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HomeMy WebLinkAboutB00-047-601 0 Development Services Department 25 40 West Huntington Drive,Post Office Box 60021 PERMIT NO. i Arcadia,CA 91066-6021 BOO-047-601 City of (626)574-5416,Fax(626)447-9173 Arcadia Permit Type: Tenant Improve w/energ; PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 8/5/2014 CM 15:19 10/10/2014 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE 400 S Baldwin Ave C-4 T-387 OWNER MAILING ADDRESS Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Plan Chk#: 14-465 Los Angeles,CA 90025- EMAIL ADDRESS: Plan#: 31391 APPLICANT MAILING ADDRESS 365 Construction(Mickey) PHONE NO. (626)393-7772 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS 365 Construction 847 Meridian Street PHONE NO. (626) 599-2002 FAX NO. Duarte,CA 91010 EMAIL ADDRESS: License No. 646056 Type: B Expires: 4/1/2016 12:00:0 TENANT MAILING ADDRESS L'Occitane En Provence PHONE NO. FAX NO. DESCRIPTION TENANT IMPROVEMENT**PERMIT INCLUDES EMP** Construction Type UOM U of Units Value Construction Type UOM N of Units Value Value Value 207,000,00 $207,000.00 c►N4_ /I- 2-6-.b14 4 OCCUPANCY: Tenant Improve TOTAL VALUATION: $207,000.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT each Plan review 1,275.50 1,275.50 01-3103 1.00 each T.I.Fire Pkc 235.00 235.00 01-3109 each Energy p/c fee 431.71 431.71 01-3103 SMIP Corn 43.47 43.47 14-2207 PC ADA 191.32 191.32 01-3103 grn bldg std 9,00 9.00 714-2203 PC Cal Green 127.55 127.55 01-3103 1.00 Flat SWMF Auto 6.25 6.25 88-3027 1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027 each Bldg permit 1,962.30 1,962.30 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027 Bldg Issue ADA 196.23 196.23 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027 1.00 flat Elec issue 44.35 44.35 01-3105 1.00 Flat Mech issue 44.35 44.35 01-3105 1.00 ' Flat Plmbg issuance 44.35 44.35 01-3105 1.00 each Fum<I00,000btu 18.74 18.74 01-3105 1.00 each Water Closet 12.46 12.46 01-3105 1.00 each Lavatories 12.46 12.46 01-3105 1.00 each Fan-vent single 9.38 9.38 01-3105 1.00 each Comp 3 hp 18.74 18.74 01-3105 29.00 each Outlets 37.00 37.00 01-3105 31.00 each Ltg fixtures 39.00 39.00 01-3105 Total Fees: $4,806.51 Balance Due: $0.00 Paid Today: $2,545.43 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 106667 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3104 2,202.88 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3105 280.83 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Ar- 14-2207 43.47 cadia building inspector for a period of 180 consecutive days. 714-2203 9.00 CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS 88-3027 9.25 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) 5 A A; 1 PERMIT/PLAN REVIEW APPLICATION • e }s• Development Services Department,240 West Huntington Drive,Post Office Box 60021 ,. `a 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. a I have and will maintain a certificate of consent to self-insure for workers' License Class 49 License No ,`y`✓9 Exp. Date*IVO, 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 ❑ 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.M:workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve,de- Carrier . veItALV /vhf7iP 4y 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 fi"'pre_ �7/0, 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 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'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). ❑ 1 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 /17.G/tcc / ! Mi. Title �9 f � -tai rim PRINT NAM 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-me toned property for inspection purposes. Signatu - i<L:,- Date / /'`71 .NO OPERATION NO OPERATION NOTES .Building Inspections Date Insp. Plumbing Inspections Date Insp. 100. Setbacks 210. Under fir/bldg.drain kri 101. Rou.h grade 211. Cogger underslab 102. Figs.&forms 212. Rough plumbing 103. Pre-slab 213. Rough gas 104. Floor joists - 214. Shower pan 105. Steel 215. Water heater 106. Grout lift 216. Roof drains 107. Shear nailing 217. Building sewer f 108. Diaph nailing 218. Water service 109. Roof nailing' 219. Final gas 110. Framing IQ-{L{.-fl.L 220. Fixtures 111. 0cc/Area Sep.Wall 221. Final plumbing - 112. Sound walls 222. Sewer cap/demo. 113. T-bar.rid 114. Insulation-flr. Pool Ins sections Date insp. 115. insulation-Wall 240. Excavation/steel 116. Insulation-Ceil. 241. Rough plumbing 117. Drywall nailing k'-kilt 1/ 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 //21j, 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical fns.ections Date I Ins . 249. Final Plumbing 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final _ 152. Underground conduit. 1 153. Underslab conduit -RerootInspections Date Insp. 154. UFER ground 270. Pre-reroof insp. - `- 155. Water ground 271. Roof framing 156. Rough electrical ,11A1 ,d 272. Sheathin. nailin. 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. Eqpt.bonding Sign Inspections Date I Insp. 160. Service sane! 280. Setback/overhana 161. Final electric WM. 281. Footing J 282. Conduit/wirin. Mechanical Inspections I Date Insp. 283. Disconnect 180. Venting/flue 284. Final sign _ 1� 181. Furnace/A.C. 182. Rauch HVAC 3M11,21. Miscellaneous Insp. Date I Insp. ;I 183. Fire dampers 290. Fire alarm V. 184. Furnace compartment 291. Underground supply l�,,K.--185. Combustion air 292. Fire sprinklers 1 186. 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 .Sewers&OffsiteInsp. . Date Insp. 191. Final mechanical .." (?� 300. Lateral(main to P/L) _� 301. Saddle/Y Block Wall Inspections Date • insp. 302. Cesspool filled 200. Footings 303. Sidewalk - 201. Steebrebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin __7 -- gyp\ / ', f 1: ��% `� .Lt� � - _�'��� ^ / 1 ;*;';)\, y c *-!,>\ f\1�, N x ti Q ' "� UOw �/ �' r cn Iv 1' 4 ❑ 'I nC^ •.;i L7 { U .?r C l • - Q v _ , ... -,-_:( b V 7 O U O G .