HomeMy WebLinkAboutTI-18-0397 a- --
I _ City of Arcadia,CA rr� i, Permit NO TI 18-0397
\ i Development Services Department D r V Permit Type•Tenant Improvement '
1 240 West Huntington Drive,Post Office Box 60021 III
Arcadia,CA 910 6-6021 a t• Lim Work Classification::.Tenant Improvement
(626)574-5416 i 1 - "3^1:. . Permit_Status:+issued ;
ARCADIA - - .issue Date;08/21/2016 Expiration: 02/17/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number `
1205 S Baldwin AVE A Arcadia,CA 5383038021 I
Contacts
BALDWIN ARCADIA CENTER LP Owner PATCH CONSULTANTING CORP Applicant
815 W NAOMI AVE A 1701 W CEDAR ST 9,ALHAMBRA,CA 91801
(626)203-7921
• JVN CONSTRUCTION INC* General Contractor(B)
3669 SAN GABRIEL RIVER PKWY,PICO RIVERA,CA 90660
(626)383-6819
Description:INTERIOR T.I FOR RESTAURANT ENERGY BISTRO. Valuation: $ 150,000.00 Tenant ENERGY BISTRO
INSTALL NON BEARING PARTITION WALLS,NEW
KITCHEN/EQUIPMENT,NEW ADA RESTROOM.WITH EMP. Total Sq Feet: 0.00 Plan Check#18-0397 Plan ff 32579
Fees Amount Payments Amount Paid
Accessibility Plan Check $152.98 Total Fees $4,718.84
Accessiblity Building Permit $156.90 Cash/Receipt p REC-000647-2018 $1,868.62
Building Issuing Fee $44.35 Cash/Receipt q REC-002095-2018 $2,850.22
Building Permit Fees $1,569.00 Amount Due: $0.00
Building Plan Review Fee $1,019.85
Cal Green Plan Check $101.99
CommercialsT.I.Fire Plan 1Chk.5 $280.00 COMPLETEDCompressor 3-5 Ton(3 to 15 hp) $137.16i
Electrical Permit Issuance Fee $44.35
Energy Plan Review Fee $313.80
Floor Drain Fee $49.84 CALLS FOR INSPECTIONS
Floor Sink $62.30 Request for inspection by telephone at 626-574-5450. Leave a message
Furnace or Burner<=100,000 BTU $74.96 requesting the address,timeframe and what inspection item is needed.
Gas System(Outlets) $80.84
Green Building Standard $6.00
Hood Serviced by Mechanical Exhaust $14.11 This permit/plan review expires by time limitation and becomes null and
Install,Relocate Appliance Vent/Hood $46.90 void if the work authorized by the permit is not commenced within 180 days
Interceptor $24.97 from the date of issuance or if the permit is not obtained within 180 days
Kitchen Sink $74.76 from the date of plan submittal.This permit expires and becomes null and
Lavatories $49.84 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
Light Fixtures $148.80 Arcadia building inspector for a period of 180 consecutive days.
Total: $4,718.84
August 21,2018
Issued By: Date
August 21,2018 Page 1 of 1
,FAR as e
PERMIT/PLAN REVIEW APPLICATION
a, 1, *
itii*' Development Services Department,240 West Huntington Drive, Post Office Box 60021
0e "`e� 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 Codde,a❑llf'
mylicenseis in full foreand effect. ( 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class. J_0 t5 se No.OSQ?) Exp. Date'S compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor
performance of the work for which this permit is issued.
OWNER-BUILDER DE ARA ON ❑ 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 mason(Section 7031.5,Business and Professions i issued. workers'rkers' ompensatio.i"nsuran^cce c er aid policy nu bei Tare:
Code.Any city or county which requires a permit to construct,alter,improve, airier WQrkfrS /�1' ih 460N"eOYq- /4*
demolish,or repair any structure,prior to its issuance,also required the applicant
o]icy Number 3 ��9 ) 7/7—I 7
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 them 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 Sect 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith coply with tl1 se 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
ite
a. ignature
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. /J �q�
(Name )an"- GE L1e ANI�'d-rv� Lr'tGU!foe,
PRINT NAME �/ d^'
I certify that I have read this application and state that the above information is cor ct and that I am the owner or duly authorized agent of the owner.
I agree to comply
lPwith
h all City ordinances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to entevthe above-me 'oned property for inspection purposes.
(signature Date ergo c)j �(
12cc , S A Cu t.-1
, NOTES
Building Inspections Date Insp. Plumbing Inspections Date Insp.
