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City iisi of Arcadia, CA '-_, ----1------ `li 13 ' iNo II-18=0610
J$ /
Development Services Department s"-. J'W ""%�'"', , Permit Type Tenant Improvement`!
l 240 West Huntington Drive,Post Office Box 60021 t, Pe t 14 11 " r `"'
r ik e I i i i two kClassrJtcatioa•Tenant improvement`s
L...,..)".., Arcadia,CA 91066-6021 „2) �„1 3
(626)574-5416 i a- ' .. Permit5tatus App oved'
..Y'
ARCADIA 'issue Date:. Expiration: 10/18/2018
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
400 S Baldwin AVE Arcadia,CA 5775031043
Contacts
SANTA ANITA BORROWER LLC C/0 Owner ADAM KWAN Applicant
WESTFIELD SANTA ANITA 19811 COLIMA RD 210,WALNUT,CA 91789
400 (626)679-4679
Anokia,Inc. General Contractor(B)
1217 Buena Vista ST#1028,Duarte,CA 91010
(626)222-0621 MJENG@ANOKIAINC.COM
Description:KIOSK FOR MYDO PIE = Valuation: $ 25.000.00 Tenant MYDO PIE
Total Sq Feet:
s 0.00 Plan Check#18-610 Plan#32585
Fees Amount Payments Amount Paid
Accessibility Plan Check $47.56 Total Fees $1,779.64
Accessiblity Building Permit $48.78 Cash/Receipt#REC-000915-2018 $493.86
Building Issuing Fee $44.35 Cash/Receipt#REC-002209-2018 $1,285.78
Building Permit Fees $487.75
Building Plan Review Fee $317.04
Amount Due: $0.00
Cal Green Plan Check $31.71
Commercial T.I.Fire Plan Chk. $280.00 � //
Commercial Service<200amps $31.43 / "�4G 2-1 lG
Electrical Permit Issuance Fee $44.35
Energy Plan Review Fee $97.55
Floor Drain Fee $24.92 CALLS FOR INSPECTIONS
Floor Sink $49.84 Request for inspection by telephone at 626-574-5450. Leave a message
Green Building Standard $1.00 requesting the address,timeframe and what inspection item is needed.
Hood Serviced by Mechanical Exhaust $14.11
Interceptor $24.97
Kitchen Sink $49.84 This permit/plan review expires by time limitation and becomes null and
Mechanical Permit Issuance Fee $44.35 void if the work authorized by the permit is not commenced within 180 days
Outlets-Receptacles&Switches $35.80 from the date of issuance or if the permit is not obtained within 180 days
Plumbing Permit Issuance Fee $44.35 from the date of plan submittal.This permit expires and becomes null and
Solid Waste Management Fee $6.25 void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Solid Waste Management Fee 2 $1.00 Arcadia building inspector for a period of 180 consecutive days.
Total: $1,779.64
4442)4
/� 44 $
Is uedtAy
Date
September 05,2018 Page 1 of 1
O AR
1 PERMIT/PLAN REVIEW APPLICATION
our 4; 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 penally 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 e ct. / o I have and will maintain a certificate of consent to self-insure for workers'
License Class B License No. 3 / Exp. Date 0 / / compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor r — rformance of the work for which this permit is issued.
NER-BUILDER DECLARATION I have and will maintain workers'compensation insurance,as required by Section
❑ 1 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 ill 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 r��
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, Cf/ ��rl
or who does such work himself or herself or through his or her own l ( 6
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(I)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:
I. 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.I
Fi
a rte s fuer Y“- Title A yert�,
PRINT NAME l
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 0-72-4
lays S. •$rau)unrr /1{ g
NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under flrIbldg.drain I4 Z-Va r
