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HomeMy WebLinkAboutB00-049-441 r 1 � Development Services Department
I Ni 240 West Huntington Drive,Post Office Box 60021
%' Arcadia, CA 91066-6021
�'' ' ' 'PERMIT NO BOO-049-441 -
City of (626)574-5416,Fax(626)447-9173 w - •
Arcadia ':Permit Type:. Comm.
TRACT NO. LOT NO. APPLICATION DATE ISSUED BY ! PRINT DATE PERMIT STATUS
0001 3/2/2015 CM 11:33 11/6/2015 Issued
ADDRESS NO. Dir.Prefix.. Street Name Street.Suffix. UNIT BLG ASSESSORS PARCEL NO. GEO CODE-130 S First Ave 5773-017-039
OWNER • ' MAILING ADDRESS
Sun's Residential Development,L1c PHONE NO. Plan Chk#: 15-128
EMAIL ADDRESS:
Plant?: 31780
APPLICANT MAILING ADDRESS
Charles Lei
School Dist#: 518
PHONE NO. (626)841-3562
EMAIL ADDRESS:
f
CONTRACTOR/PROFESSIONAL. . „MAILING ADDRESS .. .. - •
(626 NO. 841-3562 FAX NO.
Charles Lei 910 Las Rosas Dr PHONE
West Covina,CA 91791 EMAIL ADDRESS:
License No. 964401 Type: B Expires: 8/31/2015 12:00:
TENANT ._ MAILING ADDRESS "
PHONE NO. FAX NO.
DESCRIPTION Corn New -
NEW OFFICE BUILDING
Construction Type UOM 8 of Units Value Construction Type UOM S of Units Value
Air Conditioning Comm sq ft 3,955.00 $21,159.25
Office V N sq ft 3,955.00 $342,938.05
Sprinkler System sq ft 3,955.00 $13,091.05
• ' CONN E TED
OCCUPANCY: Offices TOTAL VALUATION: $377,189.00
QTY UOM DESC - AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 2,042.43 2,042.43 01-3103 1.00 each Kitchen sinks 12.46 12.46 01-3105
PC Cal Green 204.24 204.24 01-3103 1.00 each Wtr htr/vent 15.55 15.55 01-3105
PC ADA 306.36 306.36 01-3103 74.00 each Outlets 82.00 82.00 01-3105
each Energy p/c fee 691.28 691.28 01-3103 80.00 each Ltg fixtures 88.00 88.00 01-3105
200.00 Cubic yarc Grading P/C 250.00 250.00 01-3103 Fire plan check 306.36 306.36 01-3109
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 200.00 Cubic yarc Grading fee 250.00 250.00 01-3111
each 'Bldg permit) 3,142.20 3,142.20 01-3104 1.00' Flat Grading iss fee 44.35 44.35 01-3111
Bldg Issue ADA 314.22 314.22 01-3104 SMIP Corn 105.61 105.61 14-2207
1.00 flat Alec issue? 44.35 44.35 01-3105 3,955.00 sq ft general office 10,124.80 10,124.80 156-3116
1.00 Flat 2Mech-issue' 44.35 44.35 01-3105 gin bldg std 16.00 16.00 714-2203
1.00 Flat t Imbg issuan 44.35 44.35 01-3105 1.00 Flat SWMF 2 1.00 1.00 88-3027
3.00 each Fum<100,000btu 56.22 56.22 01-3105 1.00 Flat SWMF 2 1.00 1.00 88-3027
1.00 Flat Corn sv 200-1000 62.13 62.13 01-3105 1.00 Flat SWMF 2 1.00 1.00 88-3027
3.00 each Comp 3 hp 56.22 56.22 01-3105 1.00 Flat SWMF 2 1.00 1.00 88-3027
5.00 each Water Closet 62.30 62.30 01-3105 1.00 Flat SWMF Auto 6.25 6.25 88-3027
1.00 each Distrib panel 15.55 15.55 01-3105
5.00 each Lavatories 62.30 62.30 01-3105
Total Fees: $18,498.23 Balance Due: $0.00 Paid Today: $12,140.12
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 111039
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3104 943.33
the date of plan submittal.This permit expires and becomes null and void if any work authorized byl this permit 01-3105 645.78
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 01-3111 294.35
Arcadia building inspector for a period of 180 consecutive days. 14-2207105.616
6 10,124.80
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS 714-2203 16.00
1 88-3027 10.25
Requests for inspection should be made at least Monday-Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp. /30 S` MST r5t 74'44I
100. Setbacks 210. Under ft./bldg.drain b-'; & ddd 1
101. Rough grade 211. Copper underslab t
102. Figs.&forms 1 212. Rough plumbing T13(7 � /2- i� ^D; Dept) p�
103. Pre-slab ' '(( l0�`l 213. Rough gas l-� (ILA.
104. Floor joists 214. Shower pan 2 4.-lb r {. egg- LtP O 1
105. Steel 215. Water heater CM IA WAIL Ateag Moatiazir
106.7 Grout lift 216.7 Roof drains f __r' u`,a
107. Shear nailing / �17. Building sewer `� N
108. Diaph nailing (Q-Z1 Lb - 218. Water service _ _ __ �7-(� (y� -r U� /r �K
109. Roof nailing ji-�& A 219. Final gas vK-v1 j A� _'
110. Framing 7�l3-r 7 220. Fixtures W�,rL A"�61ier v�'n� tl
111. 0cc./Area Sept.Wall 221. Final plumbing 7-1S'�1 d'y� • '{7�p -C LLB( , t
112. Sound walls 222. Sewer cap/demo. Q !! {,
113. T-bar•rid 44 `46 3 l/ LIFT CPU
114. Insulation-Flr. Pool Inspections Date . Insp. WAILA p f®u/f grety
115. Insulation Wall q LTf in 240. Excavation/steel .PROPelakr L W& 414
116. Insulation-Ceil. 241. Rough plumbing
117. Drywall nailing 1 242. Light shell/bonding It- -L .4I- eazOIAT OPT of C,i-G(4
118. Interior lath 243. Underground conduit RAi�f y,-\
119. Exterior lath (1 30-17 N 244. P-trap ©''�
120. Finish grade 245. Gas line&test (D-31-46 l i iiL- D iL * '[ '1
121. Final building ?t 2-4 246. Fence,gates&signs 6124 1 cf emu WAIL .ti
122. Final demo/lot clear 247. Pool heater Lt F C' /ter,
248. Final electric I I.,Pk/ $IXtr1 &eou 1- V
LI f T 67
Electrical Inspections Date _ Insp. 249. Final slumbin• •150. Power pole ' -I.- 4 250. Pool cover Fmk,
_ �
b2
151. Sales lot lighting 251. Pool final I l t, ttt r-o"T OPT or 0-0IA
152. Underground conduit vo y,Q ! ,
153. Underslab conduit `\ Reroof Inspections Date I Insp. f vV Q Vv
154. UFER ground q-I¢-( _ , , . 270. Pre-reroof insp. 4'Z1-ZI SLDTi OF kl Fae Ai 'r
155. Water ground 271. Roof framing 1. tt t& 4k t�n � 4 (l'I
156. Rough electrical 7�-(3-4 7 r 272. Sheathing nailing i��_• [/� `t V
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E.it.bondin4 Sign Inspections I Date I Insp.
160. Service panel C40W '..4 'II T 280. Setback/overhang
161. Final electric 7 4, 1. 281. Footing
282. Conduit/wirins
Mechanical Inspections Date Insp. . 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC - ..I 4L Miscellaneous Insp. I 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 Sewers&Offsite Insp. I Date I Insp.
191. Final mechanical 7'i,2 n 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Cesssool filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
„. li Development Services Department
Q M ', 240 West Huntington Drive,Post Office Box 60021 PERMIT NO.
"% Arcadia,CA 91066-6021 BOO-055-308
�
City of (626) 574-5416,Fax(626)447-9173
ArcadiaPermit Type: Electrical
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
0001 11/8/2016 CM 1 13:44 11/8/2016 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE .
130 S First Ave 5773-017-039
OWNER MAILING ADDRESS
Sun's Residential Development, Llc PHONE NO.
EMAIL ADDRESS:
APPLICANT MAIUNG ADDRESS
Charles Lei PHONE NO.
EMAIL ADDRESS:
e
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
NO.
Charles Lei 910 Las Rosas Dr PHONE (626) 841-3562 FAX NO.
West Covina,CA 91791 EMAIL ADDRESS:
License No. 964401 Type: B Expires: 8/31/2017 12:00:
TENANT MAIUNG ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
T.P.P.
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
OCCUPANCY: TOTAL VALUATION: $0.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
1.00 flat Elec Issue Auto 44.35 44.35 01-3105 Z- - t
1.00 each Temp power/cons 31.05 31.05 01-3105 II
p ] ' J
1.00 each SWMF 2 Auto 1.00 1.00 88-3027 f� eA 5� -r—d(k/ �r W
[r�fvS � - l,{�'J(�'al "`III��- ___
co:
COpLETED
Total Fees: $76.40 Balance Due: $0.00 Paid Today: $76.40
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 114923
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 18d days from 01-3105 - 75.40
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00
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.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
.>?~'. Development Services Department
;�
l3 f 240 West Huntington Drive,Post Office Box 60021 PERMIT NO.
BOO-056-181
':✓ Arcadia,CA 91066-6021
City of (626) 574-5416,Fax(626)447-9173 Permit Type: Fire
Arcadia
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
I
0001 3/6/2017 CM ' 12:13 3/14/2017 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
130 S First Ave 5773-017-039
OWNER MAILING ADDRESS
Suns Residential Development,Llc PHoNE NO. Plan Chk#: 17-61
EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Electronic Alarm Research Lab PHONE NO.
EMAIL ADDRESS:
CONTRACTORIPROFESSIONAL MAILING ADDRESS
Electronic Alarm Research Lab 4700 Miller Drive#B5 PHONE No. (626)374-2502 FAX NO.
Temple City, CA 91780 EMAIL ADDRESS:
License No. 477555 Type: C Expires: 8/31/2017 12:00:
TENANT MAILING ADDRESS •
PHONE NO. FAX NO.
DESCRIPTION
ASCENDING EAGLE OFFICE FIRE DEVICES 18 DEVICES
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
Value Value 3,500.00 $3,500.00
•
OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $3,500.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
18.00 each fire alarm pc 2 700.00 700.00 01-3109
1.00 Flat Fire Issue Auto 44.35 44.35 01-3112
each Fire Permit 137.05 137.05 01-3112
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
12 C13IVZPLETD
Total Fees: $882.40 Balance Due: $0.00 Paid Today: $182.40
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 116050
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3112 181.40
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00
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. j
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. , 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Friday')
1
t aTzt., Development Services Department
240 West Huntington Drive,Post Office Box 60021
` BOO-055-689
Arcadia, CA 91066-6021 PERMIT NO
City of (626) 574-5416,Fax(626)447-9173
Arcadia Permit type:' Fire
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
0001 12/22/2016 CM 13:49 2/16/2017 Issued
ADDRESS NO. Dlr.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
130 S First Ave 5773-017-039
OWNER MAILING ADDRESS
Sun's Residential Development,Llc PHONE NO. Plan Chk#: 16-575
EMAIL ADDRESS:
APPLICANT • -MAILING ADDRESS
M B B Fire Protection PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL. _ MAILING.ADDRESS
323 NO.
M B B Fire Protection 4615 Abner Street PHONE (323)223-7794 FAX NO.
Los Angeles,CA 90032 EMAIL ADDRESS:
License No. 906926 Type: C-16 Expires: 11/30/2017 12:0(
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION..
FIRE SPRINKS 59 HEADS
Construction Type UOM #of Units Value Construction Type UOM N of Units Value
Value Value 20,000.00 $20,000.00
OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $20,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
59.00 each sprinkler pck 637.00 637.00 01-3109
1.00 Flat Fire Issue Auto 44.35 44.35 01-3112
each Fire Permit 404.25 404.25 01-3112
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
COPLETDr
Total Fees: $1,086.60 Balance Duc: $0.00 Paid Today: $449.60
This permit/plan review expires bytime limitation and becomes null and void if the work authorized bythe
P P P Receipt#: 115844
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3112 448.60
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00
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.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
i
I
;:14i ��. City of Arcadia, CA " ; PerrnitNo.SIGN 2070555
Development Services Department ' it=tire Permit'T a Sign
240 West Huntington Drive,Post Office Box 60021 ).
Work Classification:Sign-Illuminated,,.
Arcadia,CA 91066-6021 ,._J ' 1 ,-I
A ) g
(626)574-5416 + y , „,, •Permlt Stti,tus Issued
ARCADIA Issue Date:04/22/2020 1 Expiration: 10/12/2020
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
130 S First AVE Arcadia,CA 91006-3605 5773017039
•
Contacts
SUNS RESIDENTIAL DEVELOPMENT LLC Owner SIGNFASTIC Contractor
308 FIRST AVE F,ARCADIA,CA 91006 287 N Mountain AVE,Upland,CA 91786
(626)321-2429 JASONZHANG@GMAIL.COM 1050070
Description:NEW WALL SIGN FOR JOY REALTY Valuation: $ 3,800.00 Tenant JOY REALTY
Total Sq Feet: 0.00 Plan Check# Plan#
.. �•::-tea. wimmnma
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $484.98
Building Permit Fees $137.05 Cash/Receipt#REC-08509-21 $161.66
Electrical Permit Issuance Fee $47.01 Cash/Receipt#REC-04320-20 $323.32
Renewal Fee $161.66
Sign Connection $16.48
Amount Due: $0.00
Sign Plan Review $68.52 ''
Solid Waste Management Fee $6.25
Solid Waste Management Fee 2 $1.00
Total: $484.98
Q— 2 ( CALLS FOR INSPECTIONS
U �'�� 1 Request for inspection by telephone:at 626-574-5450. Leave a message
��L p� � I requesting the address,timeframe and what inspection item is needed.
fl (1,
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.
n
CORRETED
April 22, 2020
Issued By: Date
August 16,2021 , Page 1 of 1.
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All design text,graphics,selection end arrangements thereof F 2020 D8D Signs.L.L C.D B A I.ucky Sign 7.ALL RIGHTS RESERVED.Any use of this design(Including reproduction•modification.distribution republication)Without the prior written permission Ir. SD Signs L.L C. .E uchy Sign a,is stnclly prohibited.
Client Joy Realty
' •
Site Address 130 S 1st Ave.Arcadia a
� � Client Approval Date I /�j ��' •
www.luckySign•co (((
283 N Mountain Ave.,Upland,CA 91786
909-982-7446 Landlord Approval �?9;re
Rep.
Pt ST PSOi DAREA—rs ggvSirier._ Date I/26(7,0
•
•
ism.. .- N r � ••=1,! ", - ,1rt ' Property Owner:626.321.2427
rr. ;, � •r - � n � 4..�]QR�-p.. r•.� � � :�'. °E.a .a. rq�" .. � "�: n,r ••
P ., @. ;;Ft.------y u.. - F 1 c ? :7 1 y, I: • ' . T•l.• '•V �-r 1 .J, fir" Sun Residential Development LLC
M P't`ama i.ducaUo a *,F. . a' ,. $ '-
•
I 1 �� �; I i- +•; I a b] + 308 South 1st Ave,Suite F
_ sy, .3 ." i�:- ► a o s.ln el Arcadia,CA 91006
•c r hoccalat Day Naar,-1 ; t,+ a i l' fry ;y . , f
1 + I � :2i J� '� a ' .._.-.i,( 1 t�;e.1 , A (; ' ,, - Tenant:SAME AS OWNER
;, 11] - r p� `` $ •I t t i` !` ' , ,- —r r—ar I 1 - 130 South 1st Ave,
d l °� r, IF�.° m� ,. A. t" -cam Arcadia,CA 91006 •
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J;r ° r f�..; , ^ �, I. ti�f ti (4� .i.ii - i ..;r ;, � Legal Description:
' R ! + ( ! a , i ) -•. E ' P M 401-58-59 LOT 1
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`" -"-All design.text.graphics.selection-and an a noenients the real i'2020 DAD Signs L.L.C..D.B.A.Lucky Sign 7 ALL RIGHTS RESERVED.Any use of this design(iaci iding repkoduction,modification dshibelien,epuhlicationi witiwut Um prim Britten permission .. AD Signs LI.C.J. . Lucky Sign?-is stnetij vi-oll biied —
JoyRealty
" & Client ,93:
coo, .
Y / aAl' Site Address 130 S 1st Ave,Arcadia.CA
www.LuckySign.co Client Approval Date
0
283 N Mountain Ave.,Upland,CA 91786 edgit Re a
909-992-1446 Landlord Approval PLEASE USE ANY STAMPS ON DESIGNATED AREA ■r®�,,Wn.,'„ef., . Date
444``. F nvy9 i
O
f4.#.t r i
c`0.pa,,,aive� PLANNING SERVICES
ATTENTION: DATE: c- 6 - 2.0
FROM: BUILDING SERVICES INSPECTOR: Jeff-
,
PROPERTY ADDRESS:
PERMIT#: 010 'o4' a4 I PLAN#: 3 L 7 o
CONTRACTOR: C,OAIZI. L PHONE#: •62-6 ' g41-3J6Z
OWNER: SUA 45IT iI1+1 (4t, J Lt PHONE#:
PLEASE INSPECT THE FOLLOWING ITEMS FOR COMFORMANCE WITH APPLICABLE PLANNING
REQUIREMENTS.