100. Setbacks 210. Under flr.ftldg.drain I ' / I/ Q
101. Rough grade 211. Copper underslab - A.
?� 1S k AScr $ Var "/ I,,'z#
102. Figs.&forms 212. Rou,h'lumbin. .= 11 A. r- eGer-itic--64 V.(ilCcf /
103. Pre-slab 213. Rough gas r11-t I'Car.
104. Floor joists 214. ShowWater pan , / ,[//�
105. Steel 215. Water heater /O-(-`S in(At<- tie-AIN/NO-tlk� !A
106. Grout lift 216. Roof drains 'I,
107. Shear nailing 217. Building sewer
108. Diaph nailing 218. Water service
{Z-1 ar iS �l{
,/' e5 4/-11±2 +e
� YLaI� Ca/GL i
109. Roof nailing Finalgas110. Framing 11-f3j-LtS ^92l9.
220. Fixtures • -
Ill. Gcc./Area Sept.Wall 221. Final plumbing 17,p7-r i S
112. Sound walls ,222. Sewer cap/demo.
113. T-bar.rid „a •I8 a ' / fo-,rS-48 ocse!t GAS 1.s,- Frs f
114. Insulation-Flr. Pool Inspections Date Insp. /AiTiO 4,6S tcp` o. C ly 1
115. Insulation-Wall 240. Excavation/steel i / -
116. Insulation-Cell. 241. Rough plumbing 114.12> �CatitiFig€.•+AssE•< octie
117. Drywall nailing 1 i 2Hb'' 6'3 242. Light shell/bonding JI$-6S 2? & iftrAlG 5E/LVtCt Co-0c)25
118. Interior lath 243. Underground conduit
119. Exterior lath 244. P-trap Fir. 6c' 1tt 845-64464-
120.
As5' 4120. Finish grade 45. Gas line&test 6e u(ZC f N 65-Ar-F cr szr ro
121. Final buildins 24.- - dam./.-- 246. Fence, sates&si.ns
122. Final demo/lot clear 247. Pool heater ■ tgarrf j A1CsPASS fLSar Lnza3C
248. Final electric 760 r Tifza Aa(xr,J TO 7W€
Electrical Inspections Date Insp. 249. Final slumbin.
150. Power pole 250. Pool cover EW MCI-Ea-LecArta. ' 6i✓ r4d /�,//..y
151. Sales lot lighting 251. Pool final EL772.
6CLG eesos t. CSP izcsS A-. '" 6
152. Underground conduit 2 p y /� /4 ! J.�i t
153. Underslab conduit Reroof Inspections I Date I Insp.
154. UFER ground 270. Pre-reroof insp. -
155. Water ground 271. Roof framing
156. Rough electrical I I-15-48 •7/272. Sheathing nailing --
157. Fixtures /' " . 73. Final reroof
158. G.F.C.I. ( es-19
159. Eqpt.bonding Sign Inspections Date I Insp.
160. Serviceel panel 281. Fooling erhang ■
161. Final electric 1-$-19 a 281. Footing
282. ConduitMmin.
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. RouchHVAC -11-757 1-6 lig= Mr -II. •,i I I. D.t• I I I.
183. Fire dampers 290. Fire alarm
184. Furnace compartment 291. Underground supply
185. Combustion air _ _ __ _ 292. Are 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 I Insp.
191. Final mechanical i'1,217.(63 '. 300. Lateral(main to Pt) ■
301. Saddle/V
Block Wall Inspections ' Date Insp. 302. Cess,8.1 filled
200. Footings 303. Sidewalk
-
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
as,of tO}+No COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH
* I s} ENVIRONMENTAL HEALTH
ce(-
4 `� '' �,q�',- t SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH
}k — , IrrX PLAN CHECK PROGRAM-BALDWIN PARK
Comma Los ArKarl
xGuroaW''X 5050 COMMERCE DR,BALDWIN PARK,CA 91706 Public Health
PHONE:(626)430-5560
WWW W.PUBLICHEALTH.LA000NTV.GOWEH
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 03/20/2019 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0134787
PROGRAM ELEMENT 1704-RESTAURANT(4,000-9,999 SF) .
OWNER/REQUESTER C.C. CHANG, DESIGNER
DBA MOXIE LOUNGE AND KARAOKE
ADDRESS 1205 S BALDWIN AVE A,ARCADIA, CA 91007
FINAL REINSPECTION STATUS: APPROVED
PCIRRECTIONS'COMPLE+ IED -12 s N4. 4 '. i , 4 � "'t'
�' ... _ d �ivra.'�tt:s+.x: , _ „ T . X1-4 i rz.r, i a pO,'{xir
CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED
FOOD PROTECTION/FOOD STORAGE 01/17/2019 01/24/2019
EMPLOYEE FACILITIES 01/17/2019 01/24/2019
PLAN SUBMITTAL/REMODEL - 01/17/2019 01/24/2019
PLAN SUBMITTAL/REMODEL 01/24/2019 03/20/2019
ADDITIONAL REQUIREMENTS
RECEIVED BLDG. FINAL AND REQUESTED OWNERSHIP DOCUMENTS.