101. Rough grade 211. Copper plumbing
,/L It (S`8 {FA SY
rifir
102. Figs.&ions ,/' , ,212. Rough plumbing b 3-1 8/JILL/�Q /fffGGG-7€/z!62. pg /(SSA jjj�(�}}'/-""G-'-�7/
103. Pre-slab ISL i$ I�,K / 213. Rough gas
104. Floor joists 214. Shower pan
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailing19. Final gas
110. Framing Io-j-/$Le. 220. Fixtures '4'10 v�
111. Occ/Area Sept.Wall 221. Final plumbing (2 /x"-
112. Sound walls 222. Sewercap/demo.
113. T-bar!rid
114. Insulation-Flr. Pool Inspections Date Insp.
115. Insulation-Wall 240. Excevation/steel
116. InsulDryalln-ingil. 1�2. Rough plumondi
ng
117. Drywall nailing �0-231448/ 242. Light shell/bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade /,/7c^'y/�45. Gas line&test
121. Final building Z4`� �`(0 246. Fence,gates&signs
122. Final demo/lot clear 247. Pool heater
248. Final electic
Electrical Inspections Date Insp. 249. Final.lumbint
150. Power pole 250. Pool cover
151. Sales lot lighting 251. Pool final
152. Undere round conduit
153. Underslab conduit Deroof Inspections Date Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground z....0.7/271. Roof framing
156. Rough electrical US2 /
- % 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E..t.bondin• Sign Inspections Date Insp.
160. Service panel 280. Setback/overhang
161. Final electric 281. Footing
282. Conduit/wirin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Fumace/A.C.
182. Rauch 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
190. Duct shaft Sewers&Offsite Insp. Date Insp.
191. Final mechanical (2.1.4 11 /i 300. Lateral(main to P/L)
301. Saddle/Y •
Block Wall Inspections ' Date Insp. 302. Cess.++l filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
1 C: u°^ "' '.' y� m'�i .Y 3s ,/;q7,'� 0 .- Y v2 i „. %y
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'4 ` Certificate of Occupancy
cCity Of Arcadia 1,1..41
Development Services Department—Building Division
c
Hiy� i;
This certificate issued pursuant to the requirements of the " s !,'.1
‘s.:,,,,, -
,. ...t*ars California Building Code certifying that at the time of issuance this structure was in i-
compliance with the various ordinances of the City regulating building construction or use. � `;,n. ,.'re)
Permit No. TI-18-0610
e,
Building Address: 400 S. BALDWIN AVE ARCADIA, CA 91006 '.
r'' Permit Type: TENANT IMPROVEMENT �e'
Effective CBC: 2016 C.B.C. �t? `
A. b F
Occupancy Code: B C-2 DH8 ,
(N/ 4 .
3vf
Zone Code:
Y . .. '. do
Final Date: 2-6-19 Type of Construction: TYPE II 1 HOUR );• '
;id;,' [
Owner: WESTFIELD MALL SANTA ANITA Tenant: MYDO PIE
i, ,,,tip / / 1 I r
""' d • Kenneth Fields, 'ding,0ff%al r' q
€ r>
' 1, \
atIt
d. Post in Conspicuous Place in
.,' � Y.�f �� +�i � r ---ii-: . I•, -,;di, Com, ;,.._ _.. -x-_,,,,,.re ..
a 6,1-J /c 1\ I °, Ar4iP.e y `'rG `1 u,,> L ' 4 �` !" N ° ,: . �1 . ;'/ " �4B1i Y"+ ,1 'r i J-1tl'
." P V +�l' , ;-fi.- 'r+sa .rs� s.�y..1„,?
T'4a'ae s,rw 1 pti i i' t ��ax� J, -#� ',
"y r, it Sr _ v , miry i.. 1.y ) "
is°F 1er. COUNTY OF LOS ANGELES • DEPARTMENT OF PUBLIC HEALTH
ENVIRONMENTAL HEALTH
cre(-
t( �} qu i� SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH
,„ ® { PLAN CHECK PROGRAM -BALDWIN PARK COUNTYo LosAno ANGELES
xC4livOFiy 5050 COMMERCE DR, BALDWIN PARK, CA 91706 - Public Health
PHONE: (626)430-5560
•
W NNV.P U B L I C H EA LTH.LACO U N T Y,G O V/E H
•
OFFICIAL PLAN REVIEW REPORT
DATE 02/20/2019 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0141739
PROGRAM ELEMENT 1771 - EXPEDITED- RESTAURANT(0-500 SF) •
OWNER/REQUESTER ADAM KWAN, CONTACT •
DBA MYDO PIE
ADDRESS 400 S BALDWIN AVE#231,ARCADIA, CA 91007
INITIAL MODIFICATION OF APPROVED PLAN
STATUS: APPROVED
ADDITIONAL REQUIREMENTS •
THE REVISED PLANS ARE APPROVED, SUBJECT TO ON-SITE INSPECTION PRIOR TO OPERATION OR STOCKING
FOOD ON THE PREMISES. THIS APPROVAL IS LIMITED TO THE CHANGES AS DETAILED UNDER THE SCOPE OF
WORK(REPLACED THE OVEN WITH BAKER'S PRIDE EB-2-2828). APPROVAL IS CONTINGENT UPON THE
FOLLOWING:
1) OBTAIN LOCAL BUILDING DEPARTMENT PERMITS AND APPROVALS.
