HomeMy WebLinkAboutUntitled (2) kti44. 414,4 4,043� Permit nr0 Meth` 20 0933,
City of Arcadia, CA ), ,`"r „e
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Development Services Department ;. * = ' r Permit Type Mechanical
>`'i 240 West Huntington Drive,Post Office Box 60021 ,i ' ,,
Arcadia,CA 91066-6021 , z, ' Work Classification HVAC Repair./Replace t
;,; (626)574-5416 � � Permit Stptus:,fstimate
A �CA �� IssueDate:06/23/2020;: Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1018 W DUARTE RD UNIT 3 Arcadia, CA 91007-7461 5383001047
,,
Contacts , -
CHEUNG,MAY M TR MAY M CHEUNG Owner Connor Air Conditioning Inc Connor Air Contractor
TRUST Conditioning Inc
1018 W Duarte RD 4931 E ENCINITA,TEMPLE CITY,CA 91780
(626)286-3157 403735
33
Description:REPLACE EXISTING HVAC SYSTEM Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 1 Plan Check# Plan#
44,0391 34�� �, � 1,434.41334,
Fees Amount Payments Amount Paid
Compressor<3 Ton(up to 3 hp) $19.86 Total Fees $87.73
Furnace or Burner<=100,000 BTU $19.86 Cash/Receipt#REC-04785-20 $87.73
Mechanical Permit Issuance Fee $47.01
Solid Waste Management Fee 2 $1.00 Amount Due: $0.00
_ 1-0 covi
Total: $87.73 piETE0
2.4->ff..•••••••//
1;146 CALLS FOR INSPECTIONS
A4.,=,04....4--
Request for inspection by telephone at 626-574-5450. Leave a message
4E/40"‘O �j rc g Pe-TEt77:r. 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.Thispermit 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.
•
•
June 23, 2020
• Issued By: Date
June 23,2020 Page 1 of 1
r
U~� Fc9�r
7 PERMIT/PLAN REVIEW APPLICATION
wiam
o je Development Services Department,240 West Huntington Drive,Post Office Box 60021
mm�ulty°t"° 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. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. 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.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
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 their 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 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.
Name Title
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 Date
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'—PEIVI—, ITIPL AN ItEVIEWAPPLICATION.:
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Development Serliices-.Deparifge04,240%Vest itI0110409,nIDriy1,:ri*Office Bo*60021
.. . .,,.. . A readitii. .91,666641",f,-(62 ).S74,541 ,.F '026);447917.
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, ,... i . INIAINE--.?PERMIT/PLANREVIENMA PPLLCATIONle_.'-
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ARCADILi.k, ritiiii:Site-Additii! ‘D /
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_LICFN8ED:CONTRAC-TeiR'S.litCLARATION WORKERS'e()MP.E .ISATION.DECLARATION
LI 1 hereby arlitiviinderp6nolty'Of-•peiji4y:thafTam'liCenSedUnder:proVisintis'pf iliereby'arffIrm under pelpny'dr;riefid00fie of.the:foll6Mtig;
s" "'ChttPter;# cortitiencini.WilltSectiOn 3060,Of Division 3 of"Me.";00sinesScano)
Professions:Code'v 461,,inkliegageA 440
.C•• '; ---- ;"" -'-'---• '::‘--torte'--- :and
.::efic'•z1"-2 .,',--.§,-,:.6-. . .. ..'0•• h,• vea'•ntwill;,m..a•i-nt•a•in,..a certificate
•.. consent-Ot -•i.o-;self 4-insure
lot workers
LidctOClaSSi0C1License(o,4))1-35,ExxneAi Ucompensation is' iciidid fdr,tYkSettiin:57Q4Jor the Labor Code-foihe
PribrOancnPf.0g;vOrkwhich .
•
this is
SignAture.of Contractor•- .-.: -- ,kyv.-J\S.: :3 .-'.'.!,•7.---..:7.7.---..----:... ::- :7, _ .
ei
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• --- - - - - - • --- - ' '....,'il',.,.„•-•..,: 'Effhajit'arid wilitnalatai ti wnikeis'.compensattortths prau tei as required by Seen"
°WNW,BUILI)F*::DgCLARAI4v44 • '- -3".709. 0f,ihe.laboi;Coile..,fortheperfoimience;.of the•work for which this permit
0 1 iere0y.ifrir,n1.110q Pini-4•01.POTIW'Y•Ot41:4;011.t*IIIP.0***-;c6.4r,..4cta!* isiSsued,1*.warketV compensation insurance'.earrieifacid.poliCy numbers:are:
'
License tiwIor,thefoltoWing reason1Section:1031:51 13atintand'PMfessiOrts . .,. •i: ,; ::-,.:i:„ot, '
Codt,'..40Y•c4 lir county which requires.si!pessnifici cOnstruet,:nitery iMprove, ,Can„ler . ':- . v._.'
