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11,4 ttt0t City of Arcadia, CA
' PermitNO PIum 19-0535'
I/ 240 WDeveloest
ent Huntington
Department O : � f-y Permrt Type Pl l'Imbing
�{i� 240 West Huntington Drive,Post Office Box 60021
� �, Arcadia,CA 91066-6021 z Work Classification:Water Heater
�P" (626)574-5416 - _z-.: • -Permlt5tatus:Issued
ARCADIA Issue Date 03/18/20191
Expiration. 09/14/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
865 W Huntington DR 15 Arcadia,CA 5777029031
Contacts
VILLA RIVIERA FRED G HOLLAND Owner ADVANCED PLUMBING SOLUTIONS INC* Contractor
865 W HUNTINGTON DR M 4215 ALDERSON AVE D,BALDWIN PARK,CA
(626)272-9551 962930
Description:**UNIT 15**REPLACE EXISTING WATER HEATER, Valuation: $ 0.00 Tenant
SAME SIZE AND LOCATION
Total Sq Feet: 0.00 plan Check 9 Plan k
Fees Amount I Payments Amount Paid
Plumbing Permit Issuance Fee $47.01 Total Fees $63.56
Solid Waste Management Fee 2 $1.00 Cash/Receipt lf REC-00700-19 $63.56
Water Heater and/or Vent $15.55
Amount Due: $0.00
Total: $63.56
CT
INgL 3.28•(4
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
COMPLETEDrequesting 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.
March 18,2019
ssue By: Date
March 18,2019 Page 1 of 1
,f AR
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1 . 1: PERMIT/PLAN REVIEW APPLICATION
A .. ei„,
`zi3•' Development Services Department,240 West Huntington Drive,Post Office Box 60021
-am= on"' Arcadia, CA 91066-6021, (626) 574-5416, Fax (626)447-9173
City of
Arcadia
ICENSED 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 C 3#O ' nse No.�eZq 30 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 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 mason(Section 703 L5,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 Q ti -4
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number
for such permit to file a signed statement that heor 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
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
0 I, as owner of the property, orthwith comply with those provisions.
or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for I I a�y
sale(Section 7044,Business and Professions Code:The Contractors License Daze ` 9 Si arum
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 thecost 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 s;-
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 petrjury that theme;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. /' �// ^ ,,,,
arae 0l/I�l�l e V Amcor c c. Title
PRINT NAME
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
agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
rcadia to enter up' $ove-mentioned property for inspection purposes. /
Sig ature "���� Date 3/1 tt/ ZBI