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HomeMy WebLinkAboutB00-046-100 _ Development Services Department 1 240 West Huntington Drive,Post Office Box 60021 ';=') Arcadia,CA 91066-6021 PERMIT NO. City of of B00-046-100 Cty (626)574-5416,Fax(626)447-9173 Permit Type: Tenant Improve PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 3/17/2014 CM 11:48 7/2/2014 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE 400 S Baldwin Ave T-387 OWNER MAILING ADDRESS Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Inspector#: CHRS Los Angeles, CA 90025- EMAIL ADDRESS: Plan Chk#: 14-133 APPLICANT MAILING ADDRESS Wisconsin Lakeview Construction, PHONE NO. Plan#: 31304 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Wisconsin Lakeview Construction Inc 10505 Corporate Drive PHONE NO. (414)857-3336 FAX NO. Pleasant Praire, WI 53158 EMAIL ADDRESS: License No. 671201 Type: B Expires: 5/31/2015 12:00: TENANT MAILING ADDRESS Gamestop PHONE NO. FAX NO. DESCRIPTION • TI-GAMESTOP**INCLUDES ELECTRICAL&MECHANICAL** Construction Type UOM #of Units Value Construction Type /�C M Value Value Value 45,000.00 $45,000.00 V comptETED F 84... ...-1 9 4 OCCUPANCY: Tenant Improve TOTAL VALUATION: $45,000.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT each Plan review 482.79 482.79 01-3103 PC Cal Green 48.28 48.28 01-3103 PC ADA 72.42 72.42 01-3103 1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 each Bldg permit 742.75 742.75 01-3104 Bldg Issue ADA 74.28 74.28 01-3104 1.00 flat Elec issue 44.35 44.35 01-3105 1.00 Flat Mech issue 44.35 44.35 01-3105 25.00 each Outlets 33.00 33.00 01-3105 55.00 each Ltg fixtures 63.00 63.00 01-3105 1.00 Flat Add/Alter Ducts 9.38 9.38 01-3105 1.00 each T.I.Fire Pkc 235.00 235.00 01-3109 SMIP Corn 9.45 9.45 14-2207 grn bldg std 2.00 2.00 714-2203 1.00 Flat SWMF 2 1.00 1.00 88-3027 1.00 Flat SWMF 2 1.00 1.00 88-3027 100 Flat SWMF Auto 6.25 6.25 88-3027 Total Fees: $1,913.65 Total Amount Paid: $1,913.65 Paid Today: $1,075.16 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 Receipt#: 105559 rm the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3104 891.08 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Ar- 14-2207 1 99.45 Y Y 144-227 2.00 cadia building inspector for a period of 180 consecutive days. 714-2203 2.00 CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS 88-3027 8.25 Requests for inspection should be made at least Monday-Thursday Friday one(I)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) r il. „F,,,144 tora, PERMIT/PLAN REVIEW APPLICATION , to, Development Services Department,240 West Huntington Drive,Post Office Box 60021 A,,,of Arcadia, CA 91066-6021,(626)574-5416,Fax(626)447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION 0 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 4 i nse No .91.2-6), Exp. Date MP1//4 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 WI have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit I hereby affirm under penalty of perjury that I am exempt from the Contractors is issued.My workers'compensation insurance carrier and policy 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,de- Carrier molish,or repair any structure,prior to its issuance,also required the applicant for Policy Number such permit to file a signed statement that he or she is licensed pursuant to the pro- visions of the Contractors License Law(Chapter 9(commencing with Section 7000) (This section need not be completed if the permit is for one hundred dollars or less) 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 Section 7031.5 �I certify that in the performance of the work for which this permit is issued,I shall 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 0 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 Date 7- -psi sale(Section 7044,Business and Professions Code:The Contractors License Signatur 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,and sale.If,however,the building or improvement is sold within one(1)year of 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 