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HomeMy WebLinkAboutRALT-19-1302 b City of Arcadia, CA Permit NO.RALT-19-1302 yy ---'f.- i� '\kg-11/17 . jf 1 Development Services Department r.6)/ovt( ^ Pelmrt'Type:Residential Addition/Alteration \�\ j7/ i 240 West Huntington Drive,Post Office Box 60021 I 1 I j ' Arcadia,CA 91066-6021 h_ l I : _i `I work Classification:Res-.Addition/Alteration 1"-- f' ' (626)574-5416 - - . - - _ Permit Status:Issued ARCADIA Issue Date:07/09/20191 Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 50 E Newman AVE Arcadia,CA 5773001036 Contacts ALEXANDRA DE VISSER Owner Zachary Soetenga Contractor 50 E NEWMAN AVE 11379 Playa ST,Culver City,CA 90230 (805)898-1990 (424)443-5480 972309 Description:VOLUNTARY SEISMIC UPGRADE PER LA CITY Valuation: $ 3,100.00 Tenant STANDARD Total Sq Feet: 0.00 Plan Check ft Plan N Fees Amount Payments Amount Paid Building Issuing Fee $47.01 Total Fees $317.22 Building Permit Fees $137.05 Cash/Receipt It REC-01765-19 $317.22 Building Plan Review Fee $89.09 Cal Green Plan Check $8.91 Amount Due: $0.00 Energy Plan Review Fee $27.41 Green Building Standard $1.00 Solid Waste Management Fee $6.25 Strong Motion Inst.Program Res $0.50 Total: $317.22 CALLS FOR INSPECTIONS q Request for inspection by telephone at 626-574-5450. Leave a message t('Usti- $'1)• f / —1-- requesting the address,timeframe and what inspection item is needed. This permit/plan review expires by time limitation and becomes null and �� �� ��� void ifthe work ssuanied by the permit is not commenced within 180a days Th. 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. July 09, 2019 Issued By: Date July 09,2019 Page 1 of 1 o Alt `uFo r,.y'd , 1 PERMIT/PLAN REVIEW APPLICATION ll*' Development Services Department,240 West Huntington Drive,Post Office Box 60021 e , Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION Q 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 jS License No. Z__a p. Datet9k 26 cD compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Contractor to- ��� performance of the work for which this permit is issued. OWNER-BUILR DECLARATION I have and will maintain workers'compensation insurance,as required by Section 1:II 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.M/y`wo ers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier✓f, COMt�AT3 demolish,or repair any structure,prior to its issuance,also required the applicant _Go Mom„pO for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number 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 ❑II 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 ❑I, as owner of the property, forthwith comply with those provisions. or my employees with wages as their sole /J compensation,will do the work,and the structure is not intended or offered for [y—' //q Signature t Z . 1-e-.344,0----1" � i�4sale(Section 7044,Business and Professions Code:The Contractors License Date / 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 thousanddollars($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 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. )ffle Name - . i✓, . PRINT NAME S�l�/� 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. 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 upon the above-mentioned roperty for inspection purposes. Signature iG �l ate 7cCt frikik O6tif55eyr Sb e• AlAtdzti+A ' 1wi. /IVC4d is C*- 'pee) dP4-921 -Won CITY OF ARCADIA Development Services Department 4 APPROVED CArThis set of plans and specifications must he kept o r� ': on the job at all times and no changes or alterations J •' shall he made except b}'the Building Division. oG M ✓ The Stamping of this plan and specification shall not p be held to permit or to be an approval of the violationSI tt a Z of any provisions of any city ordinance or state law y C v. A24. 'e)