TYPE OF INSPECTION DATE& INITIAL DATE &INITIAL FINAL
APPROVAL
LANSCAPING/IRRIGATION 6,zsTLV
TRASH ENCLOSURES
PARKING/DRIVEWAYS
STORAGE AREAS
MECHANICAL EQUIPMENT
. /
WALL HEIGHT
BACKFLOW SCREENING % 2_s-i( -us,
COMMENTS:
1
4wFF9
Co\y os�
MEMORANDUM
Fire Department
DATE: August 19, 2021
TO: BUILDING DEPARTMENT
INSPECTOR Jeff Wang
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 130 S. First Avenue
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE./ INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 11-12-2019 Jill Perumean
FIRE ALARMS 2-11-2020 Jill Perumean
HOOD & DUCT
KNOX BOX
OCCUPANCY 8-19-2021 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 8-19-2021 Rita
I
f R
' :: 1 "1111191.1:1TAI : i . : : . : :. . : .. : : : ' , ' . ' : : - 1 : -
1.
. - .ems . ' .
WATER DIVISION
ATTENTION: . . E i i C DATE: :, 6--.Z0
FROM: BUILDING DIVISION INSPECTOR:
ADDRESS l J 1,:> S fsr: -`
PERMIT
PLAN NO -3 1 7 :
NO.: �6 0~ v�� � ' I .
CONTRACTOR::_ "Ci.fi L J_ .LE j PHONE NO::: 6 2.b 7. 84 _ e:Z'
OWNER: : . cv'(,(fJ( . riArL V PHONE NO.:. : . • . -
PLEASE INSPECT THE FOLLOWING ITEMS.FOR CONFORMANCE WITH APPLICABLE DEPARTMENT:
• OF PUBLIC WORKS - -
Type of Inspection . : Date&:Initial Date& Initial final•ApProVal '
Meter Location: :- . •
Blacktlow Devices - "
i� a .
t5/ : •a0
Irrigation System -
a� a0
5(\k /ago S (l as
Fire Sprinkler System :
Meter:Clear A,P.P. ':. .. . . •.
Swimming Pool 4
.
COMMENTS: "ire. IDa :c.k : L' f. DL :.L4 AME5 3OO 55 .(19501-DD)
yp�x ( 9: a OD Zbk .1,0-14i:.;) / NeP4,. 37.\ a: R-bOn o
1
r\r�t:lP r W..; vl� .c\ ~ice h2 t c v5 :
4.
6241-2,01
,<#
•�'trn1tY oI9� ..
City of Arcadia:
DEVELOPMENT SERVICES DEPARTMENT
Inter-Departmental
Inspection Re uest
Date
:
Public Works Inspector
To;
. From:'
Address: / O S. FIEST 07.i' Permit No.: . 113 06,0�q -
4l
Contractot: C.441ssELGSr��_
L 2 Phone No.:
Owner egr* - IA
o e No::
Please inspect the following items to ensure that the Contractor/Developer is in compliance with all conditions of
approval established;for the project,:and that the work performed meets.the City's standard for Public Works
construction:
Type.of Inspection Date& Initial Date_&Initial Final Approval
Drainage.
cs
Grading :.
G
Erosion Control
Offsite Impo rve
P m ents
Street Im rovement s
P
(conduit, curb/curb c4z. -
gutter,-curb numbers,
driveway approach,.
parkway planting,
sidewalk, street light,
traffic flow, etc,).
Sewers) :.
(lateral,grease/san � .
interceptor, saddle,Wye,
etc:) :. .
COMMENTS:
Rev.I/12/11
y"b:
4, CITY OF ARCADIA
r - 240 West Huntington Drive
' Arcadia,CA 91007 '
ATTENTION: Community Development Administrator
SUBJECT: Grading Verification for Project No. PM 72892
Address: 130 S. 1st AVENUE
Gentlemen:
Finish grading operations have been completed for Project No. PM72892
for Lots 1 _ through (if applicable) and has been
inspected by the undersigned Registered Civil Engineer or Licensed Architect.
Based upon the observations, the grading subsequent to the Rough Grading has been
completed in accordance with the approved plans and specifications and is in
substantial conformance with the final.grading plan approved by the City and no
unauthorized deviations were made. .
All required surface drainage.devices have been installed. Provisions have been made
for drainage of surface waters around proposed buildings and their appurtenances.
Engineer(Signature) Architect(Signature)
R.C.E. No. 34587 R.P.A. No.
Date: /2/26/2©l 7 .
Received and approved:
Date: 5—/Z2(
C. D. Planning
cc. C.D.D./Maint.Ser.
C.D,D./Building
or 3 IC 1
r.f.16ro. 3•$'587
"!---k,eXr`.-#30/.2/
\s: ciVIV
w .'H 10/09/08
i
•
130 Office Building,:130First Ave,:Arcadia, CA 91006 " - -
Projecf Information: .
- : ."Project Name:: 130 Office Building ` ' .. ..
• - , .. Project Status:
Tracking# GH900-486 9615
Created ' '
•
- _ AddressFirst Ave,tCA. 4. _
Permit#:• "� ..
Submitted
'Tract Number: NIA
Stait Date: 11/18/16
Approved* " •
End Date:. 04/17/19 _ ® -
- Proect Type New,Construction. - •
.. . � :.Building Types' .OMce - , . .. . . . . .. .. ..
Tickets Uploaded(16)
0
- 'Construction Type:, N/A .. • .. .. ..
Submitted For Final' . .
Project Value:'$800,000 " O
•
. . Square Feet:. 4,850. • Completed "
Description File: N/A ' ' "" "
Project Description: Demolish:existing one-story office building to be replaced by a new two-story office building.Construction waste management plan for demo/new . -
Selected Project Managers .
•
Name. Position Email Phone Cell
- 1. ClarksLel , Manager cklei333famail.coat -
Account Holder Info .
__.Position -Company Emell Phone .. -
- . Charles Lel Manager Chares Lei ckle1333@
gmail.com 1 g. . . @gmall.com- .� 626.841-3562 �.
•
•
•
•
•
3. .
•
Robert C. Ferrante
SANITATION DISTRICTS OF LOS ANGELES COUNTY Chief Engineer and General Manager
1955 Workman Mill Road,Whittier,CA 90601-1400
Mailing Address:P.O.Box 4998,Whittier,CA 90607-4998
Converting Waste Into Resources ! (562)699-7411 •www.lacsd.org
Counter Hours: 7:00 a.m.-4:00 p.m.Mon.-Thurs.
7:00 a.m.-3:00 p.m.Fri. Application No.: 5773017089-002
SEWERAGE SYSTEM CONNECTION FEE RECEIPT Date: June 2,2020
•
APN:5773 017 089 District No.: 15
Owner/Situs Address • Applicant Information
LC SUNS RESIDENTIAL DEVELOPMENT L Sun's Residential Development LLC-Office building
130 1ST AVE Jason Zhang
ARCADIA,CA 91006 130 S 1st Ave
Arcadia,CA 91006
Facility Type Measure of Use Unit Rate Amount
Office Building D 8,415.00 1000 Sq.Ft.
Office Building N 3,955.00 1000 Sq.Ft. $3,200.00/1000 Sq.Ft. $12,656.00
130 1ST AVE,ARCADIA
Base Line Credit 3.01 CUs $4,210.00/CUs ($12,656.00)
Connection Fee Due S0.00
Type Abbreviations
N-New or Additional;C-Change of Existing;E-Existing to Remain;D-Demolition of Existing;T-Tenn!Improvement of Existing;S-Septic to Sewer
Includes demolition of 8,415.00 1000 Sq.Ft.of existing Office Building
Processor:Elizabeth Padilla Approver:Erika Ballesteros
SAtdTATi!ON DISTRICTS
D.C.: • I OF LOS NNGEIIS COUNTY
Th JAPPROVED
Payment Received Check No Anul
ROBERTME
Jason Zhang $0.00 CHIEF EttllallC.FER R GEN.MGR.
Valid Only When Stamped
THIS IS NOT A CONNECTION PERMIT.
A CONNECTION PERMIT IS REQUIRED BEFORE CONNECTING TO ANY SEWER.
DOC#5748116
---_ _
faeigv. Li '
ilv CITY OF ARCADIA
• ® • WATER EFFICIENT LANDSCAPING DOCUMENTATION PACKAGE
CERTIFICATE OF COMPLETION
This certificate is to be filled out by the project applicant and the property owner upon completion of
the landscaping project.
Project Information i
Date of Project Completion Permit Type and No.
66,0 ^v41.--yy/
Project Address
/30 9. f/Rs'i A-t' - , A-RcA-Di.1 , ('fit- laz'
1 Name off�PProject Applicant and Tile Name of Property Ow r.
Company Name& Mailing Address Mailing Address
Gt/l/o,c17 C'M/Sbeal'r011)w 67Z-eeaw9(44/7 i 3 c g P u sr dr/e;
39413 2/?'vAir &cc'v .#0 e f}RG po-, e)/1--/'/ ,O/ i
l'/2tiiiur ev4 9' - c-7
Telephone an Fax No(s). Telephone and Fax No(s).
6,6 -lUl -3S- a 6z,— g -j_. 242--7
Email Address Email Address
• Ckt- 3g3 d6'f1,.-�, ee`�/ .—A50.72i-0i � Yr-MIL ,
Project Applicant - The signer of the landscape design plan, signer of the irrigation plan, the
licensed landscape contractor that installed the landscaping and irrigation, or a licensed
professional that performed periodic site observations to verify that the project is consistent with ,
the Water Efficient Landscaping Documentation Package for the project and that the project
complies with Ordinance No. 2267.
"I/we certify that based upon periodic site observations, the work has been
substantially completed in accordance with Ordinance No. 2267 and that the
landscape planting and irrigation installation conform with the criteria and
specifications of the approved Landscape and Irrigation Plans and Landscape
Documentation Package and acknowledge that the project may be subject to
inspection and a Landscape Water Audit to verify that the project is maintained in i
compliance with Ordinance No. 2267."
Signature /-�— Date-
Name (print) Telpph ne nd Fax No(s). ;
('k(,g12L i' 6r7 9 is f-3c
Title License No. or Certification No.
./4.47t/ ,) 8 /ci S 43 C o i
Company Email Address
A) i-lrsniL (20A47fr lfdil 2 i9LtialoxiaiJ tKL i»L ti/. 2 -,col
Mailing Address
I
Property Owner
"I/we certify that I/we have received copies of all the documents within the Water Efficient
Landscaping Documentation Package for our project and that it is my/our responsibility to see that
the project is maintained in accordance with the Landscape and Irrigation Maintenance Schedule
for the project and in compliance with Ordinance No. 2267, and I/we acknowledge that the project
may be subject to inspection and a Landscape Water Audit to verify that the project is being
m maintained in compliance with Ordinance No. 2267.
4.-H"L---1-4-4"
Property O ner(s)Signature(s) 9Date
t-,�_ -_ •
"AS-BUILT" GRADING PLAN - PARCEL MAP No. 72892
MAY 25,2021
.a
• ," N
NOTE:ALL EXISTING ONSITE IMPROVEMENTS TO BE REMOVED. .40O 4,.�'
11
tiYp GRAPHIC SCALE
I II SWIM AC. FAVEFENT I a M.T.>
II1 ImA-10 n
W I- - °'
n 1d III t. �, �'
w II 1 I , -
Q I I II,,,,, g EXISTING BUILDING I ` `\ ` 3 rk aR:A TF M avmAs
•
PIMPANT
T. 21 I'CJ II eT � xlI _� 1� Q E1Ev.tnao mom MEM COMM�avr>�
e>� NR9'5EMSE —1`S` F�'T9 , 1 195.OP , g,g � MTV,OF FIRE
a Ik''. i 4 , 1 , DFCONCRETE PAVE6
.>j,'vR —
0§ •"tp{f.(; > 'Q��� ...�j 4'DMnaOWPIE� zero
a'Pa,` �ca DRAW ALL ROOF WATER TO PAawrvowruaA ] _ .�A�.� ill �.$�> �y -a - .om'j.
s ell
// h f c PROPOSED amDWO 1 ti k ;' '�"° B� cd R.oxa
// �� Q -•. `1,'.`'` P AA.ACDRDw NARKAAY
P Can`` PAD = 470.3 T CIS ek
a �� $ ANGELUS PERMEABLE INTERLOCKING
=I R,,RC /� .3-0 'stfii i ig ;;rn► CONCRETE PAVEMENT
Afr iz "‘.. i , ..,\ ii ' htatig I ii.:,..1 S'' 4V,,q,
h T. 0. �� �° —.7- - i,
\\�>:— '.47 4` N64'S9'iPE �.x P ...,..,. `n i :. ' d -(.-:."2' 7, • ' "\IMP w
.,__
fl SDEwAU �— Q° ?;' tea �.:.:_`<�:' e ---- L 'N�
SIGN
w 1,-,-.„
.7.1 1 J • •
y ‘1,, 4i
4 mTAm GYRODERCURB Y M .—
I__ _ . BONITA . STREET
N aMSD'dIY E N ��
CONSTRUCTION NOTES DSD/ENGINEERING *INS IC)
000NSTRUCT NEW ORMAPPROACH m PER t- RAN FOR w APPROVED
0 CONSTRUCT CONCRETE PAVEMENT(SECDDxPE„S=REPORT) MAY 26 2021
0, AILPF>S�.wFPArTm-AEESEAA�CN-TWACONEDRDRNEwAr BY: 0
w1T ran-w cF AND t c sEGTrox FOR vuwNa EOr u1EA vOL REa-�s
O INSTAL..•G STWONPPETIODUGN CUM AS SKOWN 944uaYXaw VtIeAd'p.. i
C' M rA WTNN�MAGORER AIFP5E4 .EN A1=7 MID //
ALSO.ra1.VYEA5D REFUGE ANYDAMAGED OR DEFICIENT SIDEWALK FROMMTO Pit
Di REMOVEAND RECONSTRUCT CONCRETE MEW, m PansTDS. APN:5773-017-039
De NSTALLIznrwM EAND MINSITE ADDRESS:130 S.1st AVENUE
0 MULL NODUNPING TM DRAWS TO OCEAN'STENCIL trMA.MMMIM FEE, `
tt ' TOWED BM
,,NWGILBERT ENGINEERING COMPANY,INC.
i. ,
n >rxrn ) UST ROM OA II, UM NO
/A-4 M,EOP MC NM)
CITY OF ARCADIA
WATER EFFICIENT LANDSCAPING - ORDINANCE NO. 2330
LANDSCAPE DOCUMENTATION PACKAGE - SECTION A
PROJECT INFORMATION
Date:June 1, 2020
Project Name:Asendinq Eagle
Project Applicant:W Home Consturction & Development
Project Address and Location:130 S. First Ave.
Street Address Assessor Parcel Number
130 S. First Ave. 5573-017-039
Arcadia Tract/Parcel Map No.and Lot Number(s)
California 91006 Nearest Cross Street
Bonita Ave.
Project Type (Please check all that apply):
❑x New ❑ Rehabilitation ❑ Single-Family Residential
❑ Private ❑ Public ❑ Multiple-Family Residential
❑x Commercial/Industrial ❑ Mixed-Use
❑ Institutional (i.e., hospital, school, etc.) ❑ Other
Please fill in the information below to describe the landscape project:
Total landscaped area 363 (sq. feet)
Total turf area 0 (sq. feet)
Total non-turf area 363 (sq. feet)
Total active recreational areas 0 (sq. feet)
Total area of Special Landscaped Areas 0 (sq. feet)
Total irrigated landscape area 263 (sq. feet)
Total non-irrigated landscape area 1 00 (sq.feet)
Please check the Water Supplier for this project:
❑x City of Arcadia Water Services — 11800 Goldring Road,Arcadia, CA 91006 — (626)256-6650
❑ East Pasadena Water Company — 3725 Mountain View Ave., Pasadena, CA 91107 — (626) 793-6189
❑ Sunny Slope Water Company — 1040 El Campo Dr., Pasadena, CA 91107 — (626)568-4266
❑ California American Water — 2020 Huntington Drive, San Marino, CA 91108 — (831)646-3252
❑ Golden State Water Company — 110 E. Live Oak Avenue,Arcadia, CA 91006 — (626)446-1372
Acknowledgment:
I agree to comply with the requirements of the City of Arcadia Water Efficient Landscaping
Ordinance and submit a complete Landscape Documentation Package.
