HomeMy WebLinkAboutUntitled g :,. Development Services Department
g IOW
240 West Huntington Drive,Post Office Box 60021'•
PERMIT NO. BQQ_052_281
Vie" Arcadia, CA 91066-6021
City of (626)574-5416,Fax(626)447-9173
Arcadia Permit Type: Tenant Improve w/energ:
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
12/7/2015 CM 9:00 3/3/2016 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
400 S Baldwin Ave #9015 T-387
OWNER MAILING ADDRESS ,-
Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. Inspector#: HNRY
Los Angeles,CA 90025- EMAIL ADDRESS:
Plan Chk#: 15-743
APPLICANT MAILING ADDRESS
PHONE
S Visions Construction Plan#: 31847
E NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
S Visions Construction, Inc. 16161 Ventura Blvd#C813 PHONE NO. (310)409-6785 FAX NO.
Encino,CA 91436 EMAIL ADDRESS:
License No. 999353 Type: B Expires: 1/29/2017 12:00:
TENANT MAILING ADDRESS
Potato Corner PHONE NO. FAX NO.
DESCRIPTION n L���D
TENANT IMPROVEMENT P
IZ1COM
Construction Type UOM N of Units Value Construction Type UOM N of Units Value
Value Value 60,000.00 $60,000.00
--1 N0/'`— 7-1q-16 4v
OCCUPANCY: Tenant Improve TOTAL VALUATION: $60,000.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT
each Plan review 578.50 578.50 01-3103
each Energy p/c fee 195.80 195.80 01-3103
PC ADA 86.78 86.78 01-3103
PC Cal Green 57.85 57.85 01-3103
•
1.00 Flat Bldg Issue Auto 44.35 44.35 01-3104
each Bldg permit 890.00 890.00 01-3104
Bldg Issue ADA 89.00 89.00 01-3104
1.00 each T.I.Fire Pkc 245.00 245.00 01-3109
SMIP Corn 16.80 16.80 14-2207
grn bldg std 3.00 3.00 714-2203
1.00 Flat SWMF Auto 6.25 6.25 88-3027
Total Fees: $2,213.33 Balance Due: $0.00 Paid Today: $1,049.40
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 112094
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 1,023.35
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 14-2207 16.80
is suspended or abandoned for 180 consecutive days or if no progressive work has been verified by a City of 714-2203 3.00
Arcadia building inspector for a period of 180 consecutive days. 88-3027 6.25
CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS
Requests for inspection should be made at least Monday-Thursday Friday
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)
*41 !fig* �* PERMIT/PLAN REVIEW APPLICATION
_ i4,. 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. p } • I have and will maintain a certificate of consent to self-insure for workers'
License Class 7 Lice A. e o. q 7t-'3. '3 Exp. Date`-Z{7'� compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor , C performance of the work for which this permit is issued.
OWNER-BUILDER 1 fLARATION ❑ I have and will maintain workers'compensation insurance,as required by Section
❑ I hereby affirm under penal`hof perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
is issued.Iorkers'f o ensation insurance carrier and policy numbers are:
License Law for the folio /g reason(Section 7031.5,Business and Professions �v r/��G
Code.Any city or count which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant1 tLk/ 47// 7�
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
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.
0 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. y�
Name /P f C /�( 67 Pi \ Title U e 01
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 1 ','nances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the abov•• ) • tioned property for inspection purposes.
Signature dr( I Date
r-\iiiirl _ , ''' aloilitrtiffilat.' ""'ElAk #A. Milk. - Wiekaa". Alma. - inektwit ,-, ___..
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I ♦0.4.....,..-
1Certificate of Occupancy 10'
( City of Arcadia •
f 4 Development Services Department - Building Division •
1:
�' t This certificate issued pursuant to the requirements of Section 109 of the
Uniform BuildingCode
certifying that at the time of issuance this structure was in
compliance with the various ordinances of the City regulating building construction or use.
4 Permit No. BOO-052-281 0_ '
Building Address: 400 S Baldwin Ave#9015,Arcadia,CA 91007
)..
Use Classification: Tenant Improve
�rEffective UBC: C.B.C.2013 *q
Permit Type: Tenant Improve w/energy Zone Code: C2, DH8
�
— Occupancy Code: B Type of Construction:
- ah..
� TYPE II, 1-HR SPRINKLERED ) -i==>
Westfield
Final Date: 7/14/2016
Owner: Westfield Corporation, Inc.
_...4 Tenant: Potato rner
Stiii, `--Dtt -5/..-1 1,ft4)
(
i Don Stockham,Building Official
gOr POST IN A CONSPICUOUS PLACE
Or-N
I
PI
*MO trti lIIPr AIhdr ;r ' �41r - Y 1t ' 1 .
