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HomeMy WebLinkAboutUntitled 7 Development Services Department il*7' 240 West Huntington Drive, Post Office Box 60021 liF �'t` Arcadia, CA 91066-6021 PERMIT NO. B00-053-289 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 4/12/2016 CM 14:15 7/26/2016 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#: 16-159 Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAILING AD Plan#: 32010 S"� Comcore Construction, Inc. m `a PHONE NO. i EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Comcore Construction, Inc. 1613 Chelsea Rd#245 PHONE NO. (626)616-0865 FAX NO. San Marino, CA 91108 EMAIL ADDRESS: License No. 966885 Type: B Expires: 10/31/2017 12:0( TENANT MAILING ADDRESS Matche Bar PHONE NO. FAX NO. DESCRIPTION T.I. MATCHE BAR (LANEWAY PROJECT) Construction Type UOM k of Units Value Construction Type UOM i4 of Units Value Value Value 33,000.00 $33,000.00 EG.+<4 9-2(- e6 / OCCUPANCY: Tenant Improve f TOTAL VALUATION: $33,000.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT each Plan review 383.34 383.34 01-3103 each Energy p/c fee 129.75 129.75 01-3103 PC ADA 57.50 57.50 01-3103 PC Cal Green 38.33 38.33 01-3103 1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 each Bldg permit 589.75 589.75 01-3104 Bldg Issue ADA 58.98 58.98 01-3104 1.00 each T.1.Fire Pkc 255.00 255.00 01-3109 SMIP Corn 9.24 9.24 14-2207 grn bldg std 2.00 2.00 714-2203 1.00 Flat SWMF Auto 6.25 6.25 88-3027 Total Fees: $1,574.49 Balance Due: $0.00 Paid Today: $710.57 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 113747 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 693.08 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 14-2207 9.24 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 714-2203 2.00 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. crs.L........) 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) p- ARC w • , iP\.IFON.y,' ".e �` PERMIT/PLAN REVIEW APPLICATION toe, Development Services Department, 240 West Huntington Drive,Post Office Box 60021 Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173 Y City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION ❑ 1 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 for e an. • feet. 0 I have and will maintain a certificate of consent to self-insure for workers' License Class t3 License No.�, s� if xp. Dated "4 compensation, as provided for by Section 3700 of the Labor Code, for the ...mo► ��/ performance of the work for which this permit is issued. Signature of Contractor f�i►'b'�� 0 I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER DELL RATION 3700 of the Labor Code,for the performance of the work for which this permit 0 I hereby affirm under penalty of perjury that I am exempt from the Contractors is issued.My w kers'compensat n I urance carrier and polic 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, Carrier //�� ,Q demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number �ll�� 066��/ 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 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 ❑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 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 attorney's fees. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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 HI IL DING OFFICIAL FOR A PERM1IIT SUBJECT TO THE ('ONI)l'I'IONS :AND RESTRICTIONS SHIT FORTH ON THIS APPLICATION AND'HIE FOLLOW,INC: 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. 1 Name / !�i ��, ��." '/ Title i . ••INT 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. Signature Date ii r,--'-*--' --IT. ,7 7.°-- -4 0°,-/ I*1 1/--.k\t.- -*,■'/ "''--\7 1 L.. ...,--/!" -\c..- --- : ._ ,A,...,--f `'`,°'.!■■■■,.,.4 i , -,,,,, "�' —r 4 4 1):4, C 4 , d y K7 p p q =to ■ ollo e y °- l 1 r A b m • a .„..,1110) o . V W 0 p n 0 CO CP G7 O. CO o t 0 c o of h ?,\,,\, P II ! 00 < li a H. . S ^� ^ ' ) - ' 4 a a oo ,' A, ►�+•on .: a if li.:: f e' nr� o d O �. '�)f,:i 1 "1-, f r o 4i+L. K i I MI (\:,'T'-1 cil cz 00 4 \ -,1 ,..,,, 0 4 ... H a O 0 r. ,J, r -6. g • Clas D y I 1�'� a °, n oog � Vii ' C o C 601 a. 4 . .. g. .5, gs . , ,, 7, _ . ...3 n 6 5• L 1 4 � � N o 0. _ v 0.. 