HomeMy WebLinkAboutPLUM-19-2535 City of Arcadia, CA J Permit No Plurn19 2535
r ; Development Services Department r✓ " ' j Permit Type �PIUrY1bIrIg':
240 West Huntington Drive,Post Office Box 60021 '
Arcadia,CA 91066-6021
1 Work C asst canon Water Heafer
(626)574-5416
k � �o ' �i PermifiSfiatus Issued:
ARCADIA Issue°Date 1208/2019.' Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
2321 S SIXTH AVE Arcadia,CA 91006-5318 5790022011
Contacts
SAKATA,NORMAN AND JOYCELYN TRS N Owner GREENSTAR HOME SERVICES dba Contractor
AND J SAKATA TRUST 1951 N MAIN ST,ORANGE,CA 92865
2321 S SIXTH AVE (949)273-4599 795556
Description:REPLACE WATER HEATER IN SAME LOCATION Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#
Fees'I Amount payments Amount Paid
Plumbing Permit Issuance Fee $47.01 Total Fees $63.56
Solid Waste Management Fee 2 $1.00 Cash/Receipt44 REC-03399-19 $63.56
Water Heater and/or Vent $15.55
Amount Due: $0.00
Total: $63.56
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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.
December 18, 2019
Issued By: Date
December.18,2019 Page 1 of 1
of ARe
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v�4c101 , ,
7 PERMIT/PLAN REVIEW APPLICATION
CO: 6;1, Development Services Department,240 West Huntington Drive,.Post Office Box 60021
,Quoits,of 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 eff t. ,, / III have and will maintain a certificate of consent to self-insure for workers'
License Class �(1p License No. � xp. Date 2� 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 empt 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. , usiness and Professions is issued.My workers'compensation urance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier j ',
demolish,or repair any structure,prior to its issuance,also required the applicant C kl
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 ❑II 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'compen ation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith co p ith 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 ate 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 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 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.
6t---C2',',"/-
Name Title
,Ael
PRINT NAME
certify that I have read this application and state that the above information is cor ect and that I am the owner or duly authorized agent of the owner.
agree to comply with all City ordin ces and State Laws relating to building onstruction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentio ed property for inspection purposes.
Signature Date /W7411
oPTA7- ,
•
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N.14614(P
AFFWAVIT SELF,CERTIFICATION
• FOR COMPLIANCE OF SMOKE ALARMS
• AND CARBON MONOXIDE ALARMS
Property Address: £3 21
Permit Nuniber: . / 1 7-f9- 1 7P
Brief Job Description: I ggad if 4 hatreexo 4•4 ;At halt 04# ca2va
01- ;it- had edxilededt,
Number of smoke alarms installed:M-rg, SotiLit.L. afeirdsiva., . 012- e44.4.44-/
Numb
er of.carbon monoxide alarms installed; / emftelcid6,, at-eif1-4,ce
When'alterations, repairs or additions requiring a permit Occur, -..sWgrooreated,
Smoke alarms shall be installed 'in each sleeping room, a4-,outside each separate
ping area in the immediate viciniry-of thebedrooms, and-66 each ad4itional story of the
&telling, including basements and habitable attics as required by Section R314:of the 2016
California Residential Code (CRC) and California Health and Safety Code 8ection1:3113.7,
For dwellings or sleeping units containing fuel burning appliances or having attached
garages, carbon monoxide alarms shallbe installed outside each separate sleeping
area in the immediate vicinity ai the bedrooms, and on each additional story ofthe
irldltiding-biierrie-nis as required by-Section R315 of the of the 2016 California
Residential Code.(CRC).
Multi-purpose alarms(combination carbdn monOXide and smoke alarms) may be used.
All alarms shall comply with requirements for listing and approval by the Office of the State.:Fire
Marshal. httb.,//oSfm_fire:ca.00v/licenSinOliStindsllioenSelistinci .1jrni S6archeb*t f±iti16.
As owner of the above referenced property, I hereby certify that the smoke alarms and carbon
monoxide alarms.have been•installed in accordance with the manufacturer's instructions and in
WI-Offence With the code *sections referenced:above.
I:detlare under penalty of perjury that the foregoing is true sind correct,.and thatthis
(federation wet executed on (Date) _1/.1./.20to at Arcadia, California.
Miner's Name (printed/typed);
Signature of Owner: r„
This affidavit must,be returned to the City of Arcadia inspector prior to final inspection