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HomeMy WebLinkAboutUntitled s Development Services Department 1,4t/44r, 240 West Huntington Drive,Post Office Box 6021 PERMIT NO. Arcadia,CA 91066-6021 BOO-057-427 City of (626)574-5416 Fax(626)447-9173 Arcadia Permit Type: Tenant Improve wienerg; PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 7/25/2017 EP 8:26 7/25/2017 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#: 32277 APPLICANT MAILING ADDRESS • Gary Kanda PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS NO. Gary Kanda 8151 Blewett St PHONE (310)213-8183 FAX NO. Rosemead, CA 91770 EMAIL ADDRESS: License No. 480827 Type: B Expires: 10/31/2017 12:01 TENANT MAILING ADDRESS S Kobe PHONE NO. FAX NO. DESCRIPTION T.I FOR S KOBE WITH ELECTRICAL AND MECHANCIAL Construction Type UOM #of Units Value Construction Type UOM If of Units Value Value Value 80,000.00 $80,000.00 rd COMPLETED 34-2,41, .-/z.-`) OCCUPANCY: Tenant Improve TOTAL VALUATION: $80,000.00 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 1,057.00 1,057.00 01-3104 Bldg Issue ADA 105.70 105.70 01-3104 1.00 flat Elec issue 44.35 44.35 01-3105 1.00 Flat Mech issue 44.35 44.35 01-3105 19.00 each Outlets 29.26 29.26 01-3105 121.00 each Ltg fixtures 131.80 131.80 01-3105 8.00 Flat Add/Alter Ducts 75.04 75.04 01-3105 SMIP Com 22.40 22.40 14-2207 gm bldg std 4.00 4.00 714-2203 1.00 Flat SWMF Auto 6.25 6.25 88-3027 1.00 Flat SWMF 2 1.00 1.00 88-3027 1.00 Flat SWMF 2 1.00 1.00 88-3027 Total Fees: $1,566.50 Balance Due: $0.00 Paid Today: $1,566.50 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 117435 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 • - 1,207.05 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3105 324.80 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 14-2207 22.40 Arcadia building inspector for a period of 180 consecutive days. 714-2203 4.00 88-3027 8.25 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. II (Closed on alternate Fridays) �FF Rv�49d� 119 PERMIT/PLAN REVIEW APPLICATION649 „0." • Development Services Department, 240 West Huntington Drive,Post Office Box 60021 '�4°o,�N° Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173 City of Arcadia LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION ❑ I hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following: ^ Chapter 9(commencing with Section 7000,of Division 3 of the Business and Professions Code,and my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers' License Class j License No. 44/g2:7 Exp. Datel03r�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 ▪ OWNER-BUILDER DEC ARATION 121 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 AC 's demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number dd �] ! 0 76 8 Z 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 complete ,f 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 -7 sale(Section 7044,Business and Professions Code:The Contractors License Date ( �s Signature wow 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 tsRINTI certify that I have read this application and state that the above information is co)Title rect 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 ` / NOTES Building Inspections Date Insp. Plumbing Inspections Date Insp. s-zY-L7 -Kusa Ee.£ TIG/1- 100. Setbacks 210. Under fir/bldg.drain 101. Rough grade 211. Copper underslab ituLvS 7 102. Figs.&forms 212. Rough plumbing 103. Pre-slab 213. Rough gas g 104. Floor joists 214. Shower pan ` 6��7 105. Steel 215. Water heater FIRF fain Lv �/�fSli�G 106. Grout lift 216. Roof drains / w, . 