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NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp. C:K.5G EG-EGT# f ._.
Fmk
100. Setbacks 210. Under fir/bldg.drain _73.-/ r /
101. Rough grade 211. Copper undersiab r�, „ a'Y I+�I� ize- - ' /A Td��
102. Figs.&forms ////���� 212. Rough plumbing ,5/Q/6o ,- 4 4 - .*
103. Pre-slab 3 'j ei213. Rough gas
104. Floor joists 214. Shower pan
105. Steel 215. Water heater -0 CG
�szsfi14. [,vr• cmc G cam/
106. Grout lift 216. Roof drains
Shea
107. Shear nailing 217. Buildingg sewer 5:T52.4C�
108. Diaph nailing 218. Water service
109. Roof nailing 219. Final gas
110. Framing 220. Fixtures 0 2�-/L
111. Occ./Area Sept.Wall 221. Final plumbing )7 'IDS�
L re2A6E-Kcro-nt
112. Sound walls 222. Sewer cap/demo. 'rte
113. T-bar'rid
114. Insulation-Flr. Pool Inspections Date Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Ceil. 241. Rough plumbing
117. Drywall nailing 242. Light shell/bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish.rade _ 245. Gas line&test
121. Final building 246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final flumbin.
150. Power pole 250. Pool cover
151. Sales lot lighting 51. Pool final
152. Under.round conduit 21-A nu,
153. Underslab conduit Reroof Inspections Date I Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 1. Roof framing
156. Rough electrical lG • 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 71qfi 281. Footing
282. Conduit/wirin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Rouch HVAC 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
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. Cesspool filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
1' t Development Services Department
.-"- . 240 West Huntington Drive, Post Office Box 60021
�`' ' PERMIT NO. BOO-054-214
'4,1;' Arcadia,CA 91066-6021
Arcadia of (626)574-5416,Fax(626)447-9173 Permit Type: EMP Combo
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
7/13/2016 ('Ni 10:23 7/13/2016 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
400 S Baldwin Ave T-387
OWNER MAILING ADDRESS
Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO. -
Los Angeles,CA 90025- EMAIL ADDRESS: ,
APPLICANT MAILING ADDRESS
S Visions Construction, Inc. PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL MAILING ADDRESS
S Visions Construction, Inc. 16161 Ventura Blvd#C813 PHONE NO. (310)409-6785 FAX NO.
Encino,CA 91436 EMAIL ADDRESS:
License No. 999353 Type: B Expires: 1/29/2017 12:00:
TENANT MAILING ADDRESS
Potato Corner PHONE NO. FAX NO.
DESCRIPTION CoA
POTATO CORNER,NEW PLUMBING AND EL AL IYI L1ED
Construction Type UOM M or Units Value Construction Type UOM N of I nos \aloe
,_ 7-/e,-,6 47
OCCUPANCY: T TAL VALUATION: S0.00
QTY UOM DESC AMT AMT PAID ACCT Q IN t OM UFS(' ',yI"I AMT PAID ACCs
1.00 flat Elec issue 44.35 44.35 01-3105
1.00 Flat Plmbg issuance 44.35 44.35 01-3105
1.00 each Kitchen sinks 12.46 12.46 01-3105
1.00 each Distrib panel 15.55 15.55 01-3105
4.00 each Floor sink 49.84 49.84 01-3105
1.00 each Floor drain 12.46 12.46 01-3105
1.00 each Grease trap 12.46 12.46 01-3105
20.00 each Outlets 30.80 30.80 01-3105
1.00 each Wtr htr/vent 15.55 15.55 01-3105
1.00 each unit Sewer connec 31.16 31.16 01-3105
1.00 Flat SWMF 2 1.00 1.00 88-3027
1.00 Flat SWMF 2 1.00 1.00 88-3027
Total Fees: $270.98 Balance Due: $0.00 Paid Today: $270.98
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the 'eceip r:
permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3105 268.98
the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 2.00
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)
.FAR
0.1Fo1NO
�A 1011614 k PERMIT/PLAN REVIEW APPLICATION
•
® Development Services Department,240 West Huntington Drive,Post Office Box 60021
Arcadia, CA 91066-6021, (626) 574-5416,Fax (626)447-9173
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
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. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class .13 License Noll 9 S3 Exp. DateO1/2°/ 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 DE A TION ❑ 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,forthe 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 R._e U101IL.
demolish,or repair any structure,prior to its issuance,also required the applicant A�.V." 1 1Q�q I Z0
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
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.
