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Home My WebLink AboutUntitled (2) CITY OF ARCADIA • iriLy rit CHECK REQUEST Vendor No. Date 11-15-18 (for Administrative Services Only) Pay to: ARNOLDUS SUFJAN 1801 VISTA DEL VALLE DR ARCADIA, CA 91006 Account No. Amount 01-3105 $ 103.65 $ $ $ TOTAL $ 103.65 j Reason for payment. (PLEASE SUBMIT BACK-UP IN DUPLICATE) CUSTOMER NO LONGER GOING TO REPIPE ENTIRE HOUSE. 1801 VISTA DEL VALLE DR Permit: PLUM 18-1845 ❑ Check here if check is to be Approved by: P " returned to Department. Department: Building Department shy) �1 wnid. "da alli9/\ IC 1491\ 1021 • 4.Skh £28 0549 --"<* • -25-cnnn City of Arcadia, CA Permit Na Plum 18-1845 (tY /yJ/l Development services Department Tkji' f1JU'1jfjrk np Post Office Boz 60021 Clasification(6 - __ - - • (6z6)s7a-sa16 Permit Status:Issued ARCADIA , Issue Date 10/08/?0181. Expiration: 04/06/2019 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 1801 Vista Del Valle DR Arcadia,CA 5766011007 Contacts _ ARNOLDUS SUFIAN Owner (650)823-4753 -gionominammommignoni Description:COMPLETE COPPER REPIPE FROM METER TO EACH Valuation: S 5,000.00 Tenant FIXTURE AND VALVE Total Sq Feet: 0.00 Plan Check N Plan fl Fees Amount Payments Amount Paid Complete Water Repipe $103.65 Total Fees $149.00 Plumbing Permit Issuance Fee $44.35 Cash/Receipt U REC-002515-2018 $149.00 Solid Waste Management Fee 2 51.00 Amount Due: $0.00 Total: $149.00 , CALLS FOR INSPECTIONS Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. `9 This permit/plan review expires by time limitation and becomes null and PN�E� void if the work authorized by the permit is not commenced within 180 days (5 ` from the date of issuance or if the permit is not obtained within 180 days v from the date of plan submittal.This permit expires and becomes null and 0 void if any work authorized by this permit is suspended or abandoned for 180 D consecutive days or if no progressive work has been verified by a City of I Arcadia building inspector for a period of 180 consecutive days. ti KljteV • October 08, 2018 Issued By: Date October O8,2018 Page 1 of 1 vF AR cpsvo4vy1 a r..._ 4 .., !roil il PERMIT/PLAN REVIEW APPLICATION ` t1 -b. a 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 OWNER-BUILDER DECLARATION 0 I have and will maintain workers'compensation insurance,as required by Section Lhereby 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 icense 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 FA 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 (b , a 1(o sale(Section 7044,Business and Professions Code:The Contractors License �Datc—-" "'-" `�Sigtiature9 �_ - -- 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(I)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 aiI, as owner of the property, am exclusively contracting with licensed lin • contractors to construct the project(Section 7044,Business and Professions attorney's fees. 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). ' - ILI I am exempt 12'{--- and ectionn 7044,Business�and Professions Code,for this reason: - t CJAi A. "`'1Lender's Name • Dam V r I(?— __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. A- ftuLtl,u-i 4 came ceav„ ly PRINT NAME Title t 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 l� Arcadia to-enter poll the above-mentioned property for inspection purposes. {f fSignature Date "`111 b