THIS FACILITY IS HEALTH DEPARTMENT APPROVED AND ARE OK TO OPERATE.
THE DISTRICT INSPECTOR WILL CONDUCT A ROUTINE INSPECTION AND ISSUE A LETTER GRADE.
NOTE: THE SLIGHT ABRASIVE FLOORS SHALL BE LIMITED TO WALKWAYS ONLY(APPROVED ON PERFORMANCE
BASIS).
COMMENTS
NONE
Help us serve you better by completing a short survey.Visit our website at www.publichealth.lacounN.00v/eh.
EHS Signature Page 1 of 2
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 03/20/2019 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0134787
PROGRAM ELEMENT 1704-RESTAURANT(4,000-9,999 SF)
OWNER/REQUESTER C.C. CHANG,DESIGNER
DBA MOXIE LOUNGE AND KARAOKE
ADDRESS 1205 S BALDWIN AVE A,ARCADIA, CA 91007
DISCLOSURES
It is a misdemeanor violation to begin operation without a valid Public Health Permit/License.The Public Health
Permit/License will be issued by the Los Angeles County Department of Public Health Environmental Health Division(DPH-EH)
Plan Check Program at the job site following final inspection and approval by all applicable agencies. Remodeled areas of an
existing food facility/establishment must obtain a final inspection and approval from all applicable enforcement agencies prior
to use.
Any future alteration,construction,building,renovation,repair,change of equipment,change of the operation of a food
facility/establishment or change of menu may require plans to be submitted to the DPH-EH Plan Check Program. Additional
approvals may be required from other enforcement agencies.
It is improper and illegal for any County officer,employee or inspector to solicit bribes,gifts or gratuities in connection with
performing their official duties. Improper solicitations include requests for anything of value such as cash,discounts,free
services,paid travel or entertainment,or tangible items such as food or beverages. Any attempt by a County employee to
solicit bribes,gifts or gratuities for any reason should be reported immediately to either the County manager responsible for
supervising the employee or the Fraud Hotline at(800)544-6861 or www.lacountyfraud.org. YOU MAY REMAIN ANONYMOUS
Public Health Permit/License:
A separate fee is required for the Public Health Permit/License.A billing statement will be sent to the permit/license holder
annually by the DPH-EH. The fee is required to be paid to perform or carry on,conduct or engage in any mobile food facility
listed in Los Angeles County Code,Title 8,Section 8.04.720.
State and Local Licenses and Permits:
Contact the State of California and your local city hall regarding additional license and permit requirements.
Restrooms:
Customer may use restroom facilities if they are located in a customer area.Customers may not enter the food preparation
area,food storage area,or the utensils washing/storage areas in order to access the restrooms.All food,utensils and
equipment must be protected from contamination.
Routine Inspection:The DPH-EH conducts routine inspections of all food facilities in Los Angeles County. Following the
issuance of your Public Health Permit by the Plan Check Program,an Environmental Health Specialist from your local district
will conduct an inspection of your facility. If your Business is located in a city that has adopted the grading ordinance,the
inspector will post a grade or score card at your facility. Grade/Score cards are not issued by the Plan Check Program.
Help us serve you better by completing a short survey.Visit our website at vnvw.publichealth.lacounN.pov/eh.
EHS Signature Page 2 of 2
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Certificate of Occupancy N.:: '
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Development Services DeofpartmArcadient—Building Division :.e:, :`,
,'
This certificate issued pursuant to the requirements of the v 'f'
Qh California Building Code certifying that at the time of issuance this structure was in .L
izi . compliance with the various ordinances of the City regulating building construction or use. `'ill
✓^� 4,11
a:4. Permit No. TI 18-397 .F"4.
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Building Address: 1205 S BALDWIN AVE #A ARCADIA, CA 91006 i'
1 ' .
Permit Type: TENANT IMPROVEMENT Effective CBC: 2016 C.B.C. , ��
r
;:.,Y
_, 1. Occupancy Code: A-2 Zone Code: C-2 t
S .
e'� \ -- Final Date: 3-28-19 T e of Construction:
yp TYPE III A SPRINKLERED
4 A1'
4+', '= Owner: BALDWIN ARCADIA CENTER LP TENANT: MOXIE LOUNGE& KARAOKE
-
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.