0 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 /�iR ke�'eh Title P tin
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 t
±4 ., Development Services Department
1111 240 West Huntington Drive,Post Office Box 60021
PERMIT NO. BOO-054-149
`'.- ' Arcadia,CA 91066-6021
City of (626)574-5416,Fax(626)447-9173
ArcadiaPermit Type: Fire
PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS
7/5/2016 CM 9:18 7/7/2016 Issued
ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE
400 S Baldwin Ave T-387
OWNER MAILING ADDRESS
Westfield Corporation, Inc. 11601 Wilshire Blvd. 12th Floor PHONE NO.
Plan Chk#: 16-3 I I
Los Angeles,CA 90025- EMAIL ADDRESS:
APPUCANT MAIUNG ADDRESS
Allready Fire Sprinkler Co PHONE NO.
EMAIL ADDRESS:
CONTRACTOR/PROFESSIONAL ' MNra
•'E�
Allready Fire Sprinkler Co 8 (IMPUTED PHONE NO. (626)913-6720 FAX NO.
Covina,CA 91723 EMAIL ADDRESS:
License No. 358795 Type: C16 B Expires: 7/31/2017 12:00:
TENANT MAIUNG ADDRESS
Potato Corner Storage PHONE NO. FAX NO.
DESCRIPTION
FIRE SPRINKS 3 HEADS
Construction Type UOM N of Units Value Construction Type UOM N of Unit, \aloe
Value Value 900.00 $900.00
OCCUPANCY: Fire Sprink/Alm TOTAL VALUATION: 5900.00
QTY UOM DESC AMT AMT PAID ACCT QTY UOM DES( k\I I \\I I PAID \(( I
3.00 each sprinkler pck 255.00 255.00 01-3109
1.00 Flat Fire Issue Auto 44.35 44.35 01-3112
each Fire Permit 57.45 57.45 01-3112
1.00 each SWMF 2 Auto 1.00 1.00 88-3027
Total Fees: $357.80 Balance Due: $0.00 Paid Today: $102.80
This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 113530
pennit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3112 101.80
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
ill
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)
.f ARC
4 sow
r PERMIT/PLAN REVIEW APPLICATION
,404 idl, 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,nandlicense is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No3 55-7! ?Exp. Date 7-77/1. compensation, as provided for by Section 3700 of the Labor Code, for the
t u—y� performance of the work for which this permit is issued.
Signature of Contractor Q v,— C� Z
OWNER-BUILDER I9LECLARATION ❑ 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'comp nsation insurance carrier an/dlicy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier C(i2 Y'P, /VI ( V 01
demolish,or repair any structure,prior to its issuance,also required the applicant d O D �� /�
permit for such to file a signed statement that he or she is licensed pursuant to the Policy Number �� D
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.
Name 4 iAli I .----<, Title / �� G t
'INT NAME
I certify that I have read this application and s a that the above information is correct and that I am the owner or duly authorized agent of the owner.
I agree to comply wit 11 City ordinance and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upo a above-mentio property for inspection purposes.
Signa ,fes'" Date
7
ti`��oFF „,/,r
', IIIII1)IM 17
Avry.t 5.1901
4'ua,tyo0� � MEMORANDUM
Fire Department
DATE: April 17, 2017
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemich
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 400 S. Baldwin Avenue (Potato Corner Kiosk/Storage SC 1)
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 7-25-2016 Jill Perumean
FIRE ALARMS
TANKS
HOOD & DUCT
KNOX BOX
OCCUPANCY 7-25-2016 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 7-26-2016 jp
Arcadia Fire Department
�cpEPARtyre
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C � ER Permit Number 111797 Permit Date 6/17/2016 12:00:00 AM
Construction Effective Date
ARCADIA Permit Type Commercial Building 6/17/2016 3:41:19 PM
ARCADIA FIRE DEPARTMENT Tenant Improvement
FIRE PREVENTION BUREAU
710 SOUTH SANTA ANITA AVENUE Created By Perumean, Jill Expiration Date 8/16/2016 12:00:00 PM
