HomeMy WebLinkAboutT.I. 2016 d.t.4y Development Services Department
240 West Huntington Drive, Post Office Box 60021
j Arcadia, CA 91066-6021 PERMIT NO. B00-051-640
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
10/8/2015 CM 8:20 1/15/2016 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#: 15-652
APPLICANT MAILING.ADDRESS
J.A. Stowell Construction
PHONE NO. Plan#: 31819
5
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
J.A. Stowell Construction 1565 Scenic Ave Ste A PHONE NO. (949)631-8809 FAX NO.
Costa Mesa, CA 92626 EMAIL ADDRESS:
License No. 669873 Type: B Expires: 5/31/2017 12:00:
TENANT MAILING ADDRESS
Solstice PHONE NO. FAX NO.
DESCRIPTION
r.��� ' L
Ti FOR SOLSTICE
Construction Type UOM if of Units Value Construction Type UOM #of Units Value
Value Value 135,000.00 $135,000.00
OCCUPANCY: Tenant Improve TOTAL VALUATION: $135,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 952.58 952.58 01-3103 i _
each Energy p/c fee 322.41 322.41 01-3103 J..-Z(—IC t-,44061.1,44. C 1.1 yeJ 1e1-` / /'
PC ADA 142.89 142.89 01-3103
PC Cal Green 95.26 95.26 01-3103 l—Zi'—'L+'r / :odi4- --
1.00 Flat Bldg Issue Auto 44,35 44.35 01-3104 fi
each Bldg permit 1,465.50 1,465.50 01-3104
Bldg Issue ADA 146.55 146.55 01-3104
1.00 each T.1.Fire Pkc 245.00 245.00 01-3109
SMIP Corn 37.80 37.80 14-2207
gm bldg std 6.00 6.00 714-2203
1.00 Flat SWMF Auto 6.25 6.25 88-3027
Total Fees: $3,464.59 Balance Due: $0.00 Paid Today: $1,706.45
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 111620
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 1,656.40
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 14-2207 37.80
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 714-2203 6.00
Arcadia building inspector for a period of 180 consecutive days. 88-3027 6.25
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.
.1)\‘')/
(Closed on alternate Fridays)
, of AR
1 n�tIFORN/
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PERMIT/PLAN REVIEW APPLICATION
oJs.5t..r
\e Development Services Department,240 West Huntington Drive,Post Office Box 60021
Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
4iLICENSED 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 my license is in full/oorcp ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class f_ License No. `L✓_y/E . Date J compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
Signature o 'kor
7 UI► !
OWNER R E RATION % I have and will maintain workers'compensation insurance,as required by Section
0 I hereby affirm under p alty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for ich this permit
is issued.My w• ers'comp:,, .tion insuranFrrier and po4 y numbers are:
License Law for the following reason(Section 7031.5,Business and Professions s
Code.Any city or county which requires a permit to construct,alter,improve, Carrier S /y'G„
demolish,or repair any structure,prior to its issuance,also required the applicant if it ` ---- (C
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number J
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 V'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
0 I, as owner of the property, or my employees with wages as their sol forthwith co ply 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 nded or
0
o % (� 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 ow
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).
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 AM)
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.
ce i/ v `a 2 Title ___( bil- "; , —7Cr��"
•'INT NAME
tify 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.
ree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
dia to enter upon the above-mentioned property for inspection purposes.
ature
7j,
Date /
Development Services Department
5 240 West Huntington Drive, Post Office Box 60021
Arcadia, CA 91066-6021 PERMIT NO B00-052 569
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
1/19/2016 CM 16:06 1/21/2016 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#: 16-24
Los Angeles,CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Allready Fire Sprinkler Co PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
Allready Fire Sprinkler Co 818 N Grand Ave PHONE NO. (626)913-6720 FAX NO.
