Date Insp.
154. LIFER ground270. Pre-reroof insp.
r
155. Water ground 25.` 271. Roof framing
156. Rough electrical 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. Et It.bondins Sign Inspections Date Insp.
160. Service panel80. Setback/overhang
161. Final electric �� 281. Footing
282. Conduit/wirin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC 3-75-ZI d A 11 'Il-n., 1 .. Date Insp.
183. Fire dampers 290. Fire alarm
184. Furnace compartment 291. Underground supply
185. Combustion air 292. Fire sprinklers
186. Smoke detectors 293. Monitor system
187. Metal F.P.rough 294. Hood dry chem.
188. Compressor setback 295. Final
189. Commercial hood
190. Duct shaft MUM Sewers&Offsite Insp. Date I Insp.
191. Final mechanical `, --7 7- . 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Cess..ol filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
of ARc
4
�tyiFOR,�9gd
October 22. 2019
•
Sam Zhou
� ��. 320 N. Hollow Avenue
@°n,tY of 0° West Covina, CA 91790
City of SUBJECT: Single-Story Architectural Design Review No. SSADR 19-23
PROJECT ADDRESS: 111 W. Le Roy Avenue
Arcadia
Dear Mr. Zhou,
The Development Services Department has conditionally approved the
Development single story design review project dated September 17, 2019, for a 77
Services square foot one-story single family addition and 35 square foot front porch
expansion to an existing single-story residence at 111 W. Le Roy Avenue,
Department subject to the following conditions:
1. The applicant/property owner shall comply with all City requirements
regarding building safety, fire prevention, detection, suppression,
Jason Kruckeberg emergency access, public right-of-way improvements, parking, water
Assistant City Manager/ supply and water facilities, sewer facilities, trash reduction and
Development Services recycling requirements, and National Pollutant Discharge Elimination
Director System (NPDES) measures to the satisfaction of the Building
Official, Fire Marshal, Public Works Services Director and
Development Services Director. Compliance with these
requirements is to be determined by having fully detailed
construction plans submitted for plan check review and approval by
the foregoing City officials and employees.
2. The applicant/property owner shall defend, indemnify, and hold
harmless the City of Arcadia and its officials, officers, employees,
and agents from and against any claim, action, or proceeding
against the City of Arcadia, its officials, officers, employees or agents
to attack, set aside, void, or annul any approval or conditional
approval of the City of Arcadia concerning this project and/or land
use decision, including but not limited to any approval or conditional
approval of the City Council, Planning Commission, or City Staff,
which action is brought within the time period provided for in
Government Code Section 66499.37 or other provision of law
applicable to this project or decision. The City shall promptly notify
the applicant of any claim, action, or proceeding concerning the
project and/or land use decision and the City shall cooperate fully in
the defense of the matter. The City reserves the right, at its own
option, to choose its own attorney to rep esent the City, its officials,
officers, employees, and agents in the defense of the matter.
240 West Huntington Drive
Post Office Box 60021
Arcadia,CA 91066-6021
(626)574-5415
(626)447-3309 Fax
www.ArcadiaCA.gov
There is a ten (10) day appeal period for this application. To file an appeal, a completed
Appeal Application form must be submitted to the Community Development Division along
with a $600.00 appeal fee by 4:30 p.m. on Friday, November 1, 2019. You will be notified if
an appeal is filed.
Approval of SSADR 19-23 shall not be of effect unless the property owner and applicant
have executed and filed the enclosed Acceptance Form to indicate awareness and
acceptance of these conditions of approval. The Acceptance Form is due now and if it is
not received by November 22, 2019, this approval will become null and void.
This approval shall expire in one year (November 2, 2020) from the effective date unless a
building permit is issued and the construction is diligently pursued, a certificate of
occupancy has been issued, or the approval is renewed.
An extension may be granted by the Development Services Director or designee, or the
Review Authority that approved the project for a maximum period of one (1) year from the
initial expiration date. An extension can only be granted if the required findings can be
made. Please note that acceptance of an extension request does not indicate approval of
an extension.
