HomeMy WebLinkAboutTI-18-1117 S
`�-e- I City of Arcadia, CA x 3 .-Ly: Permit NO TI 18 $117
Development Services Department -m..„--,,,j-
1 Perm(t Type TenantlmpfxOvement ,
i \� I 240 West Huntington Drive,Post Office Box 60021 ! a 1 j
I i. Arcadia,CA 91066-6021 -1-1.,11"-7-.1. r , ; � work Classfficatton Tenant Improvement
{ (626)574-5416 �_.. -PermitStatus,,lssued:
ARCADIA Issueoate09/10/21)18 Expiration: 03/09/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1108 S Baldwin AVE B7 Arcadia,CA 5778007029
Contacts
500 PROPERTIES LLC Owner SCP ARCHITECTURE&BUILD INC* - Applicant
1108 5 BALDWIN AVE 87 19811 COLIMA RD 210,WALNUT,CA 91789
(626)679-4679
WANKE DEVELOPMENT GROUP INC' General Contractor(B)
18472 COLIMA RD 218,ROWLAND HEIGHTS,CA 91748
(626)202-9083
Description:INTERIOR TI FOR 000.NOBIB I I Valuation: S 25,000.00 Tenant.000.N0818 I - -�
s Total Sq Feet: 0.00 Plan Check#18-1117 Plan#32588
Fees Amount Payments Amount Paid
Accessibility Plan Check $47.56 Total Fees $1,368.99
Accessiblity Building Permit $48.78 Cash/Receipt#REC-002254-2018 $595.13
Building Issuing Fee $44.35 Cash/Receipt#REC-001585-2018 $773.86
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 regp!
Energy Plan Review Fee $97.55
Green Building Standard $1.00 flip
Solid Waste Management Fee $6.25
Strong Motion Inst.Program Corn $7.00 CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
Total: $1,368.99 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.
4
September 10, 2018
Issued By: Date
September 10,2018 Page 1 of 1
•PA. w
c..,.o,,:n:r ►
111 .� 1 PERMIT/PLAN REVIEW APPLICATION
f:i— -
rt +
,m ►►jr 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
Oki 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 Cod nd my license is in full force and effect ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class Lico.6/,
I
Signature of Contractor . Bn(S61 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.
OWNER-BUILDER DECLARATION CII have and will maintain workers'compensation insurance,as required by Section
CII hereby affirm under penalty of perjury that I am exempt from the Contractors3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following mason(Section 7031.5,Business and Professions is issued.My wocrk ,'tc�,omp nsation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier 5k/t�t'teiACI
demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number "1 2 3 S 5 0^ 201 g
for such permit to file a signed statement that he or she is licensed pursuant to the
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the L or Code,I shall
CII, 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 rt
sale(Section 7044,Business and Professions Code:The Contractors License Date �'� �20I B Signature
Law does not apply to an owner of property who builds or improves thereon, 111111
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 costof 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. i�,,.,
(Name ��� Title r, v, E+ Vtu e
PRI 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 ordina es and State Laws relating to building construction. I hereby authorize representatives of the City of
1r Arcadia to enter upon the above-men '� 'd prope . ,' pection purposes. (j
Signature /I 0IO1(Date
'1
NOTES
Building Inspections Date Insp. Plumbing Inspections I Date I Insp.
100. Setbacks 210. Underflr/bldg.drain g-a-'a reAta7
101. Rough grade 211. Copper underslab
102. Figs.&forms 212. Rough plumbing (-2--625 /•
103. Pre-slab 213. Rough gas
104. Floor joists 214. Shower pan
105. Steel 215. Water heater
106. Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
109. Roof nailing 19. Final gas
110. Framing 1-S48 220. Fixtures
111. Occ/Area Sept.Wall 221. Final plumbing 2-1?
112. Sound walls 222. Sewer cap/demo.
113. T-bar-rid
114. Insulation-Flr. I-I- Pool Inspections I Date Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Cell. 241. Rough plumbing
117. Drywall nailing • 242. Light shell bonding
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade 45. Gas line&test
121. Final building 246. Fence,gates&signs
122. Anal demoAot dear 247. Pool heater
248. Final electric
Electrical Inspections Date Insp. 249. Final.lumbin.