640t--vs € 5 SLY( 107. Shear nailing 217. Building sewer 108. Diaph nailing 218. Water service 01t 109. Roof nailing /� - 19. Final gas 110. Framing -//-/7 � ir� 220. Fixtures 111. Occ./Area Sept.Wall 221. Final plumbing 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 -//-/7 ' 242. Light shell/bonding 118. Interior lath 243. Underground conduit 119. Exterior lath 244. P-trap 120. Finish grade 245. Gas line&test 121. Final building 1O-12-/7 246. Fence,gates&signs 122. Final demo/lot clear 247. Pool heater 248. Final electric Electrical Inspections Date Insp. 249. Final Ilumbin. 150. Power pole 250. Pool cover 151. Sales lot lighting 251. Pool final 152. Underground 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 9-J1-17 272. Sheathing nailing 157. Fixtures 273. Final reroof 158. G.F.C.I. 159. Es it.bondin. Sign Inspections I Date I Insp. 160. Service panel 280. Setback/overhang 161. Final electric f(,-/2-/7 281. Footing 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 I Insp. 191. Final mechanical 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 x ' % Development Services Department 51 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. BOO-056-782 .;.- Arcadia,CA 91066-6021 City of (626) 574-5416,Fax(626)447-9173 Permit Type: Tenant Improve wienerg; Arcadia PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 5/8/2017 EP 9:04 6/16/2017 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#: 17-137 APPLICANT MAILING ADDRESS Plan#: 32277 D.D. Enterprize, Inc. PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS D.D. Enterprize, Inc. 20950 NormPHONE NO. 310 ndie Avenue#D ( )381-0017 FAX NO. Torrance,CA 90502 EMAIL ADDRESS: • License No. 951531 Type: B Expires: 8/31/2018 12:00: TENANT MAILING ADDRESS S Kobe PHONE NO. FAX NO. DESCRIPTION T.1 FOR S KOBE Construction Type UOM N of Units Value Construction Type UOM N of Units Value Value Value 8000.00 $80,000.00 CANCELLED :-�r g f / P, iII IIIYslgift 1( r 40,;11 �� OCCUPANCY: Tenant Improve TOTAL VALUATION: $80,000.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT each Plan review 687.05 687.05 01-3103 each Energy p/c fee 211.40 - 211.40 01-3103 PC ADA 103.06 103.06 01-3103 PC Cal Green 68.71 68.71 01-3103 1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 each Bldg permit 1,057.00 1,057.00 01-3104 Bldg Issue ADA 105.70 105.70 01-3104 1.00 each T.I.Fire Pkc 280.00 280.00 01-3109 SMIP Corn 22.40 22.40 14-2207 grn bldg std 4.00 4.00 714-2203 1.00 Flat SWMF Auto 6.25 6.25 88-3027 Cogitt 41-- erg Q . 56r "efiitr 4300- t -yz7 Total Fees: $2,589.92 Balance Due: $0.00 Paid Today: $1, 39.70 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the ecetpt,•: 11/1DU permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 0I—I0,' 1,207.05 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 14-2':fl 22.40 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 714-2 t 4.00 Arcadia building inspector for a period of 180 consecutive days. 88-31 7 6.25 CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS • Requests for inspection should be made at least Monday-Thursday Friday • one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m. , by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. • (Closed on alternate Fridays) % '''' 11 vo G'.CA �7 PERMIT/PLAN REVIEW APPLICATION o j, 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. gy�pp// ❑ I have and will maintain a certificate of consent to self-insure for workers' . '/ License Class /I License No.' 3/ Exp. Date elP Vi compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Signature of Contractor R-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�insura ce carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier OG-r �/rP demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number for such permit to file a signed statement that he or she is licensed pursuant to the 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 IA 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 - sale(Section 7044,Business and