The URL can be used to link to this page

Home My WebLink AboutUntitled .r..._". . VE# (AP use only) � � ;,ACCOUNTS PAYABLE CHECK REQUEST Request Date4 12/27/2019 Department DSD - Building Dept. WMCheck Payable to BRIAN LAM CITY OF Address PO BOX 2058 ARCADIA City,State,Zip Code ARCADIA, CA 91007 INVOICE NUMBER(5J (if applicable) ACCOUNT NUMBERS) AMOUNT 714-2275 $ 2,700.00 5 ' 5 5 $ TOTAL CHECK AMOUNT $ 2,700.00 Reason for Payment: Please refund the demolition bond to the above recipient. Permit B00-057-758 APPROVED,BY(MUST BESIGNED,BY<AUTHORIZED SIGNERS)- ;- Signature Date Approved 2flLLSIGNATURE-REQUIRED'POR ANY CHECK AMOUNT OVER-$2,500 ...I',;_ _ , , A , . , Signature Date Approved ACCOUNTS PAYABLE USE ONLY Check here if check is to be n Reviewer's Initials _ returned to Department YR112019 •, Development Services Department tl®a 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. BOO-057-758 `C.." Arcadia, CA 91066-6021 City of (626) 574-5416,Fax(626)447-9173 Type:Arcadia Permit yp : Demolition PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 11969 9/5/2017 CM 15:56 9/5/2017 Issued ADDRESS NO. Dir.Prean Street Name Street Suffix UNIT ERG ASSESSORS PARCEL NO. GEO CODE 265 W Duarte Rd 5778-013-021 OWNER MAILING ADDRESS Brian Lin 265 W Duarte Rd PHONE NO. Arcadia,CA 91006- EMAIL ADDRESS: APPLICANT MAILING ADDRESS G R Martinez Inc. Dba Martinez De PHONE NO. EMAIL ADDRESS: ' CONTRACTOR/PROFESSIONAL CONTRACTOR/PROFESSIONALMAILING ADDRESS G R Martinez Inc. Dba Martinez Den-.14164 Joanbridge Street PHONE NO. (626)484-0033 FAX NO. Baldwin Park, CA 91706 EMAIL ADDRESS: License No. 863529 Type: C-2I Expires: 8/31/2019 12:00: TENANT MAILING ADDRESS PHONE NO. FAX NO. DESCRIPTION DEMO HOUSE,DETACH GARAGE AND PREP FOR SFR/NEW,REFUND BOND TO BRIAN LAM P.O.BOX 2058 ARCADIA,CA 91007 Construction Type IIOM ft of Units Value Construction Type DOM F of Units Value p CO PLET� D ,lam l—<�4C /0qe-67 .4/". !I , ,I ` {v1If OCCUPANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY UO111 DESC AMT AMT PAID ACCT 1.00 Flat Plmbg issuance - 44.35 44.35 01-3105 1.00 each Sewer cap 15.55 15.55 01-3105 1.00 Flat Demo issue 44.35 44.3501-3107 ` / 2,700.00 sq a Demolition 77.78 77.78 01-7107 \„ a4,6,1 t %r/" 2,700.00 sq ft Bond-demo 2,700.00 2,700.00 2275 lt�� 1.00 Flat SWMF 2 1.00 1.00 88-3027 04 4 cr DEEP act' i YMY Total Fees: $2,883.03 Balance Due: $0.00 Paid Today: $2,883.03 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt N: 117822 permit is not commenced within 180 days front the date of issuance or if the pemlit is not obtained within 180 days from 01-3105 59.90 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3107 122.13 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 2275 2,700.00 Arcadia building inspector for a period of 180 consecutive days. 88-3027 1.00 CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS Requests for inspection should be made at least Monday-Thursday Friday one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m. • by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. (Closed on alternate Fridays) I A. kli4? ' PERMIT/PLAN REVIEW APPLICATION /or 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 ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION AI I ereby 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 Professio ode, ny license is in full force and effect. 0 I have and will maintain a certificate of consent to self-insure for workers' License ode, .21( I cense No.a(J3S Exp. Date 31 ° compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Contractor OWNER-BUILDER DECLARATIO ❑ 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 he Labor Code,for the performance of the work for which this permit License Law for the following mason(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 On_ P1 It" 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 them from and the basis for the alleged exemption. My 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 mom 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 co ply with those provisions. / compensation,will do the work and the structure is not intended or offered forDate / �. a sale(Section 7044,Business and Professions Code:The Contractors License q s/�� Signature !/ lr Law does not apply to an owner of property who buildsor 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 tosecure Workers'Compensation coverageis 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. Q 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. //7� Name Cllr Mar�incz Title t-OJ1 /4- PRINT 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. p Signature / �q�%!� Date `4�0 7—