HomeMy WebLinkAboutUntitled (2) t1I:.
s., Development Services Department
` 240 WestHngton Drive,Post Offce Box 60021PERMIT NO. BOO-050-841
Arcadia, CA 9f066-6021
066-6021
City of (626) 574-5416,Fax(626)447-9173
Arcadia Permit Type: Comm Add/Alt
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
7/16/2015 CM 16:18 9/25/2015 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
400 S Baldwin Ave T-387
OWNER MAILING ADDRESS
Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Inspector#: CHRS
Los Angeles,CA 90025- EMAIL ADDRESS:
Plan Chk#: 15-452
APPLICANT MAILING ADDRESS
PHONE NO. Plan#: W/31529
Comcore Construction
�'�' ,1EDMAIL ADDRESS:
(�>q (p, ,C..
CONTRACTOR/PROFESSIONAL MAILING ADORESSf i �J' '�'IVU t1
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: 10/31/2015 12:01
TENANT MAILING ADDRESS
PHONE NO. FAX NO.
DESCRIPTION
TI-NEW RESTAURANT-MEIZHOU DONG PO RESTUARANT
Construction Type UOM tI of Units Value Construction Type UOM it of Units Value
Value Value 200,000.00 $200,000.00
r'i r•••#/l-/ C.'-.5:—/4 Sy
OCCUPANCY: TOTAL VALUATION:
Restaurants $200,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 1,244.10 1,244.10 01-3103
each Energy p/c fee 421.08 421.08 01-3103
PC Cal Green 124.41 124.41 01-3103
PC ADA 186.62 186.62 01-3103
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 1,914.00 1,914.00 01-3104
Bldg Issue ADA 191.40 191.40 01-3104
SMIP Corn 56.00 56.00 14-2207
gm bldg std 8.00 8.00 714-2203
1.00 each -SWMF 2 Auto 1.00 1.00 88-3027
1.00 Flat SWMF Auto 6.25 6.25 88-3027
Total Fees: $4,197.21 Balance Due: $0.00 Paid Today: $2,221.00
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the R«<ipt N. 110519
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 2,149.75
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 14-2207 56.00
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 8 7.25
0273 88-3027 7.25
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)
CO,~-oto wgc9d,
ot A,
PERMIT/PLAN REVIEW APPLICATION
o jc 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
0 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. 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 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 ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
0 I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING:Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed -
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ 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
information.
N(rther
Title
PRINT NAME
Ithat 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 ow er.
Ito comply . a I City ordin. ces and State Laws relating to building construction. I hereby authorize representatives of the Cit of
Ato ente• pon the above-m•• on•' p ;.erty for inspection purposes.
Se Date
NOTES
: . ,.1. 1 ,• .' i. • i 1 • bing Inspections Date Insp.
100. Setbacks 210. Under flr./bld..drain WriM'' 4.2
101. Rough grade 211. Copper underslab
102. Figs.&forms 212. Rough plumbing
103. Pre-slab 213. Rough gas � 4/'f
104. Floor joists 214. Shower pan P1144 2e.)-1.4€02. -F-71464"4.0
105. Steel 215. Water heater Q q^f S�iS Ay
106. Grout lift 216. Roof drains n ' ` / ��l
107. Shear nailing 217. Building sewer /`v /(tet /� ,
108. Diaph nailing 218. Water service _ 4fr#"
0. .1.4oi109. Roof nailing 219. Final gas • - j� Q q
110. Framing 8.9.Rg 220. Fixtures q J�6�5 (/�_ /
111. 0cc./Area Sept.Wall 221. Final plumbing v -c6
11
112. Sound walls 222. Sewer cap/demo. i_Gs-`` r/ 4`�G A
113. T-bar grid r
yike...A.04E-7
114. Insulation-Flr. Pool Inspections Date . Insp.
115. Insulation-Wall 240. Excavation/steel n
116. Insulation-Ceil. 241. Rough plumbing �(1J','2 41.42n 1-,:rt..j 1,,,,,,f-t t_-
117.