4 W ox � MO {" P tri d el- twit )... r It lt mwoommom Sao- 053-Z69 NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. 100. Setbacks 210. Under flr./bldg.drain 101. Rough grade 211. Copper plumbing �...,4.�1 a-3-/C A�'I'Ro v-� L 102. Figs.&forms l� To. / s i 212. Rough plumbing 103. Pre slab 213. Rough gas 1 4,' L&8 47/2..c. cv,e I 5 6 1,C o- ' 104. Floor joists 214. Shower pan /A-C-LS / 105. Steel 215. Water heater �-Z2, lC �L ,_... K 106. Grout lift 216. Roof drains ��` n Lr/G� Q 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service , / 109. Roof nailing Z� �& �' l=lD'� I•fQ�s D�ic,y g 220. Final gas 110. Framing - /6 220. Fixtures /0-:-./ 111. 0cc./Area Sept.Wall 221. Final plumbing 9-2/lG -- 112. Sound walls 222. Sewer cap/demo. 113. T-bar'rid 114. Insulation-Fir. Pool Inspections Date Insp. 115. Insulation-Wall 240. Excavation/steel 116. Insulation-Ceil. 41. Rough plumbing 117. Drywall nailing -4.--g g , 242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath --3c.j! 244. P-trap 120. Finish grade 45. Gas line&test 121. Final building 7-2i-Al 0 ' ''' '246. Fence,gates&signs - 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical Inspections Date Insp. 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 71. Roof framing 156. Rough electrical !. 272. Sheathing nailing _ 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. E.•t.bonding Sign Inspections Date I Insp. , 160. Service panel Mill 280. Setback/overhang 161. Final electric 281. Footing 282. Conduit/wiring Mechanical Inspections Date Insp. 283. Disconnect 180. Venting/flue -�284. Final sign 181. Furnace/A.C. 182. Rouch HVAC 7 grit Miscellaneous Insp. Date I 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 ME Sewers&Offsite Insp. I Date I Insp. 191. Final mechanical REIM 300. Lateral(main to P/L) 301. Saddle/Y Block Wall Inspections Date Insp. 302. Cesspool filled _ I 200. Footings 303. Sidewalk 201. Steel/rebar 304. Driveway 202. Grout lift 305. Curb replacement 203. Final wall 306. Trash bin qG Development Services Department 240 West Huntington Drive,Post Office Box 60021 -0,-.. Arcadia, CA 91066-6021 PERMIT NO. City of (626) 574-5416,Fax (626)447-9173 B00-054-811 Arcadia Permit Type: Plumbing (PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 9/20/2016 CM 13:18 9/20/2016 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BIG ASSESSORS PARCEL NO. GEO CODE 400 S Baldwin Ave T-387 OWNER MAILING ADDRESS Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. I I Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAIUNG ADDRESS Plumbing Professionals PHONE NO. EMAIL ADDRESS: 'Ilia --i-- CONTRACTOR/PROFESSIONAL AILIN. A l Plumbing Professionals 938 Huntington Dr P PHONE NO. (626)429-5378 FAX NO. Duarte, CA 91010 EMAIL ADDRESS: License No. 953498 Type: C-36 Expires: 10/31/2016 12:01 TENANT MAILING ADDRESS Matcha Bar PHONE NO. FAX NO. DESCRIPTION PLUMBING FOR MATCHA BAR Construction Type UOM N of Units Value Construction T ype UOM #of Units Value i ` '2/-e /c OCC ANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT I.00 Flat Plmbg Issue A 44.35 44.35 01-3105 5.00 each Kitchen sinks 62.30 62.30 01-3105 2,00 each Floor sink 24.92 24.92 01-3105 I.00 each Floor drain 12.46 12.46 01-3105 1.00 each Wtrhtr/vent 15.55 15.55 01-3105 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $160.58 Balance Due: $0.00 Paid Today: $160.58 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 114308 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 159.58 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 INSPF(''I'ORS'OFFICE IR)t RS 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. (( (us(d on alternate I ridays) U4,Of AC, PERMIT/PLAN REVIEW APPLICATION lMt� ' --r-ro •ill 4”, 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 ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: apter 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 C—3 cense No. /$3 tic g Exp. Date 10-31-i - 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 �� ❑ I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER D CLARATION 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 Carrier Code.Any city or county which requires a permit to construct,alter, improve, demolish,or repair any structure,prior to its issuance,also required the applicant policy Number for such permit to file a signed statement that he or she is licensed pursuant to the is 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 T 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 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/sn 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 q rr__ compensation,will do the work,and the structure is not intended or offered for Date l —2.0-(Y Signature 1 sale(Section 7044,Business and Professions Code:The Contractors License f 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 CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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. (--)r` n _ame J°6J r..7 I/�tl.f' 1-k (Title © i IQ O 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 e e upo the above-mentioned property for inspection purposes. co Signature Date — 0 — f ql Mt\ a Development Services Department �rfry., 240 West Huntington Drive, Post Office Box 60021 .... i Arcadia, CA 91066-6021 PERMIT NO. BOO-054-506 City Of (626) 574-5416,Fax(626)447-9173 Arcadia Permit Type: Electrical PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 8/15/2016 CM 14:49 8/15/2016 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. Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS Genesis Electric / ''^ ".. * PHONE NO. . P g3� 5 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRES'S�8 d Vial i Itia l Genesis Electric 504 N Morris Ave PHONE NO. (626) 893-0730 FAX NO. West Covina, CA 91790 EMAIL ADDRESS: License No. 855127 Type: C-10 Expires: 2/28/2017 12:00: TENANT MAILING ADDRESS Machte Bar PHONE NO. FAX NO. DESCRIPTION MATCHE BAR, 125AMP SUBPANEL 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 Auto 44.35 44.35 01-3105 1.00 each Distnbpanel 15.55 15.55 01-3105 32.00 each Outlets 40.00 40.00 01-3105 3.00 each Ltg fixtures 4.62 4.62 01-3105 100 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $105.52 Balance Due: $0.00 Paid Today: $105.52 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 113951 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 104.52 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 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 tin all emale Fridays) �,4 oFIou,4, PF,RMIT/PLAN REVIEW APPLICATION Os VEEN -11 4 Development Services Department,240 West Huntington Drive,Post Office Box 60021 '�.0 N , °�`� 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.- and is license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class Z.:-Nr4 Be. License No.8 551 1 Z7Exp. Date220 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 Cocto/ OWNER-BUILDER DECLAR TION ❑ 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 •s issued.My o 'cosation i ranee Carrie and policy 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 demolish,or repair any structure,prior to its issuance,also required the applicant polic Number ■-■ k for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be c pleted 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 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 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 attorney's fees. ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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 hti1PORFANT: APPLICATION IS HIsI F1BY NI:AI)1'. TO 1111- Bt'ILDIN(; OFT ICI A1. FOR ;1 PL;RJ'IPF SI BRUT TO 'fill: CONDITIONS AND RI?STRIC I IONS SIT FORTH ON THIS APPI.I('-AlION SAND"UHL I t)LLO\%IN(;: 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. /// barne , P v _. 