HomeMy WebLinkAboutUntitled City of Arcadia, CA w ��� ' Permit NO Plum-18'-0265
I Development Services Department s �,--, j �
! } PecmitType Plumbing
240 West Huntington Drive,Post Office Box 60021 _ ( 3 s,
Arcadia,CA 91066-6021 n .. -- t i + , Work Classificat• ion:Water Heater
(626)574-5416
Permit Status Issued
ARRC IA Issue Date 03/05/2018.1 Expiration• 09/01/2018
Addr NO. Dir Prefix Street Name Street Suffix City,State,Zip Parcel Number
1106 5 Mayflower AVE Arcadia,CA 8509007019
Contacts
EDSON,KIRK E AND JOYCE J Owner
1106
Description:REPLACE EXISTING WATER HEATER,SAME SIZE Valuation: $0.00 Tenant
AND LOCATION
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Plumbing Permit Issuance Fee $44.35 Total Fees $60.90
Solid Waste Management Fee 2 $1.00 Cash/Receipt# $60.90
Water Heater and/or Vent $15.55
Amount Due: $0.00
Total: $60.90 -
3 2-3-18
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CALLS FOR INSPECTION Request for inspection bytelephone at 626-574-5450.
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Leave a message requesting the address,time frame and what inspection
item is needed.
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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.
March 05,2018
.sued By: Date
March 05,2018 Page 1 of 2
An
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7 PERMIT/PLAN REVIEW APPLICATION
.4-41,42r, � Development Services Department,240 West Huntington Drive,Post Office Box 60021
°a,t,°tl° Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0 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. 0 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
Signature of Contractor performance of the work for which this permit is issued.
1 WNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
EV 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
❑I, as owner of the roe forthwith comply with those provisions.
property,rty, or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for 3/- / r • ,
sale(Section 7044,Business and Professions Code:The Contractors License Date Signator ��
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 sec 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.
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).
o1 am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
—
h
��
ate V c 7 SigjLender's Address
ORTANT: APPLICATION I REBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FOR 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��, 6� " 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.
2
Signature Date
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SELF=CE,IEFICATBON
FOR COMPLIANCE OF SMOKE ALS';
AND.0BON it•NOXID
Property Address: \\O Co . N�P�`��Lo�r�1sGQ E GPrt>,4 (Pr "kkooG
Permit Number: • P\'V r « �011,45
Brief Job Description: W
Number of smoke alarms installed:
Number of carbon monoxide alarms installed: �--
When alterations, repairs or additions requiring a permit occur,,or sleeping rooms are created,
Smoke alarms shall be installed in each sleeping room, and outside each separate
sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements and habitable attics as required by Section R314 of the 2016
California Residential Code (CRC) and California Health and Safety Code Section 13113.7.
For dwellings or sleeping units containing fuel burning appliances or having attached
garages, carbon monoxide alarms shall be installed outside each separate sleeping
area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements as required by Section R315 of the of the 2016 California
Residential 'Code (CRC).
Multi-purpose alarms (combination carbon monoxide andsmoke alarms) may be used.
All alarms shall comply with requirementsfor listing and approval by the Office of the State Fire
Marshal. http://osfm.fire.cagov/licensinglistings/licenselisting bml searchcotest.php
As owner of the above referenced property, I hereby certify that the smokealarms, and carbon
monoxide alarms have been installed'in accordance with the manufacturer's instructions and in
compliance with thecode sections referenced above.
declare under penalty of perjury that the foregoi rg is true and correct, ,nd that this
declaration was executed on (Date)
3 °` / 13 at lA.rc die, California.
Owner's Narte (printed/typed):
Signature of Owner:
This affidavit must 2 returned to the City of Arcadia inspector prior tofinal inspection
SMOKEAL,,'RM-•ND CA', N M troNOXtDE At LoC ATtONS
Guest Room
Batir000
Storage
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Family Rood,
FIRST FLOOR PLAN
SO= SMOKE ALARM I = CARBON MONOXIDE ALARM
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1 '
- Master Bedroom
Dining Room
' II „
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Flail Closet
I Ciosef
; ,� Closet '
; l°atu y Room EMI ®i 1,
III,i - '! ' Bedroom Bedroom
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SECOND FLOOR PLAN
LAN'
m SMOKE AL MI = c,,,-,BON MitNOXt E ALARM