hundred thousand dollars($100,000),in addition to the cost of compensation, 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 who CONSTRUCTION LENDING AGENCY builds or improves thereon,and who contracts for such projects with a contrac- I hereby affirm under penalty of perjury that there is a construction lending agency tor(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 RE- STRICTIONS 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 fur- ther information. Name R-A-7 C ' Y4 Title S4)eEA-- PRINT NAME I certify that I have read th 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 'th :i' City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter 1, t above-mentioned property for inspection purposes. Signature A Date -Z ?..)/7 !F ,.IO OPERATION NO OPERATION NOTES .Eluilding inspections Date Insp. Plumbing Inspections Date Insp. 100. Setbacks • ' {� ,^ I 1O . 210. Under(Ir./bldg.drain t3tie r,- 1 101. Rough grade 211. Copper underslab 102. Figs.&forms 212. Rough plumbing 1 , © � 103. Pre-slab 213. Rough gas 8-1-16/ " V 104. Floor joists 214. Shower pan 105. Steel 215. Water heater 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service 109. Roof nailing`l' 219. Final gas 110. Framing �/V�'l�( 220. Fixtures 111. Occ./Area Sep.Wall 221. Final plumbing ■ 112. Sound walls 222. Sewer cap/demo. 113. T-bar grid 114. Insulation-fir. Pool Inspections Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Cell. ,,r. ', 241. Rough plumbing 117. Drywall nailing �� 41/ 242. Light shell/bonding 118. Interior lath + �� 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building i t{ 246. Fence,gates&signs 122. Final demo/lot clear t 247. Pool heater 248. Final electric Electrical Ins.eclions Date I Ins,. 249. Final Plumbing 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Underground conduit. 153. Underslab conduit Reroof Inspections Date Insp. 154. UFER ground 270. Pre-reroof insp. 155. Water ground 271. Roof framing 156. Rough electrical /i 4/ 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. Eqpt.bonding -.Sign Inspections Date I Insp. 160. Service panel 280. Setback/overhang 161. Final electric 4.ril 281. Footing 282. Conduit/wiring Mechanical Inspections Date Ins.. 283. Disconnect 180. Venting/flue 284. Final sign 181. Furnace/A.C. 182. Rouch HVAC Mrdinralli Miscellaneous Insp. Date Insp. 183. Fire dampers 290. Fire alarm 184. Furnace compartment 291. Underground supply 185. Combustion air 292. Fire sprinklers 186. Smoke detectors 293. Monitor system 187. Metal F.P.rough 294. Hood dry chem. 188. Compressor setback 295. Final 189. Commercial hood 190. Duct shaft I :.'Sewers&OffsiteInsp. . Date Insp. 191. Final mechanical ' /( 300. Lateral(main to P/L) 301, Saddle/Y etock Wall Ins.ections sate • Ins. 302. Cesspool filled 200. Footings 303. Sidewalk 201. Steelrebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin • ,,, ,,... .•„L..-, . . .. ,-.,, -i.!-7.7-""'"*...-.-.. -,>,,,,... .."-!..t'7.7.... ..,,,,,, ,.. . ....., •'-`,-. ..!..„/ „-.;,,,,,.......-77,71/47,-,..'";,\'''''. ,, ,:,,..: : .!',.... ,..„-,„„t''"'' .: . .''' :::,.. .. I' \ / I I r, I \ If ` \ /I I I ! l...,..,,.. . _.__ tom : .fir,,„ ' ..„.„..: , . ,..„. .... .k ..i7i7!"-iri K w s x t, CI W „.......„, ,.„,, , „1.., 0 00 �� U 0 W N CO - N . )_7... , .#y , .a C 8 U U H 00 ''''''' 4 N .., '..'zi■;:.".-- 1--,.,',.': '''': j •3 3 0 a' O hL+ y v 1. ':-.,,i'.p j.,!:' Z c:'. .., 2 E u +'' U r ` bD c c co c 'r;� , O s 'o •o Cj - .3' '' ' ' o a o r c c n'e c on� fi r ' -,,,,t-.., ,, ...4, , . r.' ), i r Q .s p V C . N, j ..$::&1(4.1, y U G Q -. %-,;;,:r; 4.) '4: t4 •I• •s '.. .. . � � r g • i ,.(1' gy^p ai C O 'n > > O �C v O°a w n ::::,;' E l .g O U N V H F o a o d 9 5 3 9 .m V y)vdj ° U 6 0 o a ,� c c o Q w ....... ,., . ,,v,, , ,,,,, ‘.1 ,. L .,,i,, i „\ _r„:5„.y, „,),,,,,_ t \ A,,,/ ,\,,,,,,,,,_ /, \ _...%-Y1-,,.&_ I/A .__.>',/1,\>I1.2::://' '\ ---->'..