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HomeMy WebLinkAboutUntitled City of Arcadia, CA - _ Permit NO Elec-19-1428 lel1 rtry , Development services Department 1 li tr G w" Y^'v�,i-EF Permit TypeNElettrical -1 240 West Huntington Drive,Post Office Box 60021 t •, I ` Arcadia,CA 91066-6021 • r \ �I ; I I j) Work Qlossfficotfon:Elec-Service Change (626)574-5416 - Permit Status:Issued ARCAD A Issueoate:07/25/20191 Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number . 75 W Magna Vista AVE Arcadia,CA 5782002024 Contacts DENNIS&LISA COE Owner MOSHE YACOBY ELECTRICAL Contractor 75 MAGNA VISTA AVE CONTRACTOR' (626)211-0349 6301 ELLENVIEW AVE,WEST HILLS,CA 91307 (818)445-6379 465649 Description:200 AMP SERVICE UPGRADE Valuation: $ 0.00 Tenant Total Sq Feet: 0.00 Plan Check q Plan k Fees Amount Payments Amount Paid Electrical Permit Issuance Fee $47.01 Total Fees $64.49 Residential Services up to 400 amps $16.48 Cash/Receipt N REC-01912-19 $64.49 - Solid Waste Management Fee 2 $1.00 -- Amount Due: $0.00 Total: $64.49 _004N- ter- +- es-Leo6e f-Z7-/7 g>.__ rh44-4. g—ir—, t----K ;......,Y (` A P o .... 1 7ppNS Request for inspection by te a �I. E54-5 50. Leave a message requesting the address,timeframe and what inspection item is needed. 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 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 consecutive days or if no progressive work has been verified by a City of Arcadia building inspector for a period of 180 consecutive days. July 25, 2019 Issued By: Date July 25,2019 Page 1 of 1 F AR Pal 1PERMIT/PLAN REVIEW APPLICATION _ oe 4 '' Development Services Department,240 West Huntington Drive,Post Office Box 60021 1 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,and my license is in full force and effect. License Class C10 Signature of Contractor 0 I have and will maintain a certificate of consent to self-insure for workers' License No. eExp. Date OScompensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. OWNER-BUILDER DEC ARATION ly 1 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 his 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 fJ f_nvit'Ar(I vvL Slit l'On C e demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number�V!luxes CO �,3' G for such pennit 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 ❑ 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 roe forthwith comply with those provisions. property,rty, or my employees with wages as their sole p�,�,,(/��/Q�V�'' compensation,will do the work,and the structure is not intended or offered for en1/VA V sale(Section 7044,Business and Professions Code:The Contractors License5' n9 Signature (Date -pj 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 attomey'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 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. [fmci c1f t�r 1 (Na e MCP-ion r Title �2/1'T' 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. ,, (Signature �/1.4. (� �^ (Date —1 'telCC ')—/ _ 6a City of Arcadia, CA f Permit NO. MEP-19-1538 t Development Services Department ��M�'-` (� ty ^, ` Permit Type:MEP •240 West Huntington Drive,Post Office Box 60021 r/� `'' (. r 5 ` i Arcadia,CA 91066-6021 [ 1- i C-1.741 I, LI I; j I { L, Work Classification:MEP-Residential I (626)574-5416 • ,; . - Perinif Scotus:Issued ARCAD➢A • ` Issue Date:08/06/2019 1 Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 79 W Magna Vista AVE Arcadia,CA 5782002025 Contacts DENNIS AND LISA COE Owner SMARTHOMES INC* Contractor 79 W MAGNA VISTA AVE 22287 MULHDLAND HWY,CALABASAS,CA 91302 (323)365-5676 1036356 Description:REMODEL BATHROOM Kew* cTA425 Valuation: $ 0.00 Tenant Total Sq Feet: 0.00 Plan Check P Plan# • Fees Amount Payments Amount Paid Electrical Permit Issuance Fee $47.01 Total Fees $203.51 Lavatories 513.21 Cash/Receipt N REC-02046-19 $203.51 Light Fixtures $3.26 Amount Due: $0.00 Mechanical Permit Issuance Fee $47.01 Outlets-Receptacles&Switches 58.15 Plumbing Permit Issuance Fee $47.01 Shower $12.46 Solid Waste Management Fee 2 $1.00 Q/A1 t� d Solid Waste Management Fee 2 $1.00 Omp Solid Waste Management Fee 2 $1.00 999PPP xgnF i Ventilation Fan(Single Duct) $9.94 CALLS FOR INSPECTIONS Water Closet $12.46 Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. Total: / $203.51 S-i3-i1 K�Ga� elaszec1 �,Lvrti$Lwl,(r,' This permit/plan review expires by time limitation and becomes null and 7�j / void if the work authorized by the permit is not commenced within 180 days e„.../ -c„ �/I .g.