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`ty ' /' City of Arch �`,,CA •Permit No Demo 19 0795
„ Development Set •oartment F �T� --;-1-; -trr-1,^,i; P,ermrtType Demolition
'-'r ' 240 West Huntington Drive,Post Office Box 60021 (-„� li G 11 [`T} Cl `l t.I , +
Arcadia,CA 91066-6021 ,Y, , `• SIJ--I i r r .1 ( I, V✓ork Classification Demo-Residential
626
" �; (626)574-5416 ' `.,kSv ` * Permrt3tatus:Issued
ARCADIA Issue Date 08/22/209'1 Expiration: 02/18/2020
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 1
19 W Naomi AVE Arcadia,CA 5782010032
Contacts
RODEO CONSTRUCTION AND Agent for owner TONY SHEN Owner
MANAGEMENT INC' 2028 SANTA ANITA AVE,ARCADIA,
11001 VALLEY MALL 301C,EL MONTE,CA 91731
(626)864-8648
G R MARTINEZ INC,DBA MARTINEZ Contractor
DEMOLITION CO"
14164 Joanbridge,Baldwin Park,CA 91706
(626)484-0033 863529
Description:DEMO HOUSE/GARAGE IN PREP FOR SF NEW. Valuation: $0.00 Tenant
REFUND DEMO BOND TO TONY SHIEN PO BOX 70065
PASADENA CA 91117 626-675-8828 Total Sq Feet: L455.00 Plan Check#19-795 Plan#
Fees mou Payments Amount Paid
Bond for Demolition $2,455.00 Total Fees ' $2,650.53
Demo-Sewer Cap and/or Cesspool Fill $16.48 Cash/Receipt#REC-02224-19 • $2,650.53
Demolition Permit $77.78
Amount Due: $0.00
Demolition Permit Issuance Fee $47.01
Plumbing Permit Issuance Fee $47.01
Solid Waste Management Fee $6.25 9MPII)2,1_e_tk
//Solid Waste Management Fee 2 $1.00
1
Total: $2,650.53
9 �9 /� CALLS FOR INSPECTIONS
�F � re Request for inspection by telephone at 626-574-5450. Leave a message
Elftlil . /, a requesting the address,timeframe and what inspection item is needed.
of
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 -
Ypeg/ 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
LT✓ consecutive days or if no progressive work has been verified by a City of
3N3Pe
GArcadia building inspector for a period of 180 consecutive days.
I /
,fif446 /v-3o-i'
August 22,2019
Issued By: Date
August 22,2019 Page 1 of 1
!ice 1 PERMIT/PLAN REVIEW APT "st:ATION
11.7' x ! '-_+
:::a 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
o 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 0 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 (This section need not be completed if the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
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 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, 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
sale(Section 7044,Business and Professions Code:The Contractors License Date 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 not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is uhlawful,
sale.If,however,the building or improvement is sold within one(1)year of . and snail'subject an employer to criminal'penaltiu and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundredthousand dollars($100,000),in addition to the cost of coinpensation,
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 PERMTT 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. �r� �r
Name IA 111 .fs V \� Title �� /`�
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
dia to enter upon the above-mentioned property for inspection purposes.
Tatum OIAA5k."-IN's--49 \ Date V/224
N
CITY OF ARCADIA
•
.` ' CHECK REQUEST
Vendor No. 3 Dare December 10, 2019
(for Administrative Services Only)
oft, frvezcc
Pay to: TONY SHIEN iW+d//9
PO BOX 70065
PASADENA, CA 91117
626-675-8828
•
Account No. Amount
714-2275 $ 2,455.00
$ '
a� .
-
$
$ j
TOTAL $ 2,455.00 !
Reason for payment. (PLEASE SUBMIT BACK-UP IN DUPLICATE) =
Please process a refund to the above recipient, demo bond
DEMO-19-0795 !
19 W NAOMI AVE 4
I
/ 9
❑ Check here if check is to be Approved by: _ t
returned to Department. — w
Department: Buildin"ey - mp-nt
- _