HomeMy WebLinkAboutUntitled City of Arcadia, CA Permit NO. EIeC-18-0131
Development Services Department1—'7 , f�1 Permit Type Electrical
r• 240 West Huntington Drive,Post Office Box 60021 4 � f €
Arcadia,CA 91066-6021iI §
Work Classification:Service Change
(626)574-5416
• 4, :Permit Status:,Issued
ARC: DIA Issue Date:02/14/2018 I Expiration: 08/13/2018
Addr NO. Dir Prefix Street Name Street Suffix City,State,Zip Parcel Number
2018 Elkins PL Arcadia,CA 5765009018
Contacts •
PARK,JUSTIN K AND CYNDI H Owner
2018 ELKINS PL
Description:UPGRADE EXISTING SERVICE,200 AMP Valuation: $0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan It
Fees Amount Payments Amount Paid
Electrical Permit Issuance Fee $44.35 Total Fees $60.90
Residential Services up to 400 amps $15.55 Cash/Receipt# $60.90
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $60.90 -
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Insert a permit notice prefix in the report text bank,entry:
Permit Notice Prefix
CT
PLEED
OSI
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.
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February 14, 2018
Issued By: Date
February 14,2018 Insert a permit page footer in the report text bank,entry:Permit_Page_Footer Page 1 of 2
of Afte
11 wax " PERMIT/PLAN REVIEW APPLICATION
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o44.,j�, Development Services Department,240 West Huntington Drive,Post Office Box 60021
0:',44....... ..,04,,,
°s N° 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 p •visions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the :usiness 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. Ex 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
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
IDI hereby affirm under penalty of perjury that I am- empt 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 71'1.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a p-.mit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its'.suance,also required the applicant
Policy Number
for such permit to file a signed statement :t he or she is licensed pursuant to the
provisions of the Contractors License La, (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 . d Professions Code) or that he or she is
exempt there from and the basis fo 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 .r 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 hull*,ed 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 prop-. , or my employees with wages as their sole , forthwith comply with those provisions.
compensation,will do the ork,and the structure is not intended or offered for
1Date
/I /�dIr.sale(Section 7044,Bu ess and Professions Code:The Contractors License ignature
Law does not apply t• an owner of property who builds or improves thereon, i"
or who does such ork 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,th 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 /improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owns r of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:lThe 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
contractors)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 )'Js 6i C�-k_ 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. j
Signature / / Date 9//97010 1 ir