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HomeMy WebLinkAboutPLUMB-18-0482 ti vim-
City of Arcadia, CA ''PermitNO.'_Plum 180482,
y Development Services Department . D 11f��? _. Permit Type..Plumbing`
240 West Huntington Drive,Post Office Box 60021 ^ � _ ��
Arcadia,CAWestH Huntington
alk workClassi�icadon R_IumbmgResidential
(626)574-5416 :Permit Status;-ls'sued'
ARCAIDIA Issue Date:'04/03720181 Expiration: 09/30/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number {r
970 Singing Wood DR Arcadia,CA 5769013003
Contacts
LIEVSAY,DONALD AND MARJORIE TRS Owner H S W R R Inc.Dba Roto Rooter Plumbing Contractor
LIEVSAY FAMILY TRUST Plumbing (C-36)
970 SINGING WOOD DR 23311 Madero,Mission Viejo,CA 92691
Description:BACKFILL CESSPOOLS/SEPTIC TANK,NEW SEWER Valuation: 5 0.00 Tenant
CONNECTION,NEW GAS LINE
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Ggs$ystemi Oytietsr— $15.55 Total Fees $92.06
Plumbing Permit Issuance Fee $44.35 Cash/Receipt#REC-000804-2018 $15.55
Sewer Connection on Property $31.16 Cash/Receipt#REC-000747-2018 $76.51
Solid Waste Management Fee 2 51.00
Amount Due: $0.00
Total: $92.06
COMPLETE' CALLS FOR INSPECTIONS0
Request for inspection by telephone at 626-574-5450. Leave a message
v requesting the address,timeframe and what inspection item is needed.
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.
April 03, 2018
Issued By: Date
April 06,2018 Page 1 of 1
•
c• PERMIT/PLAN REVIEW APPLICATION r
4 •..•
Development Services Department,240 West Huntington Drive,Post Office Box 60021
s\lj,
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
Signature of Contractor _ performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION 0 I have and will maintain workers'compensation insurance,as required by Section
0 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 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
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
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
hof asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909)396-2000 for
r ,r,ifurtherinformation.
`ante CG1�0't` e-\ tr Title
Ii PRINT NAME
r
Ikertify that I have read this applicat .n and state that the above information is correct and that I am the owner or duly authorized agent of the owner.
'agree to comply with all City or.' ances and State Laws relating to building construction. I hereby authorize representatives of the City of
rcdie to enter upon he above-mentt.ned property for inspection purposes.
IfI[ure — ' ` • Date
4�
�~ City of Arcadia, CA •Permit NO.,Pium 18`O482;
Development Services Department �.-"�, 4a""v""- } `-^ Permit Type Plumbing"
11 240 West Huntington Drive,Post Office Box 60021 'I �' rj ii( fjPlumbing
1 ! WorkClassl cahon: Residential
Arcadia,CA 91066-6021 -t
(626)574-5416 - _ • Permit Status:Issued-
ARCADIA Issue'Dare o4/os/20is Expiration: 09/30/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
970 Singing Wood DR Arcadia,CA 5769013003
Contacts
LIEVSAY,DONALD AND MARJORIE TRS Owner H SW R R Inc.Dba Roto Rooter Plumbing Contractor
LIEVSAY FAMILY TRUST Plumbing (C-36)
970 SINGING WOOD DR 23311 Madero,Mission Viejo,CA 92691
Description:BACKFILL CESSPOOLS/SEPTIC TANK,NEW SEWER Valuation: $0.00 Tenant
CONNECTION
Total Sq Feet: 0.00 Plan Check N Plan ft
Fees Amount payments Amount Paid
Plumbing Permit Issuance Fee $44.35 Total Fees $76.51
Sewer Connection on Property $31.16 Cash/Receipt N REC-000747-2018 $76.51
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $76.51
COMPLETED 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.
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.
April 03, 2018
Issued By: Date
April 03,2018 Page 1 of 1
•
0 •�'± i PERMIT/PLAN REVIEW APPLICATION
4 ' Development Services Department,240 West Huntington Drive,Post Office Box 60021 '
P
„„oil" Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
Chereby 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
. .fessions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
icense Class C'3 b icense No. IO1(oOZi Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor
V -,-- . L performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION I have and will maintain workers'compensation insurance,as required by Section
❑ 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'co enation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier Out. . P.
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 (This section need not be completed if the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
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 ci ' 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 object to the
workers'compensation provisions of Section 3700 of the Labor ode,I shall
❑I, as owner of the property, forthwith comply with those provisions. / c —
or my employees with wages as their sol JV,-.......,Q
---`�- (,.
compensation,will do the work,and the structure is not intended or offered fo y-%_�
sale(Section 7044,Business and Professions Code:The Contractors License Date 9 Signature
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 CONSTRUCTION LENDING AGENCY
Code:The Contractors License Law does not apply to an owner of property
-- 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.
e �--\alrl`\Q\ QC-1.-
•
Gi Title
PRINT NAME
irtify that I have read this applicationand state that the above information is correct and that I am the owner or duly authorized agent of the owner.
a e to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
r dia to enter upon a above-me oied property for inspection purposes. fq�
i azure ` Date LI-3- iJ