Applicant's Signature Date 6/5/2020
-3- December 1,2015
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 1 of 3)
Project Name: 130 S 1st Ave Enforcement Agency: Arcadia, Permit Number: BOO 049 441
City of
Dwelling Address: 130 S 1st Ave City: Arcadia Zip Code: 91006
(HVAC_Set1_1)
A.System Information
01 HVAC System Identification or Name HVAC_Set1_1
02 HVAC System Location or Area Served LOCATION 1
03 Verified Low Leakage Air-Handling Unit Credit from No,credit is not taken
NRCC-PRF-01-E
04 Duct System Compliance Category New
B. Duct Leakage Diagnostic Test-MCH-04a-Completely-New Duct System
01 Condenser Nominal Cooling Capacity(ton) •
02 Heating Capacity(kBtu/h) 60
03 Leakage Factor 0.06
04 Air Handling Unit Airflow(AHUAirflow)Determination Cooling system method
Method „ G
05 Calculated Target Allowable Duct Leakage(cfm5) 120
06 Actual Duct Leakage Rate from Leakage Test Measurement 92
(cfm25)
07 Compliance Statement: System passes leakage test
C.Additional Requirements for Compliance
01 System was tested in its normal operation condition.
02 All supply and return register boots sealed to the surrounding material.
03 Cloth backed rubber adhesive duct tape may not be used as the primary air sealing method for duct connections.
04 All connection points between the air handler and the supply and return plenums are completely sealed.
05 Verification Status: Pass-all applicable requirements are met
06 Correction Notes:
Registration Number: Registration Date/Time:2020-06-21 21:00:10 HERS Provider:CHEERS
PR0120-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:04:25
2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
•
Duct Leakage Diagnostic Test (Page 2 of 3)
C.Additional Requirements for Compliance
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D.Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
01 Complies:All specified verification protocol requirements on this document are met.
Sf
5
Registration Number: - Registration Date/Time:2020-06-21 21:00:10 HERS Provider:CHEERS
PR0120-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 ' Report Generated:2020-06-21 21:04:25
2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement ,
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation"ti Author Signature:
John Kwan .Tohn'K,wcm/
Company: Date Signed:
J.K.Balancing&Duct Testing 2020-06-21
Address: CEA/HERS Certification Identification(if applicable):
9040 Telstar Avenue#137
City/State/Zip: Phone:
El Monte CA 91731 626-274-0522
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
3. The installed features,materials,components,manufactured devices,,or.system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with'the applicable requirements in Reference Nonresidential Appendices NA1 and NA2,and the
requirements specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the Certificates)of Installation(NRCI),signed and submitted by the person(s)responsible for the
construction or installation conforms to the requirements specified'on,the,Certificate(s)of Compliance(NRCC)approved by the enforcement agency.
5. I will ensure that a registered copy of this Certificate of Verification shall be posted,or made available with the building permit(s)issued for the
building,and made available to the enforcement agency for all applicable"inspections.I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation,the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General contractor,or Builder/Owner)
Responsible Builder or Installer Name: `CSLB License:
HERS Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
J.K.Balancing&Duct Testing
Responsible Rater Name: Responsible Rater Signature:
John Kwan `Tohn,KwGm/
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
RCN13069 2020-06-21
•
NOTICE: This certificate has been generated by CHEERS using information uploaded by third parties not affiliated or related to
CHEERS. Therefore, CHEERS is not responsible for, and cannot guarantee, the accuracy or completeness of the information contained
in this certificate.
Registration Number: Registration Date/Time:2020-06-21 21:00:10 HERS Provider:CHEERS
PR0120-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:04:25 '
2016 Nonresidential Compliance Schema Version:rev 20180426 •
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 1 of 3)
Project Name: 130 S 1st Ave Enforcement Agency: Arcadia, Permit Number: BOO 049 441
City of
Dwelling Address: 130 S 1st Ave City: Arcadia Zip Code: 91006
(HVAC_Set1_2)
A.System Information
01 HVAC System Identification or Name HVAC_Set1_2
02 HVAC System Location or Area Served LOCATION 2
03 Verified Low Leakage Air-Handling Unit Credit from No,credit is not taken.
NRCC-PRF-01-E
iO4 Duct System Compliance Category New
B.Duct Leakage Diagnostic Test-MCH-04a-Completely New_Duct System
01 Condenser Nominal Cooling Capacity(ton)
h .
02 ` Heating Capacity(kBtu/h)
03 Leakage Factor F 0.06
04 Air Handling Unit Airflow(AHUAirflow)Determination Cooling system method
Method i
;;
05 Calculated Target Allowable Duct Leakage(cfm25) 48
06 Actual Duct Leakage Rate from Leakage Test Measurement 41
(cfm25)
07 Compliance Statement: System passes leakage test
C.Additional Requirements for Compliance
01 System was tested in its normal operation condition.
02 All supply and return register boots sealed to the surrounding material.
03 Cloth backed rubber adhesive duct tape may not be used as the primary air sealing method for duct connections.
04 All connection points between the air handler and the supply and return plenums are completely sealed.
05 Verification Status: Pass-all applicable requirements are met
06 Correction Notes:
Registration Number: Registration Date/Time:2020-06-21 21:01:07 HERS Provider:CHEERS
PROJ20-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:05:39
2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 2 of 3)
C.Additional Requirements for Compliance
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D.Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
01 Complies:All specified verification protocol requirements on this document are met.
•
•
S 1
Registration Number: Registration Date/Time:2020-06-21 21:01:07 HERS Provider:CHEERS
PR0120-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:05:39
2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION ,NRCV MCH-04-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
John Kwan To1,141.Kw airy
•
Company: Date Signed:
J.K.Balancing&Duct Testing 2020-06-21
Address: CEA/HERS Certification Identification(if applicable):
9040 Telstar Avenue#137
City/State/Zip: Phone:
El Monte CA 91731 626-274-0522
Responsible Person's Declaration statement •
I certify the following under penalty of perjury,under the laws of the State of California:
.1. . The information provided on this Certificate of Verification is true and correct.
2. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
3. The installed features,materials,components,manufactured.devices;orsystem performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with.the applicable'requirements in Reference Nonresidential Appendices NA1 and NA2,and the
requirements specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the Certificate(s)of Installation(NRCI),signed and submitted by the person(s)responsible for the
construction or installation conforms to the requirements specified on'the,Certificate(s)of Compliance(NRCC)approved by the enforcement agency.
5. I will ensure that a registered copy of this Certificate of Verification shall be'posted,or made available with the building permit(s)issued for the
building,and made available to the enforcement agency for all applicable'irispections.I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General Contractor,''or Builder/Owner),
Responsible Builder or Installer Name: CSLB:License:
HERS Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
J.K.Balancing&Duct Testing
Responsible Rater Name: ' Responsible Rater Signature:
John Kwan �To-hwv Kwct lv
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
RCN13069 2020-06-21
NOTICE: This certificate has been generated by CHEERS using information uploaded by third parties not affiliated or related to
CHEERS. Therefore, CHEERS is not responsible for, and cannot guarantee, the accuracy or completeness of the information contained
in this certificate.
Registration Number: Registration Date/Time:2020-06-21 21:01:07 HERS Provider:CHEERS
PR0120-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:05:39
2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION NRCV MCH-04-H
Duct Leakage Diagnostic Test (Page 1.of 3)
Project Name: 130 S 1st Ave Enforcement Agency: Arcadia, Permit Number: BOO 049 441
City of
Dwelling Address: 130 S 1st Ave City: Arcadia Zip Code: 91006
(HVAC_Set1_3) '
A.System Information
01 HVAC System Identification or Name HVAC_Set1_3
•
02 HVAC System Location or Area Served LOCATION 3
03 Verified Low Leakage Air-Handling Unit Credit from No,credit is not taken
NRCC-PRF-01-E
04 Duct System Compliance Category New
B.Duct Leakage Diagnostic Test-MCH-04a-Completely}New Duct System
01 Condenser Nominal Cooling Capacity(ton) 3'r
02 Heating Capacity(kBtu/h) "36
03 Leakage Factor 0.06
04 Air Handling Unit Airflow(AHUAirflow)Determination Cooling system method
Method
05 Calculated Target Allowable Duct Leakage(cfm25) 72
06. Actual Duct Leakage Rate from Leakage Test Measurement 68
(cfm25)
07 Compliance Statement: System passes leakage test
C.Additional Requirements for Compliance
01 System was tested in its normal operation condition.
02 All supply and return register boots sealed to the surrounding material.
03 Cloth backed rubber adhesive duct tape may not be used as the primary air sealing method for duct connections.
04 All connection points between the air handler and the supply and return plenums are completely sealed.
05 Verification Status: Pass-all applicable requirements are met
06 Correction Notes:
Registration Number: Registration Date/Time:2020-06-21 21:01:24 HERS Provider:CHEERS
PRO120-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:05:42
2016 Nonresidential Compliance Schema Version:rev 20180426
•
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 2 of 3)
C.Additional Requirements for Compliance
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
for this Certificate of Verification as a whole to be determined to be in compliance.
01 Complies:All specified verification protocol requirements on this document are met.
•
Registration Number: Registration Date/Time:2020-06-21 21:01:24 HERS Provider:CHEERS
PROJ20-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:05:42
2016 Nonresidential Compliance Schema Version:rev 20180426
•
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 3 of 3) .
•
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
John Kwan To-714v Kwc{ vi' •
Company: Date Signed:
J.K.Balancing&Duct Testing 2020-06-21
Address: CEA/HERS Certification Identification(if applicable):
9040 Telstar Avenue#137
City/State/Zip: Phone:
El Monte CA 91731 626-274-0522 •
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
3. The installed features,materials,components,manufactured devices,porsystem performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the applicable requirements in Reference Nonresidential Appendices NA1 and NA2,and the
requirements specified on the Certificate of Compliance for the building approved by the enforcement agency.
4. The information reported on applicable sections of the,Certificate(s)of Installation(NRCI),signed and submitted by the person(s)responsible for the
construction or installation conforms to the requirementsspecifed on the;Certificate(s)of Compliance(NRCC)approved by the enforcement agency. •
- 5. I will ensure that a registered copy of this Certificate of Verification shall be posted,or made available with the building permit(s)issued for the
building,and made available to the enforcement agency forall applicable"inspections.I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation the builder'provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General Contractor,or Builder/Owner);^_ ,_..
Responsible Builder or Installer Name: CSLB:License:
HERS Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
J.K.Balancing&Duct Testing
Responsible Rater Name: Responsible Rater Signature:
John Kwan Jam/ c /
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
RCN13069 2020-06-21
NOTICE: This certificate has been generated by CHEERS using information uploaded by third parties not affiliated or related to
CHEERS. Therefore, CHEERS is not responsible for,and cannot guarantee, the accuracy or completeness of the information contained
in this certificate.
Registration Number: Registration Date/Time:2020-06-21 21:01:24 HERS Provider:CHEERS
PROJ20-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:05:42
2016 Nonresidential Compliance Schema Version:rev 20180426
•
CERTIFICATE OF VERIFICATION NRCV MCH-04-H
Duct Leakage Diagnostic Test (Page 1 of 3)
Project Name: 130 S 1st Ave Enforcement Agency: Arcadia, Permit Number: BOO 049 441
City of
Dwelling Address: 130 S 1st Ave City:' Arcadia Zip Code: 91006
(HVAC_Set1_4)
A.System Information
01 HVAC System Identification or Name HVAC_Set1_4
02 HVAC System Location or Area Served LOCATION 4
03 Verified Low Leakage Air-Handling Unit Credit from No,credit is not taken
NRCC-PRF-01-E
04 Duct System Compliance Category New
• B.Duct Leakage Diagnostic Test-MCH-04a-Completely•NewDuct System
01 Condenser Nominal Cooling Capacity(ton) > t` 3`
02 Heating Capacity(kBtu/h) 36
03 Leakage Factor 0.06
04 Air Handling Unit Airflow(AHUAirflow)Determination Cooling system method
Method ,.
05 Calculated Target Allowable Duct Leakage(cfm25) 72�
06 Actual Duct Leakage Rate from Leakage Test Measurement 66
(cfm25)
07 Compliance Statement: System passes leakage test
C.Additional Requirements for Compliance -
01 System was tested in its normal operation condition.
02 All supply and return register boots sealed to the surrounding material.
03 Cloth backed rubber adhesive duct tape may not be used as the primary air sealing method for duct connections.
04 All connection points between the air handler and the supply and return plenums are completely sealed.
05 Verification Status: Pass-all applicable requirements are met
06 Correction Notes:
Registration Number: Registration Date/Time:2020-06-21 21:01:54 HERS Provider:CHEERS
• PROJ20-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:06:26
'2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 2 of 3)
C.Additional Requirements for Compliance
The responsible person's signature on this compliance document affirms that all applicable requirements in this table have
been met unless otherwise noted in the Verification Status and the Corrections Notes in this table.
D. Determination of HERS Verification Compliance
All applicable sections of this document shall indicate compliance with the specified verification protocol requirements in order
- for this Certificate of Verification as a whole to be determined to be in compliance.
01 Complies:All specified verification protocol requirements on this document are met.
Registration Number: Registration Date/Time:2020-06-21 21:01:54 HERS Provider:CHEERS
PROJ20-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:06:26
2016 Nonresidential Compliance Schema Version:rev 20180426
CERTIFICATE OF VERIFICATION NRCV-MCH-04-H
Duct Leakage Diagnostic Test (Page 3 of 3)
Documentation Author's Declaration Statement
1. I certify that this Certificate of Verification documentation is accurate and complete.
Documentation Author Name: Documentation Author Signature:
John Kwan • To-h ry Kwam/
Company: Date Signed:
J.K. Balancing&Duct Testing 2020-06-21 •
Address: CEA/HERS Certification Identification(if applicable):
9040 Telstar Avenue#137
City/State/Zip: Phone:
El Monte CA 91731 626-274-0522
Responsible Person's Declaration statement
I certify the following under penalty of perjury,under the laws of the State of California:
1. The information provided on this Certificate of Verification is true and correct.
2. I am the certified HERS Rater who performed the verification identified and reported on this Certificate of Verification(responsible rater).
3. The installed features,materials,components,manufactured devices,or system performance diagnostic results that require HERS verification
identified on this Certificate of Verification comply with the ap'plicable`requirements in Reference Nonresidential Appendices NA1 and NA2,and the
requirements specified on the Certificate of Compliance`for the building,approved by the enforcement agency.
4. The information reported on applicable sections of the'Certificate(s)of Installation(NRCI),signed and submitted by the person(s)responsible for the
construction or installation conforms to the requirements specified on`the,Certificate(s)of Compliance(NRCC)approved by the enforcement agency.
5. I will ensure that a registered copy of this Certificate of Verification;shall be posted,or made available with the building permit(s)issued for the
building,and made available to the enforcement agency forall applicable"inspections.I understand that a registered copy of this Certificate of
Verification is required to be included with the documentation.the builder provides to the building owner at occupancy.
Builder Or Installer Information As Shown On The Certificate Of Installation
Company Name(Installing Subcontractor,General Contractor,or Builder/Owner) ;
Responsible Builder or Installer Name: ' '=`CSLBLicense
HERS Provider Data Registry Information
Sample Group Number(if applicable): Dwelling Test Status in Sample Group(if applicable)
N/A
HERS Rater Information
HERS Rater Company Name:
J.K.Balancing&Duct Testing
Responsible Rater Name: Responsible Rater Signature:
John Kwan `Tah4r1/KwaNi/
Responsible Rater Certification Number w/this HERS Provider: Date Signed:
RCN13069 2020-06-21
•
•
NOTICE: This certificate has been generated by CHEERS using information uploaded by third parties not affiliated or related to
CHEERS. Therefore, CHEERS is not responsible for,and cannot guarantee, the accuracy or completeness of the information contained
in this certificate.
Registration Number: Registration Date/Time:2020-06-21 21:01:54 HERS Provider:CHEERS
PR0J20-02588623-000-001-M04000A-0000
CA Building Energy Efficiency Standards Report Version:2018.0.001 Report Generated:2020-06-21 21:06:26
2016 Nonresidential Compliance Schema Version:rev 20180426
:Certificate of Verification NRCV-PROJ-01-E
Non-Res Project Information (Page 1 of 2)
'Project Name: 1130 S 1st Ave Enforcement Agency: (Arcadia,City of Permit Number: (B00 049 441
Address: 1130 S 1st Ave !City: Arcadia ,Zip: 191006
A. Project Information
01 'Street Address: 130 S 1st Ave
02 I City: Arcadia
PJ
03 ;Zi Code: 91006
04 3 NRCV-PLB-21 Required? No
05 Auto-generate HVAC system names? [Yes
06 [Auto-generate PLB dwelling names? ;Yes " •
B. HVAC System Type Information '
01 [Verified Low Leakage Air-Handling Unit INo
'Credit from NRCC-PRF-01-E:
i _rv02 [Duct System Compliance Category: 'New
03 [Installing Contractor Company: [Alliar ce,Profession HVAC Inc.