150. Power pole ■■250. Pool cover ■■
151. l
Sales lot lighting 251. Pool final
152. Under!round conduit
153. Underslab conduit -- Reroof Inspections I Date I Insp. -
155. UFER ground 270. Pre-reroof
155. Water ground 71. Roof framing
156. Rough electrical f(- -M 272. Sheathing nailing
157. Fixtures 273. Anal reroof
158. G.F.C.I.
159. E.it.bonding --Sign Inspections I Date I Insp.
161. ServAnal e ptl 280. Footing overhang ■■
161. Anal electric /-2-�� � 281. Footing
282. Conduithvirin.
Mechanical Inspections Date Insp. 283. Disconnect
181. VentiFumace/ue -�i 284. Final sign --
181. Fumace/A.C.
182. Routh HVAC t -I -IS r%G✓J Miscellaneous Insp. Date I Insp.
183. Are 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 I-I- Sewers&Offsite Insp. I Date I Insp.
191. Anal mechanical 300. Lateral(main to Pt)
■■
galagala3011. SaddleN
Block Wall Inspections Date Insp. 302. Ce ...l filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
e. 'v4 3 *', M S
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AZ 44- Certificate of Occupancy -4
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City of Arcadia .. ,
wtzt.�, Development Services Department—Building Division
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S This certificate issued pursuant to the requirements of the
,,),.. :_it...
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4 California Building Code 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. TI-18-1117 F a .;
'; Building Address: 1108 S. BALDWIN AVE B7 ARCADIA, CA 91007
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if,,/
zz Permit Type: TENANT IMPROVEMENT
Effective CBC: 2016 C.B.C.
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Occupancy Code: B Zone Code: C-G
r ; F
Final Date: 1-31-19
¢@pType of Construction: TYPE V-N NON SPRINK �/'
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/ " Owner: 500 PROPERTIES Tenant: 000.NOBIBI
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"' . Kenneth Fields,B n f) ial K
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?doF.ws� COUNTY OF LOS ANGELES • DEPARTMENT OF PUBLIC HEALTH
,p s gs ENVIRONMENTAL HEALTH
f I r { SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH
c<-
+ 'I H. + PLAN CHECK PROGRAM -BALDWIN PARK
k*cH {/ COUNTY Of Los ANGELES
K C,EEir-- i 5050 COMMERCE DR, BALDWIN PARK, CA91706 Public Health
PHONE: (626)430-5560
W WW.PUBLICHEALTH.LA000NTY.GOV/EH
OFFICIAL PLAN REVIEW REPORT
DATE 11/01/2018 ' EHS VIVIAN TAN
PLAN CHECK NUMBER SR0150574
PROGRAM ELEMENT 1772- EXPEDITED- RESTAURANT(501-1999 SF)
OWNER/REQUESTER ADAM KWAN, CONTACT
DBA 000.NOBIBI
ADDRESS 1108 S BALDWIN AVE STE B7,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: RELOCATED SHELVES, ELIMINATED.WORK TABLE/EQUIPMENT AND RELOCATED THE WATER HEATER.
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 626 430-5546NTAN@PH.LACOUNTY.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.lacounty.gov/eh.
____L______---
EHS Signature Page 1 of 2
OFFICIAL PLAN REVIEW REPORT
DATE 11/01/2018 . EHS VIVIAN TAN `.
PLAN CHECK NUMBER SR0150574 , •
PROGRAM ELEMENT 1772-EXPEDITED- RESTAURANT(501-1999 SF)
OWNER/REQUESTER ADAM KWAN, CONTACT
DBA OOO.NOBIB!
ADDRESS 1108 S BALDWIN AVE STE B7,ARCADIA, CA 91007
COMMENTS
NONE
DISCLOSURES
Prior to construction and approval from the Los Angeles County Department of Public Health Environmental Health Division
(DPH-EH) Plan Check Program, final inspections must be obtained from Building and Safety (mechanical, plumbing, electrical)
and all other enforcement agencies.
Failure to obtain a Public Health Permit/License prior to operation of the facility/establishment is a misdemeanor violation.
Construction of the food facility/establishment must be completed and approved within twelve (12) months from the date of
approval to avoid submitting new plans.
A copy of the approved plans must be available at the time of the field construction review.
All utilities must be on and operational at the time of the field construction review.
Please contact your plan check inspector at least 3 days prior to the field construction review.
Two field inspections will be covered under the Plan Check fees assessed upon plan submission.
A charge will be assessed for each subsequent field construction review.
•
Help us serve you better by completing a short survey.Visit our website at www.pubtichealth.lacountv.00vfeh.