Professions Code:The Contractors License Date ice7Signature / s^ Law does not apply to an owner of property who builds or improves thereon, .. . or who does such work:himself or herself of through his or her. own. ,,. .). , employees,provided that such,iniprovements 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. �j \ ame � �OS�/' PRINTi1ha�0 Title J->,.., 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. agree to comply with all City ordinances, and State Laws relating to building construction. I hereby authorize representatives of the City of rcadia to enter upon the above-mentioned property for inspection purposes. ' 1gnature i — /,. -1;1/14 Date f ! p r- `/ 9 +FWi . '4` + --'1 5 - aV�4�, .d� _ �g - _ ,„.,4,,,J- ,---\,,,,,,.,,,„, _ r ,c�'' , , „ .. r,„,,,„„,,,, ,,..„,,,,,„,,,,„„,„\\„,„,,,,,,, ,\�� /f' ' -. �L yy� y yi�i y'"sr' .. `, ,,, jf ii. „.,.,5_.,„,, mi•► ® -® _-� — 2NBl` ,. , itk , , L�f tIti g ;kr • 4 . Q P. y�F vAl i •� '1 ). i �� ARCAD A '^ lip Ilal t NI t t C'e tt cate of Occupancy p iii i City of Arcadia Ivity,�,,• rg -,,, Development Services Department - Building Division p - . , ti 4k'1 I f' This certificate issued pursuant to the requirements of Section 109 of the I ll 9 Uniform Building Code certifying that at the timeofissuance this structure was in compliance with the various ordinances of the City regulating building construction or use. • c f, .,,,*-il r Permit No. B00-057-427 ,,, ti6m,Al!..; I )9.4-V4 i � i” Building Address: 4005 Baldwin Ave,Arcadia,CA 91007 r� Tenant Improve Effective UBC: ' Use Classification: C.B.C.2016 B1 R.1 �• Permit Type: Tenant Improve w/ever Zone Code: 1 P gYC-2,DH8 51, f ,,, 01 Occupancy Code: M Type of Construction: TYPE II 1 HR SPRINKLERED Q 81 Final Date: 10/12/2017 f�� Owner: • Westfield Corporation, Inc.l PikAF lye\ r( ki Tenant: S Kobe 1) ,, ,, 71.:(;1 ! \-Dtdk. -... Don Stockham,Building Official _ D - „�. id POST CN A CONSPICUOUS PLACE I y1 ce , tga t.le--- 1 F' Or,r, 11,4 vt. AFW' d �W > i s , W �l rb o QA .•� 1 � � t` NVO � ,� `� Y % �-r/21111,4V, ��� !' `tl i . �!i \\� !. _ ai , i TI lr. ! _ , Y i ,r� -4419,00 - .7,j/5*�6/rl . � Leetag ��; 4✓C[))IJ�IGS f�yea I ��1�� ›, °: � `yi� �2Y �L�L�y� � ��� ��� Q e�,,4�6y ��� ��"��.jDXY?Y Z�4"'g �{ y��,�i`+' � - . :'µ, ',Vi ..._ . LEVEL , ,,,,,. L.I 17:$••••,,,,..„..,...,..„._ 1)/ c.1- -..- • ill . VI 7 . 1::' • ''' 4'.'"A;.'11'''".....„,-') 1.' .-'.. . • • Cte, •' eIX.1,1,1,1, C1.11014...."401. .-r".sC----- id A) A IA NORDSTROM LEVELS 'L.:'''''',$,V.1:1--\ •-•.-4,-,•-• •1".-•- •,-;•.-1 IJ&J84 sr .:7,:.,...,,,, 1--1.---- ......... \ :i V/ : ,,,.....:::;' ‘',.',.., -,...„.. -- Lx.i, .. , : • , ::. :::'•MN .1/. , V.,:tr,Y.kr,.., GE.P '-•••,-.. 1,3 ...4:f. e•<••, ,...;.p. V,,. IP: ,,•••••'-- . -.,,k, \-,,, ,o,.. i...-51 ... 1:,,,jeg AR F,c: ' ".. . k's...:4 :. _ >. 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L-7,,,'-il r..._„......'" -Ii ,,_---- -- : „, „ ... ,. , --ir— --1— ...72 Ili, -I, f."tr- o 11 -;:•1" • ' r— IL.- i 4,1 Latu_J.R.111.1..L.I.,,...,.........,_=v.,. -,. • • -1? 1-- ... . . . . . )tt ''' :':.7 4.'''-'; ,:„.. ---,•,,••••,••••,:i. Ealln 7.:.., .,z-:!..7,j ....... IS ,. C--' CM= 4 . - 1...... I " • --ii,>, f .,;;',, —:• —1,,', . ' .... L . . „-..17,,7, . . . .. . 0:1 .7.--•:::'. ,;('-,",,,.:-:,,;,i . . CM • I • / •••')' i .• • • • • • 1 ii,:._ I .....„.„? e Etk.', . / , . ...... . c"N . . .I....-. —qA .L. • . . .. ... , •••1.-' -, .,? / DE.a ,,,,,,, I:7." ' " 11."1,-- •• ,, el . . '. . . . „: XX11 . 'r.01. .. . . . . . ........ ---7.-- L...... ; —t . 4 ,....,.. - •j••77 ___...:_. ...., xi!, . . r., LI ;44 . . " ... I ,i11: : ..10.,._#„._0 . .