A building permit must be obtained prior to any construction activity. Please contact
Building Services at (626) 574-5416 to determine the type of documentation, plans, and
fees for the appropriate permit. This approval letter must be presented to Building Services
to initiate the permitting process.
You may visit the City's website at www.ArcadiaCA.gov/noticesanddecisions to view this
letter. If you have any questions regarding the above approval, please contact me at (626)
574-5442 or by email at Itorrico@ArcadiaCA.gov. Thank you.
Sincerely,
DEVELOPMENT SERVICES DEPARTMENT
Community Development Division/Planning Services
r....t---. 1—c.----------'
Luis Torrico
Senior Planner
Enclosure
c. Amanda Yang, Property Owner
4.
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
cher sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709)
T`;s report includes all construction work through Z�da of
Report No.
_day FP 1:) ,20 '7/ Page No. of
Pro ect .address:
Structural Observer of Record (SOR): SOR Phone No.:
..not.",g{g Perm it No.: structural Observation Observr Professional Lic./Reg. No.: Observer Phone No. I
performed by:
�__ OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
. FOUNDATION WALL FRAMES ELEMENTS/CONNECTION
FLOOR
LOBSERVATION LOCATION
-noting, Stem Walls ❑ Concrete ❑ Steel Moment Frame ❑ Concrete
12 Mat Foundation ❑ Masonry 0 Steel Braced Frame
❑ Steel Deck
Caisson, Piles,
0 Wood 0 Concrete Moment ❑ Wood
Grade Beams Frame
Retaining Foundation 0 Others: 0 Masonry Wall ❑ Others:
Hillside Special Anchors "tea v�� 't176"._
Frame _ j�
2 Others: i-(77'74.0_ 0,,4�Gt , 0 Others: 1 "
/
L�1-locF 1 Gr
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
observed deficiencies have been resolved is required before acceptance of the Nurk by the building officials.)
- p-a lam'i � u
. v �� •ter- /' trvS G c) � — 4 6F
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
I. 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 COUNTY OF LOS ANGELES.
1 OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT
----,,,\
��
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; ��
ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORKliECTED HAVE BEEN INDICATED ABOVE;I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY — - il
I
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED. /�
S'GNATURE OF STRUCTURAL OBSERVER (STAMP OF STRUCTURAL OBSERVER)
DATE
y,,rsien :.0(2008 LACBC)
Jan. 10 200
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
cther sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709)
Report No.
This report includes all construction work through 9 _day of Rab --ca,r, ,20 '-I Page No. of
Project Address: Structural Observer of Record (SOR): SOR Phone No.:
II yJ . llaelr 46-A/'G - hoz C tom. 1 ' 3 Tts..J Cv 12-1' 6 z-6.3-2--9) i Ler)
Building Permit No.: Structural Observation Observr Professional Lic./Reg. No.: Observer Phone No.:
performed by: J Ccy.-`l t4 0 C2-6 .y'i I'. 1- I
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTION
OBSERVATION LOCATION
Footing, Stem Walls 0 Concrete 0 Steel Moment Frame 0 Concrete
O Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck
0 Caisson, Piles, 0 Wood 0 Concrete Moment 0 Wood
Grade Beams Frame
G Retaining Foundation 0 Others: 0 Masonry Wall 0 Others: W
Hillside Special Anchors Frame I T
0 Others: ® Others: X06 N i--- .M10,)41
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
ail observed deficiencies have been resolved is required before acceptance of the work by the building officials.)
f2 a
0--4 c-T
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 COUNTY OF LOS ANGELES.
2. I. OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT %:,.may dia
Cy
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN imp
47140
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 0 nal/
Exp nal/
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED • • OVIL
ABOVE;
F `n
4 I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED.
2 —el- (STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF STRUCTURAL OBSERVER DATE
Version 1.0(2008 LACBC) Jan. 10 2008
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
cther sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709)
Report No.
