HomeMy WebLinkAboutAddress Assignment °`\, Development Services Department
t 240 West Huntington Drive,Post Office Box 60021 PERMIT NO BOO-045 037
Arcadia,CA 91066-6021
City
Arcadia (626)574-5416,Fax(626)447-9173 Permit Type: Address change
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PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
11074 11/14/2013 JB 15:44 12/11/2013 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG :ASSESSORS PARCEL NO. GEO CODE
8 W Sycamore Ave 5770-009-016
OWNER MAILING ADDRESS
Robin Yiu 8 Sycamore Ave PHONE NO.
Arcadia, CA 91006 EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL - - - MAILING ADDRESS
PHONE NO. FAX NO.
EMAIL ADDRESS:
License No. Type: Expires:
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
ADDRESS CHANGED FROM 1141 N.SANTA ANITA AVE TO 8 W.SYCAMORE AVE(DUE TO NEW SF/NEW CONSTRUCTION)
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
500.00 Flat Address change 500.00 500.00 01-3530
Total Fees: $500.00 Total Amount Paid: $500.00 Paid Today: $500.00
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 103264
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 01-3530 500.00
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.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS `t,
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)
4 cO*F4O Ry1,
0614, �. PERMIT/PLAN REVIEW APPLICATION
o���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 License No. Exp.Date compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Signature of Contractor
❑ I have and will maintain workers'compensation insurance,as required by Section
OWNER—BUILDER DECLARATION 3700 of the Labor Code,for the performance of the work for which this permit is
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors issued. My workers'compensation insurance carrier and policy number are:
License Law for the following reason(Section 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, Carrier
demolish,or repair any structure,prior to its issuance,also requires 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 ❑ I certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of not employ any person in any manner so as to become subject to the workers'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil compensation laws of California,and agree that if I should become subject to the
penalty of not more than five hundred dollars($500)): workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those provisions.
❑ I, 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 Date Signature
sale(Section 7044,Business and Professions Code:The Contractors License
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING:Failure to secure workers'compensation coverage is unlawful,
sale. If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner—builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code,interest,and
attorneys 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:
I. 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 info • ation.
0 _
Name w� 1411 Title
P`INT NAME
I certify that I have read this application and state that the above information is correct and that I am the owner or the 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 above-mention property for inspection purposes.
12)1 ) 1l3
Signature Date