Covina,CA 91723 EMAIL ADDRESS:
License No. 358795 Type: C16 B Expires: 7/31/2017 12:00:
TENANT MAILING ADDRESS
Soltice PHONE NO. FAX NO.
f
DESCRIPTION
•
SPRINKS FOR SOLTICE
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
Value Value 750.00 $750.00
OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $750.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
3.00 each sprinkler pck 255.00 255.00 01-3109
1.00 Flat Fire Issue Auto 44.35 44.35 01-3112
each Fire Permit 53.25 53.25 01-3112
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $353.60 Balance Due: $0.00 Paid Today: $353.60
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 111711
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 255.00
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3112 97.60
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 88-3027 1.00
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 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. 1\
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)
PERMIT/PLAN REVIEW APPLICATION
i
„4;*, Development Services Department,240 West Huntington Drive,Post Office Box 60021
'°m.o,,,004. ° 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 Co ,a Amy license is in full f •.. e.ect. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class! —Lic :e Ne /O x Date7�����• compensation, as provided for by Section 3700 of the Labor Code, for the
p performance of the work for which this permit is issued.
Signature of Contractor • *t:—..441wirg
OWNER-BUILDE'-0 C , RATION 4 ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under pe ty of perjury that I a -xempt 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
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 ■ 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
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 /J, j-�
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,
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.
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 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 me E Mill. � ..i Title r /_LJ
PRINT AME
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.
Signature Date / C9)---)J
i Development Services Department
5 240 West Huntington Drive, Post Office Box 60021
Arcadia, CA 91066-6021 PERMIT NO. B00-052-572
City of (626) 574-5416, Fax(626)447-9173
Arcadia Permit Type: EMP Combo
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
1/19/2016 CM 11:31 1/19/2016 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.
Los Angeles,CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Justin Beedy PHONE NO.
tiA
IL ADDRESS:
CONTRACTOR/PROFESSIONAL ' MAILING ADDRESS (Justin Beedy 21022 Hampton�ay 111 LEI PHONE NO. (714)235-8602 FAX NO.
Lake Forest,CA 92630 EMAIL ADDRESS:
License No. 933562 Type: C10 Expires: 6/30/2017 12:00:
TENANT MAILING ADDRESS
Solstice PHONE NO. FAX NO.
DESCRIPTION
EMP FOR TI
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
OCCUPANCY: TOTAL VALUATION: $0.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
1.00 flat Elec issue 44.35 44.35 01-3105
10.00 each Ltg fixtures 15.40 15.40 01-3105
1.00 Flat SWMF 2 1.00 1.00 88-3027
1-2q— (C /,v44.
f
Total Fees: $60.75 Balance Due: $0.00 Paid Today: $60.75
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 111649
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3105 59.75
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
Arcadia building inspector for a period of 180 consecutive days.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
cl
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)
U~4.OFF A.Re rY
POP
PERMIT/PLAN REVIEW APPLICATION
fib*. Development Services Department, 240 West Huntington Drive, Post Office Box 60021
°„,m�e„Y oft4° Arcadia, CA 91066-6021, (626) 574-5416, Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
CI 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 ,^10 Li en q/- No."f 3•�G Exp. Date�3G-17 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-BUILDE' i ECLARATION El I have and will maintain workers'compensation insurance,as required by Section
El 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 W e-SGO
demolish,or repair any structure,prior to its issuance,also required the applicant Z Y�
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number wtn)G 1
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 ❑ 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
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,
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).
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
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. {�,,
Name 4'J S t✓� 6eee r, Title (DLv t.e_r
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 •e ab i ve-mentio •d property for inspection purposes.
Signature iir.s.all —
Date /6
u/44 ,. Development Services Department
j 240 West Huntington Drive,Post Office Box 60021
'` . Arcadia, CA 91066-6021 t PERMIT NO B00_052_463
City of (626) 574-5416,Fax(626)447-9173
Arcadia Permit Type: Sign
g
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
1/5/2016 CM 12:03 1/5/2016 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.