deninlish.lir;fepairaqvi4emreiptiotjp itsrsslia4i4lsntegtijtedthe:applicant tiliV:‘:tta-4k.'54 le0. •
for such permit to file-asigned statement tiniate-,or she is licetfscit 1*nel-a to the Policy Ntimber
tiliis section need not he completed if the permit is foi-,,one in:mired-deltas'OtlessY
provision ottheContraetorsl-icense Law(Chapter 9(commencing with.Sectiorj,
70130)of DiyAsionr-3 Of:the BusiftesS'and'PrOfessibas Code)or that he or.she is (5"`
Icerti(Y.that ink tht;performance•Ofthe-worit faryhielifb(s.permit.fs iSsued.-Ish4
eieniii:itteie-froin and die basis for the alkeketVeSemption:Any violation,of : ._.,,,..__,,,,,,.,_,,,.____.,i.,,,,,,,,_,,,,,_. ,.. .,, ,, ,,L.become subject,,_ .,,,workers
penalty
101..5 by an applicant..fot n'peettiiit subjects the applicant to kelyjj: "1''' '''''. ..:,11Y••,1.!...7.1,2"...ti171nT!". -. '"4.,-"'-v,,7,F,t.u. t?,',u,.c"3.'‘.,s":, 'ff,,',,KF'.,
- '- '• • ',' -"-•' ' .•" -' . •- '" •cPPIWOF4t041.4.1 91 ;.2111orillii.:P.114 agree that4 I•s09'.!14;°` 941?e P3P9.-•to-t:!?
peniliy•OfOot morefitan:I'llye.hundred dollars:MO));
workers compensation proviSitms:of-Seetion.:370(tof tlif:,,attorlde4.Shall.
.
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3, ,...ov•mo;0.0,pl :riy; ..14 i,1.0),.0. -.-%.,w wages..,4s_. .their 01;i tortitwithcorripl):Vith thOsepfO yiSiOtt.ts;.
compensation,will do..the.',WOric,and the sttnCtoreiis not fritendeti...:„ccoffgred-tor, ,be. ,,...,1 ,, ,• , , Signature
sale'IStCti 64 7044 Business and Professions Code lite Connectors•stkettf4 -...;-.. - • ,-, .. ,.•...-..- _ . : . ...... . . . , .
f.aw-t)oesmot apply to an'oiyner of properly,who builds oliiMptOyes thereon„
cif MI6•dbeS,such sktirkAtiiiitelf Or herself de'throtiffilieSor. Iter_oi,.id, •
, ,
employees,nmvidid.inat-•au4r.improvements are dor intended or offered for 14,TARNINGFaltureAo.secoreWorkers'Compedsation„covenngelt:0104, .
., _,.
K305*.eief,the building or itnotOetuenrik,nqld withiii oett.(I,),:yese of , SitirSlidli-Sub,100--an i*IidyerT46,i:iiiintint-tieniltieS;nda civil Sde4:4„tir,dne
.,, , „L. ., , . , _ • . ....
cdmpliiian-,,,ene4wn&46dilder ivfil nnvethie,:bdid4e.of proving that he or:she-, ; ilinctrelki110iii24:49114kt.M(90449't.i.dOititf9.14P,cost.ci.e91aPctoni ...
., „..
did not nof.twfldorinwmvgfcif;:lhe.RnpOsP..ot,..4414, .ii:iriage.gas pioifidea-,for„li skiiiii 3706.0.the,,LnbSv,Colle,:intek'St and
attorney's fees,
Has,‘,owner 4'lh''.0.'...,.0.00.6f-OW:0,.0:itir4:gfin!iaajj,4f,*ttn Itpense0! ,„
...CLOitttattOfS-40'.:C611StMetttheoptoject'.(Seetion 7044..insiness•-ind'OrdieSsidds, ,•,,,,• ••,•,,,,,..., ••,,,..- ,• — •,,,, ,, ,.•_,_ . ..
Code•,TheContractors'WO 'Law dOits', Ot apply to IMLOWneibf Property-:: •CONSTRUCTION.,. .. g , ..,12,11PINP.•AG EN-C...Y.
iit-:',=,:Hf...-i=:. . thereonCu5e' .; ,." P ....-. 4. •" h '1..,,, • • thereb.-affirm undirde-n.any of perjury that there is a construction lending agency
sif•utiisu,,yrimpro0- , :and w,.-.o'eon,,4j!...`.,,-.s9c,,,ptoir,.t with 4. '•. -- !...- ..., . ...the , -.. . -- . -. ..; ......._,
contractor(s)licensed pursuant tbAhertttiattorsticenseLaw),.... - for.the:perfotmance:of, work for which this permit- is issued (Section„nni.i,,
.., ... , ...._...._,.. ..... ._. .. ,...
