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Home My WebLink AboutUntitled (2) VE# (AP use only) ACCOUNTS PAYABLE CHECK REQUEST Request Date 12/27/2019 Department DSD - Building Dept. Check Payable to LAC LA CONSTRUCTION c3k9 Address 8921 BENTEL AVE ARCADIA. City,State,Zip Code ROSEMEAD, CA 91770 INVOICE NUMBER(S) (if applicable) ACCOUNT NUMBER(S) AMOUNT 714-2275 $ 2,190.00 TOTAL CHECK AMOUNT $ 2,190.00 Reason for Payment: Please refund the demolition bond to the above recipient. Permit B00-056-363 2700 GILPIN WAY APPROVED BY(MUST BE SIGNED BY AUTHORIZED SIGNERS) rLL Signature Date Approved • 2nd SIGNATURE REQUIRED FOR ANY CHECK AMOUNT OVER`$2,50D Signature Date Approved ACCOUNTS PAYABLE USE ONLY Check here if check is to be ri Reviewer's Initials returned to Department VRI12019 a.. Development Services Department , 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. " Arcadia,CA 91066-6021 BOO-056-363 Arcadia (626)574-5416,Fax(626)447-9173 Permit Type: Demolition PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 12619 3/27/2017 CM 11:08 3/27/2017 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT SLG ASSESSORS PARCEL NO. GEO CODE 2700 Gilpin Way 8586-008-027 OWNER MAILING ADDRESS Lu, Peter And Yi An 2700 Gilpin Way PHONE NO. Arcadia, CA 91007 EMAIL ADDRESS: APPLICANT MAILING ADDRESS Lac La Construction PHONE NO. EMAIL ADDRESS: ' CONTRACTOR/PROFESSIONAL MAILING ADDRESS Lac La Construction 8921 Bentel Ave PHONE NO. (626)484-3988 FAX NO. Rosemead,CA 91770 EMAIL ADDRESS: License No. 943830 Type: B Expires: 2/28/2018 12:00: TENANT MAILING ADDRESS E71l COMPLETED PHONE NO. FAX NO. DESCRIPTION DEMO HOUSE&GAR./REFUND BOND TO:Lac La Construction 8921 BENTEL AVE,ROSEMEAD,CA 91770 Construction Type UO111 II of Units Value Construction Type UO11 p of Units Value 7L`taC 6-7_/7 /ii R 2A��/ V2/7//f dA-ti OCCUPANCY: TOTAL $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY [IOM DESC AMT ANIT 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 44.35 01-3107 2,190.00 sq a Demolition 77.78 77.78 01-3107 2,190.00 sq ft Bond-demo 2,190.00 2,190.00 2275 1.00 Flat SWMF 2 1.00 1.00 88-3027 • Total Fees: $2,373.03 Balance Due: $0.00 Paid Today: $2,373.03 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt It: 116168 permit is not commenced within 180 days from the date of issuance or if the permit 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 2,190.00 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. .......t...) 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) n •V A• 40,,...vagyy. r4 k: PERMIT/PLAN REVIEW APPLICATION InIiw4 F "Ea 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, d my ' erase is in full force and t. A I have and will maintain a certificate of consent to self-insure for workers' License Class License No. Date% O � 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. WNER-BUILDE DECLARATION 401 j have and will maintain workers'compensation insurance,as required by Section fr 1:1I 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 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 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 ,_L-1I 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 notof 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 i 'ould become subject to the workers'compensation provisions of Section I t 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 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 5—Z7-4 1 Signature •m/ 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 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. ❑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 them 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 70414,Business and Professions Code,for this reason: Lender's Name Date t> —27 .--( 7Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY DE 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. NameLA-C, IV° Titlel�rt APA.. PRINT NAME I ertify that I have ;ead this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. I gree to compl ith all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of A dia to enter 'on the above-mentioned property for inspection purposes. 11-7 -- I/ Sig tore Date