Los Angeles,CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Pacific Coast Signs&Graphics PHONE NO.
tgaRen IL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING A DDRESS r-Pacific Coast Signs&Graphics 24656 Monita Gr PHONE NO. (949)295-0259 FAX NO.
Laguna Niguel, CA 92677 EMAIL ADDRESS:
License No. 993036 Type: C-45 Expires: 5/31/2016 12:00:
TENANT MAILING ADDRESS
Solstice PHONE NO. FAX NO.
DESCRIPTION
ONE ILLUMINATED LED CHANNEL LETTER SIGN,ONE NON ILLUMINATED SIGN FOR SOLSTICE
Construction Type UOM N of Units Value Construction Type UOM N of Units Value
Value Value 3,000.00 $3,000.00
08,,W-------.„,
GSA /-25- ff
OCCUPANCY: Sign TOTA ALUATION: $3,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
Sign plan rev 67.40 67.40 01-3103
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 120.35 120.35 01-3104
1.00 flat Elec issue 44.35 44.35 01-3105
1.00 branch cin Signs elec 59.17 59.17 01-3105
1.00 each Sign Connection 15.55 15.55 01-3105
1.00 Flat SWMF 2 1.00 1.00 88-3027
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $353.17 Balance Due: $0.00 Paid Today: $353.17
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the 'tempt ar: 11 15LU
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3103 67.40
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3104 164.70
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 01-3105 119.07
Arcadia building inspector for a period of 180 consecutive days. 88-3027 2.00
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)
pF ARC
91
1GPl1FORN/,9 1' PERMIT/PLAN REVIEW APPLICATION
mm31 -41
f Development Services Department,240 West Huntington Drive, Post Office Box 60021
,,°� 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'
License Class L" l Lic No 9 16' Exp. Date 5",31-1‘ 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 LA ION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under pen ty 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
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 ❑ 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 .hould become subject to the
workers'compensation provisions of Section 11 of the •• 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 0 6— 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 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 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.
Name re-AJJ IL LAA17 .2 tJ J2-1 Title T'-'S'y-A Lt._ /L
PRINT NAME
I certify that I have read th' pplication . I 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 ity ordi•• • es and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon above-me • ned property for inspection purposes.
Signature Date 1-d���
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 1 of 4) SLTG-1C
Project Name:
SeLSD Date: I- 05 - 1
Project Address: 1F�
Location of Sign ❑Outdoor Signs ❑Indoor Signs
Phase of Sign Construction ❑New Signs ❑Sign Alterations
Type of Lighting Control ❑New Lighting Controls ❑Replaced Lighting Controls ❑Not Installing Lighting Controls
This Certificate of Compliance includes the following components(check all that apply)
❑ Mandatory Measures(Lighting Controls) ❑ Maximum Allowed Lighting Power Z5rSpecific Lighting Sources
1. Certificate of Compliance Declaration Statement(this may be a C 10,C45 or other eligible person)
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and
correct.
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the lighting design.
• This Certificate of Compliance identifies the lighting features and performance specifications required for compliance with
Title 24, Parts 1 and 6 of the California Code of Regulations.
• The design features represented on this Certificate of Compliance are consistent with the information provided to document
this design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the
enforcement agency for approval with this building permit applicatio
Name: j Signature
I'I Atv,4 LA AJDt1Z ti(ZI
Company: Phone
{�nc►Fic CoAS-- Stc,N5 (309- alb -a7L-P-1
Address: License number(may be contractor's lie#)
ra y 6 S( Moo rrAi C Le" "3 3
City/State/Zip: Date
LA GovA- 4Wige A (-)uP 1 - CAS-1 Co
2. Installation Certificate (to be signed by responsible person after installation)
Permit number Chocked by/Date
(Eafprcement Amoy Use)
(Enforcement Agency Use)
Installation Declaration statement
• I certify under penalty of perjury,under the laws of the State of California,the information provided on this form is true and
correct.
• I am eligible under Division 3 of the Business and Professions Code to accept responsibility for construction,or an authorized
representative of the person responsible for construction.