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ALL AMERICAN
INSPECTION
PO Box 6321,San Pedro,CA 90734 1310i3&7005(Call/Text) I Contact( AIlAmericanlnspectionService.com
(gw4ii CZ-eq So
Deputy Inspector's Daily Report
tW-Concrete,f Epoxy/DIA ❑ Wood ❑ Welding ❑ Masonry ❑ Steel Check ❑ Soils ❑ Other
1207A Project Name 134\ IIWl'(1 Arca AIq (on-e( 1 Report Date
3 18/I I
>,D9 in A\A-Addr^ess 9IS IA Naomi . Ale A Permit# (5M I ` - � 1 7
\(CesdIAi(k 1100 I 7Accek,A o )C \C� Contractor C'4N1e1 _
Description of Work Observed
oby cvea -tht rei rclrc f ee.J 4 (nS-lall -honc-I' Aperax( o /a 1,Fit. ■ K13-"I Ex , . Anc1,� o }rusk enc °Sur__ erS r, �e,aon
s e s2 ofct pre e p apl fen lee Ins glln 6n 4 415 re. n{' - 8 >e 3 /„ "
\ 6TH (1. Ant tri enclosure.
& AVat `Tory- C' + TbS. w
l
C4tth 011 frr xa ck use\L cbsec*e ,n accorcrm_ To
app . pns4 specs.
vkocY- is coMn\R- .
la_ rsx-11/7 1
-ro_rvi4 ideOch 752MEM44
seri&I oR 12 728`-
(;,11brr,hon 1 8/20/7
J -
rSamples: Yes ❑ No Bit Sample Type Sample Quantity
Paid COD � ❑ To Be Billed
Chk# 1067 Chk Amount$ Zi9G G° Billing Email/Address
Cash Amount$ er Paid Credit Card ❑ Billing Info on File❑
Inspector NameuftOf)(,t M �1 C�Qill Sig Lic# P 39 y6
Time In 1,-.0t9R V Time Out Reg Hours Y Time% Double Time
Hours Verified By:
Superintendent's Signature
All Inspections are based on 4 and 8 hour minimums.Saturdays/evenings are billed at time Sundays/Holidays at double time.
-' e
•
•
ICC� INSPECTION CONSULTING SERVICES P.O.Box 2047•West Covina,CA 91793.2047
�7 Serving Southern CaliforniaPhone(626)926-4236
INSPECTION REPORT icsinspection@yahoo.com
psp�ecter Job Number Onto IA _Lr W T F SS
I
LP 70 (0Cr 3/1 19
Job Mune Bald Po AN rI OSA/GeNro ApF.iml Junemeem
;AMIE. Lovn1(aS.. KA!�oCL COMM-1R-o3S-I
Andress Gemmel Conbunor
0.05 S OWlt4 AV&T.1U� . AC[kOla nbaNsp._
MM." Engineer sw Canb.eter OWN
f REQUIREMENTS:Limit of one job number,one permit number per sheet.Identify ell work by type and SPECIFIC location.
Non-Compliant work must be specifically Identified.Communication(RFI Sketch,etc.)voiding previous non-compliant items must be listed.
Record conversations and communications with project designers.building and permit granting authority officials.
Hours •
REGULAR 1.5 X 2 x Mileage:
Expenses:
❑Reinforcement ❑Conaete ❑Masonry ❑Prestress Post Ten U Fireproofing
8•Sfructural Steel ❑ Epoxy ❑Other
Description ot Work Inspected
taS TED TAE \SuAI. Q2ec4LES OP T11EwC iptEtito WabC Fat THE(ni)-rnA5$ Enl(-lacuQa Rot*egg-
S-2(C.D,1,z ( 3. Viri_tIN(a b1AS k-9-€t o`! (ortQLErF. u?biJ_AP OVAL. WEub PvoFft- S 5 LOcATIcr4S
Ar eAR T $F fro A(c0R 00I) Affnovt0 r_i.1S b spuuFtca-ncnt.
•
Mix Used Design PSI Cubic Yards Specimens
Certification of Compliance
I declare under penalty of perjury that all of the above statements All Inspection based on a minimum of 4 hours and over 4
are true, and that of own personal knowledge that the work hours-8 hour minimum.In addition,any inspection extending
• during the period covered by this report has been performed past noon will be an hour minimum.If Inspector is called to
and installed in every material respect in compliance with the a project and no work performed, a 2 hour minimum will be ,
approved plans,specifications and all applicable codes applied.
Inspector Name: 'WOAD fit Th
Approved/Authorized by:
Inspector Signat (Project Superintendent)
•
Inspector ID's ONESO4tail t Submitted By:
• (Inspection Consulting Services)
Page: of:
•
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r- C ' PermrtNO Comm 19 0397
\i4j Development
of Arcadia, CA
A
Developmen[Services Department ,---,—" Permit Type Commercial
v.. 240 West Huntington Drive,Post Office Box 60021 D / ' f ii j
Arcadia,CA 91066-6021 12Work'Classr�'cation:Commercial-Add/Alt
T.-0j (626)574-5416 permit 5tatiigxlssued''.
