HomeMy WebLinkAboutPLUM-21-1660 .4••••
•• City of Arcadia, CA Permit NO. Plum-21-1660
Development Services Department Permit Type:Plumbing
240 West Huntington Drive,Post Office Box 60021
Arcadia,CA 91066-6021 Work Classification:Water Heater
(626)574-5416 Permit Status:Issued
•
ARCADIA Issue Date:09/01/2021 Expiration: 09/01/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
612 SANTA ROSA RD Arcadia,CA 91007-2747 5775029013 1
Contacts
WILLIAM MORALES Owner A.R.S./Rescue Rooter* Contractor
612 SANTA ROSA RD 706 W Arrow Grand CIR,Covina,CA 91722
(818)207-1185 (626)858-9284 765155
Description:CHANGE OUT WATER HEATER LIKE FOR LIKE Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#
Fees Amount Payments Amount Paid
Plumbing Permit Issuance Fee $55.00 Total Fees $78.02
Solid Waste Management Fee 2 $1.00 Cash/Receipt#REC-08700-21 $78.02
Technology Fee(Permit) $4.02
Water Heater and/or Vent $18.00 Amount Due: $0.00
Total: $78.02
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.
COMPLETED
September 01, 2021
Issued By:John Zurick Date
September 01,2021 Page 1 of 1
1 PERMIT/PLAN REVIEW APPLICATION
o 141 jr Development Services Department, 240 West Huntington Drive, Post Office Box 60021
"unity.4 * Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACT I f'S'I ECLARATION WORKERS'COMPENSATION DECLARATION
0 I hereby affirm under penalty of. q that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with S ,1 o./7000,0of Division 3 of the Business and
Professions C'✓Jl1/d my licen ! lllnfgi e . • effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class V_i). Exp. Date 1-31.2 ' 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 DECLARA ON re .ve and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury • at I am exempt from the Contractors 3700 of the Labor Code, or thee the work for which this permit
License Law for the following reason(`.. tion 7031.5,Business and Professions is issued.My w rs'c pens ti suran carrier and policy numbers are:
Code.Any city or county which rel s a permit to construct,alter,improve, Carrier
demolish,or repair any structure,p • to its issuance,also required the applicant 3D-500471' d
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 o- 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 whi this •- �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 ., ome s r t to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that shoul• .: .me subject to the
workers'compensation provisions of Sectio. t I . h Lab• r ode,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 4../ �/
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'Com. nsation •verage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal pen+ ties 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 additi.. to cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of - 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 'als requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
Name /h i rp ii2 Title
PRINT NAME
I certify that I have read t 's app.I
• on and s : , that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply with .1 Ci ordinal' and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon . . e- ention•. pro I rty for inspection purposes. C
0,
Signature Date ! . /. 2/
F