HomeMy WebLinkAboutMECH-21-0032 „... City of Arcadia, CA
Permit NO. Mech-21-0032
Development Services Department Permit Type: Mechanical
240 West Huntington Drive,Post Office Box 60021
` Arcadia,CA 91066-6021 Work Classification:Mechanical, Residential
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:01/11/2021 Expiration: 01/11/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
455 FAIRVIEW AVE D Arcadia,CA 91007-9171 5778011204
Contacts ,
ALAN STOCKE Owner E&A MECHANICAL INC Contractor
L 7323 Elmo ST,Tujunga,CA 91042
(818)988-9060 921921
Description:REPLACE 3.5 TON HORIZONTAL COIL,SAME Valuation: $0.00 Tenant
LOCATION
Total Sq Feet: 0.00 Plan Check# Plan#
1
Fees Amount Payments Amount Paid
Evaporative Cooler(Not portable) $19.86 Total Fees $67.87
Mechanical Permit Issuance Fee $47.01 Cash/Receipt#REC-06485-21 $67.87
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $67.87 -
3-1 - 21
fit1A-1 a- (IvNi
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
elk C$' 0/ /V(JI�, )(I De 4 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
S g r void if any work authorized by this permit is suspended or abandoned for 180
Fri consecutive days or if no progressive work has been verified by a City of
Vt5/21Fle0 kT . i Arcadia building inspector for a period of 180 consecutive days.
'1 COMPLETED
January 11, 2021
Issued By: Date
January 11,2021 Page 1 of 1
i
10111111 * PERMIT/PLAN REVIEW APPLICATION
.t4t*.j Development Services Department,240 West Huntington Drive,Post Office Box 60021
m6e� Arcadia, CA 91066-6021,(626)574-5416,Fax (626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0 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
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
attorney's fees.
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 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).
1] 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
i
•
:. PERMIT/PLAN REVIEW APPLICATION
/1
Development Services Department, 240 Nest Huntington Drive, Post Office Box 60021
• f Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
ONLINE PERMIT/PLAN REVIEW APPLICATION
CM'Of
ARCADIA Job Site Address: 455 FAIRVIEW UNIT D
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 for`•e�-•a�nd •(feet. El have and will maintain a certificate of consent to self insure for workers'
License Class C2- ti c e No •`a"1 Exp. DateR3.) compensation.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 3700 of the labor Code.for the performance of the work for which this permit
I hereby affirm under penalty of perjury that I am exempt from the Contractors is issued. My workers' compensation insurance carrier and policy numbers are:
License Law for the following., reason(Section 7031.5. Business and Professions . Crrle�1��.d✓1
Code.Any city or county which requires a permit to construct. alter, improve. Canter 1 l
demolish.or repair any structure,prior to its issuance.also required the applicant G��Q 2
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number_
(This section need not be completed if the permit is for unc 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 ❑ I certify that in the performance orate 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(5500)): compensation Laws of California.and agree that if I should become subject to the
workers'compensation provisions `Section 3700 of the Labor n rte.I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisio sl
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` lZ'` Signature_ _ _
Law docs 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(I)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(S100.000),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.
Dl. 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 fur 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 _
•
Datel_ 2 S gnaiure 6-4 I _ Lender's :11�ress
c1POR7:ANT: APPLICA'T'ION IS HEREBY MADE TO THI BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
ESTRICTIONS SET FORTH ON THIS APPLICATION AM)TILE FOI.LUWItNG:
I. The City's approved plans and permit inspection card must retrain 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.
acne Title
N1t1N't NAV1F,
:ertify that I have read this application and s s to that the above information is correct and that I am the owner or duly authorized agent of the owner.
agree to c.mply with all City ordi ances d State Laws relating to building construction. I hereby authorize representatives of the City of
rcadia to e' er u son the above-n) nt ned p pe ty for inspection purposes.
\�11� i,,
gnature �
ULt - . __ Date � J � I J 2_021
A•
Qc.,yiroRvia •
4 ! PERMIT/PLAN REVIEW APPLICATION
x.41 * 4 AI
1411.*' Development Services Department,240 West Huntington Drive,Post Office Box 60021
1,
*Nu elif°C%%.". 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
iOWNER-BUILDER DECLARATION Cl I have and will maintain workers'compensation insurance,as required by Section
CII 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, Carver
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 Cl 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 forthwith comply with those provisions.
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 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.
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 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).
0 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