HomeMy WebLinkAboutUntitled •City of Arcadia, CA f Permrt No MEP 19 0286','
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` + j. Development Services Department s ,-,..1.8---,' �„a Permit Type•`MEP;'
1t� 240 West Huntington Drive,Post Office Box 60021
,4 y ,I � , , WorkClassif�cahon•MEP,`,�tesidentiah
Arcadia,CA 91066-6021
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(626)574-5416 `,y4,54,,P.4.%,:: :n4„,',.., Permit Status Issued
AI2CAI)IAissue Date 02/11/2019 I Expiration: 08/10/2019 •
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number iv
102 ' W Floral AVE Arcadia,CA 5770011029
Contacts
CHALBERG,FRANZISKAJ TR CHALBERG Owner A N S BUILDERS* Contractor
TRUST 2416 VICTORY BLVD 113,BURBANK,91806
102 W FLORAL AVE (818)877-6800 1041262
,
Description:NEW OUTLETS AND PLUMBING FOR KITCHEN Valuation: $ 0.00 I Tenant
Total Sq Feet: 0.00 i Plan Check# Plan#
,
Fees Amount Payments Amount Paid
, Electrical Permit Issuance Fee $47.01 Total Fees $110.86
Kitchen Sink $13.21 Cash/Receipt#REC-00366-19 $110.86
Outlets-Receptacles&Switches $1.63
Amount Due: $0.00
Plumbing Permit Issuance Fee $47.01
Solid Waste Management Fee 2 $1.00
Solid Waste Management Fee 2 $1.00
Total: $110.86
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31z- 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.
February 11, 2019
Issued By: Date
February 11,2019 Page 1 of 1
of Anc,
09"i •_' . •PERMIT/PLAN REVIEW APPLICATION
•w, .
;•g,I<je Development Services Department,240 West Huntington Drive,Post Office Box 60021
moony°CI" . 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, nd my license is in full force and effect. I ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class
Signature of Contractor
License No. �Z Exp. Date 0&1�! compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION IDI 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 wolkperC�'YYs'compention in urance' acarrier and policyy numbers are:
Code.Any city or county which requires.a permit to construct,alter,improve, Carrier�' I�- 1V ok i,slW ottl r e_ Fmk
demolish,or repair any structure,prior to its issuance,also required the applicant l 13 L1 g) (f�
for such permit to file a signed statement that he or she is licensed pursuant to the i
Pol
cy Number � u
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
I certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of
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 • or Code,I shall
❑I, as owner of the roe forthwith with those provisions. 41, _
property,tty, or my employees with wages as their sole /�
compensation,will do the work,and the structure is not intended or offered for '2 coit ply r -I
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 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). ages as Trovrded for in Section 3706 of the Labor Code, interest, and
a orey'S fes 4 Obs
S' , 'T41 o
❑I, as owner of the property, am exclusively contracting with licensed " ,y ` x,0" .
contractors to construct the project(Section 7044,Business and Professions `` R. ,. a3tr .1i.:.:-. �� , '' u
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDINGrAGE `'" �"�s<
• who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a constructionnending a ency
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.
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tame 15K-5 4,. J �o" cte
Title
PRINT NAME
I certify that I have read this application and stat• 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 ,'d State Laws relating to buildin: construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentione/iftv opety for inspection purposes.
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ignature Date