117. Drywall nailing I 013•15 !ice// 242. Light shell/bonding 6+ Q i. j/e-2- 45 / j,
118. Interior lath 111 243. Underground conduit r
119. Exterior lath 244. P-trap
120. Finish grade 245. Gas line&test 646 44,2-p 11 ii-- o i t
121. Final building S-5-JL 4/ 246. Fence,gates&signs 2
122. Final demo/lot clear v 247. Pool heater I 1 ve) -IS Ef
248. Final electric ,� ,,,,d' 0-4".'"
1 t L/
Electrical Inspections Date Insp. 249. Final plumbing V r 044 0- - Q 0i. )2v3/s ii''
150. Power pole 250. Pool cover
• 151. Sales lot lighting 251. Pool final
152. Underground conduit •
153. Underslab conduit Reroof Inspections I Date I Insp. I', .,.. b.. • !<< .//
154. UFER ground 270. Pre-reroof insp. 0,e• 3-I-16 af
155. Water ground 271. Roof framing
156. Rough electrical t9?. /�„� 272. Sheathing nailing
157. Fixtures v�/ 273. Final reroof
158. G.F.C.I.
159. Eqpt.bonding Sign Inspections I Date Insp.
160. Service panel ` / 280. Setback/overhang
161. Final electric 54-(6 /rte 281. Footing
'�{� 282. Conduit/wiring
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC - Miscellaneous Insp. Date 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 2244/1, er
190. Duct shaft Sewers&Offsite Insp. I Date I Insp.
191. Final mechanical i• -I. 300. Lateral(main to P/L)
301. Saddle/Y
Block Wall Inspections Date Insp. 302. Cess.00l filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
4 OPISFOR�, `,.�
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wia _me
ounityott MEMORANDUM
Fire Department
DATE: May 9, 2016
TO: BUILDING DEPARTMENT
INSPECTOR Chris Ingram
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS:. 400 S. Baldwin Avenue (Mei Zhou Dong Po)
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 4-7-2016 Jill Perumean
FIRE ALARMS 4-7-2016 Jill Perumean
TANKS
HOOD & DUCT 3-25-2016 Jill Perumean
KNOX BOX 4-13-2016 Jill Perumean
OCCUPANCY 5-9-2016 Jill Perumean
COMMENTS: .
Emailed Bldg. Dept. 5-9-2016 Rita
r
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s �� .; �„2 ��w_�� ��� _. ..,, ���• ��-..,A-. �� t..r �.� ” c:^.� ; � ..- , w <i A �'' ®tea n�rA l t �i ' i '• q� ! _� 11,118.i''P.''''
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:177'
� City of Arcadia` ® DevelopmentServices Department Bl ildingDivision- - , Din
1 This certificate issued pursuant to the requirements of Section'109.of the '
;',4411
Uniform Build1 5°\4'
ing Code'certifying:that at the time`of issuance this structure was m
t Pregulating g,
u�.$ .
compliance with the.vanous ordinances of the Cityre ulattnbuilding construction or"use.
''':
i
Permit No; B00-047.=57.8 `
Building Address: 400 S Baldwin Ave,Arcadia,CA''.91007.
7),..111_., r
.® Use Classification:. Tenant Improve Effective UBC:
P.:. 2013 C.B.C.
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Permit Type Tenant Improve w/energyzone Co e• `
. occupancy Code:'f ��I tc P Y A_2 T e of Construction: I .
YP
TYPE II-B'1 HR SPRINKLERED
4 - Final Date_ 5/S/2016
2 Owner: °
d � Westfield Corporation,Inc: • �k
® Tenant: Meizhou Dong Po: D.
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Don tocicham Buildingiffici ��
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POST I A CONSPICUOUS;PLACE
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". Development Services Department
�: �-, 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. BOO-047-579- `f.`' Arcadia,CA 91066-6021
City of- (626)574-5416,Fax(626)447-9173
ArcadiaPermit Type: Comm Add/Alt
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
7/31/2014 JB 15:34 7/31/2014 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
400 S Baldwin Ave T-387
OWNER MAILING ADDRESS
Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE No. Inspector#: CRIS
Los Angeles,CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
Comcore Construction, Inc. PHONE NO. (626)616-0865
Cr �� AIL ADDRESS:
r C, .
