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Home My WebLink AboutB00-058-631 tt-," Develonment Services Department _ _ 1 240 WAt Hu angton Drive,Post Office Box 60021 PERMIT NO. BOO-058-631 `1". _!,,-11 Arcadia,CA 91066-6021 City of (626)574-5416,Fax(626)447-9173 Permit Type: EMP Combo Arcadia PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE 11:46 12120!2017 PERMIT STATUS I 0008 12120/2017 EP Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE 1436 S Baldwin Ave 5383-031-008 OWNER MAILING ADDRESS PHONE NO. (626)203-9265 f I It 1101dlns EMAIL ADDRESS: APPLICANT MAIUNG ADDRESS • PHONE NO. (626)203-9265 It Holding EMAIL ADDRESS: ' CONTRACTOR/PROFESSIONAL MAILING ADDRESS PHONE NO. FAX NO. Home Owner EMAIL ADDRESS: License No. Type: Expires: TENANT MAIUNG ADDRESS PHONE NO. FAX NO. DESCRIPTION 2 MINI SPLIT AC UNITS ON ROOF TOP Construction Type COPT 0 of units Value Construction Type UON1 11 of Units %aloe EXPIRED OCCUPANCY: TOTAL VALUATION: $0.00 ()TY Pont DESC AMT AMT PAID ACCT QTY EOM DESC +wwr AMI'PAID ACCT 100 flat Elec issue 44.35 44.35 01-3105 1.00 Flat Mech issue 44.35 44.35 01-3105 3.08 Double fee 2 3.08 3.08 01-3105 28.22 Double fee 2 28.22 28.22 01-3105 2.00 each Air out 10m cfm 28.22 28.22 01-3105 2.00 each Outlets 3.08 3.08 01-3105 100 Flat SWMF 2 1.00 1.00 88-3027 1.00 Flat SWMF 2 100 1.00 88-3027 Total Fees: $153.30 Balance Due: $0.00 Paid Today: $153.30 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the IL cc.pt n: 118881 t is not commenced within 180 daysthe date of issuance or if the permit is not obtained within 180 days from 01-3105 151.30 Peel from 88-3027 2.00 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. CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS Requests for inspection should be made at least Monday-Thursday Friday4/7 one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m. by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. (Closed on alternate Fridays) k4 ! PERMIT/PLAN REVIEW APPLICATION (140), Development Services Department,240 West Huntington Drive,Post Office Box 60021 °I' 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 herebyaffirm under Chapter 9(commencing with Section 7000,of Division 3 of the Business and penalty of perjury one of the following: 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 ��Sig`nature of Contractor performance of the work for which this permit is issued. ! UWNER-BUILDER DECLARATION ❑ 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 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 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 shall 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 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 l • f (? 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 did not build or improve for the hundred thousand dollars($100,000),in addition to the cost of compensation, Pro purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and ' ❑I, as owner of the property, am exclusively contracting with licensed attorney's fees. 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: �,�n / Lender's Name Date ' - I`IA9 I I'� Signature i ' ' .` ( 4� /1 Lender's Address RTANT: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. / ame t�,�t1 itle U.3\'‘)‘IA,1. 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 ()P\A 1 ( i( Date ` 14 g47 1 1"/ 0 dt9vi) ^y.k y 5 ()L1 1 r 6l k T N C 4 v . . 0 „-__, h ds .. (----› _ift i 6--.. i. !. I' ___Fi:174- - F k----- I 1 —► g -o _Toom -o ED O V) CD 0. .. 7 � ( IC z In, , I- c- T, � co0.) ! 7.-f75. N O �Q---->1ii : , AI • j `<j' i nO � � j\ I 1. . I . ' -i-. - C;; + : , f! ` •I lam iCDED (f) _1 i ir 1 1