•`-�+I✓ from the date of issuance or if the permit is not obtained within 180 days t from the date of plan submittal.This permit expires and becomes null and $47—PI /i4�IcA Ess S void if any work authorized by this permit is suspended or abandoned for 180 /jlL 1 -� consecutive days or if no progressive work has been verified by a City of //- r-i,jf % if Arcadia building inspector for a period of 180 consecutive days. G AND f'� xmE smoKE SHALL H pURS PURSUANT TO CRCAND CBC EFL August 06, 2019 Issued By: Date August 06,2019 Page 1 of 1 OF iR :triocAuFw3/48.o• • 1PERMIT/PLAN REVIEW APPLICATION - e �l jDevelopment 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 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 d Professions Code and m license is in full f e and effect. I have and will maintain a certificate of consent to self-insure for workers' License Clang cense N/q9.. Exp. Dat compensation, as provided for by Section 3700 of the Labor Code, for the Co Signature of and r 'cense N9.. performance of the work for which this permit is issued. OWNER-BUILDER DECor LARATION 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 or rs'compensa _ nce carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier oi/�� Ont. I demolish,or repair any structure,prior to its issuance,also required the applicant �Y///�'�Cj/�� /A� 5.— 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 exempt them 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($500D: compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Lab• '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 Dar wi l � - sale(Section 7044,Business and Professions Code:The Contractors License /�,./ Signa ` LLL / 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 attomey'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). 0 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. 'n, arae ..e In{ G Title li����jyi� / PRINT NAME VV 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 u r i : . .174;01,i,.ne 'property for inspection purposes. 79' \inature IL1/A / Date lG - / / 4i-41 Permit NO. MEP-194422 City of Arcadia, CA 1 1 V J Development Services Department I D tf r„`) Y'rI�I Permit Type:MEP + 240 West Huntington Drive,Post Office Box 60021 1 s 9 { 4 Arcadia,CA 91066-6021 `, r 1., --5 - -Ai f jJ y 'Work Classification:MEP-Residential (626)574-5416 - ' , - - ' Permit Status:Issued,' ARCAI)IA issue Date:07/24/2019' Expiration: Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 75 W Magna Vista AVE Arcadia, CA 5782002024 Contacts DENNIS&LISA COE Owner SMARTHOMES INC` Contractor 75 MAGNA VISTA AVE 22287 MULHDLAND HWY,CALABASAS,CA 91302 (626)211-0349 (323)365-5676 1036356 Description:REMODEL KITCHEN Valuation: $ 0.00 Tenant Total Sq Feet: 0.00 Plan Check# Plan# Fees Amount Payments Amount Paid Dishwasher $13.21 Total Fees $229.46 Electrical Permit Issuance Fee $47.01 Cash/Receipt#REC-01902-19 $229.46 Garbage Disposal Fee $13.21 Amount Due: $0.00 Install,Relocate Appliance Vent/Hood $9.94 Kitchen Sink $13.21 Light Fixtures $13.04 Mechanical Permit Issuance Fee $47.01 ���iii111 Outlets-Receptacles&Switches $22.82 ier Plumbing Permit Issuance Fee $47.01 l�W Solid Waste Management Fee 2 $1.00 Solid Waste Management Fee 2 $1.00 CALLS FOR INSPECTIONS Solid Waste Management Fee 2 $1.00 Request for inspection by telephone at 626-574-5450. Leave a message requesting the address,timeframe and what inspection item is needed. Total: $229.46 {J This permit/plan review expires by time limitation and becomes null and a.-111—it ?a2,60 I&etrz/c1 itnn{S' void if the work authorized by the permit is not commenced within 180 days #14,4o fg c t.si'n� • 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 Arcadia buil days if no progressive odwork f has been verified by a City of //4V-41. CvnL #7, Arcadia building inspector for a period of 180 consecutive days. July 24, 2019 Issued By: Date July 24,2019 Page 1 of 1 o Aft ` .u.,-"Rk,<,. ,, I PERMIT/PLAN REVIEW APPLICATION - lot .L;t: till_ `t43*' Development Services Department,240 West Huntington Drive,Post Office Box 60021 - =h.,•cr° Arcadia, CA 91066-6021, (626) 574-5416,Fax (626)447-9173 - City of _ Arcadia �SLICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION 0 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 fo effect. I have and will maintain a certificate of consent to self-insure for workers' License Class License N _E�Exp. Date 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 Contactor �2G// /C'v(O.