\ '''''\'''''4.. i m \ Development Services Department M 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. BOO-047-510 `''*.,-1 Arcadia,CA 91066-6021 City of (626)574-5416,Fax(626)447-9173 Arcadia Permit Type: Fire PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 7/24/2014 CM 10:38 8/1/2014 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLO ASSESSORS PARCEL NO. GEO CODE 400 S Baldwin Ave T-44 T-387 OWNER MAILING ADDRESS Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Los Angeles,CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS Building Electronic Controls PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Building Electronic Controls Inc. 2246 Lindsay Way PHONE NO. FAX NO. Glendora, CA 91740 EMAIL ADDRESS: License No. 729905 Type: C Expires: 11/30/2014 12:01 TENANT MAILING ADDRESS Gamestop PHONE NO. FAX NO. DESCRIPTION FIRE ALARMS FOR TENANT IMPROVEMENT Construction Type UOM #of Units Value Construction Type UOM #of Units Value Value Value 3,650.00 $3,650.00 U COMPLETED • OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $3,650.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 6.00 each fire alarm pc 2 587.50 587.50 01-3109 1.00 Flat Fire Issue Auto 44.35 44.35 01-3112 each Fire Permit 137.05 137.05 01-3112 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $769.90 Total Amount Paid: $769.90 Paid Today: $769.90 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 105914 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3109 587.50 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3112 181.40 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Ar- 88-3027 1.00 cadia 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 Friday 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) 0yie04„.,a I 14 .9011 l PERMIT/PLAN REVIEW APPLICATION 10 IlE431 r:41 Development Services Department,240 West Huntington Drive,Post Office Box 60021 c:,,,,..... „...--4,-. Arcadia,CA 91066-6021,(626) 574-5416,Fax(626)447-9173 'YYYIIY Y[n City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION fjI 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. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class �� License No.l t 2°I a C f'Exp. D. -)7/ \A compensation, as provided for by Section 3700 of the Labor Code, for the _Till `+ - performance of the work for which this permit is issued. Signature of Contracto ..�r�1•Iyi !_.��'—,,„,a; OWNER-BUILDER DECLARATION d 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,de- Carrier /\l'C'(Y\eV'■CG'S \V i(O.1(1 C51_ C3%.• molish,or repair any structure,prior to its issuance,also required the applicant for y G� , x \ �-� such permit to file a signed statement that he or she is licensed pursuant to the pro- Polic Number `r C visions of the Contractors License Law(Chapter 9(commencing with Section 7000) (This section need not be completed if the permit is for one hundred dollars or less) 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 Section 7031.5 I certify that in the performance of the work for which this permit is issued,I shall 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 � _ a iL% ���.�I�0 r 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,and sale.If,however,the building or improvement is sold within one(1)year of 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 hundred thousand dollars($100,000),in addition to the cost of compensation, 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 who CONSTRUCTION LENDING AGENCY builds or improves thereon,and who contracts for such projects with a contrac- I hereby affirm under penalty of perjury that there is a construction lending agency tor(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 RE- STRICTIONS 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 fur- ther information. Name � Y�CAQ\L \�C Title 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. -.more Signature tk.di' \ Date / ldr■ Development Services Department 240 West Huntington Drive,Post Office Box 60021 `" _Y✓1 Arcadia,CA 91066-6021 PERMIT NO. B00-047-523 City of (626)574-5416,Fax(626)447-9173 Arcadia Permit Type: Fire PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 