HomeMy WebLinkAboutTI-19-0409 ' 4,, City of Arcadia, CA
Permit No T 119-0409
`1‘
Development Services Department ®® ^v(=tri---,*—�.i � Remit-Type:Tenant Improvement.
i 111/ 240 West Huntington Drive,Post Office Box 60021 7 ti �-., b`: ' ! �, tf W Work Classification::Tenant Improvement
Arcadia,CA 91066-6021 >.d..,. t;f~ a_,t.,. \,,,-,, - p
, (626)574-5416 ; _ Permit Status:Issued
ARCADIAIssueDate:07/11/20191 Expiration: 08/29/2019
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number 1`11
1130 S Baldwin AVE 6 Arcadia,CA 5778007029
Contacts
500 PROPERTIES LLC Owner CARLOS ALAVAREZ Applicant
25 E Huntington DR,Arcadia,CA 91007
(626)821-8777 MSOO@ASIASPEC.COM (714)244-7192
KRIT DECOR* Contractor
8137 TILDEN AVE, PANORAMA CITY,CA 91402
(323)253-0770 ' 885275 .
Description:INTERIOR TI FOR KAI RAMEN RESTAURANT WITH Valuation: $ 45,000.00 Tenant KAI RAMEN
EMP
Total Sq Feet: 0.00 Plan Check#19-409 Plan ti 80
•
Fees Amount Payments Amount Paid
Accessibility Plan Check $72.42 Total Fees $2,663.20
Accessiblity Building Permit $74.28 Cash/Receipt U REC-01796-19 $1,631.16
Air Handling Units<=10,000 cu ft per min. $14.96 Cash/Receipt U REC-00527-19 $1,032.04
Building Issuing Fee $47.01
Building Permit Fees $742.75 Amount Due: $0.00
Building Plan Review Fee $482.79 COfthiPLE1OCal Green Plan Check $48.28zil
Commercial T.I.Fire Plan Chk. $280.00
Dishwasher $13.21
Electrical Permit Issuance Fee $47.01 •
Energy Plan Review Fee $148.55 CALLS FOR INSPECTIONS
Fire Final Occupancy Fee $200.00 Request for inspection by telephone at 626-574-5450. Leave a message
Fixture with Trap/Misc. $13.21 requesting the address,timeframe and what inspection item is needed.
Floor Drain Fee $26.42
Floor Sink $39.63
Gas System(Outlets) $99.38 This permit/plan review expires by time limitation and becomes null and
Green Building Standard $2.00 void if the work authorized by the permit is not commenced within 180 days
Hood Serviced by Mechanical Exhaust $14.96 from the date of issuance or if the permit is not obtained within 180 days
Kitchen Sink $66.05 from the date of plan submittal.This permit expires and becomes null and
Mechanical Permit Issuance Fee $47.01 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
Plumbing Permit Issuance Fee $47.01 Arcadia building inspector for a period of 180 consecutive days.
Total: $2,663.20
(-Lige -20 ,--
ell)
July 11, 2019
Issued By: Date
July 11,2019 Page 1 of 1
•F AR I
cfra"rovi'a,
,. 1 PERMIT/PLAN REVIEW APPLICATION
Alas,. till-
, 431' Development Services Department,240 West Huntington Drive,Post Office Box 60021
j,.
°mam.,.tN 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. ❑ I have and will maintain a certificate of consent to self-insure for workers'
k
License Class Lia. . -.� Dat // 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 DECLARATION 21
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
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 C. 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 provisi ns.
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 Date 7�///9 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(I)year of and shall subject an employerto criminal penalties and civil fines up to one
completion,the owner-builder will have the burden of proving that he or she hundred thousand dollars($100,000),in addition to the cost of compensation,
did not build or improve for the purpose of sale). damages as provided for in Section 3706 of the Labor Code, interest, and
attorney's fees.
0 I, as owner of the property, am exclusively contracting with licensed -
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
•
Lender's Name
Date Signature Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containin, •• requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further informatio'�
OPP 1/411.
came --VI��� Title 't - 1 ' '
sr PRINT NAME
I c ify that I h. • •., , : , •lication and state that the above information is corr ct and that I am the owner or duly authorized agent of the owner.