04 'Installing Contractor Contact Name: €BIAN JUN
05 I Number of HVAC Systems of This Type: 14'
C. HVAC System IDs or Names
1 `System Name: [HVAC_Set1_1
2 ISystem Name: t.--JHVAC_Set1_2
3 [System Name: IHVAC_Set1_3
4 !System Name: j HVAC_Set1_4
ID. PLB Dwelling Type Information (Multifamily buildings)
E. PLB Dwelling Unit IDs or Names (Multifamily buildings)
:PROJECT INFORMATION CONFIRMATION
`The Project Information Form is used to identify and name the systems for this Non-Residential project site.Also identified is the installing contractor
for each system.This information is used to generate the appropriate forms and if sample groups are used,to identify the criteria that allows grouping •
per the CEC regulations.
!Notes:
(1)NRCV-MCH-04e"Altered Duct System Using Smoke Test"requires 100%testing.It cannot be used as part of a sample group per CEC regulations.
Responsible Designer Name: 1 Responsible Designer Signature:
John Kwan John Kwan '
'Company: [Date Signed:
J.K.Balancing&Duct Testing I 6/21/2020
Address: I License:
9040 Telstar Avenue#137 [ RCN13069
Registration Number:PROJ20-02588623 Registration Date/Time:06/21/2020 20:59 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance April 2017
Certificate of Verification NRCV-PROJ-01-E,
Non-Res Project Information (Page 2 of 2):.
City/State/Zip: t Phone:
El Monte,CA 91731 i 626-274-0522
•
•
NOTICE: This certificate has been generated by CHEERS using information uploaded by third parties not affiliated or related to
CHEERS. Therefore, CHEERS is not responsible for, and cannot guarantee, the accuracy or completeness of the information contained
in this certificate.
Registration Number:PROJ20-02588623 Registration Date/Time:06/21/2020 20:59 HERS Provider:CHEERS
CA Building Energy Efficiency Standards-2016 Residential Compliance April 2017
";;1 City of Arcadia, CA Permit NO Wall 18-2209,
Development Services Department ' 1 Permit Type.:.Wall
240 West Huntington Drive,Post Office Box 60021 , • ° Work Classification Wall-Garden Wall
�� 6 6021 n .
Arcadia,CA 9106
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date 11/28/2018J Expiration: 05/27/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
130 S FIRST AVE Arcadia,CA 5773017039
Contacts
SUNS RESIDENTIAL DEVELOPMENT LLC Owner Charles Lei General Contractor(B)
308 FIRST AVE F,ARCADIA,CA 91006 910 Las Rosas DR,West Covina,CA 91791
(626)321-2429 JASONZHANG@GMAIL.COM (626)841-3562
Description:BLOCK WALL ON NORTH SIDE OF PROPERTY.6'H Valuation: $ 1.799.04 Tenant
X16'LF.TRASH ENLCOSURE 6'H X 16'LF PER APPROVED PLANS
Total Sq Feet: 0.00 �. Plan Check# Plan#
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $145.85
Building Permit Fees $95.25 Cash/Receipt#REC-002996-2018 $145.85
Solid Waste Management Fee $6.25
Amount Due: $0.00
Total: $145.85
Farrif% aT 4
rge_a/�5U� r~ CALLS FOR INSPECTIONS
J - Z-i'7 Request for inspection by telephone at 626-574-5450. Leave a message
1� � requesting the address,timeframe and what inspection item is needed.
pgp
4 U�" l
r- k
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.
•
November 28, 2018
Issued By: Date
November 28,2018 Page 1 of 1
•
Development;Services Department .
r Engineering Division
�' •mef• * 240 West.Huntington Drive/Post Office Box 60021776
_PE
RMIT
E
Arcadia,CA'91066-6021 •
toriEoaoss •
(626)574-5411 . .
'. mit'Type: ' R-O-W Temporary
('� r whatw.ArcadiaCA:gov Per
• City Of PROJECT:
Y ': TRACT NOAPPLICATION
Arcadia 0001 . : LOT1/16/2018pTE ISSUED
I. 11 as lii6rzo18
NO PERMR STATUS
. Issuid
ADDRESS No. Cir.Prenx 'Street Name - etneot Suffix uurr .. BLO ' - AeseaaoRa PARCEL rfo. oEo cons
130 •S First Ave 5773-017-039
OWNS.
Suds Residential.Development,Llc ' {626)321-2429
PHO
NE NO.
EMAIL ADDRESS: .' .
APPIJCANi MAWNG AODRE$6
PHONE NO. . .
CONrRACToRIPRoFEahRONAL MAILING A•DCRE66
Charles Lei PHONE'NO: (b2 - FAX NO.
910 Las•Rosas Dr . 6)84i:3.562
West Covina,CA 91791 :. EMAIL ADDRESS:..
License No- 964401 ::Type:. B _ • Expires: .8/31/2019 12:00
•-'TENAM . . : MAILING ADmtE9a .. • - •• .. ..
PHONE NO. . FAX NO: .
•
Pedestrian accessible scaffolding around property through July 1,2018:
Constraedoo Type UOM :: : . f+l of Uahb value Coo.tncN.f Type UOM of Valli ' • Value :
•
OCCUPANCY:' ..
- • TOTAL VALUATION: . .. .. SO
QTY UOM- DESC AMT' AMT PAID ACCT .
QTY.UOM DISC. AMT . AMT PAID ACCI'
100 Flat Engr permit fee ' . 50.00 50.00 01-3111.
2.00 Locus lnspeat-Engr '120.00 120.00 01.3505 q
ti) Ir1 •
•
•
• Total Feu; $170.00 Balance Due: . .. - Paid Today:.
, $il.00. . :S170.00 •
All Off-Site Permits (except Sewer Improvements:and Construction Bins)shall expire and become'null and void If,
1)the work authorized under the:permit Is not commenced within 60 days from the date of permit.Issuance;2)'the work Receipt#: .. 119$52
Is suspended or abandoned fora period of 60.days after the work has commenced;3) ires time limitation one
� � (1) 01-3111 50.00'
year after permit Issuance. Work authorized-under this permit for Sewer Improvement work shall be completed to the
tO1-3505 120:00
satisfaction of the City Inspector within 120 . .
days'from the date of perraR issuance. Bins are permitted on •
City streets for a maximum of three(3)weeks only. This permit shall not be.transferred or assigned to any other person.
•
'. CALLS FOR INSPECTION . INSPECTOR'S OFFICE.HOURS
Requests:for inspection.'should be.made. at: . Monday—Friday. 1 • • -
least two (2) business'days in advance of the 7:00 a.m.--8:00a.m.
Inspection by telephone at (628) 254-2725 for CLOSEPON ALTERNATE FRIDAYS F
offsite work • INSPECTOR'S OFFICE PHONE.(626)254-2725
BOUNDARY SURVEY
130 S. 1ST AVENUE, ARCADIA
PREPARED FOR:
SUN'S RESIDENTIAL DEVELOPMENT, LLC
nN
308 S. FIRST, SUITE F •
ARCADIA, CA 91006
1-1
SCALE: 1" = 30'
ILLI 40.00
N 89°59'10" E
135.04' 175.04'
s � '
06 g2 W Us
J 2
:.CI)
nD
Q Lo o o o o I."'.. Z C!) o 0 d 0 - a
r^ wl Lop r
VJ - UJ o � 0 I- .
oo W ( z z U0
T o H
1-------....L ...... "---)
N 89°59'10" E 135.04'
in 0
co
— 175.04' —
_ —
N 89°59'10" E
BONITA ST.
. (,..,--,6----
LANp S� .
ECKF 'PL
L.S.5279 0
Exp. 12/31/17 * PREPARED BY:
N� ��� GILBERT ENGINEERING COMPANY, INC.
�' / `<' 2028 EAST ROUTE 66 SUITE 203
A
OF CAL\FO GLENDORA, CALIFORNIA 91740
(626) 852-1600
j4g/L- ..,, FAX (626) 852-1601
email - gilbertcivil,©gmail.com
K-SPECIAL INSPECTION , INC.
env 9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
1 Tel: (213)382-81001 Email:ksi8100aa,'&grnail.com
Sivwvw.kspecialinspecfion.com
NSPECTION SPECIAL INSPECTION REPORT
Date: 07-21-2017
City of: Arcadia Permit#: s00-049-411
Project Name: Arcadia Office Building Address: 130 S. First Avenue
Contractor:Ray Liu Associates,Corp Off Site_Fabricator:
Type of Inspection: Steel Construction j Continuous Periodic
Date S M T W T F S
8 hrs 8 hrs 8 hrs 8 hrs 8 hrs 8 hrs
Type(s)of sample: Q'ty• Required f'c: Slump:_Tempe Mix Design:
In accordance with Section 1702 of the International Building Code,special inspection has been
provided for the followings;
-Steel opening Frame-
1. Place and weld 3-HSS 4x4x1/4 columns on existing wide flange beam with 1/4 inch thick stiffeners and
6x6x1/4 inch thick connection plates as per detail Section 1.
2. Place&.weld 1/4 inch thick top and connection plates to the top of the HSS4x4x1/4 Columns.
Weld 8"x12"x1/4 inch thick plate to HSS6x4x3/16 beams to connect to the HSS4x4x3/16 columns
as per detail Section 2 for a opening on 2nd floor.
-Trellis on Second Floor-
Weld 1/4 inch thick connection plate and stiffener plates to existing wide flange beam for 5-HSS4x4x3/16
connections as per detail 4.
Welder:Jose Arturo Chonay.
Lab Name:ASB Test Lab. (Simi Valley Adult School.
Lab Number:246584. Date:08-27-2009
Expiration Date:02-01-2018
Note(s):
Based upon inspections performed and our(my),substantiating reports,it is our(my)prspfessional judgment that,to the best of our(my)
knowledge,the inspected work .. erfo in accordance-wi . .* :; dads,specifications and applicable workmanship
previsions of the Intemation.._Bull,. t a+� }
Inspector's Signat Date: 07-21-2017
Print Full Name:YOUNGSCHICK(DEN )K(IM Certificate Number: 1005331
•
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,, Contract No. ;11 • P.'
INSPECTION CERTIFICATE ;13'::F'''4HYUrlEIR1
G GLOBAL C I rrit' IM: CusIontel .'-:•': STEEL
. , s
LiC No. Head Office 63.Jun ObOnCr-Ciaef0.D011Q-CIU, :••="7•••1•01,10,!
ncheon,401-712.S.Korea Eniiirm•.:a.
• P/0 No. 1• EN 10204(2004)TYPE 3. CoMfleate No.40201512ABOI 1 11-120160200978-25
•
Commodity Class Cest.No.
' H-BEAM ...._.,\i.,...,..„:;: ••:N.:: ' .
i ASTM A572 650/A992/ 1..
C5A G f I
ral.nte.'il-j,hil, irIZ.;!_-_ _
S ifi i Dat
pec cation
t 40.21-13 50WM(3415WM) e oIssue: 2016-U2-L15
-
Chemical Composition(9(;) Tensile Test - -
Impact Test(V-notch)Pieces
-
Nb Sn CEil) Remarks
Ht N
; Dimensions Cu Mo Al Tensile eao. C Si Mn P S
Sttenolh Y1e14.1 point Eiongationt2) Yield AVG 1 2 3 (Impact Specimen Size}
; &Length Ni Cr V
Ratio , r
i Wefahts , -
(ku) x100 x1D00 x100 x1000 x100' Nimm2. .
12X12X96 1 25.0 0.725
F.1864 84 19 14 101 20 13 22 1 ,2 542 391 3 10 41 35.00 14T 1,524 9 11 'It 537 3/35, 25.0 0.72
-
. .
12X12X96 3 21. 3 4 541 394 24.5 0.73E 186485 18 20 99 1 e 52 15 39
35_00 FT 4.572' i 7 7 15 540 383 24.5 0.71
12)(12X96 E 186140 1
18 18 96 27 9 21 2 4 4 9
40 560 402 26.0 0.7
40.00 FT 1,742 , 10, 17 15 555, 398 26.5 0.72'
12X12X96 4 18 2 99 18 2 15 39 21 3 4 541 394 24,5 0.73
E 186485 0 6 •40,00 FT 6,968- 7 7 15 54D 383 24.5 0_71,
12X12X96 1.-
t 186486 14 18 13 104 21 it 21 2 2 4 10 41 544 3927 24.5 0.72
40.00 FT 24,388 8 15 16' 538 386 24.5 0.72
4 541 3941 24_5 0.73>
12X12X96 E 186485 8 le 20, 99 18: - 21 3 2 15 39
45.00 FT 15.680 7 7 15 540 383: 24.5 0.71' _
...
12X12X96 186486 20 2-
18 13 104. 21 le 21 2 4 10 41 544 392 24.5 0.72/
45.00 FT 39.200 13) 15 16 538 386 24.5 0.72'
12)(12X96 11
'E 156454 23.958 19 14 101, 2II, 13 2i, 1.I/ 4 3 10 41 5421 391 25.0 0.7i
50.00 FT537 385 25.0 0.72
- -
I 2X12X96 4 21 3 4 541 394 24.5' 0.73
50.00 FT 8,712
E 166455 18 2 99' 18 5 7 7 15 2 16 SPA
540 383 24.5 0.71
. -.• :
66 .
SUB TOTAL
,126,744_
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Connect No. ; INSPECTION CERTIFICATE <�.•.�;
HYLJT EIRI
STEEL Q� .c__ .
M ■
Customer GS GLOBAL v�LS•,i
UC No. Head Office 63. lunpbonp-daero,OonO-Ou. f.� ' ti'
lncheon,401-712,S.Korea r
P/ONo. 4o2o1512ABO1•
EN 10204(2004)TYPE 3.1 Corllticate No. , ;�al�i:i
If-120160200978-25 ,
' Commodity
' 1i-BEAM f-1, is ClassCeR. N .
ASTM A572 G50/A992ICSA G •)lj yi:��-s'.l tl`:irQs_
Specification 4p_21-13 50WM(345WM) Date of iSsue
. 2U16-U2-US
Chemical Composition(%) Tensile
Dimensions ^ Pieces Impact Test CV-notch)
g Length Heat No. 0 5i Mn P S Cu Mo Al Nb Sn 11) Tensile Remarks
wal9I,ts r Ni Cr V _ CE 51ren0th Yield goint'Elnnpation(ZI Ratio AVG 1 2 3 "(Impact Specimen Size";
(kg) x100 x1000 ' x100 _ x1000 x100 N�,;12 % , (') • •c
12X12X96 E 185484 I 1 i4 101 20 13' 22 1 2 3 101 41 542 391k, 25.0 0.72' .d
35.001 T 1,524 9 11 15 537 385' 25.0 0.72
35XD0 12 XFT96 E 186485 4.572 18 20 99 le 5 21 7 15 2' 15 313 541 394 24 0.73,
540 383 24.5 Oil
12X12X96 l^186140 1 16 18 96+ 27 „ 21 2 4 4 9 40 550 402 28.0 0.72'
40.00 FT 1,742 10 11 15_ 555 398 26.5 0.72,
:12X12X96 E186485 4 18 20 99 18 5 21 3 4 2 16 39 541 .' 394 24.5 0.73
40.00 FT 5,968 7 7 15_ 540 ' 383 24.5 0.71'
_
12X12X96 IE 186486 14 18 13 104 21 IC 2i 2 2 q 10 41 544 392 24.5 0.72
•40.00 FT 24.388 815 16 538 388 24.5 0.72
,12X
2 O2XFT998 1=186485 f 5,688 18 20' 99 18 5 21 3, 4 2 15 39 541 394 24.5 0.73$ -
7 15 540. 38.}3 24-5 0.71 i
12X12X96 186486 20 i13 13 104 21 IC 21.• 2 2 4 10 41 544 39< 24.5 0.72/
45.00 FT 39,200 5 15' 16 53a 3861 24.5 0.72'
12X12X96 186484 11 t�+ 14 101 20 13 22 1 2 3 10 41 542 391 25. 72
50.00 FT 23.958 9• 11 15 537 385 25.0- 0.72
12X12X96 E 186485 4 i8 2R 99 18 g 21 3 4 2 i5 38 541 394 24.5 O.7".
50.00 FT 8,712 7 7 15 540 3834 24.5 0.711
SUB TOTAL 66
126,744
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r {� '.ICi; -..oti••'•1' 4' 4'=".; t 7 �',�'F�i F' �F�S.-,ti 1•SI' i^' :'i"�' �`1t
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•
Contract No. INSPECTION CERTIFICATE ;,::.;" l"lY i`1flA!
Customer GLOBAL •. STEEL ' ' .
GS _�4-
tic No. Head Office 83,Jun9bon9-daero• Dong-gu. ;+f•�•gl"
incheon,401-712•S. Korea i.,
P/0 No. 462015 i 1 A643 EN 10204(2004)TYPE 3.1 Certificate No. 1142O160100656-15
Commodity H_BEAM Class Cert.No.
