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ARCADIA
City of Arcadia, CA
Development Services Department
240 West Huntington Drive, Post Office Box 60021
Arcadia, CA 91066-6021
(626)574-5416
Addr NO. Dir Prefix Street Name
627 W Duarte
Contacts
Permit No. Plum -18-2109
Permit Type: Plumbing
Work Classification: Plumbing Commercial
Permit Status: Issued
Issue Date: 11/13/2018 I Expiration: 05/12/2019
Street Suffix Unit
RD
City, State, Zip
Arcadia, CA
KJR EASTERN ENTERPRISES INC AND
LINYAN HOLDINGS LLC C/O TIBC
PROPERTY MANAGEMENT
651 W DUARTE RD C
(626)446-1212
Owner
Description: REPLACE 2 EXISTING OVERHEAD MAIN LINE FOR
SHOPPING CENTER.
Fees
Amount
Backflow Protective Device 2" & smaller
Fixture with Trap/Misc.
Plumbing Permit Issuance Fee
Solid Waste Management Fee 2
Total:
$31.10
$24.92
$44.35
$1.00
$101.37
Parcel Number
5778007010
WESTERN SUPREME ROOTER INC`
136 E SANTA CLARA 1, ARCADIA, CA 91006
(626)448-6565
Plumbing Contractor
(C-36)
Valuation: S 0.00
Total Sq Feet:
0.00
i
Tenant
Plan Check # Plan #
Payments
Amount Paid
Total Fees
Cash / Receipt # REC-002861-2018
Amount Due:
$101.37
$101.37
$0.00
4'1RD
•s•xer)
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 13, 2018
Issued By: Date
November 13, 2018
Page 1 of 1
City of
Arcadia
PERMIT/PLAN REVIEW APPLICATION
Development Services Department, 240 West Huntington Drive, Post Office Box 60021
Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
LICENSED CONTRACTOR'S DECLARATION
O I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000, of Division 3 of the Business and
Professions Code, and�' y license is in full force and effect.
ALicense Class L-7 s3�
License Exp. Datd�
Signature of Contractor
OWNER -BUILDER DECLARATION
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors
License Law for the following reason (Section 7031.5, Business and Professions
Code. Any city or county which requires a permit to construct, alter, improve,
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
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
Section 7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500)):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Section 7044, 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 own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one (1) year of
completion, the owner -builder will have the burden of proving that he or she
did not build or improve for the purpose of sale).
0 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
who builds or improves thereon, and who contracts for such projects with a
contractor(s) licensed pursuant to the Contractors License Law).
O I am exempt under Section 7044, Business and Professions Code, for this reason:
Date Signature
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following:
O I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers' compensation insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit
is issued. My workers' mpensation insuranpe carrier and policy numbers are:
Carrier-1fP / r �%Gt i pON°`
Policy Number (0000/7 .; 0- // /
(This section need not be completed if the permit is for one hundred dollars or less)
I certify that in the performance of the work for which this permit is issued, I shall
not employ any person in any manner so as to become subject to the workers'
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
forthwith compl with those provisions.
/ Z
Date 1/ �/ Signature
WARNING: Failure to secure Workers' Compensation coverage is unlawful,
and shall subject an employer to criminal penalties and civil fines up to one
hundred thousand dollars ($100,000), in addition to the cost of compensation,
damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that
for the performance of the work for whit
Civil Code).
Lender's Name
re is a £onstruction lending agency
rmit s issu tSeition *97.
Lender's Address
1
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.
r
Name
1-114 �1
PRINT NAME
Title / ` y 5e.'"
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
//7?
%
(Date / /V/ ` Y/e