I agree to ci ply with all City • •'nances and State Laws relating to building construction. I hereby authorize representatives of the City of
Arcadia to en : upon the above-menti• •ed property for inspection purposes. �J
t 144
t
Signature ��nt Date
NOTES
il.ine l tin I. • I I. •1 • -1 . - In 1. i X30 5 `BAl.ow-IN jt
100. Setbacks tiring.Under ficg.drain
101. Rough grade 211. Copper underslab Z
102. Figs.&forms 212. Rough plumbing `
104. Pre-slab213. Rough gas �� 131-23-19131-23-199 5r
104. F raSrsz
104. Floororjoists 214. Shower pan
105. Steel 215. Water heater Fr? . foal Dt.c.r.
-3deV Grout lift 216. Roof drains
107. Shear nailing 217. Building sewer 2,1-0 /
108. Diaph nailing 218. Water service g._25.4'3 O LA-Y®2 .e Sra72
109. Roof nailing 219. Final gas ,
110. Framing 220. Fixtures � (T f /egrPt+GT.
111. Oc dArea Sept.Wall 221. Final plumbing
112. Sound walls 222. Sewer cap/demo.
113. T-bar.rid - --- - -
114. Insulation-Fir. Pool Inspections I 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 243. Underground conduit
119. Exterior lath 244. P-trap
120. Finish grade /p45. Gas line&test
121. Final building /-g'2 !!.•^fes 246. Fence,gates&signs
122. Final demo/lot clear 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. Under.round conduit
153. Underslab conduit Reran'Inspections I Date Insp.
154. UFER ground 270. Pre-reroof Insp.
155. Water ground 271. Roof framing
156. Rough electrical 272. Sheathing nailing
157. Fixtures 273. Final reroof
158. G.F.C.I.
159. E..L bondin! Sign Inspections I Date Insp.
160. Service panel80. Setback/overhang
161. Final electric frS Zo 281. Footing
282. Conduit/wirin.
Mechanical Inspections Date Insp.' 283. Disconnect
180. Venting/fue 284. Final sign
181. Furnace/A.C.
182. Rauch HVAC Miscellaneous Insp. Date Insp.
183. Fire dampers 290. Fire alarm
184. Furnace compartment 291. Underground supply
185. Combustion air 292. Fire sprinklers - - - -
186. Smoke detectors 293. Monitor system
187. Metal F.P.rough 294. Hood dry chem. •
188. Compressor setback 295. Final
189. Commerdal hood
190. Duct shaft Sewers&Offsite Insp. I Date Insp.
191. Final mechanical /-74-Zb ft. 300. Lateral(main to P/L)
-
301. SaddleN
Block Wall Inspections Date Insp. 302. Cess.00l filled
200. Footings 303. Sidewalk
201. Steel/rebar 304. Driveway
202. Grout lift 305. Curb replacement
203. Final wall 306. Trash bin
p9j' ` ' COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH
s 1ENVIRONMENTAL HEALTH
t�t,t-a}<
.p 1fti } SPECIALIZED SURVEILLANCE AND ENFORCEMENT BRANCH ... .._. ._
ty a /Jam{ PLAN CHECK PROGRAM-BALDWIN PARK Cann or Los Axons
-'YGit76110' 5050 COMMERCE DR,BALDWIN PARK,CA 91706 Public Health
PHONE: (626)430-5560
INWVV.PUBUCHEALTH.LA000NTY.GOV/E 1
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 12/26/2019 EHS ADRINE IBRANYAN
PLAN CHECK NUMBER SR0176209
PROGRAM ELEMENT 1702-RESTAURANT(501-1,999 SF)
OWNER/REQUESTER MAGALI MONZON,AGENT
DBA KM RAMEN
ADDRESS 1130 S BALDWIN AVE 6,ARCADIA,CA 91007
FINAL REINSPECTION STATUS: APPROVED
stRiG73`, ttiamY.F..r.R ,� z ``,i`!,to '�Ts e m ' `.' ,.-r ip "x'Yjz u. ;
CORRECTION CATEGORY DATE IDENTIFIED DATE CORRECTED
WAREWASHING FACILITIES 12/19/2019 12/26/2019
JANITORIAL FACILITIES 12/19/2019 12/26/2019
TOILET FACILITIES 12/19/2019 12/26/2019
EQUIPMENT/STORAGE 12/19/2019 12/26/2019
FOOD PROTECTION/FOOD STORAGE 12/19/2019 12/26/2019
LIGHTING/ELECTRICAL 12/19/2019 12/26/2019
EMPLOYEE FACILITIES 12/19/2019 12/26/2019
PLAN SUBMITTAL/REMODEL 12/19/2019 12/26/2019
x„x s 4 g'+, .��,?„ ::� r,�*yr
=" z. . •
1 Z x tr,. kh""'n'x o rt7",+q
ADt)ITIONAt RE9u1 04'40)NiFal S �< , ` &
.k� .��r��'� }�.�^ .�...�y � '���, .' ,. �'=�? °S�',��'��. �x�,�.rc��`�fz�� :n
NONE
COIYIMENTS; :. 5 2. ` E. F }r r. ) •.
