HomeMy WebLinkAboutPLUM-21-0011 City of Arcadia, CA Permit NO. Plum-21-0011
Development Services Department Permit Type:Plumbing
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Plumbing Residential
(626)574-5416 Permit Status:Issued
ARCADIA Issue Date:01/05/2021 ( Expiration: 01/05/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1128 S NINTH AVE Arcadia,CA 91006-4415 5780026001
Contacts
MERCIECA,HORACE AND ISABEL TRS Owner A.R.S./Rescue Rooter* Contractor
MERCIECA FAMILY TRUST 706 W Arrow Grand CIR,Covina,CA 91722
1128 S NINTH AVE (626)858-9284 765155
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Description:ADD CLEAN OUT Valuation: $0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Fixture with Trap/Misc. $13.21 Total Fees $61.22
Plumbing Permit Issuance Fee $47.01 Cash/Receipt#REC-06445-21 $61.22
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $61.22
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
requesting the address,timeframe and what inspection item is needed.
^ r}r This permit/plan review expires by time limitation and becomes null and
i�cU UL p� � void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
/—$r / 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.
January 05, 2021
Issued By: Date
January 05,2021 Page 1 of 1
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4 ,Fivom PERMIT/PLAN REVIEW APPLICATION
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44101" a Development Services Department,240 West Huntington Drive,Post Office Box 60021
Arcadia, CA 91066-6021,(626)574-5416,Fax(626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'. DE RATION WORKERS'COMPENSATION DECLARATION
OfrTriereby affirm under penalty of. ff, tha am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Sec'. 000 .f Division 3 of the Business and
Professions Code, . d my licen &rce an. effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class / . . •( da' Ex. •tel'
31-2 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 ave and will maintain workers'compensation insurance,as required by Section
❑ I herebyaffirm under penaltyof 3700 of the Labor Code,for the performance of the work for which this permit
perjury that I am exem from the Contractors is issued. ork corn. n tion i nseuarrce carrier and policy numbers are:
License Law for the following reason( on 7031.5 usiness and Professions
Code.Any city or county which requires a ' to construct,alter,improve, Carrier ►. I '1
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 l G'(o�� G!
provisions of the Contractors License Law(Chapter 9(commencing with Section (Thrs section need not be completed if the permit is for e hu . 'R 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 w ' s . tis 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 .-•.me . sect to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if a .a become subject to the
workers'compensation provisions of Section 00 o t e Labor Code,I shal
❑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
dAl
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature V
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 covge 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 eicil 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).
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 ANI)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 i 4 i Title __49-40,—,/
P•.i •AME
I certify that I have read appli will . d 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 •I City o . es and State Laws •ting to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon l above- tioned property for' '' on purposes.
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Signature Date
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