HomeMy WebLinkAboutUntitled r4` i Development Services Department
240 West Huntington Drive,Post Office Box 60024
..� Arcadia,CA 91066-6021 PERMIT NO. BOO-055-863
City of (626) 574-5416,Fax(626)447-9173
ArcadiaPermit Type: Tenant Improve w/energ
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
1/19/2017 CM 16:11 2/23/2017 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#: HENRY
Los Angeles,CA 90025- EMAIL ADDRESS:
Plan Chk#: 17-08
APPLICANT MAILING ADDRESS - - -'•
Gary Kanda PHONE NO. Plan#: 32194
j •
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL _ ' M LVA:.RES �11ejI LET
PHONE NO. (310)213-8183 FAX NO.
Gary Kanda 815 : ewe D
Rosemead,CA 91770 EMAIL ADDRESS:
License No. 480827 Type: B Expires: 10/31/2017 12:0(
TENANT- - - MAILING`ADDRESS ""
Marion Crepes PHONE NO. FAX NO.
T.I FOR MARION CREPES WITH EMP
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
Value Value 77,500.00 $77,500.00
i;444e-- 41/ /, -17
OCCUPANCY: Tenant Improve TOTAL VALUATION: $77,500.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 676.20 676.20 01-3103 1.00 each T.I.Fire Pkc 255.00 255.00 01-3109
each Energy p/c fee 208.06 208.06 01-3103 SMIP Corn 21.70 21.70 14-2207
PC ADA 101.43 101.43 01-3103 gm bldg std 4.00 4.00 714-2203
PC Cal Green 67.62 67.62 01-3103 1.00 Flat SWMF Auto 6.25 6.25 88-3027
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027
each Bldg permit 1,040.30 1,040.30 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027
Bldg Issue ADA 104.03 104.03 01-3104 1.00 Flat SWMF 2 1.00 1.00 88-3027
1.00 flat Elec issue 44.35 44.35 01-3105
1.00 Flat Mech issue 44.35 44.35 01-3105
1.00 Flat Plmbg issuance 44.35 44.35 01-3105
1.00 each Hood 14.11 14.11 01-3105
5.00 each Kitchen sinks 62.30 62.30 01-3105
5.00 each Floor sink 62.30 62.30 01-3105
2.00 each Floor drain 24.92 24.92 01-3105
25.00 each Outlets 35.80 35.80 01-3105
17.00 each Ltg fixtures 26.18 26.18 01-3105
2.00 Fixtures Plmbg fixture 24.92 24.92 01-3105
Total Fees: $2,915.52 Balance Due: $0.00 Paid Today: $1,607.21
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 115900
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 1,188.68
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01=3105 .383.58
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 14-2207 21.70
Arcadia building inspector for a period of 180 consecutive days. 714-2203 4.00
88-3027 if 9.25
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday I
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)
OV ARC
> 1 h"? PERMIT/PLAN REVIEW APPLICATION
o\ /�
Development Services Department,240 West Huntington Drive,Post Office Box 60021
...,„.ca 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,my license is in full force and effect. J ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class Lice e No II/' '`�S i xp. Date 1Of;]11— 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 RATION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty : .erjury 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 N.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 3701 of the Labor Code,I shall
LI 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 7.3 1,-- Signature
Law does not apply to an owner of property who builds or improves thereon, 66
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.
(lame LV 1 S k 1 bi- - Title tE-5VI 141 Vg..-.
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 al City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the bo e-mentioned property for inspection purposes.
Signature Date 2 (2-3/I
mcsc5 - c) s - 73-6
Y cs c' 5f4 c.o for/../
Pi ' C/2.67'65 -
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under fir./bldg.drain -25s-/ �'
101. Rough grade 211. Copper underslab OL)6 8- 616 3 14�4
102. Figs.&forms 212. Rough plumbing
103. Pre-slab 3-2- 1? `4P' / 213. Rough gas
104. Floor joists 214. Shower pan
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailing 19. Final gas
110. Framing 2-Zgr-6? 220. Fixtures
111. Occ./Area Sept.Wall 221. Final plumbing 3-F7-(7 ,
112. Sound walls 222. Sewer cap/demo.
113. T-bar grid
114. Insulation-Flr. Pool Inspections Date . Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Ceil. 241. Rough plumbing
117. Drywall nailing 242. Light shell/bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade245. Gas line&test
121. Final building y/c� ��246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date - Insp. 249. Final•lumbin•
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Under•round conduit
153. Underslab conduit Reroof Inspections Date I Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Roof framing
156. Rough electrical Z-27-47 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E•it.bondin• Sign Inspections I Date I Insp.
