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HomeMy WebLinkAboutB11-054-505 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT CIVIL CODE§ 1189 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 246.41/4i6.6 ) On A i)A((, i(, -2-01 6 before me, A A . ✓ -v-i , Pl1/$1_,L G� Date Thet-is Insert Name and Title of the Officer personally appeared 12...4-4.-VT". - et—is - Name(s)of Signer% who proved to me on the basis of satisfactory evidence to be the person(whose name,(s' is/fie subscribed to the within instrument and acknowledged to me that he/spe/tWy executed the same in his/hof/tt,6ir authorized capacity(itts),and that by his/I}er/th,efr signature(a)'on the instrument the persons), or the entity upon behalf of which the personVfacted, executed the instrument. ' I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph DOROTHY A.SNYDER is true and correct. ,i11111, Convniesion 0 2093217 WITNESS my han. and official seal. '; ‘I NNW/Public-CaNfomla V.."9 1 Orange ounty Com. C 9 ' Si natureO 9 / i Signs.f Notary/blic Place Notary Seal Above OPTIONAL Though this section is optional, completing this information can deter alteration of the document or fraudulent reattachment of this form to an unintended document. Description of Attached Doument Title or Type of Document: t"eAioffee4711-�lcN4 Document Date: I-P--I L 1( ,2016 Number of Pages: 1 Signer(s) Other Than Named Above: )4.491.-1.4. Capacity(ies) Clai ed by Signer ) Signer's Name: T- j oL P Signer's Name: ❑Corporate Officer — Title(s): ❑Corporate Officer — Title(s): ❑ Partner — ❑ Limited :T i General O Partner — U Limited ❑General O Individual Li Attorney in Fact ❑Individual P Attorney in Fact ❑Trustee O Guardian or Conservator ❑Trustee ; Guardian or Conservator CAOther: %�_& ❑ Other: Signer Is Representing: Nb 4D)'- Signer Is Representing: t QoPeari>rs �, :,',:` �',,\'.S\✓i.��i\ i\✓G\':i\-��tii\moi\,ii.,,-.i\✓�G\�/iis.,,4\_moi\t:S. ©2014 National Notary Association •www.NationalNotary.org • 1-800-US NOTARY(1-800-876-6827) Item#5907 31877 Del Obispo Suite 201 San Juan Capistrano,CA 92675 PROPERTIES ph 949-485-8576 fx 949-419-0948 April ii, 2016 Re: 1036 Encino Ave,Arcadia To whom it may concern: Kristy Greenwood is authorized to represent Red Fox Properties/Cal Max in any building and permitting matters regarding 1036 Encino Avenue,Arcadia. Should you have any questions or concerns, please don't hesitate to call me. Sincere e/ AD ant Doelp Broker Red Fox Properties 949-485-8576 REDFOx PROPERTIES %FA; 4 PERMIT/PLAN REVIEW APPLICATION IL ;t:11 tie ilt*• 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. 0 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 performance of the work for which this permit is issued. Signature of Contractor 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 workers'compensation insurance carrier and policy numbers are: Code.Any city or county which requires a permit to construct,alter,improve, Carrier demolish,or repair any structure,prior to its issuance,also required the applicant for such permit to file a signed statement that he or she is licensed pursuant to the Policy Number provisions of the Contractors License Law(Chapter 9(commencing with Section (This section need not be completed if the permit is for one hundred dollars or less) 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt there from and the basis for the alleged exemption. Any violation of 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 . .• e subject to the workers'compensation provisions of Sectio g 700 of th. abor ode,I shall ❑I, as owner of the property, or my employees with wages as their sole forthwith mply ith those provisions. 