ARCADIA - issue Date 02/26/2019; Expiration: 08/25/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1205 S Baldwin AVE Arcadia,CA 5383035029
Contacts
BALDWIN ARCADIA CENTER LP Owner JVN CONSTRUCTION INC' General Contractor(B)
815 W NAOMI AVE A,Arcadia,CA 91007 3669 SAN GABRIEL RIVER PKWY,PICO RIVERA,CA 90660
(626)383-6819 856932
Description:TRASH ENCLOSURE FOR ENERGY BISTRO Valuation: $ 12,000.00 Tenant
Total Sq Feet: 0.00 Plan Check# Plan#32691
Fees Amount Payments Amount Paid
Accessibility Plan Check $26.39 Total Fees $575.26
Accessiblity Building Permit $27.07 Cash/Receipt#REC-00512-19 $575.26
Building Issuing Fee $47.01
Amount Due: $0.00
Building Permit Fees $270.65
Building Plan Review Fee $175.93
Cal Green Plan Check $17.60
Green Building Standard $1.00
Solid g Motiont Management Programe $3.35 COMPLETED
Strong Inst. Corn $3.36
Total: $575.26 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.
February 26, 2019
Issued By: Date
February 26,2019 Page 1 of 1
.FAR
,....a.„.,,,
PERMIT/PLAN REVIEW APPLICATION 4
iil (;1:tit ha.rci n
ira:t Development Services Department,240 West Huntington Drive,Post Office Box 60021
t> Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
LICENSED 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 Code,andmylicense is in full force and,effect. p �,ry ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class C ZO.J Li� No. g15��3d Exp. Date O I/`I compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor %. .
erformance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION 6� 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 00 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 1/1 hiI e
for such permit to file a signed statement that he or she is licensed pursuant to the (This section need not 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 .0I 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 th those provisions.
compensation,will do the work,and the structure is not intended or offered for ( zd 6��9 Signature
sale(Section 7044,Business and Professions Code:The Contractors License ate
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).
❑ 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.
e °M r V Vac Title Ona n
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 `n(Jt�h(eJa(bboovve-mentioned property for inspection purposes. /'1 /` /// /� q�
icnature Date �/ 1-b/ tie' C
Permit NO SIGN 19-0320
ag City of Arcadia, CA ► C
} )( Development Services Department 4"'` r PermatType:Sign
` 240 West Huntington Drive,Post Office Box 60021 t wx .m 11
Arcadia,CA 91066-6021 ,,,A ar. _v Ili Wolk Closstfication Sign Illuminated;
I ,; (626)574-5416 ' `_ 'Permit Status:Issued
ARCADIA Issue oate:02/14/2019.1 Expiration: 08/13/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1205 S Baldwin AVE A Arcadia,CA 5383038021II
Contacts
BALDWIN ARCADIA CENTER LP Owner ' PRINTBYME INC* Contractor
815 W NAOMI AVE A,Arcadia,CA 91007. 251 E GARVEY AVE B,MONTEREY PARK,CA
(626)571-1300 996117
Description:LED CHANNEL LETTER SIGN FOR MOXIE LOUNGE Valuation: $ 2,000.00 Tenant
AND KARAOKE
Total Sq Feet: 0.00 Plan Check it Plan N
Fees Amount Payments Amount Paid
Building Issuing Fee $47.01 Total Fees $339.08
Building Permit Fees $103.65 Cash/Receipt U REC-00418-19 $339.08
Electrical Permit Issuance Fee $47.01
Sign and Branch Circuit $65.86 Amount Due: $0.00
Sign Connection $16.48
Sign Plan Review $51.82
Solid Waste Management Fee $6.25 COMPLETED
Solid Waste Management Fee 2 $1.00
Total: $339.08
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a message
3--20-G 7 requesting the address,timeframe and what inspection item is needed.
V -
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.
February 14, 2019
Issued By: Date
February 14,2019 Page 1 of 1
•F AR
W'''rOtV4\,
IR ..,-JIM,
h PERMIT/PLAN REVIEW APPLICATION
� �3j, 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
fessions 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 L.4S Lice. - No. ,di'i 17 Exp. Date 6Gw' compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor 41 performance of the work for which this permit is issued.
_
i
OWNER-BUILDER DECLA�.TI e N ❑ I have and will maintain workers'compensation insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors
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 � 41c e '
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 them 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 mom 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
forthwith comply with those provisions. t
❑I, as owner of the property, or my employees with wages as their sole /� /\ �/
compensation,will do the work,and the structure is not intended or offered for Date 2/(4/1-1. Signature ( V
sale(Section 7044,Business and Professions Code:The Contractors License L✓�J
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.