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 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. \ B / -/ iature t p'''''''''';''Vx Development Services Department 5 alrAlk 240 West Huntington Drive,Post Office Box 60021 1t�' ' Arcadia, CA 91066-6021 PERMIT NO. City of (626) 574-5416,Fax(626)447-9173 B��-054-467 ( ) Arcadia Permit Type:YP Mechanical (PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 8/10/2016 CM 10:56 8/10/2016 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. I I Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS D S Heating&Air Corp, Ina,/ COrtliPIETED PHONE NO. 77 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS D S Heating&Air Corp, Inc. 42215 12th St PHONE NO. (661)310-3747 FAX NO. Lancaster, CA 93534 EMAIL ADDRESS: License No. 918467 Type: C-20 Expires: 7/31/2018 12:00: TENANT MAILING ADDRESS Matchia Bar PHONE NO. FAX NO. DESCRIPTION MATCHIA BAR DUCT WORK Construction Type UOM 8 of Units Value Construction Type UOM 8 of Units Value •VositL / —21—CG OCCUPANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY I)OM DESC AMT AMT PAID ACCT 1.00 Flat Mech Issue Auto 44.35 44,35 01-3105 1.00 Flat Add/Alter Ducts 9.38 9.38 01-3105 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $54.73 Balance Due: $0.00 Paid Today: $54.73 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 113907 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 53.73 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 ',OURS / Requests for inspection should be made at least Monday-Thursday Friday 1 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) inomommumilk i`4 OFFAR,4•44, �, PERMIT/PLAN REVIEW APPLICATION 44`M j 6 Development Services Department, 240 West Huntington Drive,Post Office Box 60021 °0,,n F. N� 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 f fprce and eeffec. - ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class e�Vo 1 `�/ xp. Date 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 0 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 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 Carrier s';r �-�`�— 11 Code.Any city or county which requires a permit to construct,alter,improve, /— demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number t •6 �/ S 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 0 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 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 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 attorney's fees. CI I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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 I\IP(RTAN'I: ;11'l'I.l('.VTION IS HEREBY N1AD1? T'0 THE HI'II.DIN(: OFFICIAL FOR k PERtiIIT SUBJECT TO THE CONDITIONS ,1ND RESTRICTIONS SET FORTH ON T1HS ANNA'VI ION A\D T1111 1:01.1.0‘1 INC,: 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 AA . ice.. Title A6c-41- 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. / Signature -..----rt,,,,t,1 Date r---10`*GA& t Development Services Department 5 240 West Huntington Drive,Post Office Box 60021 1 a " Arcadia, CA 91066-6021 PERMIT NO. B00-054-638 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 8/31/2016 CM 10:19 8/31/2016 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. I Plan Chk#: OTC I Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS Building Electronic Controls Inc. PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAt .. ESE k ; s 4 4 t, e Building Electronic Controls Inc. 22 a t ds‘ aym 4 s ,, 1.„:, PHONE NO. FAX NO. Glendora,CA 91740 EMAIL ADDRESS: License No. 729905 Type: C Expires: 11/30/2016 12:01 TENANT MAILING ADDRESS Matcha Matcha PHONE NO. FAX NO. DESCRIPTION MATCHA MATCHA FIRE ALARM 7 DEVICES Construction Type UOM #of Units Value Construction Type UOM #of Units Value Value Value 5,850.00 $5,850.00 OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $5,850.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 7.00 each fire alarm pc 2 637.50 637.50 01-3109 1.00 Flat Fire Issue Auto 44.35 44.35 01-3112 each Fire Permit 170.45 170.45 01-3112 I.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $853.30 Balance Due: $0.00 Paid Today: $853.30 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 1-3109#: 114100 7.5 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3112 637.50 Y Y P 01-3112 214.80 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. 