• I certify that the installed features,materials,components,or manufactured devices identified on this certificate conforms to all
applicable codes and regulations,and the installation is consistent with the plans and specifications approved by the
enforcement agency.
• I certify that the requirements detailed on this Certificate of Compliance have been met.
• I will ensure that a completed,signed copy of this Installation Certificate shall be posted,or made available with the building
permit(s)issued for the building,and made available to the enforcement agency for all applicable inspections. I understand
that a signed copy of this Installation Certificate is required to be included with the documentation the builder provides to the
building owner at occupancy.
Com any Name:
A`1-Pc- Coi s,— _S-19,/ 04
Responsible Person's Name: Responsible Person's Signature:
FRA-N1K. LAkineAz o
License number(may be contractor's lie#) Date Signed: Position With Company:
2008 Nonresidential Compliance Forms October 2010
F '�
f
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING 1
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 2 of 4) SLTG-1C
Project Name: Date:
3. Mandatory Sign Lighting Controls
NOTES:
1. The same responsible person may install both the sign lighting power and the sign lighting controls, or a different responsible
person may install the sign lighting controls than the responsible person installing the sign lighting power.
2. The Mandatory Measures (sign lighting controls) are required.for compliance with the sign lighting Standards. If the person
responsible for installing the sign lighting power is not also responsible for the sign lighting controls, then the owner of the
sign,general contractor, or architect shall he responsible to have the sign lighting controls installed.
3. If more than one person has responsibility for compliance, each responsible person shall prepare and sign a Certificate of
Compliance and an Installation Certificate applicable to the portion of construction for which they are responsible;
alternatively, the person with chief responsibility for construction shall prepare and sign the Certificate of Compliance
Declaration Statement for the entire construction.
3a. Statements of Responsibility: Any person signing the Certificate of Compliance Declaration Statement on page 1 of
4 on this SLTG-1C shall complete Part 3a. Check Yes or No for all of the following statements:
1 I have responsibility for installing the sign lighting controls
❑ Yes,complete parts 3a and 3b of this form VI-No,complete part 3a of this form
2 There are no existing sign lighting controls and I will be installing compliant sign lighting controls
_ ❑ Yes No
3 Th re are no existing sign lighting controls and someone else will be responsible to install compliant sign lighting controls
xtr Yes ❑ No
There are existing sign lighting controls that do not comply with the applicable provision of§1I9 and §I33 and I will be
4 installing compliant sign lighting controls
❑ Yes 1'E'No
There are existing sign lighting controls that do not comply with the applicable provision of§119 and§133 and someone else
5 will be responsible to install compliant sign lighting controls
❑ Yes o
3b. Mandatory Sign Lighting Controls
If the person signing the Certificate of Compliance Declaration Statement on page 1 of 4 of this SLTG-1 C is responsible for
complying with the sign lighting control requirements,that person shall answer all of the following questions:
if there are construction documents,indicate where on the building plans the
mandatory measures(sign lighting control)note block can be located:
1 §133(a)1.All indoor sign lighting is controlled with an automatic time switch control that complies with the Y N NA
applicable requirements of§119. X' ❑ ❑
§133(a)1 and 2. All outdoor sign lighting is controlled with an automatic time switch control plus a photo Y N NA
2 control,or an outdoor astronomical time switch,that comply with the applicable requirements of§119. ❑ ❑
Exception to§133(a)2. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑ �•
§133(a)3. All outdoor signs are controlled with a dimmer that provides the ability to automatically reduce Y N NA
sign power by a minimum of 65 percent during nighttime hours. ❑ ❑ >'
Exception 1 to§133(a)3. Signs illuminated for less than one hour per day during daylight hours. 1' NA
3 ❑
Exception 2 to§133(a)3. Outdoor signs in tunnels or large covered areas that require illumination during Y NA
daylight hours. ❑
Exception 3 to§133(a)3. Only metal halide, high pressure sodium, cold cathode,or neon lamps used for Y A
illuminating signs or parts of signs. ❑
§133(a)4. An Electronic Message Center(EMC)having a new connected lighting power load greater than N NI
15 kW has a control installed capable of reducing the lighting power by a minimum of 30 percent when ❑ ❑ j
4 receiving a demand response signal that is sent out by the local utility.
