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Home My WebLink AboutUntitled (2) VE# IAP use only) ACCOUNTS PAYABLE CHECK REQUEST Lij4 Request Date 12/27/2019 Department DSD - Building Dept. Vii 3, EiJW PACIFIC I Check Payable to can-or Address 556 LAS TUNAS DR #201 ARCADIA City,State,Zip Code ARCADIA, CA 91007 INVOICE NUMBER/S) (if applicable) ACCOUNT NUMBER(S) AMOUNT 714-2275 5 1,600.00 714-2275 5 _ 3,643.00 5 5 5 $ TOTAL CHECK AMOUNT 5,243.00 Reason for Payment: Please refund the demolition bond to the above recipient. Permit: DEMO-18-0342 & DEMO-18-0555 461 W WOODRUFF AVE 320 W PALM DR r , ;a. .._',... a« w z . 1 APPROVE0'BY(MUSTBESIGNED.BYAUTHORIZEDSIGNERS) _.,-;12`3,4 , Signature Date Approved 2nd SIGNATURE REQUIREDFOR ANY CHECK AMOUNT OVER$2,500 "4.9.: a'. k .3 , . Signature Date Approved IACCOUNTS PAYARLf U5F ONLY- ' f Check here if check is to be n Reviewer's Initials returned to Department I I I VR112D19 ,N City of Arcadia, CA Permit NO-Demo-18-0342_`. 1\ — ; Development Services Department = D i✓' 's t"""om °� 1 r 'Permit Demolition 240 West Huntington Drive,Post Office Box 60021 I ) fr t, - Arcadia,CA 91066-6021 E �lj Work Classifcohdn•Demo-Residential,' 1 (626)574-5416 - Iss _$ - - Permit Statusr.„Issued ARCAI)IAIssue Date 03/14/2018 I Expiration: 09/10/2018 Addr NO. Dir Prefix Street Name Street Suffix City,State,Zip Parcel Number 461 W Woodruff AVE Arcadia,CA 5787015016 Contacts 1976500 Owner G R Martinez Inc.Dba Martinez Earthwork&Paving 461 W WOODRUFF AVE Demolition Co* Contractor(C-12) 14164 Joanbridge,Baldwin Park,CA 91706 (626)484-0033 • Description:DEMO HOUSE,GAR.REFUND BOND TOJW Valuation: $ 0.00 Tenant PACIFIC 556 LAS TUNAS DR,201,ARCADIA,91007 626-254-1898 Total Sq Feet: 1.600.00 Plan Check# Plan It Fees Amount payments Amount Paid Bond for Demolition $1,600.00 Total Fees $1,789.28 • Demo-Sewer Cap and/or Cesspool Fill $15.55 Cash/Receipt# - $1,789.28 Demolition Permit $77.78 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 ,I / t411441�v1 lall,Total: $1,789.28Lr-!'/,'It4'VvalCOM /E t t{- 1—o . 5E"t s.R (Or/F/�L(.c. CALLS FOR INSPECTION Request for inspection phone at 626-574-5450. 4/ Leave a message requesting the address,time frame and what inspection item is needed. - PPS 3p This permit/plan review expires by time limitation and becomes null and o void if the work authorized by the permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days Fr 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. March 14,2018 Issued By: Date March 14,2018 Page 1 of 2 PERMIT/PLAN REVIEW APPLICATION Elt�' 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 Profession nd ry ense is in fu'Ir rtc and e r ect. / 'o ❑ I have and will maintain a certificate of consent to self-insure for workers' License C /// ,L cense No if / Exp. Da / Ar' compensation, as provided for by Section 3700 of the Labor Code, for the 41/ 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 ❑ 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 PM for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number (J/o r c� 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 ❑ 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 becomesubject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall L as owner of the roe forthwith comply with those provisions. ❑ property,rty, 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 S//� (Y 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 isunlawful, sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminalpenalties 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. 0 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.a Name Q(�/�Lrgi LLQr Title 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 theJabove-me 'oned property for inspection purposes. Signature/fret Date 9M1/12(