Dame LI4il� e/ - \ritle Ac rC
IPRINt 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
\gnature
rcadia to enter upon he ove-mentioned property for inspection purposes.
'� Date 2i( lei
y
4. ikflq ,
PRINTING I SIGNS
251 E Garvey Ave Ste. B
Monterey Park CA 91755
Tel 626.571.1300-,
Fax 626.571.1311
I,Nicky Chung,Licensed Contractor, Authorizing CHIA YANG HUANG
to act on my behalf for the purpose of obtaining one sign permit for the
following project:
MOXIE KTV
1205 S. Baldwin Ave Unit A
Arcadia, CA 91007
This Authorization includes signing the building & planning permit and all
supporting documentation on my behalf.
Printbyme, Inc.
KICKY CHUNG
LIC. # 996117 !�
251 E Garvey Ave. Ste. B
Monterey Park CA 91755 KICKY CHUNG
Tel 626.571 .1300 Class: C45 License: 996117
Fax 626.571 .1311
DOCUMENT TYPE: AUTHORIZATION LETTER- PRINT BY ME
DOCUMENT DATE: DEC 1, 2018
ACKNOWLEDGMENT
'A notary public or other officer completing this
certificate verifies only the identity of the
individual who signed the document to which this
certificate is attached, and not the truthfulness,
accuracy, or validity of that document.
State of California
County of tI/04 ,A144&60
On DEC 1, 2018 before me,(� ,',�,,Q,(/(�1 -OW
-
A Notary Public personally appeared 1\61/4.< CAN
who proved to me on the basis of satisfactt5ry evidende to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged to me that he/she/they executed
the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the
instrument.
I certify under PENALTY OF PERJURY under the laws of the State of California that the
foregoing paragraph is true and correct.
WITNESS my hand and official seal. t f
,- se IRENE HUI <
-� r,Y,a. COMM.#2026455 rB
N f 9' NOTARY PUBLIC.CALcORNIA N
nN, LOS ANGELES COUNTY
7 ` MY COMM.EAP.JUNE 27,2017
SignaturZ�---.--------
(Seal)
,J t-'," _.. v ex^i.
City of Arcadia,CA "'PermttNO FIRE 18 1829';
Development Services Department j r} '` '+'``r -,—v ?i } z Permit Type Fire,
240 West Huntington Drive,Post Office Box 60021 t „riff �` 1.2Nil
1 Work classification:Flre Alarm-,
Arcadia,CA 91066-6021
ft_.) 1 .a ',I. L:.s = r , - - r.
(626)574-5416 il=r, *� V--„?..-'
, Permit Status:Issued.1,
ARCADIA IssueDaYe:10/04/2018 Expiration: 04/02/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1205 S Baldwin AVE A Arcadia,CA 5383038021
Contacts
BALDWIN ARCADIA CENTER LP Owner E R S SECURITY ALARM SYSTEMS INC* Fire Contractor(C-16)
815 W NAOMI AVE A,Arcadia,CA 91007 4538 SANTA ANITA AVE,EL MONTE,CA 91731
(626)579-2525
Description:FIRE ALARMS 39 DEVICES Valuation: $ 6.000.00 Tenant
Total Sq Feet: 0.00 Plan Check#OTC Plan it
Fees Amount Payments Amount Paid
Fire Alarm Plan Check $840.00 Total Fees $1,055.80
Fire Issuance $44.35 Cash/Receipt it REC-002497-2018 $1,055.80
Fire Permit Fees $170.45
Amount Due: $0.00
Solid Waste Management Fee 2 $1.00
Total: $1,055.80
* /phi
0 r
CALLS FOR INSPECTIONS W4
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.
/'
/ October 04,2018
Issued By: Date
October 04,2018 Page 1 of 1
:,,.,rney,
a<,, ? 1 PERMIT/PLAN REVIEW APPLICATION
fr
O ,110
oj, 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. q ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class G/V License No.712E90 4 Exp. Date r/3O,r/
Signature of Contractor l/ compensation, as provided for by Section 3700 of the Labor Code, for t6// y_V 1,4/1 „ 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
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My 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 O/C( T r
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 hose 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 /nom //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(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 theperformance 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.
1
)Name gi' / f o C -fes] Title .
PRINT NAME
I certify that I have read this application and state that the above information is cor4ect 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 buildin construction. I hereby authorize representatives of the City of
1 Arcadia to enter upon the above-mentioned property for inspection purposes. /_
Signature /.....".1 --, / Date / 0 -- 4 !f
�a a City of Arcadia,CA ?-.s ;# ..t � ' .i`Permit No.FIRE-184722.,
Development Services Department ws x s-' : Permit Type Fire
�y"
� 240 West Huntington Drive,Post Office Box 60021 �r-" ,. t( Work Classification Fire 5pfinkier'.