„ 4 - ,,t,), , LEVEL 1 , i LIMO •.. alfAiilii:lliiiiiN NORTI- 1 Evgl 3 kIN.11 4€ LOS ANGELES COUNTY DEPARTMENT OF PUBLIC WORKS fill I BUILDING&SAFETY/LAND DEVELOPMENT DIVISION i PUBLIC.WORKS s:, -, _ °a'_-. SPECIAL INSPECTION REPORT Each inspector must complete this report and mail it to the District office where the permit was issued. IT DAILY (l WEEKLY ❑FINAL Total time on job (in days) d/./E Building Permit No. 1300 _ 7_ ¢2.7 District No. . Job Address 406 S . .84LDigiA/ AVE. X23/, ARCA 40 /A General Contractor 44g Y KANt,4 4.,4_ .4.6L - Size of Building - No. of Stories Type of Wall: Type of Work : El REINFORCED CONCRETE 0 MASONRY n HI-TENSILE BOLTING 0 PRE-STRESSED CONCRETE 111 WELDING ❑ GYPSUM CONRETE 1 OTHERS(PRE/Par ) Discription of work inspected /) -7- / poR corlj- /A.L 1w/440/AA • A2 _ .sHOo7 frio vaJ 7 To lvj f-/ 74, pRAsccoC� STS 5. C o — : w -- A, • 33 MA IER/Ai . )1 cX/d kd TX -M/ (45" Pik .) All works on this job to date has been satisfactorily completed to the approved engineer's plans ICC#5031455(SSB/SSW/RC/SM/FP) C.O.LA#P015050(W/M/C/SC/DIA) JAYEE J. KIM LA COUNTY#01475.(W/C/M) a8— 2.6- 20/ 7 Special Inspector(Print) I.D. Number Date G --� ---_ (562) 331-5700 Special Inspector(Signature) Daytime/Cell Phone Number f1 "�• Development Services Department 240 West Huntington l`lrive Post Office Box 60021 !� Y. PERMIT NO. BOO-057-907 `<' Arcadia,CA 91066-6021 City of (626)574-5416,Fax(626)447-9173 Permit Type: Sign Arcadia PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 9/25/2017 EP 14:13 9/25/2017 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 Sun Sign Co PHONE NO. EMAIL ADDRESS: , CONTRACTORIPROFESSIONAL MAILING ADDRESS (NO. 213 Sun Sign Co 3614 W Pico Blvd PHONE )570-2409 FAX NO. Los Angeles,CA 90019 EMAIL ADDRESS: License No. 993575 Type: C 45 Expires: 6/30/2018 12:00: TENANT MAILING ADDRESS S Kobe PHONE NO. FAX NO. DESCRIPTION LED PUSH THROUGH SIGN"AIMERFEEL" Construction Type UOM 8 of Units Value Construction Type UOM 0 of Units Value Value Value 2,500.00 $2,500.00 /0--/-2--#7 �d OCCUPANCY: Sign TOTAL VALUATION: $2,500.00 QTY 11OM DESC AMT AMT PAID ACCT QTY 110M DESC AMT AMT PAID ACCT Sign plan rev 67.40 67.40 01-3103 1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104 each Bldg permit 120.35 120.35 01-3104 1.00 flat Elec issue 44.35 44.35 01-3105 1.00 branch cin Signs elec 59.17 59.17 01-3105 1.00 each Sign Connection 15.55 • 15.55 01-3105 1.00 Flat SWMF 2 1.00 1.00 88-3027 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $353.17 Balance Due: $0.00 Paid Today: $353.17 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 117995 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3103 67.40 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 01-3104 164.70 is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 01-3105 119.07 Arcadia building inspector for a period of 180 consecutive days. 88-3027 2.00 CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS Requests for inspection should be made at least Monday-Thursday Friday *9 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) 4.0„,,,,„„N, col PERMIT/PLAN REVIEW APPLICATION INE- EN0. °t Development Services Department,240 West Huntington Drive,Post Office Box 60021 o0\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 4 License No. 2)5.4-S Exp. Date b i i'I compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Contractor 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, Carrier ry., i`/ • 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 ❑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 y sale(Section 7044,Business and Professions Code:The Contractors License Date (JAI( ! 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 soldwithin one(1)year of and shall subject an employer to criminal penalties and civil fines up to one completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation, . did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. ❑I, as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY who builds or improves thereon, and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097, Civil Code). 