1711 compensation,will do the work,and the structure is not intended or offered for 1 , �ir+ ..;: sale(Section 7044,Business and Professions Code:The Contractors License Date Signature \HIP 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 t4 t/ Signature t a�•� Lender's Address IMPORTANT: APPLICATION IS HEREBYADE 0 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 '1 h`c--&e- 4(1\AM-CP Title 1 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 compl with all City ordinanc • tate Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to en rte.,• above-mentio d propert for inspection purposes. Signature IP t.,\ Date 1 ` I - Development Services Department ►•1 N 240 West Huritingto>yl Drive,Post Office Box 60021 Arcadia,CA 91066-6021 PERMIT NO. BOO-053-332 City (626)574-5416,Fax(626)447-9173 Arcadia Permit Type: Electrical PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 18241 4'14r2016 CM 13:05 4/14/2016 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. GEO CODE 1036 Encino Ave 5780-016-008 OWNER MAIUNG ADDRESS Wei,David T 2070 Avenida Del Canada PHONE NO. Rowland Heights,CA 91748 EMAIL ADDRESS: APPLICANT MAILING ADDRESS Kristy Greenwood PHONE NO. (909)358-9782 EMAIL ADDRESS: CONTRACTOR/PROFESSIONAL MAILING ADDRESS PHONE NO. FAX NO. EMAIL ADDRESS: License No. Type: Expires: TENANT MAIUNG ADDRESS PHONE NO. FAX NO. DESCRIPTION UPGRADE ELECTRICAL SERVICE,200 AMP Construction Type UOM N of Units Value Construction.1. pc t()N1 II oil nln \:111112 OCCUPANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 1.00 flat 4SSI Issue Auto 44.35 44.35 01-3105 L 1.00 each 0-400 Res Ser 15.55 15.55 01-3105 G71e\ o 51121/16e- I 1.00 each SWMF 2 Auto 1.00 1.00 88-3027 EXPIRED I ural Fees: $60.90 Balance Due: $0.00 Paid Today: $60.90 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt#: 112561 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3105 59.90 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00 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. CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS Requests for inspection should be made at least Monday-Thursday Friday one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m. by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. (Closed on alternate Fridays) 1 4 li PERMIT/PLAN REVIEW APPLICATION ,t. , �oto), Development Services Department,240 West Huntington Drive,Post Office Box 60021 4,..,,y<41%* 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 performance of the work for which this permit is issued. Signature of Contractor 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 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 1700 of the L.,• >Se,I shall forthwith om with those provisions. ❑I, as owner of the property, or my employees with wages as their sole �►/l. ���= 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 ►_._ .. 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. , as owner of the property, am exclusively contracting with licensed contractors to construct the project(Section 7044,Business and Professions CONSTRUCTION LENDING AGENCY Code:The Contractors License Law does not apply to an owner of property 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 gilt _ Er '<Ng Date 51v` < <% Signature It Lender's Address IMPORTANT: APPLICATION IS HEREBY `''DE 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. A Name '1�P�2—C7 NI, Title 2 7 A PRI\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 compl with�*• I City or' nances d State Laws relating to building construction. I hereby authorize representatives of the City of Arcadia to enter up,n iW : s ove-m'ntioned pro arty for inspection purposes. Signature Doty Date ' Development Services Department .` t ', 240 West Huntington Drive,Post Office Box 60021 PERMIT NO. ` -."