�l4--(— OWNER-BUILDER DECLARATION .,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 ._14700 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. or ers' mpensation insuranc carrier and policynumbersare: Code.Any city or county which requires a permit to construct,alter,improve, Carrier c ��z � 717.-; demolish,or repair any structure,prior to its issuance,also required the applicant J Zc'�l/!�/ 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 tThrs 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 become subject to the Workers'compensation provisions of Section 3700 of the Labor Code,I shall I, as owner , thellproperty, �fonhwith �lywp}t/thse provisions. ❑ or my employees with wages as their sole co7 / compensation,will do the work,and the structure is not intended or offered for I sale(Section 7044,Business and Professions Code:The Contactors License Date Si at z 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 CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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. Name ( -C-96V 1/4n/Z1,72— /Title is fff PRINT NAME d tIYI 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 n the .ove-mentioned property for inspection purposes. �Signamr Date �' 267,/ +" City of Arcadia, CA Permit'No. MEP- 19-1405 ;14) Development Services Department p j © i----0)-rr I'j Permit Type:MEP V,.yr/ 240 West Huntington Drive,Post Office Box 60021 ) Arcadia,CA 91066-6021 ( E � ( ! Work Classification:MEP-Residential \_� -I- � (626)574-5416 . - - - Permit Status:Issued ARCADIA - issue Daie:07/22/2019'I Expiration: - Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 75 W Magna Vista AVE Arcadia,CA 5782002024 Contacts DENNIS&LISA COE Owner SMARTHOMES INC' Contractor 75 MAGNA VISTA AVE 22287 MULHDLAND HWY,CALABASAS,CA 91302 i (626)211-0349 (323)365-5676 1036356 • Description:REMODEL 2 BATHROOMS.(EXISTING LAYOUT TO Valuation: $ 0.00 Tenant REMAIN) (JP$74(RS Total Sq Feet: 0.00 Plan Check N Plan q I , Fees Amount Payments Amount Paid Bathtubs/or Combo $13.21 Total Fees $276.20 Electrical Permit Issuance Fee $47.01 Cash/Receipt N REC-01881-19 $276.20 Lavatories $26.42 Ught Fixtures $9.78 Amount Due: $0.00 Mechanical Permit Issuance Fee $47.01 -.— Outlets-Receptacles Outlets-Receptacles&Switches $13.04 Plumbing Permit Issuance Fee $47.014 Shower $24.92 Solid Waste Management Fee 2 $1.00 4971 Solid Waste Management Fee 2 $1.00 �Solid Waste Management Fee 2 51.00 CALLS FOR INSPECTIONS Ventilation Fan(Single Duct) $19.88 Request for inspection by telephone at 626-574-5450. Leave a message Water Closet $24.92 requesting the address,timeframe and what inspection item is needed. Total: $276.20 D This permit/plan review expires by time limitation and becomes null and oaY-rt- �r,(.� �cSCT/1�c ran-,34.4 , void if the work authorized by the permit is not commenced within 180 days 7 r 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 MEG /r« / -Z �StneLTJera 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 r '� Arcadia building inspector for a period of 180 consecutive days. ae ....___.— /61-4c1-'17 "-Ga it *::::::)I July 22,2019 Issued By: Date July 22,2019 Page 1 of 1 of AR nom 1; PERMIT/PLAN REVIEW APPLICATION glik rz �1 i� 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 . ILICENSED 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 and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class License No/rs�� 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 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.M woff ke compensation i,surance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier es demolish,or repair any structure,prior to its issuance,also required the applicant �I,l for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number y� /%� v> provisions of the Contractors License Law(Chapter 9(commencing with Section (This section nee 3d 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. Any violation of 9 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 9 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 �7 /y sale(Section 7044,Business and Professions Code:The Contractors License Date C T'/ii Signature tii"'0�-- 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. 9 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). 9 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. arae /f� ,� v Y 'W {b Title .MA PRINT NAME I certify that I have read this application and state that the above information is c rrect 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 Arc dia to enter u ' • above mentioned property for inspection purposes. 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