Loading...
HomeMy WebLinkAboutRALT-21-0190 f i City of Arcadia, CA - n, Permit NO. RALT 21 0190 Development Services Departmentron--L'�--ThP rm t Type•Resl:denti•al Addition/Alteration 240 West Huntington Drive,Post Office Box 60021 { I r Arcadia,CA 91066-6021 1 `� [ 'QI/CIassiflcahon Res-Addition/Alteration "' (626)574-5416Permit Status Issued` A.RCADIA Issue Date:02/04/2021 1 Expiration: 10/11/2021 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number ' 418 W WINNIE WAY Arcadia,CA 91007-7957 5785023024 Contacts GUO JUN WANG Owner DBIK CONSTRUCTION&DESIGN INC Applicant 418 W WINNIE WAY,Arcadia,CA 910077957 13208 GRAYSTONE AVE,NORWALK,CA 90650 (626)616-8882 (714)757-4993 Sujian Wu Contractor Po Box,Arcadia,CA 91066 (310)773-0589 ext 11572 1002650 tam. Description:DEMO ILLEGAL PARTITIONS,REPAIR/REPLACE Valuation: $ 0.00 g Tenant DRYWALL REMOVE ILLEGAL WIRING,RESTORE POWER 200 AMP SERVICE,REMOVE ILLEGAL DUCT WORK Total Sq Feet: 0.00 Plan Check# Plan# • AMENDED 5-4-21 CHANGE OF CONTRACTOR TO WU CONSTRUCTION.COPPER REPIPE AND NEW HVAC SYSTEM PER APPROVED PLANS. „. Fees Amount Payments Amount Paid Add/Alter Ducts $9.94 Total Fees $1,349.47 Building Issuing Fee $47.01 Cash/Receipt#REC-06686-21 $1,068.40 Building Permit Fees $806.50 Cash/Receipt#REC-07525-21 $281.07 Change of Contractor $57.50 Compressor 3-5 Ton(3 to 15 hp) $36.35 Amount Due: $0.00 Electrical Permit Issuance Fee $47.01 Fixture with Trap/Misc. $13.21 Furnace or Burner<=100,000 BTU $19.86 Green Building Standard $2.00 Mechanical Permit Issuance Fee $47.01 Misc Elec.Conduit,Conductors or Repair $16.48 CALLS FOR INSPECTIONS Plan Check,Per Hour $120.35 Request for inspection by telephone at 626-574-5450. Leave a message Plumbing Permit Issuance Fee $47.01 requesting the address,timeframe and what inspection item is needed. Residential Services up to 400 amps $16.48 Solid Waste Management Fee $6.25 Solid Waste Management Fee 2 $1.00 This permit/plan review expires by time limitation and becomes null and Solid Waste Management Fee 2 $1.00 void if the work authorized by the permit is not commenced within 180 days Solid Waste Management Fee 2 $1.00 from the date of issuance or if the permit is not obtained within 180 days Strong Motion Inst.Program Res $6.50 from the date of plan submittal.This permit expires and becomes null and Supplemental Building Issuance $47.01 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 Total: $1,349.47 Arcadia building inspector for a period of 180 consecutive days. 1 • riPm1PLEED . . ....) 8'Q_'i il'ulti . tio February 04, 2021 Issued By: Henry Kemick Date May 04,2021 Page 1 of 1 L t ROUTING ` ACTION • Daials of c, ..' .,\° � . ASV /I `'ose°P Notes Checker PQ G° P .0 .. . on Sheet# ' Planning j i 71/f al C . X FJ MC ufiu'f o ro Eng. �. (/ Building I Fire. - , PW'-Water WE • I 1 Tree. ice, . AiY '6r yi :4-_ El 3o O 13W r 1 ill 1 xtit 7 ) . ( . ...._ vv/ • ,kAtc:Ii fr,),e 1/./ , . ( . /frlY ` - / VYtNt Q . 