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Home My WebLink Aboutmisc-18-1814 • City of Arcadia,CA Permit NO. Misc-18-1814 { Development Services Department r P" Permit Type:Misc` Ii 240 Wert Huntington Drive,Post Office Box 60021 .� 4 $# t , I j Work Classrircation Mc-Address Change`' • Arcadia,CA 91066-6021 " :..'t .. Permit`Status Issued (626)574-5416 - ARCADIA - `• IssueDate:10/03/2018!. Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 1112 S FIFTH AVE Arcadia,CA 5780007006 Contacts JENNY LIANG Owner 1112 5 FIFTH AVE (626)672-9829 Description:CHANGING CURRENT ADDRESS FROM 1110 TO Valuation: $0.00 Tenant 1112 S FIFTH AVE (NOFEE)) Total Sq Feet: 0.00 Plan Check# Plan$ (NO Fees Amount Payments Amount Paid Address Change $500.00 Total Fees Building Issuing Fee $44.35 Solid Waste Management Fee $6.25 Amount Due: Total: - $550.60 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. October 03,2018 Issued By: Date October 03,2018 Page 1 of 1 O(.JFFAORy,, pManiEm rill PERMIT/PLAN REVIEW APPLICATION ij 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 Signature of Contractor 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'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 (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 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 1:11I, 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 useand 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. �y (Name 1�.. Title l G �O a PRINT NAME I certify" b t I have read this application and state that the above information is coned 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 lignaturC--e7 Arcadia to enter upon the above-mentioned property for inspection purposes. �+(�' Datet� 073/0"( 8 CITY OF ARCADIA DEVELOPEMNT SERVICES DEPARTMENT 240 WEST HUNTINGTON DR, ARCADIA, CA 91007 (626)574-5416 APPLICATION FOR AN ADDRESS CHANGE ($550.60 FEE REQUIRED AT TIME OF APPLICATION) a-EV,v y ilk LI4/J JoNNy AAil- Applicant Propeity Owner ///0 5' Sit AVE . 4PZCA➢'A ((/o S 51-41 A riE c4yrA, O+Z' Address Property Address /1/0 66 5AVE . APOV IA t eA- We°4 /1/o SQA tr . A-pcAy(A-, CA- ?ice Mailing Address . Mailing Address (6'26 ) - ga29 ( 2L ) 402 - ?8°2 / Phone Number / Phone Number pp,� REQUESTED PROPERTY ADDRESS: ///o2 -54 ?LA VE i4PCf}p,kCSF //84 1s` Choice 2nd Choice eAAt o /%j/o2-gfc C� KJ Owner's Signature Date FOR OFFICE USE ONLY DOCUMENTATION: Current Property Tax Bill: _ Recorded Grant Deed: FEE: $550.60 PAID: Q 0 E) RECEIPT NO: APPROVED (Notification a attached) Yes: No: DENIED (Reason): ASSIGNED PROPERTY ADDRESS: 1(I Z S Wilt By: vi Building Official • *Note: Send notifications to all listed agencies upon approval of Building Official. OF ARC cis4 co.norLgr9y_., ;asit h "iiiif -pEy October 3, 2018 c°ml % Subject: Change of address: 1110 S. Fifth Ave City of Please be advised that the City of Arcadia has approved an address change for the subject property. Parcel#5780007006. Please update your records as Arcadia follows: CURRENT ADDRESS ASSIGNMENT: Development Services 11 l0 S. Fifth Ave Department Arcadia CA, 91006 Jason Kruckeberg NEW ADDRESSES ASSIGNMENT Assistant City Manager/ Development Services 1112 S. Fifth Ave Director Arcadia CA, 91006 The City of Arcadia would like to bring to your attention that we are requesting to change the Single Family address and would request you to modify the address in your records. The new address assignment is going to be 1112 S. Fifth Ave Arcadia, CA 91006. Should you have any question, please contact the City's Development Services Department/Building and Safety office at (626) 574-5416. Sincerely, TM . Don Stockham, Building Official 240 West Huntington Drive - Post Office Box 60021 Arcadia,CA 91066-6021 (626) 574-5415 (626)447-3309 Fax wnwt¢ci.arcadia.ca.us