HomeMy WebLinkAboutUntitled -r. 1 € ••A `Perm,io PIutii 18-0002
City of Arcadia, CA
,i. 14 PermitT a Plumbin
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I $ i = 3 Work classification Plumbing Residential
,� �h i Permit Status iIssued K
ARCA D� lh Issue-Date;02/06/2018�� Expiration: 08 05 2018
Location Address Parcel Number
274 Oakhurst LN,Arcadia,CA 5775012023
Contacts
1.
ASPELL,PATRICK H AND SUZANNE TRS P Owner Rudy's Plumbing Plumbing Contractor
H AND S G ASPELL TRUST (C-36)
274 OAKHURST LN 131 E Central,Monrovia,CA 91016
(626)258-1490
Inspection Requests:
Description:REPLACE MAIN GAS LINE TO DWELLING , Valuation: $0.00 (626,)574-5416
' Total Sq Feet: 0.00 : p ;
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Fees Amount Payments Amt Paid Available Inspections:
Gas System(Outlets) $15.55 Total Fees
$60.90 Inspection Type I IVR
Plumbing Permit Issuance Fee $44.35 Cash $60.90
-
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $60.90 -
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February 06, 2018
Issued By: Date
Tuesday,February 6,2018
Page 1 of 1
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PERMIT/PLAN REVIEW APPLICATION
o .j` Development Services Department,240 West Huntington Drive,Post Office Box 60021
04,.0,.,oto° Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
ereby 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 Busin:,s a.d
Professions Co.-,an. ..y license is in fu orce liffect. // I ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class _ License No. 7 '/ Exp. Date(!'J 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 Contracto :��e— s
1
OWNER-BUIL Y ER DECLARATION ave and willmaintain workers'compensation insurance,as required by Section
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 700 of the Labor Code,for the performance of the work for wide this permit
is issued.My workers'compensatip insurinnce c er and poli umbers are:
License Law for the following reason(Section 7031.5,Business.and Professions ` � 1 Cr
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 f �7
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number IP CO
9
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'compe ation 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 co pl 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 ( Signa
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.
Name64C 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
Arcad'. to enter upon the above-mentioned property for inspection purposes.
Sig..: re -..411114�J` Date 2--/L77 7