1 In/Pd , A . • NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. ( , I.G/�� �� V 100. Setbacks 210. Under fin/bldg.drain 1^ 101. Rough grade 211. Copper underslab 102. Figs.&forms 212. Rough plumbing ,54 -z 4-- 103. Pre-slab 213. Rough gas 104. Floor joists 214. Shower pan E?oC,'Z&'#(c- eve eacee-441 1415. 105. Steel 215. Water heater c f E2 y Rc'7tt6v P 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service 109. Roof nailing 219. Final gas 110. Framing 5 2712.l 220. Fixtures .,/ 111. Occ./Area Sept.Wall 221. Final plumbing q 20�( Ar`"T� 112. Sound walls 222. Sewer cap/demo. 113. T-bar•rid 114. Insulation-Fir. Pool Inspections Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Cell. 241. Rough plumbing 117. Drywall nailing 242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade �45. Gas line&test 121. Final building 20-Z( 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical Inspections Date Insp. 249. Final plumbing 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Underground conduit 153. Underslab conduit Reroof Inspections I Date I Insp. 154. UFER ground 270. Pre reroof insp. 155. Water ground 271. Roof framing 156. Rough electrical 5- 7- 1 " 272. Sheathing nailing 157. Fixtures 73. Final reroof 158. G.F.C.I. 20.. Z( 159. E•it.bondin• Sign Inspections I Date I Insp. 160. Service panel 2 4Y 2/ • / 80. Setback/overhang 161. Final electric 1-2C,-2f ! 281. Footing 282. Conduit/wiring Mechanical Inspections Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rauch HVAC S Z -2.1im Miscellaneous Insp. I Date I 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 Sewers&Offsite Insp. I Date I Insp. 191. Final mechanical 20•4( Ar, CMlui► 300. Lateral(main to P/L) 301. Saddle/Y Block Wall Inspections Date Insp. 302. Cess•ool filled 200. Footings 303. Sidewalk 201. Steel/rebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin • • n - 0 . . «. ..r...� _ _ 1 s , �` i Co0 ■ •7-1--- 1640 N. Batavia Street, grange, CA 92867 phone (714) 434-6360 Fax (714) 221.6360 www.atechinc.net 11 LIMITED ASBESTOS AND XRF.-ASSESSMENT Ms. Elaine Wang/Claim# 5010425291-1 8 Wliirtie `ay 41 li f City of Arcadia County of Los Angeles State of California Project Number: Atch-210842 March 15, 2021 P(2EPARED FOR: • Formers Insurance art {r ry r n 4t.. r,y �t PR1 'ILEGE[) & CONFIDENTIAL �f r ; }- _°£' "� lT l�:��b 1 S: / r tli I Ii JIB I. „ 1J , # 4j, ; ' r fa ':� •' •le- rIE,p1,1- t�. I .'r I Ui t f t�' r* ; "3� e ' 1. '' t tr � _"al c�t:;y i t :.d,....if•4 nr�rfit <.,.^t,:..t;.I i.' :f ua++-_ _ .� ._._ _moo.-......,�....rj� . -• n la= giA Certificate of Completion • 0 n tx-r ripEr0IVIv.,!orrk; 1:-; 0,1151)1I 17(orli10Wrfig I. fl ilon; !Z Linie,..Wang 4118 Vit WinniO Way Arcatiii0 'CA '910,07 %Nark Fi.R„, :fs completed 5(n atx.dirda lice 7.4,11:114 apOilcdilt tocat,, sate and fedeziil ClinLanthiatell iI i ii 41:‘,1112d, ph5Lic bags a.rid kralivic)rbed in veitied L.! that liras been, rogiagerINII Dielliartment C,arktrul to a 1i:cense(' il;.1?