HomeMy WebLinkAboutplum-19-0410 /
'aogo`e City of Arcadia, CA (((111 Permit NO. Pium-19-0410
Vitt
Development Services Department r� / `r—.-m * Permit Types-Plumbing.
// 240 West Huntington Drive,Post Office Box 60021
4r' f WorkClgssr taboo:PlumbingResidential
Arcadia,CA 91066-6021 \ �q� t J J >5
(626)574-5416 Permit Status:Issued •
ARCADIA Issue Date:02/27/2019 1 Expiration: 08/26/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1657 Rodeo RD Arcadia,CA 5766021021
Contacts
SAMUDRO,EDWARD CO TR SAMUDRO Owner ELITE PRO PLUMBING• Contractor
AND TANUWIDJAIA TRUST C/0 SONG P 0 BOX 74179,LOS ANGELES,CA 9004
LIEM (866)307-2345
933352
1657 RODEO RD
Description:REPLACE MAIN GAS LINE Valuation: $0.00 Tenant
Total Sq Feet: 0.00 plan Check N Plan tt
Fees Amount Payments Amount Paid
Gas System(Outlets) $15.55 Total Fees $63.56
Plumbing Permit Issuance Fee $47.01 Cash/Receipt U REC-00528-19 $63.56
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $63.56
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CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
COMPIEJEfirequesting 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.
(It
r February 27, 2019
Issued By: Date
February 27,2019 Page 1 of 1
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ll fi PERMIT/PLAN REVIEW APPLICATION
10 ,:, a,.
40,-,, Development Services Department,240 West Huntington Drive,Post Office Box 60021
a0%.n4,.."'mac 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, my license is in 11 f. d t. id� ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class Lei Lice e� o�l • p. DateD 47I J 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.
��! \hL'
. ❑ I have and will maintain workers compensation insurance,as required by Section
OWNER-BUILDER D �!,',�. i 1
❑ I hereby affirm under penalty o p 9' a ..pt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason( v ..• 0 e•. :usiness and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.My city or county which requires a permit to construct,alter,improve, Cagier
demolish,or repair any structure,prior to its issuance,also required the applicant
Polk •umber
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 r. 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. My violation of i I certify that in the performance of the work for which this permit is issued,I shall
Section 70315 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 Sectio 3 10 .f the I abor Code,I shall
0 I, as owner of the property, forthwi comp with those provisions.
wer and employees withtwages as theirsoleo �� '� I
compensation,will do the work, the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date 1 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'Compen .tion covers:e 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
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 constriction lending agency
contractors)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit'is issued (Section 3097,
Civil Code). '• '• !1
0 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 TILE FOLLOWING:
I. 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.
N/ t V ,VO kr-0\A° Sr. Ale _LOtr‘ ' ^/
PRINT NAME
I certify that I have read this application and s i`to that the above information is co rect and that I am the owner or duly authorized agent of the owner.
I agree to comp y with all Ci \ordinances a•y State Laws relating to buildin construction. I he by author e representatives of the City of
Arcadia to enter .on the ab Iv• _I entio •d pro rty for inspection purposes. fin
�\ r,
Signature ;\\ \ Date V1\\