'tiiitC6,0ei..
0 1.,..A .,Nr41,1ipa4r.spii0410.44;44iipes.,iticiPt.OfesSiOn •Cge,'TOr!his.,040n: ,..il:3-,v
. ... •.,. .. • •
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-, ,Or.-t
Lenders Nape,
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Date -- . • - :SiiTeatdre• - -,f• ..' . ..., . „ . __ . .. .. -4140 .A5141*s',- - .._.--_.:. . _.. .... :___, - .' - ...• ---,‘,... -,,,--,_
.1Mroietv4; t PPLICATicr4-1,'A'If V ttritY MArIE TO..T1.1F,BuillitKri.:01TICIAL.1-XT:4 :NR_Mry.litlqjja--,..T7Q.17.11,;;',91,M,
RIFSF liftINS SETTf)R711()NMIS,1 ITLICtf1/411r.IN1Yrfltp.:700-:(PiNIW
)
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I. llic•:CitY's aPPrOedlilans 01141itit ilitisilecti :,640:111 reth414'orf thP4P1)!P`t:tfizlCuse-IY,•‘ :itii, ins peettOrtpetSbenit,l.
2,.•.,., Fina,l inspection
p.ectio.n.of h
dmoet,k..au
dp..i
o\.
rirs,
byJ:is permit .re,.„di.,. d.Ae' mettifica..,.te Of b,ccupacyntS'ibeoliidinedpelort,o:u,st' n,d-o,. .crn,padg:ntnkew sbuildings..
andstenfuees.
3PerSoutftoast Air 944iilym 4otott-pOriel(A90):feAulatiin renovation and ednddeling„Wor:that stripping
or,aSbstos corjtining.natedals.requ4*aasbestos survey andlemo014peideld diSturbiq'ii:asbestisiPleane:contafA9M1•41•(90ff,396-2094!41
lattiolafonnaxioo:
Name
i , Car ,
I',..0eitifktwr hit*i:0444#AfifilkOti44#444t4t011ia ttlie4:40:sinformation'44vorre..,,,ctndth,lc,I am t4eoltne, ror duly-,4au thorinedagent_oi:',“ City of, _
I agree 44 040y with iifi0y..,otdinanott andand'-S44ie tn't.vireint!iit'•to.ii,tdidine onstroetiOn., l' by hereauthorize representatives of the, of•
Ai-c-iiiti7eAtehostitiiiiiheiielmetithwillitpeity,...cot Inspection.peitietks..-
, ..
•-• ;- .,. .„
. . . . , . .
Signature -.. - ,. ..:,.-,-... ..::.- . — . , .... .- ‘. . . .,_ Date .: :..... .,„,,,, . _ . • ::,..,.-. .- . . „.. .. i : .„„, .-
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ano.
Bnarfai '
1.7
AFFIDAVIT SELF-CERTIFICATION
FOR COMPLIANCE OF SMOKE ALARMS
AND CARBON MONOXIDE ALARMS
Property Address: lb 6, W' )titCtrte Pa 3
Permit Number: M C \ 7 - D�,33
Brief Job Description: yst�6, 14 �X,5fiMC-4Aectt
cetei,(
Number of smoke alarms installed: I-
Number of carbon monoxide alarms installed:
When alterations, repairs or additions requiring a permit occur, or sleeping rooms are created,
Smoke alarms shall be installed in each sleeping room, and outside each separate
sleeping area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements and habitable attics as required by Section R314 of the 2013
California Residential Code (CRC) and California Health and Safety Code Section 13113.7.
For dwellings or sleeping units containing fuel burning appliances or having attached
garages, carbon monoxide alarms shall be installed outside each separate sleeping
area in the immediate vicinity of the bedrooms, and on each additional story of the
dwelling, including basements as required by Section R315 of the of the 2010 California
Residential Code (CRC).
Multi-purpose alarms (combination carbon monoxide and smoke alarms) may be used.
All alarms shall comply with requirements for listing and approval by the Office of the State Fire
Marshall. http://osfm.fire.ca.cov/licensinglistings/licenselistinq bml searchcotest.php
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
compliance with the code sections referenced above.
I declare under penalty of perjury that the forego'ng i true and correct, and that this
declaration was executed on (Date) 7/i 7 at Arcadia, California.
Owner's Name (printed/typed): Pity CA1/147
Signature of Owner: J �J
This affidavit must be returned to the City of Arcadia inspector prior to final inspection