HomeMy WebLinkAboutUntitled Yet*. City of Arcadia, CA
Permit NO TI 19-1121
t
, Development Services Department ,,,-1-.\11
`r-ir`r -y yI '^ Permit Type:Tenant Improvement
240 West Huntington Drive,Post Office Box 60021 r t r J D 1 IJ
9 Arcadia,CA 91066-6021 : . ,I r ° . I S ! Work 6/assn kation;Tenant Improvement
.� (626)574-5416 - _ - Permit Status:Issued
ARCADIA •issue Date:07/10/20191 Expiration: 12/10/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
113 E Santa Clara ST Arcadia,CA 5773007004
Contacts
SATTARI,KAVEH AND JANE AND Owner USA Chinese Boxing Association Applicant
SATTARI,KAVEH AND JANET B 11734 E Wilshire BLVD KC 1310,Los Angeles,CA 90025
265 MARIPOSA ST 91001,ALTADENA,CA (626)888-0003 xinghan.li.sos@gmail.com
Description:INTERIOR TI FOR BOXING GYM. CREATE NEW Valuation: $ 3,000.00 Tenant BOXING GYM
SHOWER ROOM AND NEW COUNTER AREA. nr
WITH EMP Total Sq Feet: 0.00 Plan Check#19-1121 Plan N 7 jt
Fees Amount Payments Amount Paid
Accessibility Plan Check $11.74 Total Fees $972.25
Accessiblity Building Permit $12.04 Cash/Receipt K REC-01534-19 $401.87
Building Issuing Fee $47.01 Cash/Receipt ft REC-01787-19 $570.38
Building Permit Fees $120.35
Building Plan Review Fee $78.23 Amount Due: $0.00
Cal Green Plan Check $7.83
Commercial T.I.Fire Plan Chk. $280.00
Electrical Permit Issuance Fee $47.01 Ft,Jal� O,'A / 9��
Energy Plan Review Fee $24.07 C /
Fire Final Occupancy Fee $200.00
Green Building Standard $1.00 CALLS FOR INSPECTIONS
Light Fixtures $3.26 Request for inspection by telephone at 626-574-5450. Leave a message
Mechanical Permit Issuance Fee $47.01 requesting the address,timeframe and what inspection item is needed.
Outlets-Receptacles&Switches $3.26
Plumbing Permit Issuance Fee $47.01
Shower $12.46 This permit/plan review expires by time limitation and becomes null and
Solid waste Management Fee $6.25 void if the work authorized by the permit is not commenced within 180 days
Solid waste Management Fee 2 $1.00 from the date of issuance or if the permit is not obtained within 180 days
Solid Waste Management Fee 2 $1.00 from the date of plan submittal.This permit expires and becomes null and
Solid Waste Management Fee 2 $1.00 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
Strong Motion Inst.Program Corn $0.84 Arcadia building inspector for a period of 180 consecutive days.
Total: $972.25
Ei COMPLtffD
9July 10, 2019
Issued By: Date
July 10,2019 Page 1 of 1
of AR
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PERMIT/PLAN REVIEW APPLICATION
spit*' 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. ❑ I have and will maintain a certificate of consent to self-insure for workers'
License Class License No. Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the
1 rformance of the work for which this permit is issued.
i l azure of Contractor
OWNER-BUILDER DECLARATION /4I 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
for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number
provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less)
7000) of Division 3 of the Business and Professions Code)or that he or she is
exempt 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 Section 3700 of the Labor Code,I shall
❑I, as owner of the roeforthwith comply with those provisions.
property,work,and employees with wages as theirs for
compensation,will do the the structure is not intended or offered for °? hp12017
. sale(Section 7044,Business and Professions Code:The Contractors License Date Signature �1
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 upto one
co pletion,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,
di 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:
q —4A------
)
�p�� Lender's Name
\Date J /'o/2° 1 Signature , �'L°/-✓ 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. ���
arae AAi IA I. itle / jI0.NO
A
PRWT NAME ��Ly
I certify that I have read this application and state that the above information is cor ect and that I am the owner or duly authorized agent of the owner.
k •
I agree to comply with all City ordinances and State Laws relating to building onstruction. I hereby authorize representatives of the City of
Arcadia to enter upon the above-mentioned property for inspection purposes. \lite
/ Ggnature ye O? / 1U / �o / /
113 C. - - . . t.
NOTES
Building Inspections Date Insp. Plumbing Inspections Date I Insp.