EHS Signature Page 2 of 2
,:,:.-2'—',-.7--5- •
1 City of Arcadia, CA ^�' Permit No;EIeC 18 2021
1 NV .1 Development Services Department D ) o.'y *' h;ay1)r ,,,,,i ",b}b __ r. Permit Type Electrical
240 West Huntington Drive,Post Office Box 60021 l f L1- t i ui{{{ rk Classification.-Electrical Residential ,
Arcadia,CA 91066-6021 ,
0 ,•l (626)574-5416 ,',permit StatusPissued,
ARCADIA, Issue 6ati:1.030/2018 Expiration: 04/28/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1108 S BALDWIN RD Arcadia,CA 5778007029 ,`
Contacts
500 PROPERTIES LLC Owner Xue Wei Chao Electrical Contractor
11085 BALDWIN AVE B7 (C-10)
509 Elm,Alhambra,CA 91801
(626)428-2888
Description:INSTALL OUTLETS IN KITCHEN AREA g Valuation: $0.00 : Tenant {
Total Sq Feet: 0.00 Plan Check N Plan If
Fees
Amount Payments Amount Paid
Electrical Permit Issuance Fee $44.35 Total Fees $68.45
Outlets-Receptacles&Switches $23.10 Cash/Receipt if REC-002729-2018 $68.45
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $68.45 ,
f7/4,06 /—*/—IQ ile.V. CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
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.
rA COMPLETE ,
October 30, 2018
Issued By: Date
October 30,2018 Page 1 of 1
OF AR
•
PERMIT/PLAN REVIEW APPLICATION
e_%
@3 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
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.
1 0 I have and will maintain a certificate of consent to self:insure for workers'
License Class
Signature of Contractor License No. Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION 0 I have and will maintain workers'compensation insurance,as required by Section
I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number
for such permit to file a signed statement that he or she is licensed pursuant to the
(This section need not be completed if the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
7000) of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of IDI 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 property, or my employees with wages as their sole forthwith comply with those provisions.
I, as owner of theP Y
compensation,will do the work,and the structure is not intended or offered for r�J �il�
sale(Section 7044,Business and Professions Code:The Contractors License
\Date(D/3 0/ b nn Signature 0/�-�'�'
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 ManagementDistrict(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 (
PRINT NAME le 0 GL/'r --it
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 1s� \Date ( rl Qlir
•
City of Arcadia, CA
11 PermrtNO PIUmr18 2022-
4
1 Development Services Department
) D
-
. -permit Type Plumblpg1
, 240 West Huntington Drive,Post Office Box 60021 f r s
I �3 Arcadia,CA 91066-6021 43 t er. CIRSSiJtcotron Plumbing Commercial
l (626)574-5416 �94 ,. ,, ^Aermrtsrorur..Issued:.
ARCADIA Issue Date 10/3o/zois, Expiration: 04/28/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip '
1108 S Baldwin AVE ARCADIA,CA 91007 `
Contacts
REN HUI ZHU Contractor
8031 HERMOSA,SAN GABRIEL,CA 91775
(626)285-5435 °s
Description:PLUMBING FOR T.I. Valuation: $0.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan U
Fees Amount Payments Amount Paid
Floor Drain Fee $24.92 Total Fees $197.96
Floor Sink $49.84 Cash/Receipt U REC-002735-2018 $197.96
Kitchen Sink $37.38 Amount Due: $0.00
Lavatories $12.46
Plumbing Permit Issuance Fee $44.35
Solid Waste Management Fee 2 $1.00
Water Closet $12.46
Water Heater and/or Vent $15.55
Total: $197.96
// CALLS FOR INSPECTIONS
11.4/4/6
6 `_27 `7 G /,�(� Request for inspection by telephone at 626-574-5450. Leave a message
�G —7G 7 /T` 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.
•
✓ COMPLETED
, ? 4
44, 7 .Jr yy!i
I it, .i`
7 +„
'ft1 October 30, 2018
Issued By: Date
October 30,2018 Page 1 of 1
1 PERMIT/PLAN REVIEW APPLICATION
e, =
:�.;;. k`*
mkttNitrizia 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
ofessions Code,trand my license is in full force and effect. ❑ I have and will maintain a certificate of consent to self-insure for workers'
L nse Class,�.ip, '�D License N .' l'/ T.. Date_ 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.
t
OWNER-BUILDER DECLARATION O 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 t 1 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions ' is issued.My workers'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, i ci 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 1,u1 Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section
;La(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 t"
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)): 4compensation Laws of California,and agree that if I should become subj o the
�;y:,workers'compensation provisions of Section 3700 of the Labor .de, shall
❑I, as owner of the property, or my employees with wages as their sole p",. forthwith comply with those provisions.
compensation,will do the work,and the structure is not intended or offered for ''1i (O_ ^Pe
sale(Section 7044,Business and Professions Code:The Contractors License fDate Signature L�� /Lt��
Law does not apply to an owner of property who builds or improves thereon, c')
or who does such work himself or herself or through his or her own ,a
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 subjectan 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
attomey'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 woik authorizedby 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.n.`�
ame /�-'+v H .21b Title 640 41PRINT NAME
(iLertify that I have read this application and state that the . . ; e 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 aws elating to building construction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property 'or ins,•ction purposes.