ASTM A572 G50/A492/CSA G
Specification Data of Issue
i 40.21-13 50WM(345WM) _2016-01-06
Pieces Cnemical Composition(%) Tensile Test i impact Test 0/-notch) Remarks
-
Dimensions [feat N . ��=© �' ,.,, Yield AVG 1 2 3 (Impact Specimen Size)
Weight- Hato -
(ka) x100 x1000 x100 x1000 x100 N/mm2 % ( ) o
12X12X87 v+ E 186141 1 .1. t• 97 24 7 22 2 31 'p13 41 560 396 24.4 0.71 f' •
t60.00 FT 2,38= 9 17 1- 558 393 23.^ 0.70
12X12X87 3 24 2 .d 557 397 26.. 0.71
60.00 FT 186142 7,104 1' 14 9 2 11 9 17 1= 41 12 40 552 395 25.- 0..72
12X12X96 E185894 1: 1. 95 19 8 25 2 2 17 39 538 385 26.'. 0.72
35.00 FT 7,62• 8 134', 1 5351 • 384 27..r 0.72-
12X12X96 4 25 3 - 565 392 25.4 0.59
35.00 FTE 185895 6 09= 1• 1•• 99 23 5 9 17 1• 4 13 42 563 391 24.'1. 0.6
12X12X9fi E 185894 2 1 T 39
1• 25 2, 538 355 26.- 0_72'
1= 1 95 • •
.95.00 FT 27.44r 8 13{ I 535, 384 27.0 0.72.
12X12X96 4 26 3 565 392 25.• 0_69'
f_185895 1• 1 99 2 5 4 13 42
45.00 FT 7,84• 9 i7 1 563 391 24. 0.69
12X12X96 185497 1 1 99 3 -r g 24 2 4 12 40 538• 3871 27. 0.721 •
50.00 FT 4,35= 20. 1 _ 544 392 27.0 .0.72\ '
12302X96 E 185894 1� 1= 95 19 8 25 2 2 17 39 538 385 26.55 0.72
50.00 FT 4,35= 8 13 1 535 384 27.0 0.72
12X12X96 25 3 - 565r 39 25.0 0.69 •
50.00 E 185895 13 0• 1• 1• 99 23 5 3 17 1. 4 13 42 563 391' 24.5 0.69 •
SUB TOTAL 41
�80,2"• � 1 c
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Contract No. ;7 ..-• I:. HYYf OR�
INSPECTION CERTIFICATE , {°.:..;:,:<< 4. C
Customer -,, STEEL.' -�Fti
GS GLOBAL %Fi Hs. t
63.Junpbong-daero,DonQ-Qu, :t,_-t- 1•
-
UC No. Hasid � inche0n.401-712,S.Korea
P/O No. 4620151 DA601 EN 10204(2004)TYPE 3.1 Certificate No. t>92D1 51200959-14 '
Commodity - Class CerL No_
H-BEAM AA
Specification ASTM A572 G501A992/CSA G -y Date of Issue •
40.21-13 50WM(345WM) O R I G �� t'� 2015-12-07
J Chemical Composition(96) Tensile Test
Pieces "' Impact Test(It-notch)
Dimensions .Heat Na. C Si Mn P S Cu Mo Ai
Nb Sn (1) Tensile Yield point i2) Yteld Aema,ics.
8'Length weigh' , Ni Cr V CE StrengthElongation Ratio AVG 1 2 3 (Impact Specimen Slzl
., (kp) x100 xi goo xi oo xl000 x100 Nlmm2 % (.f I 'C
12X12X87 E 185578 3' 19 15 95 20 '16 25 2 2 15 40 539 3': 28.5� 0.74
50.00 FT 5,919 8 11• 14 533 38 28.5 0.73
12X12X87 E 185103 1' 19 15 97 . 24 6 28 2: 3 1 41 549 37 i 24.5 0.6
60.00 FT 2,368_ 10, 14 15 543 37• 25.0L 0.6
12X12X87 225 2 4_ 551 • 38• 24.0 0.7 ,
E185104 18 17 98 2' 10 21 40
60.00 FT 4,736 10 12 .15, _ 546 381 25.0 0.7
12X12X87 E 186141 1 19 14J 97 24 7 2c2 2 3 13 41 560 39: 24.0 0.71
60.00 FT 2,368 9� 17 15 558 39 23.5 0.7
12X12X96 2 24 2r 3 538 38 27.5 0.7
. 45.00 FT E 185497 3,920 17 15 .99 3 9 3 20 . 17 4 12 40, 544 39. 27.0 0.7
'12X12X96 E i 85506 . 1 19 1 fi 96 1 ' 6• 22 2 3 3 11 41 545 39 26.5 0.7
45.00 FT 1.960 9 15 14 551 401 28.d 0.7
12X12X96 5- 28 2 3 537 27.0 0.7
45.00 FT E 1135582 9 600� 191 15 96 21 4 9 13 15i 18` 41` 539� 26_C 0.71
12X12X96 12 27 2 4 543, 4o 1 26.5 0.74
45.00 FT 185583 23,520` 20 14 36 21 3 9 13 15 18 42 535 38 26.5 0.7
12X12X96 4 27 2. - • 535! 38 27.0 0.72 .
45.00 FT 1E 185584 7,640, 19 16 96 20 13 9 12 .14, 18 40 541 3Br 26.0 0.71 ,
31
SUS TOTAL - - 62,431 1
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INSPECTION CERTIFICATE -..,,1' s' 'Q g
Customer 1.t3S GLOBAL r • ' STEEL
' L/C No_ - -•- •--- ----- - - - --- - - - -- - -- - 53, 1nn bon Caera,DonO Du, ' - - N
Head Office 9 g- •L ---
Incheon,401-712•S. Korea
1:1-cr•`:-sty
P/0 No. 46201507A603 EN 10204(2004)TYPE 3.1 Certificate No. IH2O151 D04082-15
•
Commodity H-BEAM :;� _'�; -t• Class Cent.No.
ASTM A572 G501A992/ • ``�~`--'
Specification CSA 350W Date of Issue
2015-10-15
,.. Pieces Chemical Composition(%) ; Tensile Test Impact Test(V-notch) . L.
Dimensions • rks
Heat No. C Si Mn r P S ' Cu NM AI Nb Sn (1)r Tensile Yield point (2)' Yield •
Bh Wet Ni Cr V _ Strength Elongation Ratio AVG 1 2 3 {impact Specimer,Size)
(ko • x100 x1000 x100 X1000 x100 s N,r:nm2 % (s1 "C 1
12X5-1/2X30 26 31 2 3 540 39 • 24.5 0.73
,55.00 FT D 128652 19,448 17 14 62 23 9 7 2L 19 3 18 15 34 544 39- 25.0 0.73
•12X6-1/2X30 028 5 18 16 60 16 14 25 2 3 79 14 33 522 36' 22.5 0.74
651
60.00 FT 4,895 9 12 3 519 38: 23,0 0.74 {
12X6-1/2X30 24 a 31 2 3 1 7 34 540 39 24.5 0.73
D 128652 17 14 6� 23
60.00 FT 19,584 12 19 3 81 _ 544 39' 25.0 0.73
12X6-1/2X35 D 128645 •61 18 1 58' 17 $, 27 2 4 17 13, 33
509 37 26.0 0.73
45.00 FT 4,284 10 12 2 514 37- 26.6 0.74 . •
12X6-1/2X35 8 21 1 22 515 40• 26.5" 0.78i'
55.00 FT 1)128644 5,238 11 26 119 11 4 9 - 8 36 5 14 35 518 40• 26.0 0.79
12X6-1/2X35
50.00 FT D 128644 2 859 11 2E 115 11 4 9 8 36 5 14 35 518 40• 26.0 0.79
17 14 59 21
12X6-1/2X35 6r 25 2 17 11 34 526 40: 27.0 0.77
60.00 FT D 129280 5,718 10 21 524 40. 26-01 0.77
12X6-1/2X35 6 26 2 515 37. 24.0 0.72
80.00 FT D 129733 5,71B 16� 12 18 5 9 13 17 14 31 512 35: 25.0 0.72
12X8X40 8j 2 2 536 39: 24. 0.74
50.00 FT D 1265.33 7.25Q 18 16 59 18 8 17 17 14 34 541 40• 23.5i 0.74i +9 0
- - ` SUB TOTAL 97
75,001
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Joint Stock Company "EVRAZ Ni.zhny Tagil linear,"'nx6s!n/:;a. nc vrle:5' ;Z1 53 081 430 7^!
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' d 715 0.9: o 399 c el7 0.cif(0 it%'o os2 3 5:3.-0.035 O.UO?s•o.D30 S 5'OOSG c ].DOS 11.Oh33 <O.D�05 0 cC17 0.000E O.J03]!3701
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' .0033 c C•� 0703 O.OL`1'7,•7.nii6 0.303110 38i;4-Q.Y2-0.9393)D.19010,C11 I0.Da1ID ,0.046 _032 0.2:3 3 03501 0025(V.030 4 0,3054 < 0,00!0.0033 c D_000510.Oo17 00. 005 O.0031 0.354' -
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1 -377(55) 3741541 _ 51.(74) 523(76fT------- 27 24
2 377(555) 374(54) " ' -51:s74) 923(16) 27_24
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4 .377(55) 374(5C)- 1• ,51.1(74) 523(76) 27 24
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63,JurtObonO-daero,Dono-ou. -_P_�j'�r•c
L/C No. Head Off Incheon401-712• ,S.Korea i_I?
PIO No. 46201511AB01 EN 10204(2004)TYPE 3.1 Certificate No. IHZOt 60100559^21 �.•11
Commodlly }t-BEAM Class Cert.No.
Specttication ASTM A572 G50/A3821CSA G Date of Issue
40,21-13 50WM€345WM) _, 2016-01-06 -
Pieces Chemical Composition(16) Tensile Test Impact Test(V-notch)
0tmenstons Heal No. C Si Mn P ] S Mo r AI Nb Sn tti) Tensile Remarks
&�� yy��� i . Ni Cr V [ 10E strength txrim ElonOation€�1 AVG 1 1 2 3 (impact Specimen Size)
_Ad_ x100 x1000 x100 ' x1000 ,x100 , NLrBm2 96 (') I 'c
1>1b Q0 !i 5 F 130918 5,715" 16 16 59 30! + 6 7 0 16 2 15' 8 31 515 360 67 25.5_ 0_71
12X8X40 2 31r 2 3 517 391 25.0 0.7
35.00 FT 3 128605 1.270 18 16, 59' 22 8t 101 22 2, 15, 13 35 521 393 25.5\ 0.7
12X8X40 0 131035 10 16 15 60 29 , 7 34 2 26 16 16 33. 526 394 26.0 0.7
3.5.00 FT 6,350 12 1 531 �.39E� 25.5 0_T
12X8X40 1 33 2E 562 392 26.5' 0. '
40.00 FT 0 129807 726' 19 16 781 27 na 12 18 3 22 16� 33' 567 898k 26.0 0.7
12X8X40 0 129853 4 16 15 69 24 6 27 2 a 19 16r 36 548 401 26.5. 0.7
40.00 FT 2,904 ^ 9 22 4i 552 4Q2� 26.0‘ 0.7 `
12X8X40 'D 131035 6 16 15' 60t 29 7` 34 2 26 16 15t 33 526 394 26.0 0.7
40.00 FT 5,808 12 17 3t _ 531 396 25.5 0.7 -
12X8X40 D 126606 4 16 15 59r 23; 11 31 2 3 15 •13 32 523 379 27_0 0.7 •
45.00 FT 3,268 12 16 2 529 381 26.5 0.7
12X8X40 2 3E 2 2534r 400 24.6 0.7
45.00 FT 0 131034 ' 1,634 16 14 59 33 5 12 17 3 17' 14' 33 526 395 25.0 0.7 12X8X40 12 32 2 3, 548 411 23.5 0.7 _
D 131033 20 17 74 30 5. 22 14 39
50.00 FT 13,058 i , 11 18 3, 550 41423.0 0.7
SUB TOTAL 4g
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Conlrac1 No. INSPECTION CERTIFICATE "= �"�YUII�F I
Custome1 GS_GLQBAL • STEEL Q4 =;©�
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L/C No, Head Office 6:3,Jungbono-daero,Uono-ou, _.T,.%BI '
inch�n,401-712.3.Korea ©;4 '
P/O No. 4t3201512A801 EN 10204(2004)TYPE 3.1 Certllicate No. IH201 fi020Q978- 18
Commodity 1-1-BEAM -} Class Cart.No_
ASTM A572 G50/A992/CSA G 0�1a t r'i' r"t L
Specification 40.21-13 50WM1345WM1 `''� Date of issue 2016-02-05
Chemical Composltlon(%) Tensile Test
Dimensions Pieces Impact Test(V-notch)
Heal No. C Si Mn P S ' Cu ' Mo ' Al ' Nb Sn CO) tensile Remarks
8 Lenpth Wel¢hts Nt Cr V E Siteripih field Point F{onQationt�1 aflo AVG 1 2 3 (Impact Specimen Size)
Yield
( ) 1 x100 x1000 x100 x1000 X100. N1mm2 %
12X90(40 0 130376 4 11 21 110 32 3 31 3 '�17 3, 13 39 648 388 25.5 0.71 '0
-40.00 FT 2,904 10 25 46 551 390 25.0 0.71
12X8X40 24 21 2 9 539- 391 25.5 0.72
t40.00 FT D }31222 17 424 13 22 114 21 4 g? 9 4Q 37 4 15 542 393 25_0 0.72
12X8X40 f`187572 4 18 14 66 21 6 24 2 3 i 13 35. 526 418 25.5- 0.8
40.00 FT 2,904 1 9• 15 1 a - 527 . 422 26_0 D.80
12X8X40 D 130376 4 11 21 110 32 3 31 3 17 3 13 39 54e 388 25.5 0.71
45.00 FT 3,268 10 25 48 551 390 25.0 0.71
12X8X40 D 131181 a 17 20 60 29 5 26 4 4, 17 16 34' 528 420 27.0 0.80
45.00 FT 6 536. 13 la 3534 421 26.0 0.79
12X8X40 0131034 17• 16 14 59 33 5 36 2 2 17 14 33 534r 400 24.5 0.75
50.00 FT 15,419 12_ IT 3 _ 526, 39`5 25.0 0.76
12X8X40 4 26 4 4 528 420 27.0 0,8U . -
50_00 FT p 131181 3,628 17 20 601 29 5 13 1 , 31 17 15 34 534 421 26.0 0.79
12X8X40 12 21 30 544 416 25.5 0.76
D 131221 11 19 111 20 4' 3 10 34
60.00 FT 13,066� _ 9 8 41 540 415 25.0 0.77
12X8X40 12 21 2 9 539 391 25.5 0.72
60.00(-1 0 131222 }3,068, 13 22114 21 4 9 9 40 4 }5 37 542 393, 25.0 0.72
SUB TOTAL 89
78.219
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DEPARTMENT OF BUILDING AND SAFETY
STRUCTURAL OBSERVATION REPORT FORM
Report No:
This report includes all construction work through � day of Pa , 20 (4,
No. of
Project Address: Structural Observer of Record(SOR) Phone No.of SOR:
P7 D S I S-r !a"T- ( ((c
Building Permit No: Structural Observation Performed by: Professional Lic./Reg.No.of Observer. Phone No.of Observer:
e
5-4get&
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED,IF NOT WHOLE
❑ Footing,Stem Walls ❑Concrete ❑ Steel Moment Frame ❑Concrete 'OF fMM//.(' (O orpii
❑ Mat Foundation ❑ Masonry ❑Steel Braced Frame ❑Steel 7 p(? PlzkiiiA16 /t'f/}/'//
❑ Caisson, Piles,Grade Beams [Wood ❑ Concrete Moment Frame []'Wood (/JAkarwp-(i(, oNry/r/A,J
❑ Retaining Foundation ❑Other: ❑ Masonry Wall Frame 12Others:
DEL f12A'!-1 C r✓ak1 ftWicd
❑ Others: ❑ Others: i2-017"
L
OBSERVED DEFICIENCIES:
pi 2. 9VO Gr e CT
•
SIGNED 7 1 OF ?-(Q1, 1 ' IC,AT l "'Ot(/G�vi ,CA i
DAY MONTH YEAR CITY r;
r,
EtcAi
WET SIGN RE OF REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS.
r- f
,4 '",'i� , K-SPECIAL INSPECTION , INC.
Ai 9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
*\* S I Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT f
Date:cab --'-Z�d
City of: A-Rog P i Permit#: POO•-ort 99 — Al
Project Name: - tZ) & tJ). OAddress:J37 '_ / --r-
Contractor: Off Site Fabricator:
Type of Inspection:ilk //(e 1 ❑Continuous ❑Periodic
Date S M T W T F _ S
Hours
Type(s)of sample: Q'ty:_Required f c: - - Slump: Tempt: Mix Design#
In accordance with Section 1702 of the International Building Code, special inspection has been
provided for the followings;
6(} 4-9 /''''--.‘- >(/--2- X );hiE -cra 7 C gY ,ea*/e Pf,/P 1 61 ''-''—-
e 1,(,)'2-k- 96 ee/- i-Ws fr7 -/& (
'- ce- - 45 r f)-i
9/.. I , /1--gh c ._....,-/9,-D 6
.> �` n , -
l _ r
_l' Z� `- (V off-- 7� � - <>r (,i s
,9
`� p1 a��o-frz-- oc fir-r/Ai
(-i 7 - ,t,. , 1._( C; - ' ©o, 6f
0.) c---, . - - a 1e7
---,-- ,/,eja-ro fi-ND (vM)---A6ter
Note:
Based upon inspections performed and our(my)substantiating re orts,it's our(my)professional judgement that,to the best of our(my)
knowledge,the ins ected work erf din accordance w' a app ved plan spegifications and applicable workmanship provisions
of the Internationale Building ode
Inspector's Signature: ate: ©F ZZr/Z
Print Full Name: t9C( Gil .e('/C /d-iTi/ C Certificate Number: ,/ e,c� •5 1
i r
� a'n- ,, K-SPECIAL INSPECT,ION , INC.