CONTRACTORIPROFESSIONAL MAILING ADDRESS IIU II u
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: 10/31/2015 12:0(
TENANT MAILING ADDRESS
Meizhou Dong Po PHONE NO. FAX NO.
DESCRIPTION
DEMO BANANA REPUBLIC IN PREP.FOR MEIZHOU DONG PO
Construction Type UOM N of Units Value Construction Type UOM N of Units Value
Value . Value 500.00 $500.00
OCCUPANCY: Tenant Improve TOTAL VALUATION: $500.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 40.65 40.65 01-3104
Bldg Issue ADA 4.07 4.07 01-3104
SMTP Com 0.50 0.50 14-2207
gm bldg std 1.00 1.00 714-2203
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
1.00 Flat SWMF Auto 6.25 6.25 88-3027
Total Fees: $97.82 Total Amount Paid: $97.82 Paid Today: $97.82
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 105906 ,
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 89.07
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 14-2207 0.50
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of Ar- 714-2203 1.00
cadia building inspector for a period of 180 consecutive days. 88-3027 7.25
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) v
4 -
4O
v . 1�c.d
~ PERMIT/PLAN REVIEW APPLICATION
a\taj.. Development Services Department,240 West Huntington Drive,Post OfSce Box 60021
Arcadia,CA 91066-6021, (626) 574-5416,Fax(626)447-9173
City of
Arcadia
ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
Ivie
hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
hapter 9(commencing with Section 7000,of Division 3 of the Business and
rofessions Code,and my license is in full forrcce`andd effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
cense Class LicenseNo. fi U d Exp. Date.4' / compensation, as provided for by Section 3700 of the Labor Code, for the
gnature of Contractor
performance of the work for which this permit is issued.
ER-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,de- Carrier
molish,or repair any structure,prior to its issuance,also required the applicant for
such permit to file a signed statement that he or she is licensed pursuant to the pro-
Policy Number
(This section need not be completed if the permit is for one hundred dollars or less)
visions of the Contractors License Law(Chapter 9(commencing with Section 7000)
of Division 3 of the Business and Professions Code)or that he or she is exempt
there from and the basis for the alleged exemption.Any violation of Section 7031.5 I certify that in the performance of the work for which this permit is issued,I shall
by any applicant for a permit subjects the applicant to a civil 'not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for
�r /
sale(Setion 7044,Business and Professions Code:The Contractors License Date�� � Signature����• =!
-411
Law does not apply to an owner of property who builds or improves thereon,or
who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING:Failure to secure Workers'Compensation coverage is unlawful,and
sale.If,however,the building or improvement is sold within one(1)year of shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she did hundred thousand dollars($100,000),in addition to the cost of compensation,
not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code,interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property who CONSTRUCTION LENDING AGENCY
builds or improves thereon,and who contracts for such projects with a contrac- I hereby affirm under penalty of perjury that there is a construction lending agency
tor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
•
Date Signature Lender's Address
IMPORTANT:APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RE-
STRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures..
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of
asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for fur-
ther information.
Na e l2"/Ile/ ,/&/•,- --""1 Title
- PRINT N
I/ertify 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
rcadia to enter upon the above-mention pro 1• ty for inspection purposes.
_/r
Si12,4
nature A.��li►��I� Date
�6'
i- -� y.-
Development Services Department
240 West Huntington Drive,Post Office Box 60021
�' _ ' Arcadia, CA 91066-6021 PERMIT NO. B00-051-248
City of (626) 574-5416,Fax(626)447-9173
ArcadiaPermit Type: Mechanical
'PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
8/24/2015 JB 9:43 8/24/2015 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#: CRIS
Los Angeles, CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS
High Quality H.C.E. PHONE NO.
EMAIL ADDRESS:
CONTRACTORIPROFESSIONAL MAILING ADDRESS
E26 NO. 378-6171 FAX NO.
High Quality H.C.E. 19380 Spring Port Drive PHONE (
Rowland Heights,CA 91748 EMAIL ADDRESS:
License No. 1000285 Type: C-20 Expires: 4/30/2017 12:00:
TENANT MAILING ADDRESS
Meizhou Dong Po PHONE NO. FAX NO.
