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Home My WebLink AboutUntitled VE if (AP use only) ACCOUNTS PAYABLE CHECK REQUEST Request Date 12/27/2019 Department DSD - Building Dept. Check Payable to XIAO WANG CITY 012Address 119 ST JOSEPH ST ARCADIA City,State,Zip Code ARCADIA, CA 91006 INVOICE NUMBERS) (if applicable) ACCOUNT NUMBER(S) AMOUNT 714-2275 $ 4,859.00 $ TOTAL CHECK AMOUNT $ 4,859.00 Reason for Payment: Please refund the demolition bond to the above recipient. Permit: DEMO-18-0261 1020 HAMPTON RD APPROVED BY(MUST BE SIGNED BY AUTHORIZED SIGNERS) _ Signature Date Approved -2nd SIGNATURE REQUIRED FOR ANY;CHECK AMOUNT OVER$2,500 a. .r Signature Date Approved ACCOUNTS PAYABLE,USE ONLY'- - -r-- Check here if check is to be Reviewer's Initials returned to Department VR112019 City of Arcadia, CA - f:. PermitNO Demo18 0261: Development Services Department 1 D V----,,,..tri---c----,c., { v v #j Permit Type Demolition 6 1. 240 West Huntington Drive,Post Office Box 60021 t) ,� ..J, 4'11 i' €i 6 ,1 r `,.' a Arcadia,CA 91066-6021 U -i.`.— 0. f i f'� i - , ti Work Classificanon::Demo Residential (626)574-5416 F°°:,,,, - , Permit status:°Issued , ARCADIA _ Issue Date:03/0520181 Expiration: 09/01/2018 Addr NO. Dir Prefix Street Name Street Suffix City,State,Zip Parcel Number 1020 Hampton RD ,,Arcadia,CA 5769004002 , Contacts ---- 'XIAO WANG Owner Mur Sol Builders - General Contractor(B) 1020 HAMPTON RD 119 E St Joseph ST,Arcadia,CA 91006 d (626)447-0558 Description:DEMO HOUSE/GARAGE IN PREP FOR SF NEW. i Valuation: S 0.00 . Tenant REFUND DEMO BOND TO XIAO WANG 119 E STJOSEPH ST i ARCADIA CA 91006 6268028822 i Total Sq Feet: 4.859.00 : Plan Check it Plan# Fees Amount Payments Amount Paid Bond for Demolition $4,859.00 Total Fees $5,079.43 Demo-Sewer Cap and/or Cesspool Fill $15.55 Cash/Receipt# $5,079.43 Demolition Permit $108.93 Demolition Permit Issuance Fee $44.35 Amount Due: $0.00 Plumbing Permit Issuance Fee $44.35 Solid Waste Management Fee $6.25 Solid Waste Management Fee 2 $1.00 Total: $5,079.43 - CALLS FOR INSPECTION Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,time frame and what inspection item is needed. COI�Q�E`-' ) I ! This permit/plan review expires by time limitation and becomes null and . ; I / void if the work authorized by the permit is not commenced within 180 days I _jn/J I from the date of issuance or if the permit is not obtained within 180 days 1 [/ t from the date of plan submittal.This permit expires and becomes null and l 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. March 05, 2018 Issued By: Date March 05,2018 Page 1 of 2 :,„Poa.N. 4 .. i . PERMIT/PLAN REVIEW APPLICATION �i12Development Services Department,240 West Huntington Drive,Post Office Box 60021 F. 'aI Oa" Arcadia, CA 91066-6021, (626) 574-5416,Fax(626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION ja,,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 license is in full force and effect. q ❑ I have and will maintain a certificate of consent to self-insure for wo kLeers' License Class License No. 1975115 Exp. Date 3/%10 compensation, as provided for by Section 3700 of the Labor Code, for-tie-- f performance of the work for which this permit is issued. Signature of Contractor `OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section 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 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 75 r �,- 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 ❑ I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption.Any violation of 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. p perry, or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for 1,..C., - it sale(Section 7044,Business and Professions Code:The Contractors License Date Signature r� 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 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 TILE 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 ( 1 Q Name (N / �Ilf Title S(.p.-v-1 llTan�teii PRINT NAME C 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. gDate ...... () \Sinature - c