160. Service panel , 80. Setback/overhang
161. Final electric 3x-29-67 21, 281. Footing
282. Conduit/wiring
Mechanical Inspections Date Insp. ' 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC ear 47 ;,i `'Miscellaneous Insp. I 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 17
190. Duct shaft Sewers&Offsite Insp. I Date I Insp.
191. Final mechanical -2$"a Arr- i 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Cess•ool filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
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® Development Services Department Building Division
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: v, ', .. _ __._ _-°__ _ ._: .. :'° .. Thiscertificate►ssud," rsuantto'ahe:re uit'ements°of.Setion_1 :
.. : „ _. P Q..,, 09 of the • • ��
,..-.:,,. ",,,y.::-.:2.,.,..,'-_--,,:..1.?:.:., `UniformoBuildtng_Code certifying thatat the`tiiiie o1 ssuance thistriictuie was-in • • • • •"i,i
• '= • compliance witti;the various ordinances of the City re Mafia buildin :construction or-:use:r' ,•fv�'m
® • Permit NQ B00 055 :863
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ii *' Bwldmg Address 400 S Baldwin Ave,Aradl ,CAL 91007:.:
rr
! - ▪ Use Classification :. -, Effective:UBC.. ..,, I �\
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Permit_. e
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w� Occupancy Code ,
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k :cio 3P TYPE II 1HR ��
d - Final Date: 4/15/20,.17 -
k owner Westfield Co oration Inc:: lilt.• .m I
� � Tenant '' ;n�
( • Mar-ion Crepes
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Don Stocicham, mldmg Official
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' '' Development Services Department
a F12411 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. BOO-056-391
5S Arcadia,CA 91066-6021
City of (626)574-5416,Fax(626)447-9173
ArcadiaPermit Type: Fire
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
3/29/2017 EP 14:47 4/5/2017 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#: 17-86
Los Angeles,CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Building Electronic Controls Inc. LETED PHONE NO.
C EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
Building Electronic Controls Inc. 2246 Lindsay Way PHONE NO. FAX NO.
Glendora,CA 91740 EMAIL ADDRESS:
License No. 729905 Type: C Expires: 11/30/2018 12:01
TENANT MAILING ADDRESS
Marion Crepes PHONE NO. FAX NO. •
DESCRIPTION
FIRE DEVICES FOR MARION CREPES 7 DEVICES
Construction Type UOM 8 of Units Value Construction Type UOM Hof Units Value
Value Value 6,800.00 $6,800.00
OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $6,800.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
7.00 each fire alarm pc 2 700.00 700.00 01-3109
1.00 Flat Fire Issue Auto 44.35 44.35 01-3112'
each Fire Permit 187.15 187.15 01-3112
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $932.50 Balance Due: $0.00 Paid Today: $232.50
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 116275
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3112 231.50
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 on alternate Fridays)
A Of ARO
•
�' PERMIT/PLAN REVIEW APPLICATION
• • 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
In 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 CVO License No. it q t)S Exp. Date)I I ftI , compensation, as provided for by Section 3700 of the Labor Code, for the
71 p performance of the work for which this permit is issued.
Signature of Contractor � �` I `— \ c�,��
r\
OWNER-BUILDER DECLARATIONI have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'ry�� compensation insurance carrier and policy rnumbers ar�1(
Code.Any city or county which requires a permit to construct,alter,improve, Carrier• C1r l�� \ \ f""
demolish,or repair any structure,prior to its issuance,also required the applicant 2 S, r f�.q( (�j, �
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number V V Ci
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
❑I, as owner of the roe forthwith comply with those provisions.
property,rty, or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for Date /�//� v
G, \ i
sale(Section 7044,Business and Professions Code:The Contractors LicenseIP
h Signature ��,_�li�
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 lC1—Ck
NT 1/V�c/ Title C � qJ7 n` d 5CPIC - C i
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 abov•- enti' -:, property for inspection purposes. `
Signature \ r1�/ ` ` Date ✓/ `1
�� oft,9dr
..,,csk-A,
i�����:: -SIM
Aury.t 5.1993
��aityof 16P MEMORANDUM
Fire Department
DATE: April 21, 2017
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemich
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 400S. Baldwin Avenue, FC7 (Marion Crepes)
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS
FIRE ALARMS 4-7-2017 Jill Perumean
TANKS
HOOD & DUCT
KNOX BOX
OCCUPANCY 4-13-2017 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 4-13-2017 Rita
o Development Services Department
,;�..