IV 9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
NI. SI Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date: 0 i—AI
City of: A Cl PP la Permit#: &C9 ,--L9C --4 /
Project Name: -e C P 7Address: /3O �4 / 5
Contractor: Off Site Fabricator:
Type of Inspection: _e/ I ❑Continuous ❑Periodic
Date S M T W T F S
Hours
Type(s)of sample: Q'ty: Required f c: Slump: Tempt: Mix Design#
In accordance with Section 1702 of the International Building Code, special inspection,has been
provided for the followings;
�` PhCt
•
y s-
fJG i
tdP-- W /ifvfi5 Fria FR -#L- MP Por o-PeT
.21 - _ �-) CL -- l� IC-97(A—
Dr':Vriti --(4760
r _ G ►f/ C' /'-
v � � ,
ci) ->.— r kflAialf 4 /_ ---
c �` c / -, ,Li c)03 X-6
'..9 /A-rA/--rd (/(4,A7tre(
Note:
Based upon inspections performed and our y)substantiating reports,it is our(my)professional judgement that,to the best of our(my)
knowledge,the inspected work w rfo ed io accordance with t prove plan rspecifications and applicable workmanship provisions
of the International Building Code. /
Inspector's Signature: � Date: G' c)
Print Full Name: ertificate Number: / S 3'
4 '" ���, K-SPECIAL INSPECTION , INC.
9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
ITel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date:6/7--t2
City of: / -R(. -o lii Permit#:000 —04P.-- ,4G 7
Project Name:s , fC 1449GAddress: (: 7 .; a / ---.r
Contractor: Off Site Fabricator:
Type of Inspection.M_j��i} f7/, 0 1 ❑Continuous ❑Periodic
Date S M T W T F S
Hours
Type(s)of sample: Q'ty:_Required f c: Slump: Tempt:— Mix Design# - -
In accordance with Section 1702 of the International Building Code, special inspection has been
provided for the followings;
(� � ��
•
...r ,i F
t,
- ---C,T7[Z: ..2--07:2) ---- . ,•• .
c.0
Q � ( p1 ,
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ibriirs12__ :r7,/44/2 L- L. -- --- ,
'9 � , //-C fp0�
Ottc C �( .
*S5/47C: 3 !'-‘ 61--A711
Note:
Based upon inspections performed and ur(my) ubstantiating reports,it is our(m )professional judgement that,to the best of our(my)
knowledge,the inspected work was er orm n a roan h the proved s,specifications and applicable workmanship pro isions
of the International Building Coc} .
Inspector's Signature. Date:.O d —�
/
Print Full Name: v ' ertificate Number: /(�‘"�� /
,
,44- % K-SPECIAL INSPECTION , INC.
9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
, I Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website: www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date:( --G'5 /{
City of: /--�i4-171 iC Permit#: _0R-- l
Projectame: '- f. 7 SS a '4 , �-
N ���' ��� Address. r_ �� • ___
Contractor: Off Site Fabricator: __
Type of Inspection:I(Ci7/Ae __IEl❑Continuous Periodic
Date S M T, �W T F S
Hours
Type(s)of sample: - Q'ty:- - Required f c: - - - Slump: Tempt: Mix Design# - __
In accordance with Section 1702 of the International Building Code, special inspection has been -
provided for the followings;
• 6svL ' � t z �
7
`
- , 1 � .,
Pt W i f) --- . -/
f' t 4 - 3 fitsf/D f ,
te),::: g , R i7' /---/ - -- , -,
. - / �
. L i , - do 3 56
,,,
�." 4 �, ,. ,� raj
/,
Note:
Based upon inspections performed and our(my)substantiating reports,it is our(my)professional judgement that,to the best of our(my)
knowledge,the inspected work w rfor d in ccordance with the approved lans,specifications and applicable workmanship provisions
of the International Building de. �� ��_
Inspectors Signature: Date: 7 1
] r.
Print Full Name: F`- 6 �,. ✓G Certificate Number: e7C,--.
,4 '"=���, K-SPECIAL INSPECTION , INC.
9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
Ni` SI Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website: www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date: 9i9—l/7 —l6
City of 6-0i Y Permit#: s 0 — r �
Project Name: •
7 - ow-
Contractor: 4i4 l„-4 Off Site Fabricator: 5460 ( A,-/r7C7
Type of Inspection: L � ❑Continuous ❑Periodic
Date S T W T F S
Hours
Type(s)of sample: Q'ty:_Required f c: Slump: Tempt: Mix Design#
In accordance with Section 1702 of the International Building Code, special inspection has been
provided for the followings;
r f -r j
f L.._
Gig cy.�
f, pg--(=-0-- 0 _2i.. e56 � z
Note: - O
Based upon inspections performed and our(my)substantiating reports,it is our(my)professional judgement that,to the best of our(my)
knowledge,the inspected work ,a per , med i :- sal with the approve• . ans,specif cations and applicable workmanship provisions
of the International Building f od: C�
Inspector's Signatur- �• �1 Date: /'O --
Print Full Name: t4 ;if A ; _ . V Certificate Number: G c � /
'ATI*, K-SPECIAL INSPECTION.,.INC.
9746 Woodleaf Dr. Rancho Cucamonga., CA 91701
SI Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date:
City of: /•'j` P I Permit#: pOO-04-9 _4L f
Project Name:/fl ,dG $1i? Address: (&17 _ T1
Contractor: Off Site Fabricator:
r4 �� a '.. ff:
Type of Inspection: �t 1 F. y .;S ❑Continuous ❑Periodic
Date S
Hours
'
- Type(s)of-sample: - -- - -:Q'ty �equu'ed-::Required --- - -- S tunp—`=Tempt:--.=--=—=Mug°Design °`- - - - . _'_. --
In accordance with Section 1702 of the International Building Code,special inspection has been
provided for the followings;
e()r-4-0 X y;_t_ /3,11jcs --
Pf
eto4r,N,a,,,/ fry2-4_ (
- r.
. A/14 6 - 4.."- -
&of, .-,-- -/-/d7,44 _ (2,6cffitrue
._ c e ©i •.
1 1,L�'� •P —
$- .
Note:
Based upon inspections performed and our(my)substantiating re.orts,it's our(my)professional judgement that,to the best of our(my)
knowledge,the ins ected work ..: .erf• '-d m accordance w' • e app eyed plan spe ifications and applicable workmanship provisions
of the International Building C ode t
Inspector's Signature: - r Pate:OF
Print Full Name: . .may- „ Certificate Number:
e '�A •;, K-SPECIAL INSPECTION ,
, INC.
�V9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
NI S I Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date: 0 f'Al
City of: 1 Q--P i / Permit#: 0 7-tC , —LA G/
Project Name: €, (4W67 Address:_730 S, /9.
Contractor: Off Site Fabricator:
Type of Inspection: d . , 4, 1g t49,e., 4: ❑Continuous ❑Periodic
Date S M T W T F S
Hours
.Type(s)of sample:-.__- ___ Q ty:_ Required-f c:.. . Sump: Tempt:=— =Mix Design -
In accordance with Section 1702 of the International Building Code, special inspection has been
provided for the followings;
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Note:
i
Based upon inspections performed and our y)substantiating reports,it is our(my)professional judgement that,to the best of our(my)
knowledge,the inspected work w rfo- ed in accordance with t1e approve plan specifications and applicable workmanship provisions
of the International Building Co e.
Inspector's Signature: L : Date:Oil—a (--/(J/
Print Full Name: L' IC ' 61- ertificate Number: /aas_ >I
,4 '" K-SPECIAL INSPECTION INC.
14 '' 9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
`\v SI Tel: (213) 382-8100 I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspecialinspectioninc.com
SPECIAL INSPECTION REPORT
Date:617--177
City of: AP -172il Permit#:&ems — 41—
4 4e-- 7
Project Name: N��'� GilfC �_�G�ddress: f3� � • /se fi
Contractor: Off Site Fabricator:
Type of Inspection: V 7/ �' f ❑Continuous El Periodic
Date S M T W T F S
Hours
_ � - _ _ -
- ._---TYpe(s).ofsampf :-. . -. - --- P -_ 1?: _-- - ---- -- - --_ -=
Q tY:—�Zequtred f'c:- - S`um -"'rim t-~- Mix esigri
In accordance with Section 1702 of the International Building Code, special inspection has been
provided for the followings;
ori—.. -- l' cyP - i`�� /r " — -
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11)- (4)- -172- mexp,2_if - i,_ , ,-- •
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S57,e; e- 61.-/cfq'
Note:
Based upon inspections performed and ur(m ) ubstantiating reports,it is our(m )professional judgement that,to the best of our(my)
knowledge,the inspected work was orm n a rdan h the proved s,specifications and applicable workmanship pro isions
of the International Building Cori
Inspector's Signature- C ;Date:Qj7-a
Print Full Name: �- /`"fertificate Number: / , /
r - t
, K-SPECIAL INSPECTION INC
'It 9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
Tel: (213) 382-8100 I E-Mail: ksi8100®yahoo.com INSPECTION Website: P
www.ksP ecialins ectioninc.com
SPECIAL INSPECTION REPORT
Date:���4�-��a�
City of: AP W/ Permit#: aye
Project Name:, , L6rOAddress: f 30 e3
Contractor: n Off Site Fabricator:
Type of Inspection:Er,whpr ❑Continuous ❑Periodic
Date S M T W T F S
Hours
— --- -Type(s)of:sample:-- -- - -Q'ty _R.equired Pc:— -Slump: renzpt — 3vfix Hesign#
In accordance with Section 1702 of the International Building Code, special inspection has been
provided for the followings;
fil i%st��L7� / '4 C . l
/ i _ j � 096
3 1127,4D
i G f
� r
Note:
Based upon inspections performed and our(my)substantiating reports,it is our(my)professional judgement that,to the best of our(my)
knowledge,the inspected work w rfor ed in ccordance with the approved Tans,specifications and applicable workmanship provisions
of the International Building de.
Inspector's Signature: Date:0/7 o9 fr
Print Full Name: �,1 t �� Certificate Number: /'fc',9 �
Ki-SPECIAL 'INSPECTION INC
p4 p\ •
. • 9746 Woodleaf Dr. Rancho Cucamonga, CA 91701
No - S Tel: (213) 382-8100. I E-Mail: ksi8100@yahoo.com
INSPECTION Website:www.kspeCialinspectionitic.com
•
SPECIAL INSPECTION REPORT
Date: --r
City of:MCA-OA Pennitit: /-
Project Naiiie:Mealtt Address: b -
• Contract:Jr:6v/PA 0:XS LE.-j Off Site Fabricator: 5/44,u tt1iL,V7
Type of Inspection4 co) - Continuous CI Periodic
Date S T W
Hours
Type(s)of sample: Q'ty:_ReqUired c: Tempt: Mix Design#
In accordance with Section 1702 of the International Building Code,speeial inspection has been
provided for the followings;
Cc
A91-0ry t_
0 7"-g. b
Note: C
,.
Based upon inspections performed and o (my)substantiating,reports,it is our(my)professional judgementthati-to the best of.our(my.)
knowledge,the inspected work •• pe •ed . .? with the approve. t ,specifications and apphcable workmanship provisions
of the InternatiOnal Building odt - -
Insector's Signatur-:- Date:
p (9,y
. :
Print Full'Name: Certifidate.NUinber:
July. 12, 2017
Building Official
Building and Safety
CITY of Arcadia
Regarding: Office building construction
130 S . 1st Ave.
Arcadia, Ca 91006
Dear Building Official:
This letter is to verify that Simpson hardware H2 . 5T in structural
detail 10/S2, 14/S2, 21/S2 and 9/S2 is not required. The connector
H2 . 5T is needed only when floor joist overhang over 10' -0" which is
not happen at this project.
��pP ck0 F ES S/0.::_:..
LI 0 No.S3948 rn rn ,
Exp.03/31/7,0q
Sincerely,
•
Peter Lee, SE 3948
Engineer of Record
INSPECTOR'S DAILY REPORT OF COMPACTED FILL
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INSPECTOR'S DAILY REPORT OF COMPACTED FILL
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INSPECTOR'S DAILY REPORT OF COMPACTED FILL
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.CAL LAND ENGINEERING, INC._ : . ,./ Ili ' C:,771:1-f--fiAl)
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Company Policy:Four(4)hours minimum Charge(including travel time)._A., , • -,,,t ',..-, -=',,------ --,s•.:3",.-:.-_L.-,-,
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111604
.10
CITY OF ARCADJA
240 West Huntington prime
Arcadia,CA 9I007
R'QIJGH GRADING VERIWJCATION
ATTENTION: Community Development Administrator
SUBJECT: Grading Verification for Project No.
Address; /. _l •
Gentlemen
Rough grading operations have been completed for Project No. for
Lots _. _ through _ (if applicable) and has been inspected
by, the undersigned Registered Civil Engineer or License.Architect.
Based upon the observations, the rough grading of the lot(S) listed above have been
completed in conformance with plans marked "APPROVED" by the City. The work
includes but is not limited to the following: grading to approximate final elevations;
staking of property lines; location and gradient of cut and fill slopes; location, cross-
sectional configuration and flow-line gradient of drainage swales and terraces; berms
I4
installed where indicated;and required drainage slopes provided on building pads.
Enclosed herewith is a Soil and Compaction Report for the Building Division which is
required on all sites which will be raised or filled more than 12".
Engineer(Signature) Architect(Signature)
R.C.E.No. 14 6- /F; .A.No.
Date: '
Received and approved:
` No. 34587 rs7.7
C.D.D./Pianning =_^
ccT C.D.D./Maint.Ser.
C.D.D./Building
= 10/09/08
•
Cal Land Engineering, Inc.
dba Quartech Consultants
Geotechnical, Environmental, and Civil Engineering
January 19, 2016
Sun Homeland, Inc.
308 South First Avenue Suite F
Arcadia, California 91006
Attention: Mr. Jason Zhang
Subject: Soil Compaction Report, Proposed Office Building Development,
130 South First Avenue, APN: 5773-017-039, Arcadia, California
QCI Project No.: 14-125-002C
Gentlemen:
This report presents results of our field density tests performed on the proposed building pad at
the subject site. The site conditions, field and laboratory test results, and post-grading
recommendations are presented as follows:
SITE CONDITION
This report present result of our field density tests performed on the proposed building pad. The
building pad as depicted on the attached Site Plan (Figure 1) was excavated to a minimum depth
of four feet below the final pad grade, and four feet horizontally beyond the building footprint or
until the limits of the existing structure. The loose and/or disturbed soils were removed and
exposed competent natural soils within the building pad area.
FIELD DENSITY TEST
1. Field density test was performed using the Nuclear Gauge Method (ASTM D-6938-10) and/or
Sand Cone Method (ASTM D-1556-07). The field density test results are presented in Table I.
Approximate locations of the test are shown on the enclosed Site Plan (Figure 1).
2. Field density tests were performed at random locations to check compaction effort provided
by the contractor. The test results exceeded minimum required relative compaction of 90
percent. The test results herein are considered representative of the compacted area.
•
LABORATORY TESTING
The laboratory maximum dry density and optimum moisture content for the onsite soils were
determined according to laboratory standard ASTM D-1557-09. The following table presents the
test result of representative soil samples collected from the subject site:
576 East Lambert Road, Brea, California 92821; Tel: 714-671-1050, Fax: 714-671-1090
Sun Homeland, Inc. Page 2
QCI Project Number: 14-125-002C January 19, 2016
TABLE II
LABORATORY TEST RESULTS
Soil Type Maximum Dry Density Optimum Moisture Content
(pcf) (%)
A- Brown silty sand 132.0 8.0
POST-GRADING RECOMMENDATIONS
1. All utility backfill should be brought to near optimum moisture content and then compacted to
obtain a minimum relative compaction of 90 percent of the laboratory standard.
2. Soils generated from footing excavations to be used on onsite should be compacted to 90
percent minimum relative compaction, whether it is to be placed in landscape areas or within
areas to be improved. This material must not alter positive drainage patterns away from the
structural areas.
3. All trench excavations should conform to CAL-OSHA and local safety codes.
REGULATORY COMPLIANCE
The field compaction tests were performed in accordance to the American Society for Testing and
Materials (ASTM) standard procedures. The test results would not indicate the conditions of the
subsurface materials underlying the fills. The engineering performance of the underlying materials
and other materials are therefore not included in this report.
