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City of Arcadia, CA , Permit Na Mech-19-2315
)!!!lir, Development Services Department ! yuir u ,—;r . - Permit Type:Mechanical
k7 240 West Hundngron Drive,Post Office Box 60021 I �� i ,1
!. Arcadia,CA 91066-6021 'U 'y\--. �j��^l ,l�f k Classification:HVAC Repair/Replace
Ti (626)574-5416 -- - - Permit SfotuS:.Issued
ARCADIA Issue Date:11/14/20191 Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
117 W SANDRA AVE Arcadia,CA 91007-8501 5788018023
Contacts
THOMAS OLAUGHLIN Owner W C HEATING&AIR CONDITIONING Contractor
117 SANDRA AVE INC'
(626)447-5742 41085 GOLDEN GATE CIR,MURRIETA,CA 92562
(951)600-0700 779604
Description:REPLACE FURNACE IN SAME LOCATION (ATTIC) Valuation: $ 0.00 Tenant ,
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Furnace or Burner<a 100,000 BTU $19.86 Total Fees $67.87
Mechanical Permit Issuance Fee $47.01 Cash/Receipt#REC-03095-19 $67.87
Solid Waste Management Fee 2 $1.00 - - -
Amount Due: $0.00
Total: $67.87
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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.
November 14, 2019
Issued By: Date
November 14,2019 Page 1 of 1
„,UFoyy4 ,
0 t ,tel 1; PERMIT/PLAN REVIEW APPLICATION
IF” ..,I '-q
241;" Development Services Department,240 West Huntington Drive,Post Office Box 60021
/. Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
I
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 Busines and
Professions Code,and my license is in f ffect. ,• �3 d/ Uhave and will maintain a certificate of consent to self-insure for workers'
License Class nVpinv License No. �1Exp. Date U/ 7compensation, 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 DECLARATIO 0 I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am xempt from the Contractors 3700 of the Labor Code,for the perf ante of the work for which this permit
License Law for the following reason(Section 7031 ,Busin d Professions is issued.My worlcgts'c m ensp nsurance carrier and policy numbers are:
Code.My city or county which requires a permit to onstmct,alter,improve, Carrier u
demolish,or repair any structure,prior to its issuance,also required the applicant
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 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 property, or my employees with wages as thein sole forthwith comply with those provisions.
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 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 is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employerto 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 ofcompensation,
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).
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:
L 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
\Tagme_ilA`l//t/v _ Title 4d 19
PRINT NAME
rtify that I have read this app tion and state that the above information is co ct and that I am the owner or duly authorized agent of the owner.
ree to comply with all City ordinances and State Laws relating to building construction. I ereby authorize representatives of the City of
Arcadia to enter upon the abov -m tioned property for inspection purposes. /
Signature tate aI /Y 0