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Home My WebLink AboutELEC-19-0478 e t CYty of Arcadia, CA Permit No EIeC 19 0478 43 / ,t Development Services Department -� s PermrtTyper.Electdcal' 240 West Huntington Drive,Post Office Box 60021 � 4 " £ r' Arcadia,CA 91066-6021 Work Classf¢cationr.:Elec VCU-Residential- (626)574-5416 y - - [ r"�"""j -= ,"> � -;- _Permit Issued ' ARCADIA _. Issue:Date 03/11/20191 Expiration: 09/07/2019 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 42 DIAMOND ST B ARCADIA, 5779001098 Contacts JAMES CHANG Agent for owner JIN YANG Owner 42 DIAMOND ST B (626)624-2700 (626)353-0059 Description: EVC OUTLET Valuation: $ 0.00 Tenant Total Sq Feet: 0.00 Plan Check# Plan# Fees Amount Payments Amount Paid Electrical Permit Issuance Fee $47.01 Total Fees $54.61 Electrical Vehicle Unit(240 Outlet) $6.60 Cash/Receipt#REC-00631-19 $54.61 Solid Waste Management Fee 2 $1.00 Amount Due: $0.00 Total: $54.61 3-1 --41 iJkL 0 COUPLETS 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. March 11, 2019 Issued By: Date March 11,2019 Page 1 of 1 4fl PERMIT/PLAN REVIEW APPLICATIQN •'E 42" Itteettla 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. 0 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 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 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 (Tiecfion 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 37 f the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply with hose provisions. .....e-----% compensation,will do the work,and the structure is not intended or offered for Date 3/iia A011 Signature sale(Section 7044,Business and Professions Code:The Contractors License 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 3/fid/2o1 1 re i Lender's Address i 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. frame - --01,1110.2 Cil a'`% \itle J'y�eA - -- �eserrr NAME I 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. I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter upon the above-mentioned property for inspection purposes. })ate Si ature • % 3/f1// a/1 a , State of California,County at Los geles ,Fere Subscribed and swam to[old1M11e9 befareme on this 0,300rµ., ANITA C.WANG adaya �6,iO4 by �}',,-,_ Y % Notary Public-California 't of Los Angeles County f proved to me on the basis actory mope �-„ a`j a,a i = • Commission N 2267213 to be the pelsonls1 who appeared before me. Fwatv..r ,,,o, ,43-27-tela � ,..,.e, _s� _ My Comm.Expires Nov 17-2022 Ia C. Wong slj City of Arcadia • Building Division 240 West Huntington Drive,Arcadia CA 91007 Office: (626) 574-5416 Fax: (626) 447-9173 When the permit application and the Owner-Builder Declaration have been executed by a person other than the property owner, prior to issuing the permit, the following shall be completed by the property owner and returned to the agency responsible for issuing the permit: AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. I declare under penalty of perjury that I am the property owner for the address listed above, and I personally filled out the above information and certify its accuracy. Property Owner's Signature: a' Date: , 22 ,2109 Property Address: 42 DP/tamed St. at-`-f h . Ai Owner's Name: j f')? /ag Owner's Address: /Sfo GUi/goat Ale , A-reakt l`zz Phone# (626) 3R —070C 7 Agent's Name: 3 0242te_s oh/0 Agent's Address: 4'2 ,Di`a rvLprtd V- . 9.,,v-,s, gratim Agent's Phone#: ( z6) ,321J' — 2701) pet'] an deeire)t al ger 22a✓ electiv`c Scope of Work: 04/- Caita'ir OzcHtet NOTE: This authorization must be NOTARIZED or accompanied by a copy of the homeowner's current photo I.D. (i.e., driver's license, passport or military I.D. with signature), when presented for issuance of a permit.