�P J u 1� � W N F z a, ai w N} n a, ..., = g ° A p cn tl n E O 0 01 O Y , n U V pi w + °i. `` : , 'C 1r to .� v ~ g p i El O • ++ fn 'Q ! a+ " 3•My a,) a> U Q d c ` I p cu`= b, 3 p ■ " as ?8 o a V ,' . g pO G 10 (5 - 4. - r-A oa r 1 4 F" F-S 'd J r �;f.� O tE •V . Ilt IA ❑ u u y O cnQ !:)11.,,;;T"."'` J , I I I Hr? ' a '�°j Development Services Department s 240 West Huntington Drive,Post Office Box 60021 * Arcadia,CA 91066-6021 PERMIT NO. City of (626)574-5416,Fax(626)447-9173 B00-047-86� Arcadia ( ) Permit Type: Fire PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 9/9/2014 CM 9:25 9/16/2014 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. Plan Chk#: 14-517 Los Angeles,CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS B.E.C., Inc. 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 L'Occitane En Provence PHONE NO. FAX NO. DESCRIPTION FIRE ALARMS FOR L'OCCITANE EN PROVENCE Construction Type UOM COlPETED UOM #of Units Value Value Value .4/1 OCCUPANCY: Fire Sprink/AIm TOTAL VALUATION: $3,830.00 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 Balance Due: $0.00 Paid Today: $769.90 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#: 106351 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- 88-3127 181.40 cadia building inspector for a period of 180 consecutive days. 88-3027 1.00 CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS Requests for inspection should be made at least t 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) to- Gny,,,,4, e II PERMIT/PLAN REVIEW APPLICATION oil L4. r—io Development Services Department,240 West Huntington Drive,Post Office Box 60021 �' Y0`+ Arcadia,CA 91066-6021,(626)574-5416,Fax(626)447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION 1 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' License Class CA© License No agl'oS Exp. Date 3/ '�.5 compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ignature of Contractor OWNER-BUILDER DECLARATION I 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 qU[i C jeN— >ve)4('CO,v k .74-LX.\L$' molish,or repair any structure,prior to its issuance,also required the applicant for Policy Number V v GC4 o \`.--\ \\k '-Z such permit to file a signed statement that he or she is licensed pursuant to the pro- (This section need not be completed if the permit is for one hundred dollars or less) visions 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 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 DateC /\ sale(Section 7044,Business and Professions Code:The Contractors License ' .-0 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 G: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 1, 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. ` r� N e `(Nckc>_L T�`0\ Title L Lief-(�i (' PRINT t ME 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. 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. i :ice Si ature -I. _',, &• �� �ii►. Date c1 / \LD / \• \- Development Services Department S 240 West Huntington Drive,Post Office Box 60021 rs,;. Arcadia,CA 91066-6021 PERMIT NO. BOO-047-784 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 8/29/2014 CM 10:12 9/15/2014 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. Plan Chk#: 14-498 Los Angeles,CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS Allready Fire Sprinkler Compny PHONE NO. 5 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Allready Fire Sprinkler Co. 818 N Grand Av PHONE NO. (626)913-6720 FAX NO. Covina, CA 91723 EMAIL ADDRESS: License No. 358795 Type: C16 Expires: 7/31/2015 12:00: TENANT MAILING ADDRESS L'Occitane PHONE NO. FAX NO. DESCRIPTION SPRINKS FOR L'OCCITANE Construction Type UOM 8 of Units Value Construction Type UOM 8 of Units Value Value Value 1,300.00 $1,300.00 COMpitEO OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $1,300.00 QTY (IOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 13.00 each sprinklerpck 587,50 587.50 01-3109 1.00 Flat Fire Issue Auto 44.35 44.35 01-3112 each Fire Permit 74.25 74.25 01-3112 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $707.10 Balance Due: $0.00 Paid Today: $119.60 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 106335 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3112 118.60 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Ar- 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) %FA.; Wpo�1 IY. PERMIT/PLAN REVIEW APPLICATION W' 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 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 Cod a my license is in f nd e c. D I have and will maintain a certificate of consent to self-insure for workers' License Class L-1 License No. n-/5 xp. Date(I ) compensation, as provided for by Section 3700 of the Labor Code, for the J performance of the work for which this permit is issued. Signature of Contractor OWNER-BUILDER DECLARATION U I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the perfo ance of the work for which this permit ❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors is issued.My won compen ation r urance carrier and policy numbers are: License Law for the following reason(Section 7031.5,Business and Profession ,!( (� Code.Any city or county which requires a permit to construct,alter,improve,de- Carrier J molish,or repair any structure,prior to its issuance,also required the applicant for Policy Number 1 I such permit to file a signed statement that he or she is licensed pursuant to the pro- 4 'CC Y� 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 [11 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 S: ion 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 Sign.' "�3��►�.��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. ❑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.) y�-� Name(.1 ILI 1'EY(es Title 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 comp) with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter ,on the above:mentioned property for inspection purposes. foam 91)5)/i Signa�u-rt". frwr _r,aw.�-_ Date IF r i G