„-traota:-; was,te [an.dflit for burial, The 1,-tenrral scope of mirk, 0111 plia0I i IS RNT101.';11i acoti i611 -1.11C-H) It melee& !De .441a Rod- 4 - 03126121 simi k re. Date , . -110wmpowddiw 7,11.11111,1111111.11i. _ 46 s,a7inc.44 Ger)!irlyi S41 r.:4-1,-..N:.11,10c CA 9 t730 ovni:49..341,44 oxtvoci 9119 0464 a . . . . ' . . .. . . . . . • I. . L-:-L-.7...tikttrei.krr.-‘,- - 1 ?--:--•---,. i.-=---- " . ';',-,,,.--i&-:,;.7,,,,f;_.12-1.0'is• t'.,51,L-f.i-1.7.Cii _ .1!...,`-i.--,:,-3;;;;J:f.,.°-i::.:-7,-7.7-7---t-t-,‘,!...:..:1;Cr....,-.1.!-- .'-..F.f.iiir_7:ze, _ -----— Ve`kSTC,V.;.!:,ii f?II 1 C 4 6.6-1043 li's, 57 YAT-7 1 i . 1 Gau,1 tKIA-,)n131, '0'0,' 0 4 4 2 5 2 OBF L . . ., •,,,,,!,;,,r,,is.----,.,,--.....,.:-,-,:t..--14.,;771--:--,t7-'--...I i . . ' ;CI 416V kill& ILO 4144,1 a 11..t..-,1 -riti,..'•ill.."I. F--ti.17'Y-di 4'A' g.L'....',;1.e.11;F.i{ . ---: ..-. . . I ,i • i• - 1 ti kil eij -t ' i ' 1•A=IV . . . i . . : l, i.1,7;'-'ALH::1:,!-_ILThiL____L . - l'tf,r4,047igI :OA-. .9.i..t.el.13._•L _.. . •,. ,_kr, ,:fr"'-'i I',..• ;_',r.,..-„, _ • )-:.:.ki..J:p.Ir•---1',..-,L. (i.'0Vii, IrriG, I .1;21#P14111 141:31.11ezi . . . It !' 1 lirh.1x,----,j.,,,..••NN!.---,•,---:1,--7- :,,,:i. i-Ti: 15ft,i1_;1,:lifti:IeitiP,'i --41-...,iu.,..,,t,it. ._. , 1"d.1 tAl"..11 CiI0d,..;11-.:,10:Z,I, A: f ii.r.-J. f. ,,, A 11,1,?1.?....e! • . v..'..- .:2'e' il 1 d,•:-.., -.5..17, _ ... ___._,_......, . ____ _ 1 - CO liN 10 r_,A,P4R1,1,11.:41,,44:4 ----- -.-...,-- *-- r 1;.°:7,i , ,, -.1', • i , '..;.I i -of:Pz•;.:,::n-,...r::1,7,--,,. I:.,'A t.-21:.1:!,--:??...1 t ' . 1 1 1 • • 1 I 71 li a i • 1 e•N::.) N AV,E5 i 9 it.'0-4-kiir--.10-v?'!Ill PC1111 1 . _,. I l• • - , - 47 ' 1 • ) , r ILI ' • . ! . . . ! .. •______ - - - - P Ir. ' . : . ! I -- _.,., ---------- -.-....-- -. II_ .. i_ 1-Jrant;R:40:11t th gig::i-Illni.::, i'l 27 qtfer:-.A , .2 Builifj -`i 0,!,n.n.ir Or. NE 1ill A.?,ert i.7".0; .'7:: .i'lii,CO-iTc.if..ii,C1vT, .. .4. 211:„.:-.5 5 if,.`.:-TiViNs, Dr, //,10-,..714.,c44, R;1;4f-40 I:ir.4prigr,ga,,CA 917,:let , . . . • 1 . Olortienul , Olt 11 76;4; '. f.(I 0 0;1 0x1-;',.).44;ii - '''-7"-.'------ - ------‘.--r----- - r'2, 'LV q;?.14!CA&*4-flEr-plitvatleiCAD-7,-4 I .5..,,.y...1. .4,..e,e,..--#,:i!..1 r.i!_i_i• jr Lip/!Lire'54 4.i'.....-!.(4-4-,...;4 W!,-4-1.0"..--•!!,14.1 i.!4,1:.*.!"iirttNI rOrW,arel al Ll...”_.A.P. L.,,,i.,,,:l iii.....t,,:.....,..,,r.I.,:,„xl(,,,I,„:,,o..4,,,0 7,4...m.ft,1.,,zi,jcw ,1_7-,... k. f.. -,..n.-„I -,-)i,-, fa NAs_,:_k.N t.‘kiy=-.0..?.1:LICK rit_2•,.,&?..,,..f.,.,-.1.4.4. 3.ik..--rs!7."r_t•,.-.0!„,'1.,".•**"..1"."-:_,/fi'.fri Pre-Jr), . .1,;•--),„ 4 r41-,r1,4,7,d Mrdtli143:I 4.,:311fk94i .:17.'''74.14.4 T 41w-A,Ts:tNi le...-52,krA .,,,,444ANzift:1-14,--'d.:::---wi I r.,71 "P r4iC.-.r°144:1i1 .....---.....__ .......14296020MIRCIIM, 014 jilit;, -tey ....v i - •.64.1v1,0.0 -fr-4-...' "z__,...,„___ ________ _ ___,___.1____ Es-•; ,_.10 k.,- 4.,-t-s.L__________16ALT1t1 ' tv:rrp41,-0. . _ __ __ . ,,, _ •___________., 1z'ffr•-s-fi....;cif r,-,„-:f'.re+.7,21c.i......)fl.'IX'•-::::--1.h;'-e'12'19.1 Nim'.k-t,',5.:4 I).-1., •: - - -- _ ;IX 4 qv 5.i-_•.;.vilw Ik-171-...4-kr..1f/0-7.i v4-_-.igl IA(.