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A-4 id0 l f 4 City of Arcadia, CA r Permit NO Elet 19 0263 � Development Services Department © Permit Type:ElectHCal.. 1`!'// 240 West Huntington Drive,Post Office Box 60021 ‘illArcadia,CA 91066-6021 - ork.Classificatio_n:ElectricaLResidential _ ^J (626)574-5416 - 'Permit Status:'Issued. ARCADIA H. . - Issue Date 02/08/2019 1 Expiration: 08/07/2019 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 957 Hampton RD Arcadia,CA 5769013032 1 Contacts RYKADAN 003 LLC Owner TESLA ENERGY* Electrical Contractor 957 Hampton RD,Arcadia,CA 91006 (C-10) 3055 Clearview Way,San Mateo,CA 94402 (323)240-3174 888104 Description:ESS FOR SFR(PV SYSTEM EXISTING)NEW 200 AMP Valuation: $ 0.00 Tenant LOAD CENTER Total Sq Feet: 0.00 • Plan Check# Plan# Fees Amount Payments Amount Paid Battery Storage Device $53.00 Total Fees $117.49 Distribution Panel $16.48 Cash/Receipt#REC-00352-19 $117.49 Electrical Permit Issuance Fee $47.01 Amount Due: $0.00 Solid Waste Management Fee 2 $1.00 i Total: $117.49 3 Si, ne, (A(4s j1_ I 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. f. ;. A. February 08, 2019 Issued By: Date February 08,2019 Page 1 of 1 %V AR 0,onoun2,:i saw1_ PERMIT/PLAN REVIEW APPLICATION I .....,lig 0 Iij 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 ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: hapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code Li VOL(nd my license is in full force and effect. 0 I have and will maintain a certificate of consent to self-insure for workers' License Class License No. OL( Exp. Date)71DL a. 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 DE ARATION ave and will maintain workers'compensation insurance,as required by Section ❑ I hereby affirm under penalty o perjury that I am exempt from the Contractors 3700 of he 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' 'ccompensati i urance er and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier t .1 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 exempt there from and the basis for the alleged exemption. Any violation of _1-1I 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 CII, as owner of the property, or my employees with wages as their sole orthwith comply with those provisions. V,t'""-r)._._.., compensation,will do the work,and the structure is not intended or offered for sale(Section 7044,Business and Professions Code:The Contractors License nate?�� 19 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 no intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful, sale.If,however,the building or imprbvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fides up to one completion,the owner-builder will have the;liitrden'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 ofnew buildings and structures. a " 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 \ 1 _e Name l Is. \ _ 14 V` Title re,` hk r Cc cC iYlc.- 'y PRINT N• I certify that I have read this application and state that the above information is correct and that I am the owneror duly authorized agent of the owner. I agree to comply with all City ordinances and State Laws relating to building construction. Irehereiiy authorize representatives of the City of Arcadia to enter upon the above-mentioned property for inspection purposes. , SignatureJ Date l % 1 I I