HomeMy WebLinkAboutUntitled �'` Development Services Department
k�� , 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. B0O-056-088
''� j Arcadia,CA 91066-6021 .
City of (626) 574-5416,Fax(626)447-9173 Permit Type: Tenant Improve w/energ:
Arcadia
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
2/16/2017 EP 15:24 4/21/2017 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#: 17-42
APPLICANT MAILING ADDRESS Plan#: 32240
Anokia, Inc. PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
626 NO.
Anokia, Inc. 1217 Buena Vista St#102B PHONE ( )222-0621 FAX NO.
Duarte,CA 91010 EMAIL ADDRESS:
License No. 983891 Type: B Expires: 5/31/2017 12:00:
TENANT MAILING ADDRESS
Sichuan Kungfu Fish PHONE NO. FAX NO.
DESCRIPTION
T.1 SICHUAN.KUNGFU FISH
Construction Type UOM #of Units Value Construction Type UOM 1114711
Value
Value Value 300,000.00 $300,000.00 t'riii i�
OCCUPANCY: Tenant Improve TOTAL VALUATION: $300,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 1,692.60 1,692.60 01-3103 1.00 Flat SWMF 2 1.00 1.00 88-3027
each . Energy p/c fee 520.80 520.80 01-3103 1.00 Flat SWMF 2 1.00 1.00 88-3027
PC ADA 253.89 253.89 01-3103
PC Cal Green 169.26 169.26 01-3103
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 2,604.00 2,604.00 01-3104
Bldg Issue ADA 260.40 260.40 01-3104
1.00 flat Elec issue 44.35 44.35 01-3105
1.00 Flat Pltnbg issuance 44.35 44.35 01-3105
1.00 each Kitchen sinks 12.46 12.46 01-3105
100.00 each Ltg fixtures 110.80 110.80 01-3105
4.00 outlets Gas piping 15.55 15.55 01-3105
45.00 each 220-240v outlet 280.35 280.35 01-3105
1.00 each T.I.Fire Pkc 280.00 280.00 01-3109 •
SMIP Corn 84.00 84.00 14-2207
grn bldg std 12.00 12.00 714-2203
1.00 Flat SWMF Auto 6.25 6.25 88-3027
Total Fees: $6,437.41 Balance Due: $0.00 Paid Today: $3,520.86
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the 'ecetp :: .4
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3104 2,908.75
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3105 507.86
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 14-2207 84.00
Arcadia building inspector for a period of 180 consecutive days. 714-2203 12.00
88-3027 8.25
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday !C\`�
one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m.
by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m.
(Closed on alternate Fridays)
I
1,
PERMIT/PLAN REVIEW APPLICATION
Eli, Development Services Department,240 West Huntington Drive,Post Office Box 60021
° Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
)4
I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
ll
i !Chapter 9(commencing with Section 7000,of Division 3 of the Business and
1 Professions Code,and my license is in full force and effect. [] I have and will maintain a certificate of consent to self-insure for workers'
Q compensation, asprovided for bySection 3700 of the Labor Code, for the
• License Class License No. �$ i1 c Exp. Date f P
Signature of Contractor
\�/,�`r performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION I have and will maintain workers'compensation insurance,as required by Section
I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, ; i Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant I 'Polic Number
for such permit to file a signed statement that he or she is licensed pursuant to the , ' j y
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 d
exempt there from and the basis for the alleged exemption. Any violation of iI 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 r I '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 w'h 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 `L ( ,�
sale(Section 7044,Business and Professions Code:The Contractors License wl Datefri Signature V v
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 ofand 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).
ID 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. P �.
a N1 & & -'JE Title ( ?Ari-ecl.C �✓
I
PRINT N CJ
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.
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.
t\. _._.
Signature Date +1.2A/ .,,
EL
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under ft./bldg.drain -
101. Rough grade 211. Copper underslab ///
102. Figs.&forms 212. Rough plumbing 2-17/1171-7,
103. Pre-slab 213. Rough gas
104. Floor joists 214. Shower pan
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailingA/220.
19. Final gas
110. Framing f !7Fixtures
111. Occ./Area Sept.Wall 221. Final plumbing '7-1(-(7M'J�
112. Sound walls 222. Sewer cap/demo. �J
113. T-bar.rid
114. Insulation-Flr. Pool Inspections Date . Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Ceil. is .. 41. Rough plumbing
117. Drywall nailing 5.-5-1 7 242. Light shell/bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade45. Gas line&test
121. Final building ariy-/701,1i2246. 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 I Date Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground '// 71. Roof framing
156. Rough electrical Y -(7���444333 fh _4 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E..t.bondin. Sign Inspections Date I Insp.