I 1 A - 1 Z
100. Setbacks 210. Under tirdbldg.drain 7•Zt;•t? I
101. Rough grade 211. Copper underslab
102. Figs.&forms 212. Rough plumbing 7. 26•f 9 S--
103. Pre-slab 213. Rough gas
104. Floor joists 214. Shower pan $• (• ).9 '
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 219. Final gas
110. Framing rJ.iC•(4 a-- 220. Fixtures
111. Occ./Area Sept.Wall 221. Final plumbing $'(9 £19
112. Sound walls 222. Sewer cap/demo.
113. T-bar grid - ---
114. Insulation-Fir. Pool Inspections Date I Insp.
115. Insulation-Wall 240. Excavation/steel
116. Insulation-Ceil. 241. Rough plumbing
117. Drywall nailing 242. Light shell/bonding
118. Interior lath 9.6 .f g 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade 245. Gas line&test
121. Final building Q'f 9 it? -a _--. 246. Fence,gates&signs
122. Final demo/lot dear 247. Pool heater - - -248. Final electric
Electrical Inspections Date Insp. 249. Final .lumbin.
150. Power pole 250. Pool cover - -
151. Sales lot lighting 251. Pool final
152. Underground conduit
153. Underslab conduit Reroof Inspections Date I Insp.
154. UFER ground 270. Pre-reroof insp.
155. Water ground 271. Roof framing
156. Rough electrical t)•2L49 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E.it.bondin. Sign Inspections Date Insp.
160. Service panel 280. SetbacWoverhang
161. Anal electric $• it f9 S- 281. Footing
282. Conduitkvirin,
Mechanical Inspections Date Insp. 283. Disconnect
180. Venting/flue 284. Final sign
181. Furnace/A.C.
182. Routh HVAC Miscellaneous Insp. Date I Insp.
183. Fre dampers 290. Fre alarm
184. Furnace compartment 291. Underground supply
185. Combustion air 292. Fire sprinklers --- --
186. Smoke detectors 293. Monitor system
187. Metal F.P.rough 294. Hood dry chem.
188. Compressor setback 295. Final
-
189. Commercial hood
190. Duct shaft Sewers&Offsite Insp. Date I Insp.
191. Final mechanical 300. Lateral(main to AL)
301. Saddle!?
Block Wall Inspections Date Insp. 302. Cess...l filled
200. Footings 303. Sidewalk
201. SteeVrebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
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OF o
City of Arcadia 3 Building Division
240 West Huntington Drive,Arcadia CA 91007
Office: (626) 574-5416 Fax: (626) 447-9173
When the permit application and the Owner-Builder Declaration have been executed by a person
other than the property owner, prior to issuing the permit, the following shall be completed by
the property owner and returned to the agency responsible for issuing the permit:
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal
responsibility, I hereby authorize the following person(s) to act as my agent(s) to apply for, sign,
and file the documents necessary to obtain an Owner-Builder Permit for my project.
I declare under penalty of perjury that I am the property owner for the address listed above, and
I personally filled out the above information and certify its accuracy.
Property Owner's Signature: 1 - ��� Date: 04/0.3/00/9
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Property Address: . L- ,rW C�aYO. )e / TCQc&c{,. LUyb
Owner's Name: Xavr
£'a-tear‘
Owner's Address: 1/3. E. SIM& CkerR, Se. Arcadia,. G-7/006
Phone# C26 6 - 86 ), - 73 7t5
Agent's Name: DI/iglu/4i 2
a 1 7-31F i'c h;r Md. * 0)3lo . As Aiweicas
Agent's Address: / 04 f, 0015
C2.6 Agent's Phone#: 2.6 - 9 88. 11 ODDS
Reptut - BvvAon 1,01Pda s), Pealne Xnkicie ZOn&.
I Scope of work: Y_ ..t_twit/ Y w/ ofe!.l/ , J dAI4 , li /v ,.b 1 s • -•••••.4 lT 1.
y . .Av v. lwril �,l...w
NOTE: This authorization must be NOTARIZED or accompanied by a copy of the
homeowner's current photo I.D. (i.e., driver's license, passport or military I.D.
with signature), when presented for issuance of a permit.