ARCADIA,CA 91006
(626)574-5104 (626)445-1819 FAX Authorized Date Authorized By
Site Information Billing Information
POTATO CORNER
400 S BALDWIN AVE #KK9015
Arcadia, CA 91007
Point of Contact
Nir
Permit Notes:
nir@svisioninc.com
Permit Form:
Form: Commercial Building Occupancy Final
Description: Commercial Building Occupancy Final
Permit Topics:
Plan Check Submittal
Application Date
Date
Status:
Notes:
Plan Check#
PC#
Status:
Notes:
Contractor Information
Information
Status:
Notes:
Job Description
Description
Status:
Notes:
Printed on 6/17/16 at 15:59:51 Page 1 of 5
Jbb Valuation
Valuation
Status:
Notes:
Plan Review Status
Approved/Not Approved
Status: Not Approved
Notes: Need fire alarm plans to add smoke detector, need fire sprinkler plans for cooler in storage unit
I
Exit Signage
Pass
Pass
Status:
Notes:
Fail
Fail
Status:
Notes:
N/A
N/A
Status: Approved
Notes:
Exit Doors
Pass
Pass
Status:
Notes:
Printed on 6/17/16 at 15:59:51 Page 2 of 5
Fail
Fail
Status: Not Approved
Notes: Door on storage unit must be fire rated. Vent compromises fire rating
•
•
Exit Locking Devices
Pass
Pass
Status: ,,pproved
Notes:
Fail
Fail
Status:
Notes:
Emergency Lighting
Pass
Pass
Status:
Notes:
Fail
Fail
Status:
Notes:
N/A
N/A
Status: Approved
Notes:
Fire Extinguishers
Pass
Comments
Status:
Notes:
Fail
Comments
Status: Not Approved
Notes: Please mount both fire extinguishers on the wall; fryers must have suppression systems installed and tagged
by a licensed contractor, mount fire extinguisher in storage unit
Printed on 6/17/16 at 15:59:51 Page 3 of 5
Address/Suite Number
Pass
Comments
Status:
Notes:
Fail
Comments
Status:
Notes:
Fire Resistive Assemblies
Pass
Pass
Status:
Notes:
Fail
Fail
Status: Not Approved
Notes: Need fire door for storage unit, illegal fan installed in fire rated wall
1111111.11111
1111111.
. *
N/A
N/A
Status:
Notes:
Fire Lane
Pass
Pass
Status:
Notes:
Fail
Fail
Status:
Notes:
N/A
N/A
Status: Approved
Notes:
Printed on 6/17/16 at 15:59:51 Page 4 of 5
Knox Box
Pass
Pass
Status:
Notes:
Fail
Fail
Status:
Notes:
N/A
N/A
Status: Approved
Notes:
Closing Notes:
Issued By:
Name: Perumean, Jill
Rank: Fire Inspector
Email(s): city_fire_prevention@arcadiaca.gov,jperumean@arcadiaca.gov
Signature of: Jill Perumean on 06/17/2016 15:58
•
Signature Date
Contact Signature:
Signature Date
Printed on 6/17/16 at 15:59:52 Page 5 of 5
JLI
JOHN LORENZO INSPECTIONS, INC.
DEPUTY CONSTRUCTION INSPECTION and TESTING
"SERVING FROM LOS ANGELES TO SANTA BARBARA SINCE 2003"
2069 LATHAM ST. SIMI VALLEY, CA 93065 • PHONE (805) 857-7908 • EMAIL: JLI(c�ROADRUNNER.COM
REGISTERED INSPECTOR'S FIELD REPORT
INSPECTION DATE: 23/ 1 5 1,(,.o
PROJECT ADDRESS: q 00 S. 6At..41..„1t I,Q Agl�
4
OWNER: ' -7Fit�LI� CD2P V�T,AT� Lfie,jtt " PHONE:
GENERAL CONTRACTOR: S, v I si Did S (p j PHONE:C31 Q) UvA- !a'7 05-
SUB
SSUB CONTRACTOR: PHONE:
ENGINEER/ARCHITECT: -
PERMIT#/JURISDICTION: ga..9 O.2- Z f A iQcj4 sl s A
LOCATION / DESCRIPTION OF WORK
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CONCRETE SUPPLIER: #:
SAMPLE TYPE/QUANTITY: TEST SC- DULE: t.�-•THER
EMAIL RESULTS TO:
BY SIGNING BELOW, I CERTIFY THAT I HAVE OBSERVED THE ABOVE LISTED WORK,AND UNLESS NOTED OTHERWISE, TO THE
BEST OF MY KNOWLEDGE, HAVE FOUND THIS WORK TO CONFORM TO APPROVEDD AANS, AND APPLICABLE LOCALrz�GOVERNING
BUILDING CODES. - .
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INSPECTOR'S NAME: l Lo2 LIC#: 5)-1304,,�- y 9 3UIRISDICTION:ILL
INSPECTOR'S SIGNATURE: N DATE: Vc95-h4„,„
HOURS: (ALL INSPECTION-ARE BA ED ON A MINIMUM 4 HOUR(Y2 DAY) CHARGE, OR 8 HOUR(FULL DAY) CHARGE
FOR INSPECTIONS LASTING OVER 4 HO► '- .
APPROVED BY: DATE:
ORIGINAL WHITE COPY TO BUILDING OFFICIAL - YELLOW COPY TO CONTRACTOR/OWNER - PINK COPY TO INSPECTOR