Our field observation and soil tests were conducted in conformance with generally accepted
professional engineering practices, and no further warranty is implied nor made. This report is
subjected to review by the controlling authorities of this project.
This opportunity to be of service is appreciated. If you should have any questions, please call the
undersigned.
Respectfully submitted,
CalLand Engineering, Inc. (CLE)
dba Quartech Consultants (QCI)
�`JGK c C��<�2�2
Fr)Ja•:dI l�
:3:2417
ck C. Lee, GE 2153 (wghn Thurlo
Principal Engineer , x � Project Engineer
0,. OTECH0.f�o�
Encl.: Figure I—Site Plan
Dist: (4)Addressee
576 East Lambert Road, Brea, California 92821; Tel: 714-671-1050, Fax: 714-671-1090
Sun Homeland, Inc. Page 3
QCI Project Number: 14-125-002C January 19, 2016
TABLE I
FIELD DENSITY TEST SUMMARY
Depth Moisture ! Dry Relative
Test Test Test Soil
Below Content Density Compaction
NO. Date Location FS (ft) (%) (pcf) (%) Type
X-1 1-9-16 Building Pad 2 7.1 121.8 92.3 A
X-2 1-9-16 Building Pad 2 8.6 122.8 93.0 A
X-3 1-9-16 Building Pad 2 8.0 120.1 91.0 A
X-4 1-9-16 Building Pad 2 7.4 118.8 90.0 A
X-5 1-9-16 Building Pad 2 8.3 122.1 92.5 A
X-6 1-12-16 Building Pad 2 8.3 120.1 91.0 A
X-7 1-12-16 Building Pad 2 9.2 119.6 90.6 A
X-8 1-12-16 Building Pad 2 9.5 121.4 92.0 A
X-9 1-13-16 Building Pad FS 8.3 121.4 92.0 A
X-10 1-13-16 Building Pad FS 9.0 120.8 91.5 A
X-11 1-13-16 Building Pad FS 8.2 120.1 91.0 A
X-12 1-13-16 Building Pad 2 10.0 119.7 90.7 A
X-13 1-13-16 Building Pad 2 8.5 121.3 91.9 A
X-14 1-14-16 Building Pad FS 7.8 120.9 91.6 A
X-15 1-14-16 Building Pad FS 9.0 119.2 90.3 A
X-16 1-14-16 Building Pad 2 8.4 120.1 91.0 A
X-17 1-14-16 Building Pad 2 8.8 120.8 91.5 A
X-18 1-15-16 Building Pad FS 9.0 120.5 91.3 A
X-19 1-15-16 Building Pad FS 9.9 119.7 90.7 A
X-20 1-15-16 Building Pad FS 9.4 120.1 91.0 A
X-21 1-15-16 Building Pad FS 8.1 119.5 90.5 A
X-22 1-15-16 Building Pad FS 8.5 118.8 90.0 A
X-23 1-15-16 Building Pad FS 9.1 119.2 90.3 A
Note: FS = Finish Surface
576 East Lambert Road, Brea, California 92821; Tel: 714-671-1050, Fax: 714-671-1090
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BONITA STREET
. CalLand Engineering, Inc. Project Address:
dba Quartech Consultants
LEGEND APN: 5773-017-039
Geotechnical, Enviromental & Civil 130 South 1st Avenue
Engineering Services Arcadia, California
X-1 Approxmiate Field Density Test Location
— — — — Approximate Limit of Compacted Fill
Placed Under Purview of This Report SCALE AS SHOWN SITE PLAN
1/16 FIGURE 1
DEPARTMENT OF BUILDING AND SAFETY
• STRUCTURAL OBSERVATION REPORT FORM
Report No:
This report includes all construction work through 2A) day of F-to'Yµe+I;7 ,
20 1 —7
No. of
Project Address: Structural Observer of Record(SOR) Phone No.of SOR:
( o s. 1ST AvcG:�;C'�� r. Lee G 2-6- g
Building Permit No: Structural Observation Performed by: Professional Lic./Reg.No.of Observer. Phone No.of Observer:
17-L ep ` cr-E
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED,IF NOT WHOLE
❑ Footing,Stem Walls ❑Concrete USteel Moment Frame ❑Concrete pd, ?7L({i'r(ed c ( P(A,G(.
❑ Mat Foundation ❑Masonry ❑Steel Braced Frame ❑Steel Fez-) g ( 9(A-p`i
Li Caisson,Piles,Grade Beams aiWood ❑ Concrete Moment Frame U'Wood � g�G f�,6ioty �L
r
❑ Retaining Foundation Li Other: ❑ Masonry Wall Frame ❑Others:
❑ Others: ❑Others:
p
OBSERVED DEFICIENCIES:
tiJ PEric ( -, '
?.Or /
SIGNED ?Ay P OF &I VA t� AT t et cA ,CA
DAY MONTH� YEAR CITY - ..
r:.
WET JIGNATURE OF REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS.
DEPARTMENT OF BUILDING AND SAFETY
STRUCTURAL OBSERVATION REPORT FORM
Report No:
This report includes all construction work through --A Srday of 06-,-&70.. _ , 20 (.6
No. of
Project Address: Struct ral Observer of Record(SOR) Phone No.of SOR:
cp
Building Permit No: Structural Observation Performed by: Professional Lic1 Reg.No.of Observer. Phone No.of Observer:
),Lee - -314
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR. PORTION OBSERVED,IF NOT WHOLE
❑ Footing, Stem Walls ❑Concrete ❑Steel Moment Frame • ❑Concrete Ft?ro• 1)jCtp�✓o / 2•-wx-!
❑ Mat Foundation ❑Masonry ❑Steel Braced Frame ❑Steel • b 1,-(boy ,`
J � �/l.6ti: I' V
❑ Caisson, Piles,Grade Beams 1 Wood ❑ Concrete Moment Frame [Wood _ �6�,5,�✓k�,� ��
❑ Retaining Foundation ❑Other: ❑ Masonry Wall Frame U Others:
LiOthers: U Others: !/
OBSERVED DEFICIENCIES: .
/�l ' P6 rc-it,-,Ai c-=�
5 t_ = .
SIGNED -I c OF O -1 ��` 7/D16,AT ✓ ,CA r,. / J`A' r
DAY MONTH YEAR CITY • P ,s`
1
V-UN °1---e--12---
WETS! NATURE OF REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS.
DEPARTMENT OF BUILDING AND SAFETY
STRUCTURAL OBSERVATION REPORT FORM
Report No:
This report includes all construction work through t t. day of te- ' ^ , 20 /6
No. of
Project Address: Structural O server of Record(SOR) Pone No.of SOR:
/ b Ss_ (Sr A-JP. /�YC'Let,: .L47rJ L (-z o,00-
Building Permit No: Structural Observation Performed by: Profession I Lic./Reg.No.of Observer. Phone No.of Observer:
12
Lee 93 818
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED,IF NOT WHOLE
Footing,Stem Walls ❑Concrete U Steel Moment Frame ❑Concrete G t4t'E ee 9-M N f
�7
❑ Mat Foundation U Masonry ❑Steel Braced Frame ❑Steel i C cot e, i,) (24P
❑ Caisson, Piles,Grade Beams ❑Wood ❑Concrete Moment Frame ❑Wood
U Retaining Foundation ❑Other: ❑ Masonry Wall Frame U Others:
❑ Others: ❑ Others: G
'i4., aeVed 5717 4,if,
1Pall
OBSERVED DEFICIENCIES:
. /) PEf<<i //(7 .
-- �'^ _ _- AI-'L \`/ �
<� jvy l�-- ,1,- _
II 3/3 I I 4m '�
(� �^ -(4.� / / 411(4SIGNED T OF J� '��9 � AT D'1'r'1(li CA � ..',�^� d
DAY M NTH YEAR ITY �' `'' ` - ''i D-�-�+ "r
X -
WET SIA ATURE OF REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS.
DEPARTMENT OF BUILDING AND SAFETY
STRUCTURAL OBSERVATION REPORT FORM
Report No:
This report includes all construction work through *11"kday of ���''`'/ , 20 .6
No. of
Project Address: Structural bserver of Record(SOR) Phone No.of SOR:
tom° S . lC% UZ- A cPo 1LGL 62-6--2- j--?Gb
•
Building Permit No: Structural Observation Performed by: Professional Lic./Reg.No.of Observer. Phone No.of Observer:
F, L6- 52, 14 ?
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
FOUNDATION WALL FRAMES FLOOR PORTION OBSERVED,IF NOT WHOLE
❑ Footing,Stem Walls ❑Concrete ❑Steel Moment Frame U Concrete 5( i._ 66(u 4 N
❑ Mat Foundation ❑Masonry ❑ Steel Braced Frame ❑Steel 0/ v r cA e A, cetb(Z ot-;
U Caisson,Piles, Grade Beams ❑Wood ❑ Concrete Moment Frame U Wood 1
❑ Retaining Foundation U Other: U Masonry Wall Frame U Others: y
Others: 4(.6.a., a Li it 'D A ❑Others: pi-A-t)
`
OBSERVED DEFICIENCIES:
NV )0 (0aocr .
4:')-
r,10 �3943 ITO fn g
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g 'If ;tip.03f31/ f
SIGNED ,)1Z1 OF I V` , 14 ,AT (d k�tln ,CA ,-) r� _ ;1
DAY MONTH YEAR CITY <'� �" '�/
.11\s27_
WET SINATURE OF REGISTERED CIVIL OR STRUCTURAL ENGINEER OR LICENSED ARCHITECT STAMP OF ENGINEER OR ARCHITECT
STRUCTURAL OBSERVATION DOES NOT WAIVE ANY OF THE REQUIREMENTS FOR BUILDING INSPECTION BY AUTHORIZED EMPLOYEES OF THIS DEPARTMENT
DISTRIBUTION:STRUCTURAL OBSERVER TO SEND ORIGINAL TO THE BUILDING INSPECTOR'S OFFICE,ATTACH THE FIRST COPY TO THE APPROVED PLANS,AND KEEP SECOND COPY FOR STRUCTURAL OBSERVER'S RECORD AND DISTRIBUTIONS.
.. h 2 y';, / // j
[os An„ eles Uniform Coe Program A
Unif rm Proce ore Ir-7: Spledfo;Inspectio. s AR u
:$ ECIAL INSPECTION t EPORT :,
c ri op ikrZ-c.Ai9r1-.
SPECIAL INSPECTION 'REPORT ,%
"
E C tS ttl P N l N fxCONFORMANCE °,,
Ail disctopanc.les shalt be brought to Um Imm :tote attention of the if work conforms to approved,design and code requrrernnents submit this
Contractor for'correction. If corrections ore not made In a ttmely report to Building Oepartme€Ot"""and,copies to Contractor Eng€Weer Or
mariner,this report shalt too utaod na a discrepancy natica,Submit the Architect of record and Owner no later than the business day following
original to ,:autiding Depprtmnornt and copies to Contractor, the conclusion-Of the special inspection.For inspections greater than 5
Engine rtArchttectof record and Owner, days duration,submit a conforfaance report et least once every We A•
This is a: " Progjress Re,ort —Final Re r rt Report No.:" ..,;, I Page No _4._ ;__ _of.,.,}
Praia tAcltht W Dascep€onarProject
"'"""""""`""" -',� .'.�."-`-""' „_ u. M t_cVEn finer eeorct -Contractor:.
Permit Nutni:ar, CI�,ft9f: �rchi w 9
,ii
Full[game err 41-pect to pectoo " City 1 strut in Menntor: Co npany: Phone Number
Type of inspection: ` ,
°Reinforced Concrete JStructural Masonry °Piling,Piers and Caissons / ` .Smoke Control
w,lPrestressedtPasl-tensioned °Bo€tsin Cancrete/Masanry ,ClExcavationn0Fitis i, °Energy.Compiiance ;
DShotcrete/Gunite DStructurai iNelding DSpray-Applied Fire Proofing Testing Reports.
Jinsutatng:Concrete(Gy( 'ate ,High Strength Bolting °Other
Time Time `
• Date Arrived Departed Description,,and Location of Work inspected "A'
. Lt,(p_r/ik,„1.,!.saA k9,1.,RP_ _0..Q_Y-1,1. .N—i-itc,t-iiil,2•O Oil -*..,,c.. P-f. OP'4(..$' "r1:7
__, ., ;;,. .t L. , e_ t 4o ix . x , c42#4 le Ii
�� .4-"'Ole
Remarks;._ ,. .
o
I HEREBY DECLARE THAT THE FOLLOWING IS TRUE TO THE BEST OF MY KNOWLEDGE:
i '" -1. I AM,OR'MY COMPANY tS;RETAINED BY THE'OWNER OR`THE ARCHITECT/ENGINEER•OF ReetiRp To PROVIDE SPECIAL I€SPEGTrON
FOR THEWORK COVERED IN THIS REPORT:
' 2, I HAVE PERFORMED THE REQUIRED INSPECTION DURING Tii tE TIME PERIOD AS STATED ABORT i
3. THE WORK COVERED IN THIS REPORT IS IN CONFORMANCE TO THE APPROVED PLANS, SPECIFICATIONS AND APPLICABLE
• WORKMANSHIP PROVISIONS OF THE CODE CEP-TAS INP,i3OATED OTHERWISE; ,
�.na€u€a Date `
(Revised 10/2%2)
I Pae e 1 of i
I
. .4, .
Ray Liu Associates, Corp. • . : - '
, .
600 West Main Street Suite#212,Alhambra;CA 91801 Tel:(626)308-2196,Fax:(626)308-2195;E-mail:ray@raylivassociates.com
September 8, 2016 _
To: Mr. Jeff Wang
City of Arcadia
Development Services Department
240 West Huntington Drive,
Arcadia, CA 91007
RE: 130S. 1st Avenue;Arcadia, CA 91006
Permit No.: BOO-049;441 .
Structural Observation Report No..1 (Field Work.on Columns) ..
Dear Mr.Wang, . .
The design engineer of strengthening column rigidity performed a structural observation at.
the above construction site dated on September 8, 2016. We provide the structural observation
report regarding aforementioned tasks, the observed location refer to attached report and photos
per City approved document. . .
If you need any additional information;please contact us @(626) 308-2196,
Very"truly:yours,
e1;1(r fi'
e/1"144
Ray Liu; Ph.D.;P.E.
Principal
Ray Liu Associates,Corp:
600 West Main Street,Suite#212
Alhambra, CA 91801 .
ray@a,rayhuasso ciates.com
i
County of Los Angeles'.
DEPARTMENT OF PUBLIC WORKS BUILDING & SAFETY DIVISION
PUBLiO WORKS
Los Angeles Regional Uniform Code Program
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 Los Angeles County BuildingCode. (Bections 106.4.5, 1709)
Report No. /
This report includes all construction work through e day of jet it*6.6-t- 20_ iS Page NO. / of 7
Project Address: /6 ,5 Structural Observer of Record (SOR): SORPhone No,:
/17?-c-adi4, CA 7/00 ro4-de Lig : (4414)43s7jeg71
Building Permit No.: Structural Observation Observr Professional Lic./Reg. No.: Observer Phone No::
13°O'd t-f-*1. I P!rformOd by: I. r.L . c o eL4,#33 4677
OBSERVED STRUCTURAL ELEMENTS AND THEIR CONNECTIONS
ELEMENTS/CONNECTION
FOUNDATION WALL FRAMES FLOOR
OBSERVATION LOCATION
0 Footing, Stem Walls 0 Concrete Steel Moment Frame 0 Concrete: coot - ir+1.1
o Mat Foundation 0 Masonry Q Steel Braced Frame 0 Steel Deck .2 .3
o CaiSson, Piles, 0 Wood 0 Concrete Moment 0 Wood 7/fra eel Meet'
Grade Beams. Frame ,
et,/ to-eof de tat; (
El Retaining Foundation 0 Others: 0 Masonry Wall 0 Others: CI
Hillside Special Anchors Frame /6;3 mat.of
, .
0 Others 0 Others: •
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.)
No 0'4 t-St4-4-cilitl dei(tem c,i&s A.)-crc $Cie a
4/facRei fhotei tacikedt tido fri.ift / re.#Irce
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.
Vre9f?r
2. I, OR ANOTHER ENGINEER OR ARCHITECT WHO I HAVE DESIGNATED ABOVE AND IS A ,--:71N 0 UN
G
UNDER MY RESPONSIBLE CHARGE;HAS.PERFORMED THE REQUIRED SITE VISITS AT ,f,' ---74-7"
EACH.SIGNIFICANT CONSTRUCTION STAGE TO VERITY 10 THE STRUCTURE IS IN 11-~ .* I .
z GENERAL CONFORMANCE WITH APPROVED PLANS AND SPECIFICATIONS; 70729cz.)