-Miuti-A. . --`-"`" " `""'`---- —..e • '— . — 00. v•_,•01,7--‘)rici.;+;'1'......1x.,-,4 az 'or-7.49F_ ii led_ p,._,.... ..v.,,Lte,_ _______.............._.......±... ,, ,i le .__..____. .,, ,.....,,L112'til-- ,j-jr - ' -- .' ilFa>94i_wt.. wk.,-,thaegir". • _..i....--- _1. lir_0 MI ''4it :-1,-74...q.1.-31,•;!•:,nrc.,-...,f....;*li krei Ycilikl+ rialo I! • . _ _ , , -•:-,,-c....:.:,-,;,......,-- _ ___, _. . _ . ' i :(c.if..lo-61--;.-1•h:,-'1L'r-i-r-6' 1 __I ,-.141-ity ii- ..o4.4,4 i._.,i heti sipoic... I.1!i4ii IVe.c.Vi I • ...........,-. . - ---IIMIli•BN I'llittik_rf0 ... •_ ...._. _ 5,1774,24,,,,Le tkr..enat I.pH*"rpt:firer-Vol --,.....1, I- - - - 14144.-.9 Likirwoiliel Miltrad QM*':111-..OOP ir,ait*Gla witIt,rhartef41;ilkOla..011K10141'10/10.40 _. ,i ..T _ , , ............„_ _ ._.,__ , ':.01.4.0110-01"_1/41, - •- - .7,,,,,,,,,,,,,,..i....i,";,,r,-,,,....a.6,.....i ...:,:k.... -- - ' 4............... - 1 r„,..........,.,......7-....•.•••• t --........ --- --. _6 - ... - SiliWIMMile ki Ili ill 400+11041011611.441 . ti:11 Ciskym-ita 1444 Oar*.:f 1.4.4rAr.tarlfto061 41 orP 0.0 P.A.th*._....L ._.,..• .i. .__,.... ..,__,.„,m.. .,---...----,........ Winiallitai4 __. • ..,,...,., . • .,. _ • • '''"'"n" 'L'-/------E,-• , Xii .gcge ' 1)4 ficir.""-N144 ari ktigillyt-1 I 6- .:, • , : : .' '=DiletaliVattiRACIM TO litPO4:,.ipitiliriliFia SYSilit ... . . • . , _.-- . . . . . . r 11 • • South Coast Air.Quality ManageMont District .'llll:.,Crt:4..Uiy��,ri1lIiirtitcl P t,rd,r1.i•1i':.I so) l fume ID mtli aluq`;-tr1lh,,r riu•om.Su ii 1911•L3.1t, 107976 647156 Rule 1403 Notification of Eiuer!Jency PrOC(ittuie 1 Asbestos.Removal • Fksn_rho ebb"e coot' `1t95 rdluirm,,.11)6•.it OK":;ob 5 te,,Ili itrr1171i v)31.UT h:ylcr- • Proj E et•TyW e . PrDif_t'I-i;CC A!13(5t05 Removal •Pn,Jcct'Jigcrf,;y 'Emergency i:...1,nLlott 3;19/?0$12739:60PM C._irvict�d c. M flit:inhaeun Pithil.Ni14ib11' (909)989-3444 Lw=el anion k•.;.ugltiinc.cn i Contractstr In1i rit'rado i Cori atop rdiirne AQHI,INCORPORATED IUlclr:i.iii 4513 LOAM ESS CENTER DR City RANCHO CUCAMONL(A Slot.! CA . Z,D 9].730 CSLIi LictiF1; c 715954 r iA REG 0 632 _` ,F:r"L-iao; Y 1 Eddie Castillo Phone (909)208.1384 Site Information Sirs K.rn' Elanle Wang P:oje_8 SIGH 5%re ..a 41 B 5iroot Nome 'Nf WIN ICE WAY Crp';,,S'rut Site Cc ity OP,. ARCADIA State CA Z,r, 01007 Corti:c,None El.mie Wang ant-act Phone (626)616.813.82 Sip_0iNne. Einnllr Wang C°xna I tidre 1 418 W WLNNIIE WAY City ARCADIA State CA Yip 91007 Fro;oaSL:rtDate 3/22/2021 Prt.Ji!A End Dale 3/2612021 Pn*.ct%Yuri' 1ti t1i) Clay F3;ildrl1 Size in 5;t.lt 3445 N.rnbcr of Fiiy r, 1 Holding Ave(4 i r5) 52 Number of Bu dingiCwellirg Units 1 Rtildirg Prior Use House &must05 Sui', Yea Asbestos I incd Yes Asbeac6 Rernoved No Butding to W Dernolix.ed No Dtt;;Criw ViroTic acoustic ailing removal DEIcrlL Wade Location Throughout resldan's Project information Asbestos Inform ittdon Amount of Asbcatos in each type Ie 501 Ft Ai ou :Cr:Ibiiq Imo,Linoleum I 0 vl rr twon 0 .•Fire Proofing 0 Ducting 0 Dry Wall I . 