HomeMy WebLinkAboutPLUM-21-1237 ' Permit N0. P I u Im-°21 �1237
' ' - City of Arcadia, CA
ikDevelopment Services Department , ) v—e�~ I Perm tType�°PIUnlbing,
240 West Huntington Drive,Post Office Box 60021 i i {' I')
:.•a Arcadia,cA 91066-6021 i Wor>C Classification;Plum;Sewer Line Repair/Replacement
(626)574 5416 It sued
PermitStdtus Issued
A.)'°cADIA issue Date:o /07/2021I Expiration• 07/07/2022
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
211 LONGLEY WAY Arcadia,CA 91007-8528 5787018021
Contacts
ELEANOR CHEN Owner . ALL SERVICE PLUMBING* Contractor
10621 BLOOMFIELD ST 20,LOS ALAMITOS,CA
(888)306-9648 922604
.ze ._
Description:INSTALL SEWER LINER INSIDE PROPERTY Valuation: $ 0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#
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Fees Amount Payments Amount Paid
Plumbing Permit Issuance Fee $55.00 Total Fees $93.87
Sewer Connection on Property $33.03 Cash/Receipt#REC-08136-21 $93.87
Solid Waste Management Fee 2 $1.00
Technology Fee(Permit) $4.84 Amount Due: $0.00
Total: $93.87
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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.
'7/ A(_
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.
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COMPftTkQ
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July 07, 2021
Issued By: Henry Kemick Date
July 07,2021 Page 1 of 1
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Of ARO
II! • �� PERMIT/PLAN REVIEW APPLICATION
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, Development Services Department,240 West Huntington Drive,Post Office Box 60021
\Y% Arcadia, CA 91066-6021, (626) 574-5416,Fax (626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
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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 C& License No. gi24201-1 Exp. Date 61 i b/7, 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 Contracto
IDI have and will maintain workers'compensation insurance,as required by Section
OWNER-BUILDER DE RATION
❑ 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 011r`\Q-
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 sheds licensed pursuant to the
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 ill I 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
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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 f 1024
sale(Section 7044,Business and Professions Code:The Contractors License Date J SignaturLaw does not apply to an owner of property who builds or improves thereon, l
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.
❑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
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO 1'HE 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.
tame VWA\k'.2-\
S qVik` _ 1A
tleR1NT NAME Gn 1n 2 1-r
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 gree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
A cadia to enter upon the above-mentioned property for inspection purposes.
S' ature Date 11 / 1 il)ZI
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