240 West Huntington Drive,Post Office Box 60021 PERMIT NO. B00-055-897
�� Arcadia, CA 91066-6021
City of (626) 574-5416,Fax(626)447-9173
ArcadiaPermit Type: Tenant Improve w/energ;
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
1/24/2017 CM 12:39 1/24/2017 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#: HENRY
Los Angeles,CA 90025- EMAIL ADDRESS:
Plan Chk#: IN FILE
APPLICANT
"''DR -- - - -
Gary Kanda tainaTE0
PHONE NO.
EMAIL ADDRESS:
CONTRACTORIPROFESSIONAL MAILING ADDRESS
Gary Kanda 8151 Blewett St PHONE NO. (310)213-8183 FAX NO.
Rosemead, CA 91770 EMAIL ADDRESS:
License No. 480827 Type: B Expires: 10/31/2017 12:01
TENANT MAILING ADDRESS
Marion Crepes PHONE NO. FAX NO.
DESCRIPTION
INTERIOR DEMO FOR MARION CREPES
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
Value Value 10,000.00 $10,000.00
F/,* 4 t-
OCCUPANCY: Tenant Improve TOTAL VALUATION: $10,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 154.21 154.21 01-3103
each Energy p/c fee 47.45 47.45 01-3103
PC ADA 23.13 23.13 01-3103
PC Cal Green 15.42 15.42 01-3103
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 237.25 237.25 01-3104 ,
Bldg Issue ADA 23.73 23.73 01-3104
SMIP Com 2.80 2.80 14-2207
gm bldg std 1.00 1.00 714-2203
1.00 Flat SWMF Auto 6.25 6.25 88-3027
Total Fees: $555.59 Balance Due: $0.00 Paid Today: $555.59
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 115618
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 240.21
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3104 305.33
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 14-2207 2.80
Arcadia building inspector for a period of 180 consecutive days. 714-2203 1.00
88-302 'Or6.25
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.
(Closed on alternate Fridays)
U%4�FF RN,44.6
PERMIT/PLAN REVIEW APPLICATION
It IIEREMI -4.41 .
o '. Development Services Department,240 West Huntington Drive,Post Office Box 60021
X03.„,,Yofw' 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:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Code,and my license is it full force and effect. / ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class ilf
Lic s o. 48Q€L 11'Exp. 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
OWNER-BUILDER i LARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, arrier
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 olicy 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 �d1 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 3 01 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith co ply w'th 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 l Late Z� �� SignatureII
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.
L /1 s - �o{�� Title tt—S LA a j 1, Art f�-�-c•A:•JT r
(Name
PRINT NAME COow L
tirtAL
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 C'ty ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the . i ve-mentioned property for inspection purposes.
11
41,1Signature mate o z-'4f111.--
ti�aF"Losq^# COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH
2 �c
rc `st ENVIRONMENTAL HEALTH
t}f,� �•,,,��I;l{� BUREAU OF SPECIALIZED SURVEILLANCE AND ENFORCEMENT
PLAN CHECK PROGRAM-BALDWIN PARK
k „� J COUNTY OF LOS ANGELES
`�
5050 COMMERCE DR, BALDWIN PARK,CA 91706 Public Health
PHONE: (626)430-5560
WW W.PUBLICH EALTH.LA000NTY.GOV/EH
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 04/14/2017 EHS VERNY GRAJEDA
PLAN CHECK NUMBER SR0094070
PROGRAM ELEMENT 1702-RESTAURANT(501-1,999 SF)
OWNER I REQUESTER LUIS ALONSO TORRES/SHINJI TANABE,(626)548-9855
DBA MARION CREPES
ADDRESS 400 S BALDWIN BLVD STE FC7,ARCADIA, CA 91007
FINAL INSPECTION STATUS: APPROVED
THE APPROVAL'S CONTINGENTUPON CORRECTI N G THE FO LLOWING
CORRECTION CATEGORY: EQUIPMENT/STORAGE IDENTIFIED: 03/29/2017
CORRECTIVE ACTION:
*ALL REFRIGERATION UNITS MUST BE ON AND MUST HAVE AN AMBIENT TEMPERATURE AT 41°F AND BELOW.