0 I am exempt under Section 7044,Business and Professions Code,for this reason: Lender's Name Date Signature Lender's Address IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING: 1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel. 2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings and structures. 3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for further information. Name ..� �eS2. Title 6,10......./„...- 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 9/),—(( fn Approved by: S*Kobe(aimerfeel) 400 S.Baldwin Ave. SUN SIGN Arcadia CA 91007 Signature sign,banner,graphics and etc =� Print: Date: • Thsoriginal unpublished rendering is submitted solely for the protect being planned It is not to be copied or shown to person 3614 W Pico Blvd,Los Angeles,CA 90019 i 213.507.2409 lasunsign@gmail.com Phone: e-mail: outside of your organization with out express written authorization - -—from C-45 LED Push Through Sign • 1 ' dr ed JAPAN 4" 6,_8„ __ , Nate - . en :ie'.•.•-d for ceneral design ... .. ..c.. ....r,t:ton,are required to be •,v tr„- tt•-+ 7• :S'\r.i,ite.:t and/Or Cortractor. Tenant ,i!yl 1,1 with all government regulations. or--it, !::ndlord stamped set of drawings is t e kept on the job site at all times. •gned Date Approved by: I fS*Kobe(aimerfeel) C. SUN SIGN 400 S.Baldwin Ave. Signature: sign,banner,grcph!cs and etc Arcadia CA 91007 . `/� Print: Date: This odgmrl unpublishedrendering is submitted soleiytor the project beingplanned.It is novo be copied orshown to persons 3614 W Pico Blvd,Los Angeles,CA 90019.1213.507.24091 lasunsign@gmail.com Phone: e-mail: outside of your organization with out express:written authorization from C-45. LED Push Through Sign Building Wall 0.5" 3" ILLUMI N ATED CHANN EL LETTERS Wood penel Q UL APPROVE Face and Returns Match wall colors This sign is intended to be installed in accordance with the requirements of Article 600 of the National Electrical l Code and/or other applicable local 3/ i -v lite Acryf w/Tr lusent film 1 ' codes.This includes proper grounding / e and bonding of the sign. ®� Working Drawing Review Note on plans:"The construction shall not Approved I restrict a five-foot clear and unobstructed .;roved aslrl �Fs'cbre-finished-Bright White ' access to any water or power distribution E subi it it facilities(power poles,pull-box,transformers, I vaults,pumps,valves,meters,appurtenances, Th0se a av'nqs have been reviewed for general design etc.)or not the lines are located on the ' "'"} "1 1"-• 'core a tions are required to be property."Otherwise,clearance from DW v' ,.`: try;ht, ;r:eCi and/or�io��nf�r,��pctp T I required. is responslDlc `ui c o•Title 29 FArnig nytcgfrfehe �DsTjenant 7:41 '° On;r 1' c� of,h;s landlord stamped set of drawings islons. Low Voltage 12v DC recwraq to r e kept on the job site at all times. transformer / ^ /A/ contained within L% steel metal box • •ned Attached on oo.en r►a, _ - Metal Screw w/Anchor 1/ . emin.Bea ' ^ Electrical junction box Located behind sign area. 1+- --1 120 volt 2oamp dedicated cercuit power provided within I5'of sign area by landlord. S*Kobe(aimerfeel) Approved by: 400 S.Baldwin Ave. C, 4 5 SUN SIGN Arcadia CA 91007 Signature: sign,banner,graphics end etc Print: Date: Thts original unpubIrshed rendering Is submitted solely for the project being planned It is not to be copied or shown to persons 3614WPicoBlvd,Los Angeles,CA90019I213.5072409Ilasunsign@gmailcom Phone: e-mail: outside.oiyour organization with out express written authorization from C-45' eee . j a 1 r-6n V -- — JAPAN - 0'-4° ' 6'-8" / 111 s t n`r-.-H6--; Drawing Re . 