1 Arcadia,CA 91066-6021 3-. �i`r'
(626)574-5416 =?y "Permit Status Issued
s ytr[ r
y s
ARCADIA , Issue Date 10/OS/2018, Expiration: 04/03/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1205 S Baldwin AVE A Arcadia,CA. 5383038021Il
Contacts
BALDWIN ARCADIA CENTER LP Owner Alabout Fire Fire Contractor(C-16)
815 W NAOMI AVE A,Arcadia,CA 91007 220 N Crescent WAY#L,Anaheim,CA 92801
(714)284-0264
Description:FIRE SPRINKS FOR ENERGY BISTRO tValuation: S 3,000.00 Tenant ENERGY BISTRO
Total Sq Feet: 0.00 Plan Check#18-1722 Plan#
Fees Amount payments Amount Paid
Fire Issuance $44.35 Total Fees $865.70
Fire Permit Fees $120.35 Cash/Receipt#REC-002512-2018 $165.70 •
Solid Waste Management Fee 2 $1.00 Cash/Receipt#REC-002348-2018 $700.00
Sprinkler Heads $700.00
Amount Due: $0.00
Total: $865.70 .,
CALLS FOR INSPECTIONS
Request for inspection by telephone at 626-574-5450. Leave a messa ®
requesting the address,timeframe and what inspection item is needed.
9
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.
(1
October 05, 2018
Issued By: Date
October 05,2018 Page 1 of 1
Ie AR
rnt`F°°mti:i
I , I PERMIT/PLAN REVIEW APPLICATION
. . 4 .' Development Services Department,240 West Huntington Drive,Post Office Box 60021
°m•,,,,rN' Arcadia, CA 91066-6021, (626) 574-5416,Fax (626) 447-9173
City of
Arcadia
,la 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:
ikChapter 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 , 16
License�o. 9-S44/Cif/Exp. Date
compensation, as provided for by Section 3700 of the Labor Code, for the
Signature of Contractor �j[.x571 tnl/� e'i, r(l L, 41 performance of the work for which this permit is issued.
OWNER-BUILDER DECLARATION 0I I have and will maintain workers'compensation insurance,as required by Section
0 I hereby affirm under penalty of perjury that I am exempt from the Contractors 3700 of the Labor Code,for the performance of the work for which this permit
License Law for the following reason(Section 7031.5,Business and Professions is issued.My worker'compen=anon insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier 71 ln_.+YU.S 7
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number (l\./ ?J 1c6/6 t2CZ,
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
WI I certify that in theperformance of the work for which this permit is issued,I shall
exempt there from and the basis for the alleged exemption. Any violation of �'
not employ anyperson in anymanner so as to become subject to the workers'
Section 7031.5 by any applicant for a permit subjects the applicant to a civil p y J
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 i0/S/�t3 Signature GF I is i.r•h �ln.rLst..
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).
0 I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909) 396-2000 for
further information.
6.
Name (Th 1.-.137/-u.1.--‘ ( &r t.1 N Title
PRN 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.
iI 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 Gr1 /u-t� Ga-rottA Date /h/45/"C3
•
I City of Arcadia, CA ':PermttNoFIRE-18-1772
E Development Services Department `�lr )`"`�y rq -PermrCType Fire
240 West Huntington Drive,Post Office Box 60021 } - - 'G
Arcadia, -591066-6021 3- EE WOrkciass, cabonl.Ftre Su cession
(626)574-5416 .;-: ik , Permit Status•Issued
ARCADLA Issue Date 10/04/20181 Expiration: 04/02/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1205 S Baldwin AVE Arcadia,CA 5383038021
Contacts
BALDWIN ARCADIA CENTER LP Owner United Fire Service,Inc' Fire Contractor(C-16)
815 W NAOMI AVE A,Arcadia,CA 91007 8110 Remmet ST 10,Canoga Park,CA 91304
(818)346-2499
Description:FIRE SUPPRESSION HOOD FOR ENERGY BISTRO Valuation: $ 1.700.00 Tenant ENERGY BISTRO
Total Sq Feet: 0.00 Plan Check#18-1772 Plan#
Fees Amount Payments Amount Paid
Fire Extinguishing System Plan Check $560.00 Total Fees $696.40
Fire Issuance $44.35 Cash/Receipt#REC-002492-2018 $136.40
Fire Permit Fees $91.05 Cash/Receipt#REC-002412-2018 $560.00
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $696.40
4�CALLS FOR INSPECTIONS r®-
Request for inspection by telephone at 626-574-5450. Leave a mess.
le
requesting the address,timeframe and what inspection item is needed. bb
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.
/ October 04, 2018
Issued By: Date
October 04,2018 Page 1 of 1
,FAR
.**4
`,Uroaj,0.
