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HomeMy WebLinkAboutB00-041-443 Develo ,���°�, pment Services Department Ilie 240 West Huntington Drive,Post Office Box 60 21 - Arcadia,CA 91066-6021 - PERMIT NO. BOO-041-443 City of Arcadia (626)574-5416,Fax(626)447-9173 Permit Type: Tenant Improve (PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 10/9/2012 CM 15:10 10/10/2012 Issued ADDRESS No. Dir.Prfi: Street Name Street Suffix Project J ASSESSORS PARCEL NO. CEO CODE 400 S Baldwin Ave T-387 OWNER MAILING ADDRESS Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Los Angeles, CA 90025- EMAIL ADDRESS: II1SpeCtOr#: CRIS APPLICANT MAILING ADDRESS Plan Chk#: Liza Regis-Tecson Plan#: IN FILE PHONE NO. (626)429-7749 School Dist#: EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Owner PHONE NO. FAX NO. EMAIL ADDRESS: License No. Type: Expires: TENANT MAILING ADDRESS White Owl PHONE NO. FAX NO. DESCRIPTION T.I. Construction Type UOM #of Units Value Construction Type UOM N of Units Value Value � I COMLETED2'°°°°° l 2.-2.‘-/S ti/ OCCUPANCY: Tenant Improve TOTAL VALUATION: $2,000.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT I Flat Bldg Issue Auto 44.35 44.35 01-3104 , ,.—i 3—I Z each Bldg permit 103.65 103.65 01-3104 µtkiC 0 w V 1 each T.I.Fire Pkc 225.00 225.00 01-3109 ls� p SMIP Corn 0.50 0.50 14-2207 f/yv�`_ ©.d x I I—7--v /�., (/�r- ' grm bldg std 1.00 1.00 714-2203 /+ I Flat SWMF Auto 6.25 6.25 88-3027 Total Fees: $380.75 Total Amount Paid: $380.75 Paid Today: $380.75 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 98907 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 01-3104 225.00 this permit is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by 14-2207 0.50 . a City of Arcadia building inspector for a period of 180 consecutive days. 7814-2203 1.00 CALLS FOR INSPECTION 88-3027 6.25 Requests for inspection should be made at least Monday-Thursday INSPECTORS'OFFICE HOURS 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) I 4 •Aproiti.. • . ■ PERMIT/PLAN REVIEW APPLICATION 04 , ''. , 44 ° Development Services Department,240 West Huntington Drive, Post Office Box 60021 t °vi,y "°m 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. ❑ I have and will maintain a certificate of consent to self-insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the License Class License No. Exp.Date performance of the work for which this permit is issued. Signature of Contractor ❑ I have and will maintain workers' compensation insurance,as required by Section OWNER-BUILDER DECLARATION 3700 of the Labor Code,for the performance of the work for which this permit is ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors issued. My workers'compensation insurance carrier and policy number are: License Law for the following reason(Section 7031.5,Business and Professions Carrier Code: Any city or county which requires a permit to construct, alter, improve, demolish,or repair any structure,prior to its issuance,also requires 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 ❑ 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 not 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 compensation laws of California,and agree that if I should become subject to the penalty of not more than five hundred dollars($500)): workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ❑ I, as owner of the property, or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for Date Signature sale(Section 7044,Business and Professions Code:The Contractors License 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 attorneys 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 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. N jertify me L 1 Z0". Re o ., S — t t✓C�or) Title 0 W � PRINT NAME I that I have read this application and state that the above information is correct and that I am the owner or the duly authorized agent of the o ner, I agree to comply with all City ordinances and State laws relating to building construction. I hereby authorize representatives of the City of rcadia to enter upon the above-mentioned property for inspection purposes. Si nature—�;__ � ` ' ...,A Date 1 0 / fl I 4 ifa;;;,„ :01 City of Arcadia • Building Division 240 West Huntington Drive,Arcadia CA 91007 Office: (626) 574-5416 Fax: (626) 447-9173 When the permit application and the Owner-Builder Declaration have been executed by a person other than the property owner, prior to issuing the permit, the following shall be completed by the property owner and returned to the agency responsible for issuing the permit: AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder Permit for my project. I declare under penalty of perjury that I am the property owner for the address listed above, and I personally filled out the above information and certify its accuracy. Property Owner's Signature: Date: WIG"I Z Property Address: 400 S. Baidwiiv AUem,u,e_,Sui-i-e 1007_U , Arcudta.,C A of ooq Owner's Name: 1_f Re -Tec3on Owner's Address: 12$ I\1. ( L2.)K (h n��-Za4 b 11 Aye/W.12 t �' Sind111 a` � Ca pI Phone # lc 24, - 318 - 4 5I-q- Agent's Name: A -EX Agent's Address: 12S N . OAK KNOLL AVE , Uk1T 204 C ono 1 Agent's Phone #: 2.(o — 42q - 7747 Scope of Work: GONTC +GTOCZ To - UILC� \(JHL7EUY�tL STORE NOTE: This authorization must be NOTARIZED or accompanied by a copy of the homeowner's current photo I.D. (i.e., driver's license, passport or military I.D. with signature), when presented for issuance of a permit.