0 : 'rHHEPA Vacuum aoltet wipe 0- ' 1!Mastic(Non-4rli3tle) 0 t$ . r ,yc.. ir, C - City of Arcadia *;13ttildingi al 240 West . I.uatti gton Drive,Arcadia CA. 91 OO7 Office: (626) 574-5416 Fax: (626) 44?-9 73 When the permit air) ication and the Owner Builder Declaration have been executed by a person other than the prciptlry owner,prior to issuing the permit, the following shall be completed by the property owner and returned to the agency responsible for,issuing the permit: AUTIIORIZ;CION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Not&.c Property Owner,.the execution of which I understand is my,personal responsibility I he etty authorize the following person(s) to act as my agent(s)to apply for, sign, and file the docum. its necessary,to obtain an Owner-Builder Permit for my project. I.declare under per silty of perjury that I am the property owner for the address listed above, and T personally filled o,the above information and cert fy its accuracy.. Property Own Date; Owner's mature. `' �" Property Addres 4t., I g` („). .< € el:. }r Ct)- /00 7 Owner s Name. ' �.., ... 0 4! owner's Address "'t �t • ivy) '" .;���� +��. ; t � `. �" Phone Agent's Name; &I- ` Agent's Addressrx, Agent's Phone , ) t . Scope of Work NOTE: This hto ization must be NOTARIZED or accoir pannied by a copy of the ner's current photo.LB, (i.e., driver's license, passport or military 1,D. with s .°,i ttire),when presented for issuance of a perin.it.: OF ARC *1 op.ivokv4,96 ,~ wiliime 7 PERMIT/PLAN REVIEW APPLICATION e •9T�+;ti - Development Services Department,240 West Huntington Drive,Post Office Box 60021 o@munity oS N'4.e Arcadia, CA 91066-6021, (626)574-5416,Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION pI 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, d my license is in full force and effect. �l ) l ❑ I have and will maintain a certificate of consent to self insure for workers' License Class License No. 0 p}���Exp. Date'i'/5�/>'3 compensation, as provided for by Section 3700 of the Labor Code, for the / performance of the work for which this permit is issued. Signature of Contractor OWNER-BUILDER DELL O ❑ I have and will maintain workers'compensation insurance,as required by Section CI hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers''compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed if the 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 r Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwitmpl 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 lDate5/ /v 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 attomey's fees.El I,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 Cityi 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. 1 ^ J .-C.o ' ( 1 f�l/ 'ame Title lr • PRINT AME 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 agentof the owner. I agree to comply with all City ordinanc L a i i State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter upon the above-mentio'•d i operty for inspection purposes. Si/nature _, Date 1/I