,
p_
.. c '
Signature I� Date fP —�—/6
ry
i
<th F .. -
l o"-f} ] City of Arcadia, CA
Permit NO::FIRE-18-2079
,� ,.'� Development Services Department Permit Type:Fire
240 West Huntington Drive,Post Office Box 60021
z WorkClassificahon Fire.Alarm
Arcadia,CA 91066-6021 } `
(626)574-5416 n y mss. permit Status Issued
ARCADIA issue Date 11/07/2018.1 Expiration: 05/06/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1108 S Baldwin AVE Arcadia,CA 5778007029
Contacts
500 PROPERTIES LLC Owner E R 5 Security Alarm Systems Electrical Contractor
1108 S BALDWIN AVE 87 (C-10)
4538 Santa Anita,El Monte,CA 91731
(626)579-2525
Description:FIRE ALARM FOR TI 4 DEVICES Valuation: 5 2.000.00 Tenant
Total Sq Feet: 0.00 Plan Check N Plan 0
varsi
Fees Amount Payments Amount Paid
Fire Alarm Plan Check $280.00 Total Fees $429.00
Fire Issuance $44.35 Cash/Receipt N REC-002824-2018 $429.00
Fire Permit Fees $103.65
Amount Due: $0.00
Solid Waste Management Fee 2 $1.00
Total: $429.00
•
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
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.
November 07,2018
•
Issued By: Date
November 07,2018 Page 1 of 1
F ARC.
0.,,,F.„4.,
paw kr PERMIT/PLAN REVIEW APPLICATION
iiti 6411,
E�3*' Development Services Department,240 West Huntington Drive,Post Office Box 60021
,F 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 C' O License No.'-&S/t'4Exp. Dates.e compensation, as provided for by Section 3700 of the Labor Code, for the
Il
Signature of Contractor 4.X. -
performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATIOl� CII 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 y
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number r�fV ic•r GP:for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed rf the permit is for one hundred dollars or less)
provisions of the Contractors License Law(Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code)or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ 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 I"—,J Date ,i -If'Signature °'" '
sale(Section 7044,Business and Professions Code:The Contractors License
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 performanceof 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 14f Tro C. )ritle•
PR AME
•
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 (/moi ate //— 0 ( — / t
JE ' PermitNO'FIRE 18 1878;
•er, City of Arcadia, CA �
i I Development Services Department i] '^ Pelmrt Type Flre'�,
13I 240 West A 9106 -6 Drive,Post Office Box 60021 ° a-? �' 1 kff Wo k classijicobon Fire Sprinkler
Arcadia,CA 93066-6W1 � �- x � k1 ,.:.
(626)574-5416 , ,--Permit Status-Issued"
ARCADIA issue Date 10/1o/zo181 Expiration: 04/08/2019'
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip
1108 S Baldwin AVE Arcadia,CA 91007
Contacts
F&H Fire Protection* Applicant
1119 Westminster AVE,Alhambra,CA 91803
(626)262-3876 DANIEL@FH FIREPRO.COM
Description:FIRE SPRINKS FOR T.I. Valuation: $400.00 Tenant
Total sq Feet: 0.00 Plan Check#18-1771 plan#
•
Fees Amount payments Amount Paid
Fire Issuance $44.35 Total Fees $366.00
Fire Permit Fees $40.65 Cash/Receipt#REC-002552-2018 $366.00
Solid Waste Management Fee 2 $1.00
Sprinkler Heads $280.00 Amount Due: $0.00
Total: $366.00
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
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.
1112 COMPS
TED
October 10, 2018
Issued By: Date
October 10,2018 Page 1 of 1
rF A,
° " 1 PERMIT/PLAN REVIEW APPLICATION
14 p. Development Services Department,240 West Huntington Drive,Post Office Box 60021
c),-..-- /• Arcadia, CA 91066-6021, (626) 574-5416,Fax (626)447-9173
0ou„of
City of
Arcadia
LICENSED CONTRACTOR'S DECLARATION WORI{ERS'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 y license is in full force and a ct. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class_ [ License No. f�Exp. Date g�Ii",, compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor f performance of the work for which this permit is issued.
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�rMy workecompensatiom insurance carriernsvtd policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, CarrierVpy yA V9iA}gyl ce / `A'ic c .
demolish,or repair any structure,prior to its issuance,also required the applicant Policy Number I'+\/v 7000_02
(((��� /
for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not be completed if the permit is orr one hundred dollars or less)
provisions of the.Contractors License Law(Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code)or that heor 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
0 I, as owner of the property, or my employees with wages as their sole forthwith tour ly h those provisions.
compensation,will do the work,and the structure is not intended or offered for 114) // i
. sale(Section 7044,Business and Professions Code:The Contractors License Date Signature L/«l�
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
rther information. I�,y ,I/,.1/4/I /� /l/
Name AHI- H - PRmWr'NAME �' V �j Title Ct- W
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. /:12Signature Date l� 0