THIS RETAIL FOOD FACILITY IS APPROVED TO OPERATE.
Help us serve you better by completing a short survey.Visit our website at WWW.publichealth.lacounty.gov/eh.
4:I.
Operator Signature Page 1 of 2
PLAN CHECK OFFICIAL INSPECTION REPORT
DATE 12/26/2019 EHS ADRINE IBRANYAN
PLAN CHECK NUMBER SR0176209
PROGRAM ELEMENT 1702-RESTAURANT(501-1,999 SF)
OWNER!REQUESTER MAGALI MONZON,AGENT
DBA KAIRAMEN
ADDRESS 1130 S BALDWIN AVE 6,ARCADIA,CA 91007
.litrcs 2 ' '}au..sh
DISCLOSVKES
feCbAt x � £ � A."�,t;
-..�. 2..?,a .,Y
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 www.publicheaIIh.lacounty.gov/eh.
..................A:j.
Operator Signature Page 2 of 2
AtireiN1 City of Arcadia, CA Permit NO FIRE491768
y Development Services Department D!y---t ren''',--,V--v -, Permit Type:Fire
240 West Huntington Drive,Post Office Box 60021 ,i 1, qt f (1 4 i Work C/ossi'catfon:Fire Suppression
Arcadia,CA 91066-6021 _ S1h i ; ( 5 h PP
(626)574-5416 - - - -, _, ' - Permit Status:Issued
ARCADIAIssue Date:09 /19/20191 Expiration: 03/02/2020
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1130 W - BALDWIN RD Arcadia,CA 5778007029
Contacts
500 PROPERTIES LLC Owner UNITED FIRE&SAFETY CO.' Contractor
25 E Huntington DR,Arcadia,CA 91007 2318 CHICO AVE,SOUTH EL MONTE,CA
(626)821-8777 MSOO@ASIASPEC.COM (951)279-8208 621096
Description:6 NOZZLES FOR KAI RAMEN Valuation: $ 3,200.00 . Tenant
a Total Sq Feet: 0.00 Plan Check#19-1768 Plan U
R
Fees Amount Payments Amount Paid
Fire Extinguishing System Plan Check $280.00 Total Fees $465.06
Fire Issuance $47.01 Cash/Receipt U REC-02547-19 $185.06
Fire Permit Fees $137.05 Cash/Receipt U REC-02355-19 $280.00
Solid Waste Management Fee 2 $1.00
Amount Due: $0.00
Total: $465.06 I`Atr�Iq o
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.
September 19,2019
Issued By: Date
September 19,2019 Page 1 of 1
1, ,•4 PERMIT/PLAN REVIEW APPLICATION
e...2/If44 r*
%Lit 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, C and my license is in full force and ffect. __II LII have and will maintain a certificate of consent to self-insure for workers'
License Class C0 License No. 0 Exp. Date 04-'50-]mobil 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 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.My
pwo �s'compensation insurance carrier and policy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier J"Qsrkerovket 1,3tatv-C-e_ Co
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 racy Number u}ur_n 1334-rL
provisions of the Contractors License Law(Chapter 9(commencing with Sections section need not be completed if the permit is for one lion ed dollars or less)
7000)of Division 3 of the Business and Professions Code) or that he or she is
exempt there from and the basis for the alleged exemption. Any violation of ❑ I certify that in the performance of the work for which this permit is issued,I shall
Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers'
penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the
workers'compensation provisions of Section 3700 of the Labor Code,I shall
❑I, as owner of the property, or my employees with wages as their sole forthwith mpl with those provisions.
compensation,will do the work,and the structure is not intended or offered forQ
sale(Section 7044,Business and Professions Code:The Contractors License Date o9 I b ii Signature
Law does not apply to an owner of property who builds or improves thereon, YYY
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 t disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information. ��� 7.414 J
Name 4Y/ Title _44-0
P•r 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 buildin_ construction. I hereby authorize representatives of the City of
Arcadia to enter upon the - I:ve-mentioned property for inspection purposes.
