HomeMy WebLinkAboutUntitled City of Arcadia, CA r Permit NO. ROOF-20-1172
Development Services Department Permit,Type:Roof
.64' `` 240 West Huntington Drive,Post Office Box 60021
tm Arcadia,CA 91066-6021 "Work Classification:Reroof-Residential
P
(626)574-5416• �,�� . � ' � ermit-Status:Issued
ARCA D I A Issue,Date:08/06/20201 Expiration: 08/06/2021
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
316 LAUREL AVE Arcadia, CA 91006-2517 5772019026
Contacts
LI,XIANGYI AND SUN,MING Owner
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Description:T.0 REROOF HOUSE/ATTACHED GARAGE WITH Valuation: $ 14,000.00 Tenant
BORAL BARCELONA SANTA CATERINA BLEND 900 LBS CLASS A
28 5Q(EA) Total Sq Feet: 0.00 Plan Check# Plan#
**FIELD VERIFY EXISTING TILE IS HEAVY WEIGHT**(If not
customer to provide structural calcs or change to light
weight file and amend permit)
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $357.31
Building Permit Fees $304.05 Cash/Receipt#REC-05142-20 $357.31
Solid Waste Management Fee $6.25
Amount Due: $0.00
Total: $357.31
cetekr4t tO•LZ•U ItAMPIETED
E1 JkL- (o• Z® •Zo e
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
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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.
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August 06, 2020
Issued By: Date
August 06,2020 Page 1 of 1
OF ARC
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117 PERMIT/PLAN REVIEW APPLICATION
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"4 Development Services Department,240 West Huntington Drive,Post Office Box 60021
Y 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
performance of the work for which this permit is issued.
Signature of Contractor
❑ I have and will maintain workers'compensation insurance,as required by Section
OWNER-BUILDER DECLARATION
0 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
Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed if the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
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 0 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
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.
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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PERMIT/PLAN RJLI
EVIEW APPLICATION,
• Development Services Department,.240%1'tst•Huntington Drive., Post Office Box 60021
iii.:
• Arcadia,CA• 91066-6021, (626)574-5416, Flit (626).4479173
W' . • ONLINE PERMIT/ILAN REVIEWAPPLICATION .
ARC'AD1A. - Job Site Atldress: `r• C�IQ�4�h e-
• LICENSED CONTRACTOR'S DECLARATION 1VORKERS'•COMPENSATION DECLARATION-
!hereby affirm under penalty of perjury thm-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. O i.have and will.maintain'a Certificate of consent'to self-insure for wartier,'
License Class_C'3C License No.II IO'2- ' Lap. Date 2-4.2-1-.' compensation, as provided for•by Section 3700 of the Labor Code. (oi the
S_ipnature of Contractor / performance of rhe,work for which this permit is issued. -
OWNER-BUILDER DECLARAT ON I have and Will maintain sorkers'compensation insurance,as rccuirsad by Sectio
Dhereb aflimt under nett of r u that I a t exempt I fromthe Contractors 700 of the labor Code for the'performance of the work for sshich this-prmit
y. penalty pt n rt n p his issued.My workers"compe.q�. tion insurance carrier and policy numbers are
• License Lase:for the following reason(Section 7031.5,Business and Professions. • y c'On e
Code;Any city or county which requires a permit to constrttch alter,improve;' •Carrier' - �..
• • demolish,or repair.any structure,priorto.its issuance,also required the applicant policy Number 9pgQ3, 2-'"z.z
for Such permit to file a signed statement that he or she is licensed pursuant to the
. provisions of the Contractors License Lain(Chapter 9(cotnntencing 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 O,1 ceni fy that in the performance of the.work for which this.permit is iss,rd 1.shall
Section 7031:5 by any applicant.-for a-permit subjects the applicant to a civil • . not employ any person in arty manner so as to become subject io the Worker'
penalty of not more than five hundred dollars(S500)): .• compensation Laws of California;and agree that ill should become subjeci.to the
workers'compensation provisions of Section 3700•oCo
f the Labor de_I shall
/,‘,./.._____ .:.____ .±. . .
El I; as owner of the.property, of my employees with wages as their sole, • forthwith comply with those provisions
.compensation,Will do the work,and die structure is not intended or offered for ,. �? Si
Date_ gnatum
sale(Section.7014, 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 oscn
employees, provided that such_impioyements are not intended Or offered for , \YARNING: Failure to sosue\Yorkers'Compensation coverage u tallaw(ul;
• . sale.If,however,the building or improvement is sold within'one(I)year of and shall subjectan 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 cernp a trop,
did not builder improve for the purpose of sale). damages as provided for toSecdm 31.06 of the Labor Cts . in:crest. and
attorney's fees: - -
ElI, as owner of the property, am exclusively contracting with licensed .
. •contraclori to construct:the project(Section 704.7;Business and'Pmfessions•
Code:The Contractors Liicense•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 ContractorsLicense Las). for the perfomiance of the work'for which this permit'is issued (Section 3097,
Civil Code)..
i am exempt under Section 7014,Business and Professions Code;for this reason:
• lender's: Name_ - - - • - .. - _
- Date . • Signatum . -. Lender's Address.=. --
lll('1)l l ',I,: \1'1'1.1('\•fl(I,\ i'i•Iil1iltl \1\U1.-. iti rm. Ill.:III)l\li oil.li•1\1. 1(lt 1 Il•it Nil 1 "L Ilsii..c r II) rich; ta:Am nlit\_ti s\is
.
Ill 1 Klr-1 ill\ FII Mit ll\ I'IIIh \PPI l( It lLt\' \\lt HIE 11)1 1.O'N INC,:
I. The.City's approved plans and permit inspection card must remain oti the job site Tor use by City inspection personnel.
2. Final inspection of the wok authorized by this permit is required-A Certificate of Occupancy muslbe obtained prior to use and occupancy of nese buildings .
•
and structures •
3 Pcr South Coast Air Quality:Management District(AQ\1D)regulations,'renovation and remodeling work that.results in the remot al,.stripping,or altering
of asbestos containing Materials.requires an asbestos sure:ey and removal prior to disturbing the asbestos. Please contact AQ\iD.at(909)396-.2000 for
further information.
Name—_._ .. • Title • ' • _ '
•
• • • - • - • MUNI FAME • • - .
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I certify that I have read lids upplicaliun and state that the above information,is correct and that I ant theoisner or duly authorized agent-of the oisnen
t agree to comply. with all.City ordinances and Stifle Lusts relating to. building construction. I hereby authorize rcprcsentnlives of the City of
-Arcadia to enter upon the;thus^.itientlotied property far Inspection purposes. -
Si fna4ure -,_____,._-__•_,.._.L._-___.. .. --- - —
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