'w I' Pigsti7e, ,o4 / / / C Th; ..::r •_. ,,wad for gen design , • in' • . • _:lions are req d to be vc ,.1"-:ti Ar itect and/or Conti Lou. Tenant is :rniy, wan all governmt regulations. Or: Alpi clord stamped set of. ings is 1 :,,,n ed Date S*Kobe(aimerfeel) Approved by: SUN SIGN Arcadia S.Baldwin Ave. C. A Arcadia CA 91007 Signature: sign,boner,graphi.,end etc Print: Dater Th.anginal unpublished rendering is Submitted solely for the. project being planned.0 i's not be copied or shown to persons 3614 W Pico Blvd Los Angeles,CA 900191.213:507.2409 lasunsign@gmail.com Phone: e-mail: outside ofyour organizatton with out express Wntten authorization. - _ _ from GAS: Wstfiebi •'iCPenrtey Optical " ~ - ,. Working Drawing Review "aC enrley Salon .E` ' i 0 Approved . Approved as Noted *JCPenney 17,--, ' Resubmit • These drawings have been reviewed for general design. _i , • fes, Dave-,k' ave Bu ter 5'------....„T-7 intent only. All actual field conditions are required to be ?• .___41...' Fashion fr,1 ` ! verified by the Tenant's Architect and/or Contractor. Tenant 3 `';� �: is responsible for complying with all government regulations i; One(1)copy o .is landlord stamped-setof drawings is '> r . . �.n r ' required to b- et on job site at all times. 7 ,, I�Ic'�.�'�t-�Y,4 k 8e- 1-- ' 1t ictor�aes See ret C ,,= ,s, y q et° '--� Si• ed Dane t i-r ° - � _ t , '� M,-'._ ftt* ECCD' * AMB/Iheatr-es . Gap 1V ---vi—u-'67.0 utique Nordstrarrl -- M -:!g-' ..Papyrus,..Aa r, ------iii SIdeChick___.---..a * Forever-21 t * Adids - ,� * Boarders Skate- *`April,Snq r p, �► Foot,Action USA -r t; �._ " Zara zl uoca "- _,_"` Coach i""" * Chico s * lieavana, .,. +SNC .4 10 . J 10 (il fl f i t . Thee) a f i 1/1 I i IN f_-c-i -1-11-q- IIII 1111111all -— SGe.li 0-eM 1-----IWn=sAnd _____ _____ IMO au --- tuppg lliniiiiiii ' lif• .•tu3 ,...-, . ..._.: . #leaus uo --,4.1801,10113 seloN ,S6)( -bzI)\R 6.A i\Tc1:__Lv . . • •-sk\' 'N ' oo S. •:.•P '''" . .. • . . ., . . • .,:. . _ IA Development Services Department 1A!' II 240 West Huntington Drive,Post Office Box 60021 BOO-057-656 • ' PERMIT NO. ..•' Arcadia, CA 91066-6021 City of (626)574-5416,Fax(626)447-9173 Permit Type: Fire Arcadia YP PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 8/22/2017 CM 11:49 9/7/2017 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#: 17-277 Los Angeles, CA 90025- EMAIL ADDRESS: I APPLICANT MAILING ADDRESS Building Electronic Controls Inc. PHONE NO. EMAIL ADDRESS: f CONTRACTORIPROFESSIONAL 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 l2:0( TENANT MAILING ADDRESS S Kobe PHONE NO. FAX NO. DESCRIPTION FIRE DEVICES FOR S KOBE II DEVICES Construction Type UOM #of Units Value Construction Type UOM #of Units Value Value Value 7,732.00 $7,732.00 vtIlltilt D OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: $7,732.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 11.00 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 203.85 203.85 01-3112 1.00 each SWMF 2 Auto '1.00 1.00 88-3027 Total Fees: $949.20 Balance Due: $0.00 Paid Today: $249.20 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the 'eceipt r: :, 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 248.20 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. 0 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) Re U`4 AFP 4 ;4, PERMIT/PLAN REVIEW APPLICATION 0044.j` 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 aLICENSED 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. El I have and will maintain a certificate of consent to self insure for workers' License Class C 1�:. tek.,License No� a S Exp. Ie '�?J�f compensation, as provided for by Section 3700 of the Labor Code, for the Signature of Contracto performance of the work for which this permit is issued. OWNER-BUILDER DECLARATION El 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 