DESCRIPTION
MECHANICAL FOR T.I.(MEIZHOU DONG PO)
Construction Type UOM N of Units Value Construction Type UOM 8 of Units Value
g"; /6 4„
OCCUPANCY: Tenant Improve TOTAL VALUATION: $0.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
1.00 Flat Mech Issue Auto 44.35 44.35 01-3105
1.00 each Furn>100,000bt 23.49 23.49 01-3105
1.00 each Comp 3-15hp 34.29 34.29 01-3105
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $103.13 Balance Due: $0.00 Paid Today: $103.13
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the N. 110132
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 102.13
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)
AR
Vti• oFF c4,
ill PERMIT/PLAN REVIEW APPLICATION
E4,,,. ; Development Services Department,240 West Huntington Drive,Post Office Box 60021
`m\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'
License Class &-.2'0 3�License No. 0.022-2-S Exp. Date -2.51--T 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
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 0 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
sale(Section 7044,Business and Professions Code:The Contractors License Date Signature
Law does not apply to an owner of property who builds or improves thereon,
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers' Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ 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.
rl
J � < H C� Title 2 -a-
NamePRINT NAME
I LrL thatI have read this a lication and state that the above information is correct and that I am the owner or authorized a ent of the owner.
iiY PP duly g
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 1\ '7( j,—2 6 '---/S--- e
Date
•
it' % Development Services Department
r Z 240 West Huntington Drive,Post Office Box 60021
�4P Arcadia, CA 91066-6021 PERMIT NO. B0O-051-242
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
8/24/2015 CM 9:19 8/24/2015 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#: CBIS
Los Angeles, CA 90025- EMAIL ADDRESS:
APPLICANT MAILING ADDRESS n„LEE
DI
Gebesis Electric
1u u li i) PHONE NO.
�
EMAIL ADDRESS:
1
CONTRACTORIPROFESSIONAL MAILING ADDRESS
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
Meizhou Dong Po PHONE NO. FAX NO.
1
DESCRIPTION
ELECTRICAL FOR T.I.(MEIZHOU DONG PO)
Construction Type UOM N of Units Value Construction Type UOM II of Units Value
F' 1- - 5---5-_-i
OCCUPANCY: Tenant Improve 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
8.00 each Distrib panel 124.40 124.40 01-3105
132.00 each Outlets 140.00 140.00 01-3105
96.00 each Ltg fixtures 104.00 104.00 01-3105
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $413.75 Balance Due: $0.00 Paid Today: $413.75
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt A: 11DUN
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 412.75
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
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)
I
��4 op�Fn Rv,C9dr
�q PERMIT/PLAN REVIEW APPLICATION
044 immili .:1,
• f • Development Services Department,240 West Huntington Drive,Post Office Box 60021
Y% Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
0't 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
i,___
Professions Code,and my license is in full force and effect. 0I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. �5 ��Exp. Date 'ZS)-/7 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 , Ai/
r--7 I
OWNER-BUILDER DE LARATION 0 I have and will maintain workers'compensation insurance,as required by Section
0 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 workzrs'compe tion ins rance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, ' Carrier -e _ rur\of
demolish,or repair any structure,prior to its issuance,also required the applicant i
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 g(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 ,__, I
exempt there from and the basis for the alleged exemption. Any violation of I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
0 I, as owner of the property, or my employees with wages as their sole , Iforthwith 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 6/2.,t0 5 Signatur
Law does not apply to an owner of property who builds or improves thereon, f ..:. :(
or who does such work himself or herself or through his or her own
employees,provided that such improvements are not intended or offered for WARNING: Failure to secure Workers'Compensation coverage is unlawful,
sale.If,however,the building or improvement is sold within one(1)year of and shall subject an employer to criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor-Code, interest, and
attorney's fees.
❑I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
0 I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures..
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
tirther information.
Name L " �' A I. Ilk Title v
eY
" NAME & �;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�,e, er :1 n�the ab i ve-mentioned property for inspection purposes.
�\ X41011, n'
Signature Date _UV/7c