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~�o�rAR',, ,,, 1 PERMIT/PLAN REVIEW APPLICATION low, Development Services Department, 240 West Huntington Drive,Post Office Box 60021 '0, 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 Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' / �-7 ;foe 1i 13D/1 , compensation, as provided for by Section 3700 of the Labor Code, for the License Class V, License No. ! ii_� Dam performance of the work for which this permit is issued. Signature of Contractor . .A. `ALC-10`•.4 6_ \ 'N 0 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 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 CarrierY�C� Code.Any city or county which requires a permit to construct,alter,improve, demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number w bot kQto\ `se\,A0 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 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 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(I)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 CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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 I\IPOR'I';A NT: .1PPI.ICATION IS HEREBY MADE TO THF. Ill I1.DING OFFIC1.-M1, FOR .-k PERMIT SEBJ1?C'1' 'I'O THE CONDITIONS 1.ND RESTRICTIONS SET FORTH ON THIS APPLICATION:AND'I 1111 FOLI O\\ING: 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 &� __������ Title •111 As A: \ I I:I,_II . — _,i* PRINT NA 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- d property for inspection purposes. I li. Signature I A 1�.�� _\/. . A i..ie Date 0/ ?)k/ l La 4 Ak�.� Development Services Department 5i' 240 West Huntington Drive,Post Office Box 60021 r Arcadia, CA 91066-6021 PERMIT NO. City of B00-054-676 Arcadia (626) 574-5416,Fax(626)447-9173 Permit Type: Fire IPROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 9/7/2016 CM 8:44 9/7/2016 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. I I Los Angeles,CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS Hydro-Matic Fire Protection PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL 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: 6/30/2017 12:00: TENANT MAILING ADDRESS Matcha Bar y r a { 5 PHONE NO FAX NO DESCRIPTION ' _i`tom MATCHA BAR 4 HEADS Construction T - u. --- ----- - YPe UOM #of Units Value Construction Type YP UOM #of Units Value Value Value 1,200.00 $1,200.00 OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $1,200.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 4.00 each sprinkler pck 255.00 255.00 01-3109 1.00 Flat Fire Issue Auto 44.35 44.35 01-3112 each Fire Permit 70.05 70.05 01-3112 I 00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $370.40 Balance Due: $0.00 Paid Today: $370.40 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#: 114150 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-314.40 Y Y p 01-3111 2 2 1 1114.40 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 I NSPEC 1 ORS'01'FR'F 1101 RS 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. ((!used oil) allernate I ri(111 s) U4.OFFA4,44, PERMIT/PLAN REVIEW APPLICATION E4 . Development Services Department, 240 West Huntington Drive,Post Office Box 60021 °a,4n `� Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173 y City of Arcadia ' LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION ❑ I hereby affirm under penalty of perjury that I a .,ensed der provisions of I hereby affirm under penalty of perjury one of the following: Chapter 9(commencing with Section 7000,of Div sion 3 f the Business and rofessions Code,and my license i' i ull f•, ce . d e ct. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class_ C—\C.' Li l s- No A i5 E . Date6- ?