HomeMy WebLinkAboutELEC-19-1114 City of Arcadia, CA `_ _ • Permit NO.
1�11�' Development Services Department t� I"'r; '1(1 L' Permit Type:Electrical
w1 240 West Huntington Drive,Post Office Box 60021 I Jd s + i t
X Arcadia,CA 91066-6021 ? s V;i I I ' + t u 'Work Classification:Elec-VCU-Residential
I (626)574-5416 Permit.Status:Issued
ARCADIA IssueDate:06/13/Z019I Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
436 Fairview AVE 3 Arcadia,CA 5778010044
Contacts 111
JIEYING SHEN Owner
436 FAIRVIEW AVE 3
(626)703-7789
Description:INSTALL 240 OUTLET IN GARAGE Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan it
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-01527-19 $54.61
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $54.61
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.
June 13, 2019
Issued By: Date
June 13,2019 Page 1 of 1
C.
_ 1 PERMIT/PLAN REVIEW APPLICATION
it for Development Services Department,240 West Huntington Drive, Post Office Box 60021
`%,,,,h,•r e' 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
performance of the work for which this permit is issued.
ignature 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 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
(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 0 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 subjec o the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should e subject to the
workers'compensation provisions of Section 3700 of the ' .•.r Code,I shall
❑I, as owner of the property, or my employees with wages as their sole for hwithrComy with those provisions. -• /
compensation,will do the work,and the structure is not intended or offered for
Date \�1\ Signa4 /
sale(Section 7044,Business and Professions Code:The Contractors License ture
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 am not intended or offered for WARNING: Failure to segue Workers'Compe .;on 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,
id 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 ' ason:
Lender's Name
Date ° \3 l /".-11 Signature � �t Lender's Address
IORTANT: APPLICATION IS HEREBY MA%TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLIC IN 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. \
Name \1 \ Vit((� j
Title v\ (
PRINT NAME
\ertify that I have read this applicati and state that the above information is corre t and that I am the owner or duly authorized agent of the owner.
I agree to comply with all City or ces and State Laws relating to building construction. I hereby authorize representatives of the City of
(((Arcadia to enter upon t e above-me do ed property for inspection purposes. t(/� / `/'��
'¢ignature /7\—\ 1 1\_\Date " .1 " I1 I