ca�rr{i—er and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier'il ((Ca,�. \( 4 and k�S demolish,or repair any structure,prior to its issuance,also required the applicant 2 �� 0°I‘ 1 t1( DD 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 I certify that in the performance of the work for which this permit is issued,I shall exempt there from and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith comply with those provisions. compensation,will do the work,and the structure is not intended or offered forpp sale(Section 7044,Business and Professions Code:The Contractors License Date ������ Signature ) VV 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.CA ^�— - r L Name ��"O \,\ \ Title--KI v is> v2� ��k,, —Ckh L\ 1�IJ�Ur PRINT NMVIE 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-menti c ned property for inspection purposes. ` )Signature / ;,�* I ` Date °/7A7`7 1 - Development Services Department I1 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. BOO-057-615 `.�.. :� Arcadia,CA 91066-6021 City of (626) 574-5416,Fax(626)447-9173 Permit Type:Arcadiayp : Fire PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 8/16/2017 CM 9:13 8/30/2017 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#: 17-269 Los Angeles, CA 90025- EMAIL ADDRESS: APPLICANT MAILING ADDRESS Allready Fire Sprinkler Co. PHONE NO. EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS Allready Fire Sprinkler Co. 818 N Grand Av PHONE NO. (626)332-7066 FAX NO. Covina, CA 91723 EMAIL ADDRESS: License No. 358795 Type: C16 Expires: 7/31/2019 12:00: TENANT MAILING ADDRESS S Kobe PHONE NO. FAX NO. DESCRIPTION FIRE SPRINKS FOR S KOBE 24 HEADS Construction Type UOM #of UnitsCo illral ED UOM #of Units Value Value Value 3,100.00 $3,r,11l' i . OCCUPANCY: Fire Sprink/AIm TOTAL VALUATION: $3,100.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 25.00 each sprinklerpck 700.00 700.00 01-3109 1.00 Flat Fire Issue Auto 44.35 44.35 01-3112 each Fire Permit 137.05 137.05 01-3112 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 Total Fees: $882.40 Balance Due: $0.00 Paid Today: $182.40 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 117773 permit is not commenced within 180 days from the date of issuance or if the peanut is not obtained within 180 days from 01-3112 181.40 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 //-'-'3 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) ti4 oAR � Rvy9 i moo1. PERMIT/PLAN REVIEW APPLICATION l a j` 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 forcce� and effect. CII have and will maintain a certificate of consent to self-insure for workers' License Class C I (r, License No. 3 5 O 79 5" Exp. Date 7=') !-/ compensation, as provided for by Section 3700 of the Labor Code, for the / Signature of Contr. — performance of the work for which this permit is issued. . OWNER-BUILDER I` CLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section D I hereby affirm under pe ty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number3 / 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 nee not be completed if the permit is for one hundred dollars or less)�U u w G�' I //b (a 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 o,e-------- sale(Section 7044,Business and Professions Code:The Contractors License Date 0` 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 additionto 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. JJJ111 ..Name /94 /2 vk e 04 Title PRINT NAME I certify that I have read this application and state that the above information is correct and that I am the owner or duly authorized agent of the owner. I agree to comply with all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter upon the above-mentioned property for inspection purposes. -! r- 30 - igna��-% Date