CALIFORNIA RETAIL FOOD CODE:Equipment and utensils shall be designed and constructed to be durable and to retain their characteristic qualities
under normal use conditions. All new and replacement food-related and utensil-related equipment shall be certified or classified for sanitation by an
American National Standards Institute(ANSI)accredited certification program. Section#:114130, 114157, 114169, 114172,114175, 113996, 114244
CORRECTION CATEGORY: PLAN SUBMITTAUREMODEL IDENTIFIED: 03/29/2017
CORRECTIVE ACTION:
*PROVIDE THE LOCAL BUILDING AND SAFETY FINAL SIGN OFF.
* PROVIDE THE GREASE TRAP ENCLOSURE AS NOTED ON THE APPROVED PLAN.
CALIFORNIA RETAIL FOOD CODE:A person proposing to build or remodel a food facility shall submit complete,easily readable plans drawn to scale,and
specifications to the enforcement agency for review,and shall receive plan approval before starting any new construction or remodeling of any facility for use
as a retail food facility. Section#:114380, 114381
SCOPE OF OPERATION,
APPROVED TO STOCK PREPACKAGED/NON-POTENTIALLY HAZARDOUS FOODS
ADDITIONAL REQUIREMENTS
1. FACILITY APPROVED.WILL BE OPEN AFTER PROOF OF BUILDING FINAL IS PROVIDED.
Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacounty.gov/eh.
EHS Signature Page 1 of 3
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 04/14/2017 EHS VERNY GRAJEDA
PLAN CHECK NUMBER SR0094070
PROGRAM ELEMENT 1702-RESTAURANT(501-1,999 SF)
OWNER/REQUESTER LUIS ALONSO TORRES/SHINJI TANABE, (626)548-9855
DBA MARION CREPES
ADDRESS 400 S BALDWIN BLVD STE FC7,ARCADIA, 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.lacounty.gov/eh.
EHS Signature Page 3 of 3
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 04/14/2017 EHS VERNY GRAJEDA
PLAN CHECK NUMBER SR0094070
PROGRAM ELEMENT 1702-RESTAURANT(501-1,999 SF)
OWNER/REQUESTER LUIS ALONSO TORRES/SHINJI TANABE,(626)548-9855
DBA MARION CREPES
ADDRESS 400 S BALDWIN BLVD STE FC7,ARCADIA, CA 91007
COMMENTS
E-MAIL BUILDING FINAL TO VERNY GRAJEDA
Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacounty.gov/eh.
EHS Signature Page 2 of 3
kkalt____
Gary. aryda
III__
; . .
miiiiimi & A s s o c ia t e s
_ ___
: 8151 Blewett St. Rosemead CA 91770 c/310-213-8183 -
Consent between Contractor and Designer.
Contractor Gary Kanda 4 Associates, Design and Build # 480827
c/a-Gary Kanda -
contact@garvkanda.com'
c.310.213,8183
,Rosemead, CA:91770 .
8151131e�rett Street
-:Designer: . Luis :.
Luis Alonso Torres: .
10610 South Gramercy Place
Los Angeles, CA 90047 : .
DateC 1/16/2015
DD�( ?s...sti
1n •I F- 1. \ PP have agreed and give full consent to Luis
Aionso Torres of to take care of the following,
. 1: Zoning Info . _ 4. Pull any required permits _
2 Plan Check+Counter Review 5.: Cashier-any necessary payments
3: Plan Submittal+Pick-Up: : 6: Miscelieneou3. Engineer
I have provided the required information necessary for any money transactions and for any other
business that needs to take.place on our behalf..
. trOr
•
p, Date: •1/16/2015. Initials:
Gar :Kanda ..
il
, Date 09:2314 Initials G
Luis " o o Torres