160. Service panel /280. Setback/overhang
161. Final electric 7--11-‘7 *..75 281. Footing
6 282. Conduit/wirin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC 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
190. Duct shaft Sewers&Offsite Insp. I Date Insp.
191. Final mechanical 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Gess•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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4,711 City of Arcadia141
eveli Development Services Department - Building Division D
Aftri
Ns
/bell " This certificate issued pursuant to the requirements of Section 109 of the �£'i .
Uniform Building Code certifying that at the time of issuance this structure was in
�y+ compliance with the various ordinances of the City regulating building construction or use.
A'1^ I' p ,
4
4,,
Permit NO. B00-056-088
�.g,„
• � Building Address: 400 S Baldwin Ave,Arcadia,CA 91007
, r4 t
I Use Classification: Tenant Improve Effective UBC:
� Y
A P 2016 C.B.C. •'1- I) ',"'
s� Permit Type: Tenant Improve w/energy Zone Code: C-2,DH8 ' y
I Occupancy Code: A-2
Type of Construction: � -
•
��ti � yp TYPE V B SPRINI{LERED �� �-.
-dab, - �� .
fi�--� Q Final Date: 8/14/2017 �-
��Cl Owner: Westfield Corporation, Inc.
CI Tenant: Sichuan Kung Fish .' Y.
iStocdiflgOL
L'O'fs.fill '. r7-DINAL m,,,=,..xe. _ ;1 15i.:44
/il l �. ,�
POST IN A CONSPICUOUS PLACE 4 It t .','
LI q , ''': VA—
,0 Vo -',.., pi I 0, ,,,.,...,T,.t e,.i
Y � t_ ® � off ,,ISP - � �= _� -41
• ` .cif , r t i iP' �t iso ��� eft. tib: -� rk,%- ( -t 32141111,141111'� ..1t__i _ f �t t� ft,,
a a . S 1 - `"k I �e`s - 'I�� a�� - ili fi� - - 7 - _ � i .
CA INSPECTION SERVICES Welding•Bolting•Concrete•
661 312-9347 Masonry•Wood Nailing.
Epoxy Anchors
email: info@cainspectioninc.com
31625 Cherry Dr
Castaic, CA 91384 Field Daily Report
Project# Job Name: Shum Residence
Job Address:60 W Birchcroft St,Arcadia, CA
Report Date: 4-19-2017
Inspector: Chris Abbatoye Client:Owner
License# 8181895/P002118 Exp Date:6-2019 Contractor: HT Construction
License Required for Inspection:Concrete/Drilled Anchors Contact at Site:Tri Huynh
City/County License: # ICC 8181895/LA City P002118 Permit: # Jurisdiction: Arcadia
1300- 05g- 309
Safety Meeting Held: 0 Yes 0 No Offsite Location:
Type of Work: [■ Reinforced Concrete 0 Prestressed Concrete 0 Masonry Q Steel/Welding 0 Fireproofing Q Soil
Description of Work:
Observed the installation of approx. 55 pcs#4 rebar dowels with 6" embedment. Verified hole size,
embedment, holes brushed and blown clean and free from debris prior to installation with Simpson Set
XP epoxy per details 3/SD2, 7/SD2 and LARR#25744. Work occurred at foundation level at new slab to
existing slab/footings on grid B-D/1-2.5.
DATE TASK# REGULAR O.T. TIME IN TIME OUT
4-19 4 12:00 4:00
Chris Abbatoye
Inspector Name: Signature:
Approved by: Signature: _
e(�tzazre)
,ffelzik Development Services Department
1PIA 4 240 West Huntington Drive,Post Office Box 60021
Arcadia, CA 91066-6021 PERMIT NO. B00-057-388
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
7/17/2017 CM 15:42 7/19/2017 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#: 17-232
Los Angeles, CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
United Fire&Safety Co. PHONE NO.
EMAIL ADDRESS:
CONTRACTORIPROFESSIONAL MAILING ADDRESS
909 NO.
United Fire& Safety Co. 12305 Doherty Street PHONE (909)279-8208 FAX NO.