Th;s report includes all construction work through - day of (') ,20 2-cc Page No. of
Project Address: Structural Observer of Record (SOR): SOR Phone No.:
I t( W .. 1—va-oy ,tr&-- /&42-e40.-17(.Al 17 o .3 Z',as�,.1 Cv r 6 z-6 3 1 Li-)
BL;ilo ng Permit No.: Structural Observation Observr Professional Lic./Reg. No.: Observer Phone No.:
performed by: 2,4.3 _,6... C�...t lam- o G'z-6 3 s9 t t 1- i
_y OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTION
OBSERVATION LOCATION
Footing, Stem Walls ❑ Concrete ❑ Steel Moment Frame 0 Concrete
:: Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck
Caisson, Piles, 0 Wood 0 Concrete Moment 0 Wood
Grade Beams Frame
Retaining Foundation 0 Others: 0 Masonry Wall 0 Others: 1,
Hillside Special Anchors Frame
Others: 0 Others: NL 1.4 ei
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
observed deficiencies have been resolved is required before acceptance of the work by the building officials.)
F SLA i�.�`Zl-� mit lam►'- )�itilcr
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 COUNTY OF LOS ANGELES.
2. I. OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS G;1„
UNDER MY RESPONSIBLE CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT ,
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN
1Zd11
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; rryp
.y
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED \.J . V‘\'
i
ABOVE;
4 I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED.
c:N4,14-1 ,� /e) -- -- _U_nom (STAMP OF STRUCTURAL OBSERVER)
S'GNATURE OF STRUCTURAL OBSERVER DATE
Version 1.0(2008 LACBC) Jan. 10 2008
2a -'z( o
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
ether sections of the Los Angeles County Building Code. (Sections 106.4.5, 1709)
Report No.
This report includes all construction work through 2 2. day of Se-to 1_0-,20 ""2-0 Page No. _ of __,
Project Address: Structural Observer of Record (SOR): SOR Phone No..
1 k I. • - c-- A..-4,--7 2,d.1 __ . 17- ,..l na - 6 _ 3 ^ t L- )
B;:ilo:ng Permit No.: tructural Observation •bservr Professional Lic./Reg. No.: Observer Phone No.
performed by. p�� T:—.,,1
cf-`j t.4- o _ az-6 32-9 i t 1- I
rOBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR ELEMENTS/CONNECTION
OBSERVATION LOCATION
Lr2 Footing, Stem Walls ❑ Concrete ❑ Steel Moment Frame 0 Concrete
Mat Foundation 0 Masonry 0 Steel Braced Frame 0 Steel Deck J I
C Caisson, Piles, 0 Wood 0 Concrete Moment 0 Wood
EGrade Beams Frame
C Retaining Foundation 0 Others: ❑ Masonry Wall 0 Others: .
Hillside Special Anchors Frame I� f-Edl, ��� �
_,,Cthers. �� . /2_45 ,1;,_06f.4., ❑ Others: I ,
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
;, observed deficiencies have been resolved is required before acceptance of the work by the building officials.?
ix"i tz--C., GSA--R...__ a.pc._
,4.J Cl-ic 12- P .es L- �Cc
a
I DECLARE THAT THE FOLLOWING STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE:
I AM THE ENGINEER OR ARCHITECT RETAINED BY THE OWNER TO BE IN RESPONSIBLE I
CHARGE FOR THE STRUCTURAL OBSERVATION IN ACCORDANCE WITH THE
REQUIREMENTS OF THE COUNTY OF LOS ANGELES.
i. OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS -
UNDER MY RESpON$I81-E CHARGE, HAS PERFORMED THE REQUIRED SITE VISITS AT N2.eE� _-
EACH SIGNIFICANT CONSTRUCTION STAGE TO VERITY IF THE STRUCTURE IS IN «o cc- .ti t,nrarfI
II
GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; .,::..w. a." , AO
s ,
3. A24'411ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED \ r
ABOVE;
xi. CIV
OFV___--ie
1
I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY ~-
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED. II
- ' -2 Z - 4-2)Z-a (STAMP OF STRUCTURAL OBSERVER}
:;NATURE OF STRUCTURAL OBSERVER DATO
Version 1.0(2008 LACBC) Jan 10 2ooe.
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