Exception to§133(a)4.EMC required by a health or life safety statue,ordinance,or regulation, including Y Ntj
but not limited to exit signs and traffic signs. ❑ j
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010
f x
STATE OF CALIFORNIA
CERTIFICATE OF COMPLIANCE, SIGN LIGHTING
CEC-SLTG-1C(Revised 10/10) CALIFORNIA ENERGY COMMISSION
Certificate of Compliance (Sign Lighting) (Page 4 of 4) SLTG-1C
Project Name: Date:
5. Specific Lighting Source Method of Compliance
Certificate of Compliance and Field Inspection Energy Checklist
Complete this part if there are signs using the Specific lighting source method of compliance. (Complete part 4 of this
Certificate of Compliance if there are signs using the maximum allowed lighting power method of compliance)
A B C D E
OPTIONAL Field
ENERGY Specific light source used for
Symbol VERIFIED compliance Inspector
or Description Check that
P label Shall include only lighting Sign
Code (see instructions technologies listed below
below) Complies
lo List all that apply
LP L( t!v4/4./.21T t h
CPANNEt
❑ D
❑ 0
❑
0
❑
0
❑
0
A Symbol or code used on the plans(when plans are required)and other documents.
B A narrative description of the sign,or location of sign on the building;and the location of sign on construction documents
C OPTIONAL-Check this box only if this sign has a permanent,pre-printed,factory-installed ENERGY VERIFIED label,confirming that
this sign complies with the Section 148 of the California 2008 Title 24,Part 6 Standards,using the Specific Lighting Source Method of
Compliance. The only labels that will be recognized for this purpose are ENERGY VERIFIED Certification Marks authorized by
Underwriters Laboratories(UL)or other Product Certification Body accredited to ISO/IEC Guide 65 by the American National Standards
Institute in accordance with ISO/1EC 17011. Surveillance by the Accredited Certification Body shall be an ongoing annual inspection
program carried out by a Type A Inspection body in accordance with ISO/IEC 17020. For signs with such an ENERGY VERIFIED label,
column`D'is not required to be filled out.Note:Using an ENERGY VERIFIED label is an optional method to validate compliance.An
ENERGY VERIFIED label is not needed for compliance.
Specific Light Source Compliance Method. The sign(s)identified above use only the following lighting technologies:
List all applicable numbers(1 through 10)that apply in column D above for each row.
I High pressure sodium lamps
2 Pulse start or ceramic metal halide lamps served by a ballast with >88%efficiency
3 Pulse start metal halide lamps that are<320 watts,are not 250 watt or 175 watt lamps,and are served by a ballast
with>80%efficiency
4 Neon or cold cathode lamps with transformer or power supply efficiency> 75%with rated output current<50 mA
5 Neon or cold cathode lamps with transformer or power supply efficiency>68%with rated output current>50 mA
Fluorescent lamps with a minimum color rendering index(CRI)of 80
6 (Note:when using electronic ballasts for compliance,lamps with a CRI<80 may be used)
7 Light emitting diodes(LEDs)with a power supply with> 80%efficiency
Single voltage LED external power supplies designed to convert 120 volt AC input into lower voltage DC or AC
8 output,having a nameplate output power less than or equal to 250 watts,and certified to the Energy Commission as
complying with the applicable requirements of the Appliance Efficiency Regulations(Title 20)
9 Compact fluorescent lamps that do not contain a medium screw base sockets(E24/E26)
10 Electronic ballasts with a fundamental output frequency>20 kHz
E This page doubles as a field inspection checklist.
Field Inspector Notes:
2008 Nonresidential Compliance Forms October 2010