S gnature ieS Date 09740
I
of Ake
O~4 otavoiwo„�
OPIOT
\'° MEMORANDUM
Fire Department
DATE: December 13, 2019
TO: BUILDING DEPARTMENT
INSPECTOR Henry Kemich
FROM: FIRE DEPARTMENT
SUBJECT: FIELD INSPECTION
ADDRESS: 1130 S. Baldwin Avenue #6
THE FOLLOWING ITEMS WERE CHECKED FOR CONFORMANCE WITH APPLICABLE FIRE
DEPARTMENT REQUIREMENTS:
TYPE OF INSPECTION DATE / INITIAL
FINAL INSPECTION
FIRE SPRINKLERS 12-11-2019 Lill Huang
FIRE ALARMS
HOOD 8, DUCT
KNOX BOX
OCCUPANCY 12-12-2019 Jill Perumean
COMMENTS:
Emailed Bldg. Dept. 12-13-2019 Rita
s City of Arcadia, CA Permit Na FIRE-19-2443
'., Development Services Department Df " 'iffjl
'. - Permit Type:Fife:
240 West Huntington Drive,Post Office Box 60021 `
Arcadia,CA 91066-6021 ` , - }fit_,' -Work Classification:Fire Sprinkler;
I (626)574-5416
_ Permit Status-Issued
ARCADIA Issue'Date:.12/10/20191 Expiration: 06/02/2020
Addr NO. Dir Prefix Street Name Street Suffix Unit City,State,Zip Parcel Number
1130 5 Baldwin AVE Suite 6 Arcadia,CA 91007-7508 5778007029 b
Contacts
S00 PROPERTIES LLC Owner UNITED FIRE&SAFETY CO.' Contractor
25 E Huntington DR,Arcadia,CA 91007 2318 CHICO AVE,SOUTH EL MONTE,CA
(626)821-8777 MS0O@ASIASPEC.COM (951)279-8208 621096
Description: FIRE SPRINKLERS FOR T.I.KAI RAMEN Valuation: $ 2,200.00 Tenant KAI RAMEN RESTAURANT
RESTAURANT
Total Sq Feet: 0.00 Plan Check tt19-2443 Plan a
Fees Amount Payments Amount Paid
Fire Issuance $47.01 Total Fees $448.36
Fire Permit Fees $120.35 Cash/Receipt p REC-03269-19 $280.00
Solid Waste Management Fee 2 $1.00 Cash/Receipt N REC-03301-19 $168.36
Sprinkler Heads $280.00
Amount Due: $0.00
Total: $448.36
4( COMPLETED
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.
(-7:?2r2
December 10, 2019
Issued By: Date
December 10,2019 Page 1 of 1
‘E A•
!WO. ' PERMIT/PLAN REVIEW APPLICATION
lik Elft' 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 licenseis in full t force n effect. 0 I have and will maintain a certificate of consent to self-insure for workers'
License Class t—I b License No,oAI Exp. Date Gl1nI Id'f 0 compensation, as provided for by Section 3700 of the Labor Code, for the
N/17 performance of the work for which this permit is issued.
Siof Contractor
OWNER-BUILDER DECLARATION ® I have and will maintain workers'compensation insurance,as required by Section
1:1I 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,�Mpv�w,,r o_rrkers'c mpensation insmanpolicy numbers are:
Code.Any city or county which requires a permit to construct,alter,improve, Carrier :7L ' V hvinnicrft •
demolish,or repair any structure,prior to its issuance,also required the applicant
Policy Number g MMS 01 Tr 76 2
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
0 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. My 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 ...1
❑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 Date r� v S7n�
ignature
sale(Section 7044,Business and Professions Code:The Contractors License 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.
0 I, as owner of the property, am exclusively contracting with licensed -
contractors to construct the project(Section 7044, Business and Professions
Code:The Contractors License Law does not apply to an owner of property CONSTRUCTION LENDING AGENCY
who builds or improves thereon,and who contracts for such projects with a I hereby affirm under penalty of perjury that there is a construction lending agency
contractor(s)licensed pursuant to the Contractors License Law). for the performance of the work for which this permit is issued (Section 3097,
Civil Code).
❑ I am exempt under Section 7044,Business and Professions Code,for this reason:
Lender's Name
Date Signature ___ Lender's Address
IMPORTANT: APPLICATION IS HEREBY MADE TO THE BUILDING OFFICIAL FOR A PERMIT SUBJECT TO THE CONDITIONS AND
RESTRICTIONS SET FORTH ON THIS APPLICATION AND THE FOLLOWING:
1. The City's approved plans and permit inspection card must remain on the job site for use by City inspection personnel.
2. Final inspection of the work authorized by this permit is required.A Certificate of Occupancy must be obtained prior to use and occupancy of new buildings
and structures.
3. Per South Coast Air Quality Management District(AQMD)regulations,renovation and remodeling work that results in the removal,stripping,or altering
of asbestos containing materials requires an asbestos survey and removal prior to disturbing the asbestos.Please contact AQMD at(909)396-2000 for
further information.
\Name en4‘ i i ,- I`1 Y��"7-�✓Title U
��Q/r
P•r�-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 proper• '+r inspection purposes. Q
Signature aDate h a 1 t 4 I d.J 1 1 .