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Home My WebLink AboutRALT-18-2353 CANCELLED PERMIT REFUNDED ,s CITY OF ARCADIA i• t gin, CHECK REQUEST Vendor No. Date NOVEMBER 6, 2019 (for Administrative Services Only) Pay to: WAI-CHEUNG FU 135 LUBEN LN ARCADIA, CA 91006 Account No. Amount 4104-3104 $ 187.15 $ $ TOTAL $ 187.15 Reason for payment. (PLEASE SUBMIT BACK-UP IN DUPLICATE) Please process a refund to the above recipient. 135 LUBEN LN Permit: RALT 18-2353 • ❑ Check here if check is to be Approved by: returned to Department. BUl�dl ment Department: g p City of nt Services CA Y Permit ivo.,RALT 18-2353. t 1 Development Services Department "v``" PermitType ResidenttalA"ddlttOn/Alteration. e 240 West Huntington Drive,Post Office Box 60021 , cE:3 ?fi � �� • t. Arcadia,CA 91066-6021 � 'work CCllasshcallot Res Window Change Out ' (626)574-5416 - 4- ,.: »-Permrtstatus:lssued ARCADIA - Issue Date 12/18/2018 Expiration: 06/16/2019 Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 135 Luben LN Arcadia,CA 5789012044 i Contacts ARLENE FU Owner THE HOME DEPOT USA* General Contractor(B) 135 LUBEN LN 105465 Po Box,Atlanta,GA 30348 4 (626)250-4591 (626)225-4591 602331 E Description:RETROFIT 7 WINDOWS PER APPROVED PLANS. ' Valuation: $6,400.00 Tenant ' Total Sq Feet: 0.00 Plan Check# Plan# Fees Amount Payments Amount Paid Building Issuing Fee $44.35 Total Fees $410.84 Building Permit Fees 5187.15 Cash/Receipt#REC-003192-2018 $410.84 Building Plan Review Fee $121.65 Cal Green Plan Check $12.17 Amount Due: $0.00 Energy Plan Review Fee $37.43 Green Building Standard $1.00 Solid Waste Management Fee $6.25 Strong Motion Inst.Program Res $0.84 Total: $410.84 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. • 4 December 18, 2018 Issued By: Date December 18,2018 Page 1 of 1 •F AR . ._,.,.ice .., PERMIT/PLAN REVIEW APPLICATION ‘,..t841:15,_> 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,,ya a�nd my license is in ful force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' ILicense Class J7 Liter nse No._i_ Exp. Date k u compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Contractor /%/ / i , performance of the work for which this permit is issued. • OWNER-BUILDER 1 ECLARATIO / ❑ 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 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 orkers'c pensation insurance�n�� carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier q� � � /(.fes demolish,or repair any strucare,prior to its issuance,alsorequired the applicant olicy Number /CJK/� 4 V7---e— 3—)D / 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 ❑ 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 he Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions. compensation,will do the work,and the structure is not intended or offered for 12�/S�/r/ w sale(Section 7044,Business and Professions Code:The Contractors License • ate LL t o Signature /�-rxr 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 anemployer 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),inaddition 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). 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 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 t. disturbing the asbestos. Please contact AQMD at(909) 396-2000 for further information. �,�j��I I r )4ame (/Y�J �„ itle P i U , / PRINT NAME I ii ir 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 buildin' construction. I hereby authorize representatives of the City of rcadia to enter . ion thee.. :ove-mentioned property for inspection purposes. [� / Signamre �.041I � 1'� ate I WI a /l Q2ZQ —JSP -4219 Z—z/-497," —g —9 t9 7:77Lh �— -nay7 — ).-vv‘ Li et (* ,,arr-anO(V -72Q- -1°114 aj4- 1°a) n14--0 p-r7 --494-914 7A,1 --a)nntf-21 ymo 4JM -36/z/ a� p shy 'N7 /1/aen7 SO Sf Z - $ 1 11-GJ