7/28/2014 CM 12:25 7/28/2014 Issued ADDRESS NO. Dlr.Prefix Street Name Street Suffix UNIT BLO ASSESSORS PARCEL NO. GEO CODE 400 S Baldwin Ave T-387 OWNER MAILING ADDRESS Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Plan Chk#: OTC Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS PHONE NO. EMAIL ADDRESS: CONTRACTORIPROFESSIONAL MAILING ADDRESS Hydro-Matic Fire Protection 1161 Rosedale Avenue PHONE NO. (818)247-9812 FAX NO. Glendale, CA 91208 EMAIL ADDRESS: License No. 718393 Type: C-16 Expires: 6/30/2015 12:00: TENANT MAILING ADDRESS PHONE NO. FAX NO. DESCRIPTION SPRINKS FOR GAMESTOP Construction Type UOM #of Units Value Construction Type UOM #of Units Value Value Value 1,900.00 $1,900.00 ' COMPLETED OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $1,900.00 QTY UOM DESC AMT AMT PAID ACCT QTY I1OM DESC AMT AMT PAID ACCT 19.00 each sprinkler pck 587,50 587.50 01-3109 1.00 Flat Fire Issue Auto 44.35 44.35 01-3112 each Fire Permit 99.45 99.45 01-3112 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $732.30 Total Amount Paid: $732.30 Paid Today: $732.30 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 Receipt#: 105838 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3109 587.50 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Ar- 87 143.00 88 8-3-300227 1.00 cadia 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 Friday 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) t_ Af irl k• PERMIT/PLAN REVIEW APPLICATION RE top, Development Services Department,240 West Huntington Drive,Post Office Box 60021 .o Arcadia,CA 91066-6021,(626)574-5416,Fax(626)447-9173 City of Arcadia LICENSED CONTRACTOR'S DEC , RATION WORKERS'COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I $m licensed under provisions of I hereby affirm under penalty of perjury one of the following: / hapter 9(commencing with Sec on 7!I I, -,f Division 3 of the Business and Professions C�q��my lic s is i I . - i 'ect. �-❑ I have and will maintain a certificate of consent to self-insure for workers' License Class !� I cen ..Wt! Exp. Da 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 r , OWNER-BUILDER D CLARATION ❑ 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,de- Carrier molish,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 pro- Policy Number visions of the Contractors License Law(Chapter 9(commencing with Section 7000) (This section need not be completed if the permit is for one hundred dollars or less) 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 Section 7031.5 I certify that in the performance of the work for which this it is issued,I shall by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become ffject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree th t i sho come subject to the workers'compensation provisions of Secti 00 a abor Code,I shall fort comply 1 with th I, as owner of the property, or my employees with wages as their sole P,y ose p rovisions. I ❑ 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 /n 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,and sale.If,however,the building or improvement is sold within one(1)year of 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 hundred thousand dollars($100,000),in addition to the cost of compensation, 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 who CONSTRUCTION LENDING AGENCY builds or improves thereon,and who contracts for such projects with a contrac- I hereby affirm under penalty of perjury that there is a construction lending agency tor(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 RE- STRICTIONS 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 fur- ther information.t �� Lactiocid Name G. ` t, Title PRINT NAME I certify that I have re th' app• a o and tate that the above information is correct and that I am the owner or duly authorized agent of the owner. I agree to comply w' Cit or • ance and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter up t abo e- tioned roperty for inspection purposes. t R , 1't Signature Date