Riverside, CA 92506 EMAIL ADDRESS:
License No. 621096 Type: C16 Expires: 6/30/2019 12:00:
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
FIRE SUPPRESSION FOR HOOD.KUNGFU FUSH 1 DEVICES
Construction Type UOM #of Units Value Construction Type UOM #of Units Value
Value Value 2,000.00 $2,000.00
OCCUPANCY: Fire Sprink/AIm TOTAL VALUATION: $2,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
1.00 each fire alarm pc 2 280.00 280.00 01-3109
1.00 Flat Fire Issue Auto 44.35 44.35 01-3112
each Fire Permit 103.65 103.65 01-3112
1.00 each SWMF 2 Auto 1.00 1.00 88-3027 •
f.3 $^- ' r-�n.
m
Eil
Total Fees: $429.00 Balance Due: $0.00 Paid Today: $149.00
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 117412
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 148.00
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
4
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)
v�4�FFo vi,es,
_ 117 PERMIT/PLAN REVIEW APPLICATION
o 0j`, Development Services Department, 240 West Huntington Drive,Post Office Box 60021
�...yaw Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED 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 in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class C (o License N 1 09 (a Exp. Date/ I 30I i9 compensation, as provided for by Section 3700 of the Labor Code, for the
�/ performance of the work for which this permit is issued.
Signature of Contractor
OWNER-BUILDER DECLARATION 0 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, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number 0 N 1 1— L'
for such permit to file a signed statement that he or she is licensed pursuant to the
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 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 ' 1 CI_1'7
sale(Section 7044,Business and Professions Code:The Contractors License Date 1 1 r 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.equi ,s • asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909) 396-2000 for
further inform. or/
Name �� -Ar /9/ Z /" C2r.
�� ' Title PSA MN- N.1 "=--._
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 th• . •ove-mention• •rope • for inspection purposes.
Signature / Date
lAgu ,19O
AuN.t 5.190]
424nityoi MEMORANDUM
Fire Department
DATE: August 2, 2017
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemich
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 400 S. Baldwin Avenue #2360 (Kungfu Fish)
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS
FIRE ALARMS
TANKS
HOOD & DUCT 7-19-2017 Jill Perumean
KNOX BOX
OCCUPANCY 8-1-2017 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 8-1-2017 Rita
` , Development Services Department
�� 1
240 West Huntington Drive,Post Office Box 60021 PERMIT NO.
Arcadia,t'A 91066-6021
BOO-057-503
City of (626)574-5416,Fax(626)447-9173
ArcadiaPermit Type: Sign
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
8/1/2017 CM 15:05 8/1/2017 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.
Los Angeles,CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Anokia, Inc. PHONE NO.
EMAIL ADDRESS:
r
CONTRACTORIPROFESSIONAL MAILING ADDRESS
626 NO.
Anokia, Inc. 1217 Buena Vista St#102B PHONE (626)222-0621 FAX NO.
Duarte,CA 91010 EMAIL ADDRESS:
License No. 983891 Type: B Expires: 5/31/2019 12:00:
TENANT MAILING ADDRESS
Sichuan Kungfu Fish PHONE NO. FAX NO.
DESCRIPTION
ILLUMINATED REVERSE CHANNEL LETTER SIGN FOR KUNGFU FISH
Construction Type UOM N of Units Value Construction Type UOM 8 of Units Value
Value Value 4,000.00 $4,000.00
PFI
ER
151 �PYI.Ti9r
OCCUPANCY: Sign TOTAL VALUATION: $4,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
Sign plan rev 76.75 76.75 01-3103
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 137.05 137.05 01-3104
1.00 flat Elec issue 44.35 44.35 01-3105 r.7‘ `n ppp{ °
1.00 branch cin Signs elec 59,17 59.17 01-3105R2 jj ocrAlimil ,..irol
ir .+ W e
1.00 each Sign Connection 15.55 15.55 01-3105 4r_ .:,
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: $379.22 Balance Due: $0.00 Paid Today: $379.22
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 11/515
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 76.75
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3104 181.40
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 m
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)
of AR
U~� Rvy9 r
11116111111.'LA! 7 PERMIT/PLAN REVIEW APPLICATION
04 .*,ems ?NA
00j, 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 License No.TD3/S1 (, Exp. Date k t <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
OWNER-BUILDER DECLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.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 gI 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 p r
sale(Section 7044,Business and Professions Code:The Contractors License Date 61 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 M C,—k*t l QTitle C
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 Date S 7-1 1