HomeMy WebLinkAboutPLUM-20-0695 • ; City of Arcadia, CA Permit No. Plum-20-0695
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:05/14/2020 f Expiration:
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
935 PALOMA DR Arcadia,CA 91007-6123 5776013005
Contacts
SANDER,STANLEY P AND JOAN Y TRS Owner D K A LANDSCAPE CONSTRUCTION INC* Contractor
GAZA TRUST 4170 EVE RD EVE RD,SIMI VALLEY,CA
935 PALOMA DR,ARCADIA CA,91007 458003
Description: INSTALL RETENTION BASINS PER APPROVED Valuation: $ 0.00 Tenant
PLANS.
Total Sq Feet: 0.00 Plan Check b Plan It
Fees Amount Payments Amount Paid
Double Fee(MEP) 595.00 Total Fees $167.93
Plumbing Permit Issuance Fee 547.01 Cash/Receipt tf REC-04476-20 $167.93
Rainwater Systems 524.92
Solid Waste Management Fee 2 51.00 Amount Due: $0.00
Total: $167.93
j24, 6
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
C✓7 COMPLETED 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 arty 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.
May 14, 2020
Issued By: Date
May 15,2020 Page 1 of 1
009104,-,•
PERMIT/PLAN REVIEW APPLICATION
rt em14„,s,~ 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'S DECLARATION WORKERS'COMPENSATION DECLARATION
❑ I hereby affirm under penally 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 0 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).
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
PERM1'1'/PLAN REVIEW AI'PL1 CA 1'lON
•
t,� Development Services Department, 240 West Huntington Drive, Post Office Box 60021
Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
ONLINE PERMIT/PLAN REVIEW APPL C'ATl()N
Job Site:Wticlress:
(LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
LI 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 Busin.s and
Professions Code,and my license is in full f.rc and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
can
License ClasaL�Zl � .se No. "..•af1/3 Exp. Date 'Gv''I pensa(ion, as provided for by Section 3700 of the Labor Code. for the
�r! 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 herebyaffirm under.penalty of perjury that I am exempt from the Contractors -700 of the Labor Code,for the performance of the work for which this permit
y 3 rY p is issued. My workers'c pensation insurance carrier and polis numbers are
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. Carrier ft Cf72 �Ci Ltt2/1s .2f� C:O�t+ s
demolish,or repair any structure,prior to its issuance.also required the applicant \V ,• ''�
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number---L�i-. --- 1 7
(This section need not he 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
❑ I certify that in the performance of the work for which this permit is issued.I shad
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 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 sublesi to the
workers'compensation provisions of Section 37(X)of the Labor Code. I shall
1, as owner of the property, ormy employees with wages as their sole forthwith c mply ith those provisions.
compensation,will do the work,and the structure is not intended o r offered for �1r-Th
sale(Section 7044, Business and Professions Code:The Contractors License Date 1'T __ Signatu
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 ate 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 penalises and civil fines up to one
completion.the owner-builder will have the burden of proving that he or she hunted 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-
•
1. 7'he 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.
•
me - ..�_.._.. _.._ Title __ael&L — - .....
PRINT __..
PRINT NAME
ertify 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.
'area to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
radia to enter upon the abov• • 'oned property for inspection 'ur r ses.
-
;nature r__ Date /4/ ?.V?4)
4 • K PERMIT/PLAN REVIEW APPLICATION
•., Ill!-" Development Services Department,240 West Huntington Drive,Post Office Box 60021
„ tv
`• 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. 0 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 0 I have and will maintain workers'compensation insurance,as required by Section
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 0 I certify that in the performance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation ofnot employ any person in any manner so as to become subject to the workers'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil
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 CONSTRUCTION LENDING AGENCY
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 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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