HomeMy WebLinkAboutUntitled City of Arcadia, CA _ Permit No Muth-19-1891
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Development Services Department }� Permit Type Plumbing
240 West Huntington Drive,Post Office Box 60021 -1-(1/4_7,,i Cl i i (") r Itti (.
It =+ Arcadia,CA 91066-6021 ', {v 1=:,F , P i t; f Work Classication:Plumbing Residential
(626)574-5416 - • '";` - - `M m- Permit'Sto ws;Issued
ARCADIA Issuefpate:09/17/2019: Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
269 W Norman AVE Arcadia, CA 5785005020
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Contacts
HEADLEY,BRUCE E AND ARSE CTRS Owner MIKE DIAMOND PLUMBING HEATING& Contractor
HEADLEY FAMILY TRUST AIR CONDITIONING"
269 W Norman AVE 3801 LENAWEE AVE,CULVER CITY,CA 90232
(310)838-0408 765436
Description: REPLACE DRAIN LINE UNDER HOUSE Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#
,
Fees Amount Payments Amount Paid
Fixture with Trap/Misc. $13.21 Total Fees $61.22
Plumbing Permit Issuance Fee $47.01 Cash/Receipt#REC-02519-19 $61.22
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $61.22
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CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
September 17, 2019
Issued By: Date
September 17,2019 Page 1 of 1
4cj.Ir evy+d
.4, P 1 PERMIT/PLAN REVIEW APPLICATION
lEa ail
rira Development Services Department,240 West Huntington Drive,Post Office Box 60021
Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LIICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions.of t I.hereby affirm under penalty of perjury one of the following:
+51 Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is in full force and effect ,® I have and will maintain a certificate of consent to self-insure for workers'
ill: icense Class C-36 License No.÷bS 93 L Exp. Date ii-lQ ti compensation, as provided for by Section 3700 of the Labor Code, for the
`� I performance of the work for which this permit is issued.
f _._,;,$ignature of Contractor ,
f1 11
OWNER-BUILDER�ON ■ I have and will maintain workers'compensation insurance,as required by Section
0 I herebyaffirm under penaltyof perjury that I am exempt from the Contractors ", ti3700 of the Labor Code,for the performance of the work for which this permit
P 9 ry P 'S� •is issued.MyRor s'compensation insurance carrier and policy numbers are:
License Law for the following reason(Section 7031.5,Business and Professions 'Eirf1s
Code.My city or county which requires a permit to construct,alter,improve, ig 'Carrier n°
demolish,or repair any structure,prior to its issuance,also required the applicant r it
Lt'Policy Number MIWCOn-S7i
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 `gtT�h's 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 1 .%'.
exempt there from and the basis for the alleged exemption. Any violation of ' 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 e_nbt employ any person in any manner so as to become subject to the workers'
penalty of not morethan five hundred dollars($500)): :1 Compensation Laws of California,and agree that if I should become subject to the
F, orkers'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 if forthwith omply with those provisions.
compensation,will do the work,and the structure is not intended or offered for tDate
hip
y Signa
sale(Section 7044,Business and Professions Code:The Contractors License -' >—
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(I)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). damagesas 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 THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
I. 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.
<-,9,
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�, e \ '11t. + /ul•/et�� Title
33 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 o +finances and State Laws relating to building construction. I hereby authorize representatives of the City of
Aicaadia to enter upon the abo tinned property for inspection purposes.
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