2)SUBJECT TO ON-SITE INSPECTION AND APPROVAL. ALL EQUIPMENTS MUST BE CERTIFIED OR CLASSIFIED
FOR SANITATION BY AN AMERICAN NATIONAL STANDARDS INSTITUTE(ANSI)ACCREDITED CERTIFICATION
PROGRAM OR AN ACCREDITED TESTING AGENCY.
3)ALL USED AND/OR EXISTING EQUIPMENT AND FINISHES SHALL BE IN GOOD REPAIR AND ARE SUBJECT TO
ON-SITE INSPECTION AND APPROVAL.
4) ENSURE THAT THE COMMERCIAL HOOD AND MECHANICAL EXHAUST AND MAKE UP AIR SYSTEMS MEET THE
UNIFORM MECHANICAL CODE.
5) READ AND COMPLY WITH THE FOLLOWING ATTACHMENTS REGARDING:
A) FINAL INSPECTION NOTICE
B) PLAN APPROVAL CHECK LIST
C) CERTIFIED FOOD HANDLERS CERTIFICATE •
6) HEALTH DEPT. APPROVED SET OF PLANS SHALL BE MADE AVAILABLE-SITE AT THE TIME OF FINAL
INSPECTION.
•
CONTACT VIVIAN TAN AT 626 430-5546/VTAN@PH.LACOUNTY.GOV<MAILTO:430-5546/VTAN@PH:LA000NTY.GOV>
TO SCHEDULE A FINAL INSPECTION.
PROVIDE AT LEAST 3 WORKING DAYS PRIOR NOTICE FOR A FINAL INSPECTION:
A FINAL INSPECTION SHALL BE CONDUCTED AND A PUBLIC HEALTH PERMIT SHALL BE OBTAINED PRIOR TO'
OPENING AND OPERATING THIS FOOD ESTABLISHMENT.
Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacountv.00v/eh.
EHS Signature Page 1 of 2
%,` COUNTY OF LOS ANGELES • DEPARTMENT OF PUBLIC HEALTH
n�"s`y ENVIRONMENTAL HEALTH
ff tit + SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH
749PLAN CHECK PROGRAM -BALDWIN PARK
k " COUNTY OF LOS MOMS
"��,,a n/ 5050 COMMERCE DR, BALDWIN PARK, CA91706 Public Health
PHONE: (626)430-5560
WVWV.PUBLICHEALTH.LA000NTY GOV/EH
OFFICIAL PLAN REVIEW REPORT
DATE 02/20/2019 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0141739 •
PROGRAM ELEMENT 1771 - EXPEDITED - RESTAURANT(0-500 SF)'
OWNER I REQUESTER ADAM KWAN, CONTACT
DBA MYDO PIE
ADDRESS • 400 S BALDWIN AVE#231,ARCADIA, CA 91007 •
INITIAL MODIFICATION OF APPROVED PLAN
STATUS: APPROVED
ADDITIONAL REQUIREMENTS •
THE REVISED PLANS ARE APPROVED,:SUBJECT TO ON-SITE INSPECTION PRIOR TO OPERATION OR STOCKING
FOOD ON THE PREMISES.-THIS APPROVAL IS LIMITED TO THE CHANGES AS DETAILED UNDER THE SCOPE OF
WORK(REPLACED THE OVEN WITH BAKER'S PRIDE EB-2-2828). APPROVAL IS CONTINGENT UPON THE
FOLLOWING:
1) OBTAIN LOCAL BUILDING DEPARTMENT PERMITS AND APPROVALS.
2) SUBJECT TO ON-SITE INSPECTION AND APPROVAL. ALL EQUIPMENTS MIDST BE CERTIFIED OR CLASSIFIED
FOR SANITATION BY AN AMERICAN NATIONAL STANDARDS INSTITUTE(ANSI) ACCREDITED CERTIFICATION
PROGRAM OR AN ACCREDITED TESTING AGENCY.