-i compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. S•> ature of Contractor 4, Air ❑ I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER DECL, RATION 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 •s issued.My workers'compensation insurance carrier and policy numbers are: License Law for the following reason(Section 7031.5,Business and Professions Carrier �j�' +�tL �1�4� Code.Any city or county which requires a permit to construct,alter, improve, demolish,or repair any structure,prior to its issuance,also required the applicant policy Number ���- for such permit to file a signed statement that he or 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 ❑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 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($100,000),in addition to the cost of compensation, did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044, Business and Professions CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097. Civil Code). ❑ I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS .1ND RESTRICTIONS SET FORTH ON THIS APPLICATION AND'1'HE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(909) 396-2000 for further information. Nme p ie\G y_ ri C/0, 1A$O [it1e CS`-)Wr y"* _ PRINT NAM v I certify that I have read t• s appli..ti,n 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 ' th .11 Ci or' pane, .nd State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter 1 s n e a I. a-m:, do ;s p operty for inspection purposes. Signature • / Cate q—1— \lv '4 OF AR 1• eauA,tyosIto MEMORANDUM Fire Department DATE: September 23, 2016 TO: BUILDING DEPARTMENT INSPECTOR Henry Kemich FROM: FIRE DEPARTMENT SUBJECT: FIELD INSPECTION ADDRESS: 400 S. Baldwin Avenue #2203 (Matcha Bar) THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE DEPARTMENT REQUIREMENTS: TYPE OF INSPECTION DATE / INITIAL FINAL INSPECTION FIRE SPRINKLERS 9-15-2016 Jill Perumean FIRE ALARMS 9-21-2016 Jill Perumean TANKS HOOD & DUCT KNOX BOX OCCUPANCY 9-21-2016 Jill Perumean COMMENTS: Emailed Bldg. Dept. 9-22-2016 Rita b y 1 c i t� i`L- e N, BB PACKAGE ROOFTOP / HEATPUMP / AC . UNIT REPORT PROJECT MO l J3A [ / MA-�{-t,► AA-TGNA*�a LOCATION ©U 4 0U (4 • .` piAJ ,� IV 4 - (� FAN NAME 12—TL)--J SERVICE f'Ac Gj 4- (o ,LOCATION g-VOF ,MANUFACTURER 2.-ekk ox MODEL NUMBER 1-41A112-01-1 c,I E 3t SERIAL NUMBER 6,01 A-10 2.1 t 1 CFM DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL TOTAL FAN ?>(p10 041 RETURN AIR 2 S 2 --V.711 OUTSIDE AIR -7(9O ., 2b5 :: STATIC PRESSURES DISCHARGE ,fi SUCTION ,61, ESP I.2.- _ L.01 FAN MOTOR MANUFACTURER t7O HORSEPOWER 2-0 — VOLTAGE eo,0 42 971477 AMPERAGE � Z 3•(2 3.C9 V4 PHASE -3 SPEED(RPM) L1 Z- I J 7 2$ SERVICE FACTOR _ .1 � DRIVE L� MOTOR SHEAVE SIZE I UL,L(0'` x 7(S %CLOSED 7Q 4, J FAN SHEAVE SIZE ?`'ate r [N _ FAN,RPM 14 s I _ BELTSIZE/#OF CENTER LINE, NOTES: Scanned by CamScanner w.., 0 y.- y Ne BB rye INOUT y, REPORT y PROJECT MO/■,1 -Y ( A C- MA-1-641A NtkTGt-k.A NO AREA � I �� !, !NO. KIND I SIZE AK DESIGN I PRELIM I FINAL I REMARKS 12-1U-1 I 1 , i 1'tT]14C-7 l� E#- 1 1 �_ _1._7'" ' /-U . G,7S L ; GJ�S" -_2 ! — 57S I �9 a ; _ _ 1 3 1 1 t i ' 4 i ; 1 t�1 . : '' 1 Gil 1 5D0 I yip I 442 1 11}« ; ®r, ; 75 - -- ; i I j- 13b00 ' ., g 4 i s — v ! 'u i - Z — I I D"-ie) S I � ' 1. i(op '_ iJO — A` . u-. _;© ! 60 ! 16 256'0 J I I _ ' . I 0, 1 1 v� ; 3e x .3 x.75 ?red : 17bS ; --- - I .—i I - 1 I I t I 1 I I 1 I I -I ;- I I I I , T I I l i I I I 1 i -r I I I i j ! I i I ■ , I I REMARKS DATE READINGS BY Scanned by CamScanner PLAN CHECK OFFICIAL INSPECTION REPORT DATE 09/22/2016 EHS I JESS BARRIOS PLAN CHECK NUMBER SR0066984 PROGRAM ELEMENT 1772-EXPEDITED- RESTAURANT(501-1999 SF) OWNER I REQUESTER ANJU DUD,ARCHITET DBA MATCHA BAR ADDRESS 400 S BALDWIN AVE 222, LOS ANGELES,CA 91007 ADDITIONAL REQUIREMENTS FACILITY IS APPROVED TO OPERATE CONTINGENT UPON THE FOLLOWING: 1)PERMANENT REMOTE STORAGE FACILITY IS COMPLETED BY OCTOBER 21,2016. 2)PROVIDE AN APPROVED FINISH ON THE EMPLOYEE SIDE OF THE EXPOSITION COUNTER BY SEPTEMBER 30, 2016. COMMENTS FACILITY IS APPROVED TO OPERATE. Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.aov/eh. EHS Signature Page 2 of 3 PLAN CHECK OFFICIAL INSPECTION REPORT DATE 09/22/2016 EHS I JESS BARRIOS PLAN CHECK NUMBER SR0066984 PROGRAM ELEMENT 1772-EXPEDITED- RESTAURANT(501-1999 SF) OWNER/REQUESTER ANJU DUD,ARCHITET DBA MATCHA BAR ADDRESS 400 S BALDWIN AVE 222, LOS ANGELES, CA 91007 DISCLOSURES It is a misdemeanor violation to begin operation without a valid Public Health Permit/License.The Public Health Permit/License will be issued by the Los Angeles County Department of Public Health Environmental Health Division(DPH-EH) Plan Check Program at the job site following final inspection and approval by all applicable agencies. Remodeled areas of an existing food facility/establishment must obtain a final inspection and approval from all applicable enforcement agencies prior to use. Any future alteration,construction,building,renovation,repair,change of equipment,change of the operation of a food facility/establishment or change of menu may require plans to be submitted to the DPH-EH Plan Check Program. Additional approvals may be required from other enforcement agencies. It is improper and illegal for any County officer,employee or inspector to solicit bribes,gifts or gratuities in connection with performing their official duties. Improper solicitations include requests for anything of value such as cash,discounts,free services,paid travel or entertainment,or tangible items such as food or beverages. Any attempt by a County employee to solicit bribes,gifts or gratuities for any reason should be reported immediately to either the County manager responsible for supervising the employee or the Fraud Hotline at(800)544-6861 or www.lacountyfraud.org. YOU MAY REMAIN ANONYMOUS Public Health Permit/License: A separate fee is required for the Public Health Permit/License.A billing statement will be sent to the permit/license holder annually by the DPH-EH. The fee is required to be paid to perform or carry on,conduct or engage in any mobile food facility listed in Los Angeles County Code,Title 8,Section 8.04.720. State and Local Licenses and Permits: Contact the State of California and your local city hall regarding additional license and permit requirements. Restrooms: Customer may use restroom facilities if they are located in a customer area.Customers may not enter the food preparation area,food storage area,or the utensils washing/storage areas in order to access the restrooms.All food,utensils and equipment must be protected from contamination. Routine Inspection:The DPH-EH conducts routine inspections of all food facilities in Los Angeles County. Following the issuance of your Public Health Permit by the Plan Check Program,an Environmental Health Specialist from your local district will conduct an inspection of your facility. If your Business is located in a city that has adopted the grading ordinance,the inspector will post a grade or score card at your facility. Grade/Score cards are not issued by the Plan Check Program. Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.00v/eh. EHS Signature Page 3 of 3 1 or tor COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH t { ENVIRONMENTAL HEALTH + ' BUREAU OF SPECIALIZED SURVEILLANCE AND ENFORCEMENT ��'' �+ f PLAN CHECK PROGRAM-BALDWIN PARK � X c 5050 COMMERCE DR,BALDWIN COMM 0i LOSMral'WfOt<N�� , N PARK,CA 91706 Public Health PHONE:(626)430-5560 VWVW.PUBLICHEALTH.LA000NTY.GOV/EH PLAN CHECK OFFICIAL INSPECTION REPORT DATE 09/22/2016 EHS I JESS BARRIOS PLAN CHECK NUMBER SR0066984 PROGRAM ELEMENT 1772-EXPEDITED- RESTAURANT(501-1999 SF) OWNER/REQUESTER ANJU DUD,ARCHITET DBA MATCHA BAR ADDRESS 400 S BALDWIN AVE 222, LOS ANGELES, CA 91007 FINAL REINSPECTION STATUS: APPROVED rt?SN y CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED WALLS 09/14/2016 09/21/2016 CEILINGS 09/14/2016 09/21/2016 WAREWASHING FACILITIES 09/14/2016 09/21/2016 FOOD PREPARATION SINKS 09/14/2016 09/21/2016 HANDWASHING FACILITIES 09/14/2016 09/21/2016 JANITORIAL FACILITIES 09/14/2016 09/21/2016 WATER SUPPLY 09/14/2016 09/21/2016 EQUIPMENT/STORAGE 09/14/2016 09/21/2016 VERMIN EXCLUSION/ENCLOSURE 09/14/2016 09/21/2016 PLAN SUBMITTAUREMODEL 09/14/2016 09/21/2016 PLAN SUBMITTAUREMODEL 09/21/2016 09/22/2016 SCOPE OF OPERATION APPROVED TO STOCK PREPACKAGED/NON-POTENTIALLY HAZARDOUS FOODS APPROVED TO STOCK PERISHABLE/POTENTIALLY HAZARDOUS FOODS APPROVED FOR FOOD PREPARATION-LIMITED FOOD PREPARATION APPROVED TO USE MULTISERVICE UTENSILS Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.aov/eh. EHS Signature Page 1 of 3