I PERMIT/PLAN REVIEW APPLICATION
IF �rmf T
-i*' Development Services Department,240 West Huntington Drive,Post Office Box 60021
oma,„„,or+`°P•' 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. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class G-f License No. g2 'exp. Date 7-31-t
Signature of Contractor
G 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 la-1 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 U e.S C c.
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number t.�4'L 3 2v r r71
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 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, forthwith comply with those provisions.
or my employees with wages as their sole
compensation,will do the work,and the structure is not intended or offered for
sale(Section 7044,Business and Professions Code:The Contractors License tate ) O - Lf I t 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).
0 I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
r
1I
Name Afr� LP�-r'1:(- Title /3.1tt.�
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. Ir
Signature c' rate
/U' /,../
- f 7
OF AR
~ G0,uo �
AeP..f.
Coe\Y oc/v°�6.
MEMORANDUM
Fire Department
DATE: January 14, 2019
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemich
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 1205 S. Baldwin Avenue, Suite A
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 1-7-2019 Jill Perumean
FIRE ALARMS 1-9-2019 Jill Perumean
TANKS
HOOD & DUCT 1-7-2019 Jill Perumean
KNOX BOX
OCCUPANCY 1-9-2019 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 1-9-2019 Rita
V
rnos,C COUNTY OF LOS ANGELES• DEPARTMENT OF PUBLIC HEALTH
9 \ ENVIRONMENTAL HEALTH ++( r tl SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH
t fitj �jt PLAN CHECK PROGRAM-BALDWIN PARK co NTY or ANGELES
e611# - 5050 COMMERCE DR, BALDWIN PARK, CA91706 Public Health
PHONE: (626) 430-5560
V VW.PUBLICHEALTH.LA000NTY.GOV/EH
.OFFICIAL PLAN REVIEW REPORT
•
DATE 06/21/2018 EHS VIVIAN TAN •
PLAN CHECK NUMBER SR0134787 •
PROGRAM ELEMENT 1704 - RESTAURANT(4,000 -9,999 SF)
OWNER/REQUESTER C.C. CHANG, DESIGNER
DBA ENERGY BI
ADDRESS 1205 S BALDWIN AVE A, ARCADIA, CA 91007
REVISED PLAN REVIEW STATUS: APPROVED
CORRECTIQNS COMPLETED
CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED
PLAN SUBMITTAL/REMODEL 03/12/2018 06/21/2018
- ADDITIONAL REQUIREMENTS
THE REVISED PLANS ARE APPROVED, SUBJECT TO ON-SITE INSPECTION PRIOR TO OPERATION OR STOCKING
FOOD ON THE PREMISES. 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.LA000NTY.GOV<MAILTO:430-5546/VTAN@PH.LACOUNTY.GOV>
TO SCHEDULE A FINAL INSPECTION.
PROVIDE AT LEAST 3 WORKING DAYS PRIOR NOTICE FOR'A FINAL INSPECTION.
4 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, •
EHS Signature Page 1 oft
r'. OFFICIAL PLAN REVIEW REPORT
DATE 06/21/2018 EHS VIVIAN TAN
PLAN CHECK NUMBER SR0134787
PROGRAM ELEMENT 1704 - RESTAURANT(4,000 - 9,999 SF)
OWNER/REQUESTER C.C. CHANG, DESIGNER
DBA ENERGY BI
ADDRESS 1205S'BALDWINAVE,A,,ARCADIA, CA91007
a _
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. ti
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.oublichealth.lacounty.gov/eh.
EHS Signature Page.2 oft
i peal.
a.g�e¢
k PLANNING SERVICES
J
ATTENTION: DATE: I-3 O-I 9
•
FROM: BUILDING SERVICES INSPECTOR: ACT
PROPERTY ADDRESS: I I-os-- S. 6 ACO UJtM ' 4
PERMIT#: _ .t f 3 -0391 ` PLAN#: 3 ZS 1°I
CONTRACTOR: 7 V 1\J 6-ar a'c,rv7✓ PHONE#: C.2.4/3$3--C%(9
OWNER: PHONE#:
PLEASE INSPECT THE FOLLOWING ITEMS FOR COMFORMANCE WITH APPLICABLE PLANNING
REQUIREMENTS.
TYPE OF INSPECTION DATE& INITIAL DATE& INITIAL FINAL
APPROVAL
LANSCAPING/IRRIGATION
TRASH ENCLOSURES
PARKING/DRIVEWAYS
STORAGE AREAS
MECHANICAL EQUIPMENT •
WALL HEIGHT
BACKFLOW SCREENING
COMMENTS: 1.1 ra-► 'TO c r-IPLn. —rizA k e'4cLocLR
r VA4zt4.,1[. Lot t Pgo'IEr LTs . I.tit err
z11c /Ig