3. ALL NOTED DEFICIENCIES WHICH REMAIN TO BE CORRECTED HAVE BEEN INDICATED — ER Ogld° -"-47
ABOVE;
(51.97, • CAM.-
4. I RECOMMEND THAT ACCEPTANCE OF THE STRUCTURAL SYSTEMS BY THE COUNTY •e cky:
OF ciko
OF LOS ANGELES BE WITHHELD UNTIL ALL OBSERVED DEFICIENCIES ARE
CORRECTED.
e'44 p&p" 7- d' (STAMP OF STRUCTURAL OBSERVER)
SIGNATURE OF ST CTURAL OBSERVER DATE
Version 1.0(2008 LACBC) Jan.10 200/3
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1
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1 ' Ray Liu Associates, Corp . ..,, : :
. .
600 West Main Street,Suite#212,Alhambra,CA 91801 Tel:(626)308-2196,Fax:(626)308-2195,E-mail:rav@raylivassociates.com
August 1,2016
To Building Officer .
City of Arcadia
Development Services Department .
240.West Huntington Drive; . •
Arcadia, CA 91007
RE • 30 S '1st Avenue,Arcadia; CA 91006
Permit No.:.B00-049-441 . -
Detail of Field Repair(Column Shortage) .
Dear Sir/Madam; - : .
We as the shop drawing f rm reviewed the attached structural drawing Sheet S-5 and shop
drawings Sheet E4:1 and E4:2 along with a Site visit on May 30, 2016in regard to.field-,verify the
: . column shortage issue. We provide a detail for General:Contractor's field repair-. If you need.
additional information,please contact us @(626) 308-2196.
Very truly yours,: .
:44 ///47 -, / .• . - : - ./ } 0F Slp4,
Ray Liu, P1i.D.,P.E. .�14 kii Cs'`/G�,�`
Principal. . — :.70729 = z.
:;Ray Liu Associates, Corp: : ,. * lap. �/
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600 WEST MAIN ST.SUITE 212
ALHAMBRA,CA 91801
1011(626)308.2196,FA3I:(626)308-2195
PROTECT STEEL SHOP DRAWING,16.110'
PROJECT SITE 130 5.IST AVE.ARCADIA CA 91006
DRAWN BY P.L
DATE 3/25/2016
SHEET COLUMNS
• SHEET NO. E-4.1
NO. DATE ISSUE
REVISIONS
3 MATERIAL LIST
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RAY 1,1E ASSOCIATES,CORP.
600 WEST MAIN ST.SURE 212
. ALHAMBRA.CA 91801
TEL:(626)308-2196,FAX:(626)308-2195
PROJECT STEEL SHOP DRAWING.16-118
PROJECT SITE 130 S.1ST AVE ARCADIA.CA BOWS
DRAWN BY P1.
DATE 3/25/2016
. SHEET COLUMNS
SHEET NO. E-4.2
NO. DATE ISSUE
REST SONS
STRUCTURAL CALCULATION AND
DETAILS
FOR
���,�C�IT
Y OP
STRENGTHENING RIGIDITY IN COLU1V11Vnen( '•cr`912�:iiv,
Thi•. , �j�� ll<c.s f�,
AT on c s sc t Of'• /)/al) ft(� 'j�� (hlr(/))c r)t
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130 S. 1STAVF7 shall be 1' )(s.a,) (rltiOns./))u.
t be ARCADIA, CA�1 �j�t)In)pin�, (.vccZ, k;
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PREPARED FOR
SUN'S RESIDENTIAL DEVELOPMENT,LLC.
308 S. 1ST AVE. #F,
Ncz,O�ES$(
ARCADIA CA 91006 oq.
S 70729 m
EXP.a63o)e/,'
PREPARED BY
RAY LIU ASSOCIATES, CORP.
600 WEST MAIN STREET, SUITE#212, L
ALHAMBRA, CA 91801
TEL: (626) 308-2196
FAX: (626) 308-2195
RayLiu Associates, Corp. PROJECT I3 aS'e J. ��
; NO /s t Ave;,Atcaatiq
DATE 7-22-J-0jA
600 West Main Street,Suite#212,Alhambra,CA 91801
Tel:(626)308-2196,Fax:(626)308-2195 'PAGE / OF 3
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Ray Liu Associates, Corp. PROJECT/3 045. /s t f(,/c.,,47-cad;q
DATE 7-2•2--1-0/4
600 West Main Street,Suite#212,Alhambra,CA 91801
Tel:(626)308-2196,Fax:(626)308-2195 PAGE 2- OF 3
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1.SMF:Beam/Column properties
Fy= 50 ksi : : .
: :..Mp=: . . 7350 k-in AISC 341--0 D2.5b/D1.4a
Mu=1:1 RyFyZx .. 8893.5 k:in AISC:341=0:. D2:6c: Base PL :- :
Mu= 741.1 k-ft
H.story= 14 ft. H used Conservatively for talc.only,
Vp=EMpc/H : 87.5 k
W12X96: : .
A. . .28:2: in2. .• . .
b k des min tis. in
Aw=d'tw=. .• 7.0. in2 .
Sx �31 : in3
.. rx - sa4: : in.
lyy 270 . in4
8 Zx: '147 in3'
:.2:SPL Plate Design Web Side PL(2 sides total) .
Fyp :. 50 ksi - - Use:GJP from Column Flange to Web'Side PL
t _ 0 9"0 6*fy*tf=p.total- : .: 4an : . . Rw= . 24.3 krn. . . ; '.-
b 15 in. Lw.re Mu/d /2/ + •
. P- . 4-( ( -tfl).. Rw" tf' ` 1T.3 in " ; ; :
Ap- 60.00 in2.
i.web : 6760.0.in4 • USE CJP weld at Column Flange to Side PL
Z• .PL= :- . 225.0 in3:. each side. w/min'Length 18,0.in .: :
•
Mp.web= 10125 k-in
.. 3..Check Z,Ix,.Mp:and Vu
Demand. :: ; . . .. . Design:Flange+Web
= _
xc.. � . . < ,Elp . . •6757. in4 ' ; OK-..
. 833:in4. .
: . Zx = - -147 in3 . .. <. £Zp. , 226 in3 : . , .. Ol(
:.. = •
8,894 k-in: . <:: EMP.= 10,125 .k-in.; OK ;
Mu .
Vu=
88."k � itiVn.web . . . . 1620 k.: :OK
USE(2)Side PL s: PL 2 in X 15 in Wide X-18.in Long-Bich side of SPL&each side of Column
I . .
STRUCTURAL CALCULATION AND
DETAILS
FOR
SPLICE CONNECTION IN COLUMN
AT
130 S. 1ST AVE.
ARCADIA,CA 91006
PREPARED FOR
PETER LEE RNGINEERING,INC.
8748 VALLEY BLVD.#L,
ROSEMEAD, CA 91770 k a•�0LlN ve�
=' 70729
111
6i1 rn
EXP.06 30 30/ .i
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CNIV
PREPARED BY c OF Cp:Uft
RAY LIU ASSOCIATES,CORP. ,e4i,/G.
600 WEST MAIN STREET, SUITE#212,
ALHAMBRA, CA 91801
TEL: (626)308-2196
FAX: (626) 308-2195
Ray ��� 06 NO /6 ``/�'
Associates, Corp.Corp• PROJECT/3sis./Si Are., li-read i4
DATE ‘-3 - /t
600 West Main Street,Suite#212,Alhambra,CA 91801 PAGE / OF 1
Tel:(626)308-2196,Fax:(626)308-2195
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Ray Liu Associates, Corp.l PROJECT /3 a s. 1st /'Y •,hreALi q •
DATE —cfl— /4
600 West Main Street,Suite#212,Alhambra,CA 91801
Tel:(626)308-2196,Fax:(626)308-2195 PAGE / OF 2.
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600 West Main Street,Suite#212,Alhambra,CA 91801
Tel:(626)308-2196,Fax:(626)308-2195 PAGE .2- OF 2-
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Ray Liu Associates, Corp.
600 West Main Street,Suite#212,Alhambra,CA 91801 Tel:(626)308-2196,Fax:(626)308-2195,E-mail:rayaravlivassociates.com
June 6,2016
To: City Inspector
City of Arcadia
Development Services Department
240 West Huntington Drive,
Arcadia, CA 91007
RE: 130 S. 1st Avenue,Arcadia,CA 91006
Permit No.: BOO-049-441
Detail of Field Repair(Column Shortage)
Dear Sir/Madam,
We as the shop drawing firm reviewed the attached structural drawing Sheet S-5 and shop
drawings Sheet E4.1 and E4.2 along with a site visit on May 30,2016 in regard to field verify the
column shortage issue. We provide a detail for General Contractor's field repair. If you need
additional information,please contact us @(626) 308-2196.
Very truly yours,
, 707 —eir
Ray Liu,Ph.D.,P.E.
Principal
Ray Liu Associates, Corp.
600 West Main Street, Suite#212
Alhambra,CA 91801
ray(airaylivassociates.com
f Y
jOB NO
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A .. i RAY LID ASSOCIATES,CORP.
_ 600 WEST MAIN SC.SUITE 212
ALHAMBRA,CA
TEL(626)308 2 96,FA%(626)1308.2195
PROJECT STEEL SHOP DRAWING,16319
PROJECT SITE 130 S IST AYE ARG01A,CA 91006
P.L.COSCRI
II Mal 3/25/2016 4
II ® COLUMNS ,
[ ® E-4.1
NO. DATE ISSUED_
REVISIONS ,
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D RAY LN ASSOCIATES,CORP.
600 WEST MAIN ST.SUITE 212
ALHAMBRA,CA 91801
TEL:(626)308-2196,FAX:(626)308-2195
PROJECT STEEL3110P DRAWING,16110
PROJECT EITE 110 S.1ST AVE.ARCADIA.CA 91006
DRAWN BY P.L.
DATE 3/25/2016
SHEET COLUMNS
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SO. DATE ISSUE
REVISIONS
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30 5. I ST. AVE.
ARCADIA, CA 9 I OOG
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Exp.O3/31 JA(7
S'T-e OCT'
Certificate No. 20121023 — 518
ARCADIA UNIFIED SCHOOL DISTRICT
150 South Third Avenue,Arcadia, CA 91006 • (626) 821-8300 Ext. 6732
(Certificate of Compliance with Fee Provisions of Government Code Section 65995)
This new Fee Schedule is effective December 26,2012.
Any Developer Fee Worksheet brought in on or after this date will be charged at the new rate.
Address of Development:
130 S. 1st Ave. , Arcadia, CA 91006
Number of Buildings in Project: one Plan Check Number: 15—12 8
[ ] [ ] [X] [ ]
Exempts (500 sq.ft.or less. Residential2 Commercial/Industrial Commercial/Industrial
Future additions chargeable $3.20/sq.ft. $0.51/sq.ft. Parking Structure
at regular rate) $0.26/sq.ft.
Area in Sq. Ft.: A developer may request refund of fees to the
3, 9 5 5 District within twelve months of payment of fees,
in the event the Building Permit expires or the
Developer Fee: $ project is canceled. The refund will be reduced by
2 , 017 .05 a $100 administrative fee. The refund check will
Receipt No. [X ] 318 0 6 6 [ ] N/A be issued in the name of the original payee and
mailed to the address of payee.
Owner: Sun' s Residential DevelopmenYeie�l�per:
Address: Address:
308 S . 1st Ave #F
Arcadia , CA 91006
Home Phone: Business Phone:
6 2 6—3 21—2 4 2 9
Pager/Cell Phone: Pager/Cell Phone:
'This is to certify that the above-described development has been determined to be exempt from the developer fees
of Government Code Section 65995 and a Building Permit may be issued therefore.
2This is to certify that all fees due to the Arcadia Unified School District, under provision of Government Code
Section 65995, as a prerequisite to the issuance of a Building Permit by the Building Department of the
Development Services Department,have been received. Based on the information presented above, this Certificate
of Compliance is hereby executed.
➢ 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 bounced 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 issued on any type of development. Said request for refund of fees paid to the District must be
made within twelve months of payment of fees.
Applicant confirms that he/she is authorized to sign on behalf of the owner/developer and that
the information he/she provided herein is true and accurate to the best of his/her knowledge.
Signature of Applicant:
District Approval: Date: 11/6/15
WHITE—City YELLOW—Accounting Dept PINK—Business Servicee GOLD —Applicant Certificate of Compliance(10-23-12)
®fir RC,��
v �
November 17, 2014
r..w,,,903 Mr. Ben Wu
oo\ 308 S. First Ave., Suite F
'44nnity°f 1A° • Arcadia, CA 91006
LAtyof Subject: Tentative Parcel Map No. TPM 14-07 (72892)
• Architectural Design Review No. ADR 14-06
Arcadia Caula Modification Application No. MC 14-04
130 S. First Ave.
Dear Mr. Wu,
Development
Services At its meeting on November 12, 2014, the Arcadia Planning Commission
voted 3 to 1 with one abstention, to conditionally approve`Tentative
Department Parcel Map No. TPM 14-07 (72892), Architectural. Design Review No.
ADR 14-06 and Modification Application No. MC 14-04 for a two-unit,
residential-condominium subdivision at 130 S. First Avenue, subject to
Jason Kruckeberg the conditions listed in the attached Resolution No. 1924, which was
Assistant City Manager! adopted at the same meeting.
Development Services
Director Approval of TPM 14-07 (72892), ADR 14-06 and MC 14-04 shall not
take effect until the applicant/property owner has executed and filed the
attached.Acceptance Form to indicate acceptance of the conditions of
approval within 30 days following approval by the Planning Commission.
There is a ten (10) day appeal period from the date of approval. Appeals
must be submitted in writing to the Community Development Division
with an appeal .fee by 5:30 p.m. on Monday, November 24, 2014. You
will be notified if an appeal is filed.
This tentative tract map will expire twenty-four months (November
25, 2016) from the effective date. If an extension is necessary, a
written request and fee must be submitted to the Community
Development Division in time for the Planning Commission to consider
the extension request prior to the expiration date.
If you have any questions, please contact me at (626) 574-5422 or via
email at tschwehr@ArcadiaCA.aov.
Sincerely,
DEVELOPMENT SERVICES DEPARTMENT
Comm nity Development Division/ Planning Services
Tim Schwehr
Associate Planner
240 West Huntington Drive Enclosures
Post Office Box 60021
Arcadia,CA 91066-6021
(626) 574-5415
(626)447-3309 Fax
www..ArcadiaCA.gov
1
it ; t.►
PERMIT/PLAN REVIEW APPLICATION
\2aj. 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 g License No.`7 644 v( 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 .Aa� —ems
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
Li 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 I
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
forthwith comply with those provisions.
IDI, as owner of the property, or my employees with wages as their sole
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 f ( 2�'f/d 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 e/aA-R C xS Lc--( 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
A cadia to enter upon the above-mentioned property for inspection purposes.
Si nature Date T/ /)J /1
l OAF Ake
:.N
17 PERMIT/PLAN REVIEW APPLICATION
Et , 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 CO. License No. 0 50070 Exp. Date9''2,/J2 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 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 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
❑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.4I /4/2 1 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.
❑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
N ate, dq f 16/21 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.
an1e �6'Tfe,r ,i,®!Yf"ez!/i' Title U,
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 G / le /•�
U~4OFF R.v,../6
Y_ PERMIT/PLAN REVIEW APPLICATION
'E 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:
r ❑hapter 9(commencing with Section 7000,of Division 3 of the Business and
rofessions 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,'—1(P License No.qb6 (.)-(O Exp. Date(t 130(17 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
s issued.My workers'compensation insurance carrier and policy numbers are:
License Law for the following reason(Section 7031.5,Business and Professions y
Code.Any city or county which requires a permit to construct,alter,improve, Carrier (t- Fl l-e.-.
demolish,or repair any structure,prior to its issuance,also required the applicant olicy 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
❑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
1
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 ©G+JN,Q'� Asvt� �
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 -----)" bate c 266p7
of ARL,
°~ el ' PERMIT/PLAN REVIEW APPLICATION
.f Development Services Department,240 West Huntington Drive,Post Office Box 60021
'mm�o,.Y°,x 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
ofessions 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.— ID icense No. 4-0 5 C Exp. Date 313Ii 17 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 'ilea.----
OWNER-BUILDER DECLARATION IDI 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 s issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
Name 4(4(J tle ec e
\\\ 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 on the above-mentioned property for inspection purposes. 1 (Zcf gnature teG III
C7
of AR
G�LIFOR�.�C9A
11 PERMIT/PLAN REVIEW APPLICATION
• j 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
aI 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 15 License No. 1440 I Exp. Date eisSI/('7 compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Signature of Contractor
OWNER-BUILDER DECLARATION ElI 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 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 ofICalifornia,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).
AI am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date S; Ai 0 t'I 245 f 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 61 tirtrt r Lc t 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 1 f' / 2/I
4°tr ,4d 9
o 9 " }
PERMIT/PLAN REVIEW APPLICATION
j 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 1. License No. 9 p 440 !Exp. Date k(.>(/l1 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-BUILDeit DECLARATION 0 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
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
sale(Section 7044,Business and Professions Code:The Contractors License Date t I/ , `t Signatures_
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.
J
Name (/ N.6\V A C Title C/en-C4 O C.--
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 VA /6 /L S