� Arcadia,CA 91066-6021 B00-053-574 City of (626)574-5416,Fax(626)447-9173 Arcadia Permit Type: EMP Combo PROJECT TRACT NO. LOT NO. APPLICATION DATE ISSUED BY PRINT DATE PERMIT STATUS 18241 5/9/2016 ('Ni 9:22 5/9/2016 Issued ADDRESS NO. Dir.Prefix Street Name Street Suffix UNIT BLG ASSESSORS PARCEL NO. 0E0 CODE 1036 Encino Ave 5780-016-008 OWNER MAIUNO ADDRESS Wei,David T 2070 Avenida Del Canada PHONE NO. Rowland Heights,CA 91748 EMAIL ADDRESS: APPLICANT MAILING ADDRESS Greenwood,Kristie PHONE No. (909)358-9782 EMAIL ADDRESS: • CONTRACTOR/PROFESSIONAL MAILING ADDRESS Owner PHONE NO. FAX NO. • EMAIL ADDRESS: License No. Type: Expires: TENANT MAIUNG ADDRESS PHONE NO. FAX NO. DESCRIPTION EMP FOR BATH AND KITCHEN Construction Type UOM N of Units Value Construction Type UOM H of Units Value OCCUPANCY: TOTAL VALUATION: $0.00 QTY UOM DESC AMT AMT PAID ACCT QTY UOM DESC AMT AMT PAID ACCT 1.00 flat Elec issue 44.35 44.35 01-3105 1.00 Flat Plmbg issuance 44.35 44.35 01-3105 2.00 each Bathtub 24.92 24.92 01-3105 1.00 each Shower 12.46 12.46 01-3105 3.00 each Water Closet 37.38 37.38 01-3105 3.00 each Lavatories 37.38 37.38 01-3105 1.00 each Kitchen sinks 12.46 12.46 01-3105 1.00 each Dishwashers 12.46 12.46 01-3105 1.00 each GarbageDisp 12.46 12.46 01-3105 EXPIRED 23.00 each Outletsutlets31.00 31.00 01-3105 15.00 each Ltg fixtures 23.10 23.10 01-3105 1.00 Flat SWMF 2 1.00 1.00 88-3027 Total Fees: $293.32 Balance Due: $0.00 Paid Today: $293.32 This permit/plan review expires by time limitation and becomes null and void if the work authorized by the Receipt a: 112867 permit is not commenced within 180 days from the date of issuance or if the permit is not obtained within 180 days from 01-3105 292.32 the date of plan submittal.This permit expires and becomes null and void if any work authorized by this permit 88-3027 1.00 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. CALLS FOR INSPECTION INSPECTORS'OFFICE HOURS Requests for inspection should be made at least Monday-Thursday Friday one(1)business day in advance of the inspection 7:30 a.m.to 8:30 a.m. 7:30 a.m.to 8:30 a.m. by telephone at(626)574-5416 for onsite work. 4:00 p.m.to 5:30 p.m. 4:00 p.m.to 4:30 p.m. (Closed on alternate Fridays) •F A; 0yteok,%,4,, 4 si9Pr, . PERMIT/PLAN REVIEW APPLICATION fit{= Development Services Department,240 West Huntington Drive,Post Office Box 60021 '�• yArcadia,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: 41Chapter 9(commencing with Section 7000,of Division 3 of the Business and ••.fessions 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 License No. Exp. Date compensation, as provided for by Section 3700 of the Labor Code, for the / performance of the work for which this permit is issued. Si!nature of Contractor -.0, ❑ I have and will maintain workers'compensation insurance,as required by Section OWNER-BUILDER DECLARATION 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 is issued.My workers'compensation insurance carrier and policy numbers are: License Law for the following reason(Section 7031.5,Business and Professions 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 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. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil not employ any person in any manner so as to become subject to the workers' penalty of not more than five hundred dollars($500)): compensation Laws of California,and agree that if I should become subject to the workers'compensation provisions . ect'Aa3700 of the Labor Code,I shall forthwith omp with those provisio '► ❑I, as owner of the property, or my employees with wages as their sole ;,1� compensation,will do the work,and the structure is not intended or offered for .0' `�''� sale(Section 7044,Business and Professions Code:The Contractors License Date Signature v--`_ 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: I i_ Lender's Name qtly Date k� Signature , �`` Lender's Address 41111 IMPORTANT: APPLICATION IS HEREBY MA 1 • O 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 A L ... . , PRINT NAME i 41 , Title a 7 I J ) 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 compl with a Ai . ' dinances and State L: s relating to building construction. I hereby authorize representatives of the City of Arcadia to enter ,i o ;y T a- `'oned property for in•i•ction purposes. 1►�i%i‘-:le g,, J \ Signature Date