3)ALL USED AND/OR EXISTING EQUIPMENT AND FINISHES•SHALL BE IN GOOD REPAIR AND ARE SUBJECT TO
ON-SITE INSPECTION AND APPROVAL.
4) ENSURE THAT THE COMMERCIAL HOOD AND MECHANICAL EXHAUST AND MAKE UP AIR SYSTEMS MEET THE
UNIFORM MECHANICAL CODE.
5) READ AND COMPLY WITH THE FOLLOWING ATTACHMENTS REGARDING:
A) FINAL INSPECTION NOTICE
B) PLAN APPROVAL CHECK LIST
C) CERTIFIED FOOD HANDLERS CERTIFICATE
6) HEALTH DEPT. APPROVED SET OF PLANS SHALL BE MADE AVAILABLE-SITE AT THE TIME OF FINAL
INSPECTION:
CONTACT VIVIAN TAN AT 626 430-5546/VTAN@PH.LACOUNTY.GOV<MAILTO:430-5546/VTAN@PH.LACOUNTY.GOV>
TO SCHEDULE A FINAL INSPECTION.
PROVIDE AT LEAST 3 WORKING DAYS PRIOR NOTICE FORA FINAL INSPECTION.
A FINAL INSPECTION SHALL BE CONDUCTED AND A PUBLIC HEALTH PERMIT SHALL BE OBTAINED PRIOR TO
OPENING AND OPERATING THIS FOOD ESTABLISHMENT.
Help us serve you better by completing a short survey.Visit our website at www.oublichealth.lacountv.00v/eh.
EHS Signature Page 1 oft
r a
qty City of Arcadia, CA Permit Na SIGN-18-2265
A{ i Development Services Department _ .` . Permit Type Sign
\1t• 240 West Huntington Drive,Post Office Box 6od21 ,
I - Arcadia,CA 91066-6021 I }_. <_ „,,,,,. .t.,� WorkClassificanon Sign-Non Illuminated-;
(626)574-5416 - - 'Permit Status:Issued
ARCADIA 9 Issue Date 12/06/2018' Expiration: 06/04/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
400 S Baldwin AVE Arcadia,CA 5775031043II
Contacts
SANTA ANITA BORROWER LLC C/0 Owner ALEXIS ESTRADA Electrical Contractor
WESTFIELD SANTA ANITA (C-10)
400 1928 TYLER AVE F,SOUTH EL MONTE,CA 91733
(562)441-3172 432339
Description:ACRYLIC SIGN FACE CHANGE FOR MYDO PIE I Valuation: $2,200.00 Tenant ,
Total Sq Feet: 0.00 Plan Check q Plan M
Fees Amount Payments Amount Paid
Building Issuing Fee $44.35 Total Fees $276.48
Building Permit Fees $120.35 Cash/Receipt k REC-003074-2018 $276.48
Electrical Permit Issuance Fee $44.35
Sign Plan Review $60.18 Amount Due: $0.00
Solid Waste Management Fee $6.25
Solid Waste Management Fee 2 $1.00
Total: $276.48
CALLS FOR INSPECTIONS
/.__S —.1(1 J Request for inspection by telephone at 626-574-5450. Leave a message
ri-italic- requesting the address,timeframe and what inspection item is needed.
/iii.......7/
This permit/plan review expires by time limitation and becomes null and •
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit is suspended or abandoned for 180
consecutive days or if no progressive work has been verified by a City of
Arcadia building inspector for a period of 180 consecutive days.
o CUA$PLEThD
. ..,
December 06,2018
Issued By: Date
December 06,2018 Page 1 of 1
of Art • 4,
<,.,�, 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
Cfy of. ,
Arcadia'
ICENSED CONTRACTOR'S DECLARATION WORKERS'COMPENSATION DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of I hereby affirm under penalty of perjury one of the following:
Chapter 9(commencing with Section 7000,of Division 3 of the Business and
Professions Cott license is in full f e a°�d�/{�f act, �I I have and will maintain a certificate of consent to self-insure for workers'
License Class �/)/v se '� '/ E cp. Date ! ❑ compensation, as provided for by Section 3700 of the Labor Code, for the
`x> performance of the work for which this permit is issued.
Signature of Contractor \
OWNER-BUILDER DECLARATION ,i1, ave 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 '`licy Number
provisions of the Contractors License Law(Chapter 9(commencing with Sectio s 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 •
Ty 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 • employ any person in any manner so as to become subje • the workers'
penalty of not more than five hundred dollars($500)): ompensation Laws of California,and ale that if I sh•i I eco subject to the
workers'compensation provisions• ji0370r •1 • • ode,I shall
❑I, as owner of the roeforthwith comply those provisio `
property,work,or and employees with wages or theirs for e� r '1 `I
compensation,will do the the structure is not intended or offered for 1 �(p I`
sale(Section 7044,Business and Professions Code:The Contractors License Date Signatu .
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 thecost 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 inspectionioafd•inust 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
'? '''4
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,strip ing,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos. Please contact AQMD at(9 )396-2000 for
further infffoormation.� B ( y (A--
PRINT
— 'y/1�I
arae 17?‘
l �.A�1 I 1It t Title I C
PRINT NAME
I certify that I have •ad this application and state that the above information is correct and that I am the owner or duly authori d agent of the owner.
I agree to compl all Cit ordinan'•s d jte Laws relating to building construction. I hereby authorize represe tatives of the City of
Arcadia to enter . i . abo,�menf: ' ;• 'to.- •r inspection purposes. (� lI
Signature , �4 ``� Date \ U 4-1 l
City of Arcadia,CA �~ ( Permit No.FIRE-18-2328
i Development Services Department t °✓' v" ( "j -, • Permit Type Fire
240 West Huntington Drive,Post Office Box 60021 ,.f{ t.1 ) I l7 r w = -
! 1I Arcadia,CA 91066-6021 U= .4 }i "s% )• LI-C) Work Cfosstfrcation:•.Fire Suppression
(626)574-5416 - Permit Status:Issued
ARCADIA Wide Da[e 12/i7/2018 .Expiration: 06/15/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
400 S Baldwin AVE Arcadia,CA 5775031043
Contacts
SANTA ANITA BORROWER LLC C/0 Owner USFP INC' Fire Contractor(C-16)
WESTFIELD SANTA ANITA 11589 TUXFORD ST 1,SUN VALLEY,CA 91352
400 (310)849-6023 895398
Description:2 NOZZLES FOR MYDO PIE Valuation: $2,000.00 Tenant MYDO PIE
Total Sq Feet: 0.00 : Plan Check#18-2328 Plan It
vor.L.tai
Fees Amount Payments Amount Paid
Fire Extinguishing System Plan Check $280.00 Total Fees $429.00
Fire Issuance - $44.35 Cash/Receipt#REC-003163-2018 $429.00
Fire Permit Fees $103.65 -
Amount Due: $0.00
Solid Waste Management Fee 2 $1.00
Total: $429.00
CALLS FOR INSPECTIONS
COM���I Request for einspectiondesby telephone a atd what inspection
626-574-5450. Leave a
essage
requesting the address,timeframe and what inspection item is needed.
This permit/plan review expires by time limitation and becomes null and
void if the work authorized by the permit is not commenced within 180 days
from the date of issuance or if the permit is not obtained within 180 days
from the date of plan submittal.This permit expires and becomes null and
void if any work authorized by this permit 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.
/ December 17, 2018
Issued By: Date
December 17,2018 Page 1 of 1
' 'R
.vm.FO,,, ', .
i wan h PERMIT/PLAN REVIEW APPLICATION
EOr Development Services Department,240 West Huntington Drive,Post Office Box 60021
N. .,,,oro 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. ''//''yy ❑ I have and will maintain a certificate of consent to self-insure for workers'
I License Class C"/( Stene No./539..V 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 Contract-0---- V
OWNER-BUILDER DE LARATION 1 have and will maintain workers'compensation insurance,as required by Section
CII hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for he perfo mance of he work for which this permit
License Law for the following mason(Section 70313,Business'and Professions is issued.My workers'compens tion insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier 4al'6101 1- /J7 S l k°n/6
demolish,or repair any structure,prior to its issuance,also required the applicant J G /` o
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number Sin/L 9 �/GFrf�/
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. My 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 w h those provisions.
compensation,will do the work,and the structure is not intended or offered for / �9
sale(Section 7044,Business and Professions Code:The Contractors License Date lal/ /�X Signature s
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 penaltyof 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. 2.
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.
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n
Name 1 L • _ ti Title 0 TI'i C ✓
.. tJT - E
I certify that I have read this application and state that the above information is c erect 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. �
._ Date b]/7/AX7\sina4
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