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Home My Public Portal About6259 LOMA AVE_BUILDING_3/2/2016_ (3)PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION ID: DPR261 ROUTE TO: BS0508 LOT DRAINAGE FIRE • COUNTY OF LOS ANGELES' TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL BUILDING AND SAFETY / LAND.DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1510190105 PHONE: (626) 285-0488 EXT: ILEGAL ID: I N0. OF CONST NEW I BUILDING ADDRESS: ITR: 5904 LT: 242 I SQ. PT STORIES TYPE OCCUP GROUPI 6259 LOMA AV I (STRUCTURE: 500 2 V-B U I TEMP CA 917801635 (ASSESSOR INFORMATION NUM03ER: GARAGE: I NEAREST CROSS STREET: LONGDEN 15384-009-018 OTHER: I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CA (TENANT: USE ZONE: R-1 TISSUED ON: PROCESSED BY: 103/02/16 SR IOWNER: TEL. N0: JBLDGS. NOW ON LOT: VALUATION: (FINAL TE FZ CODE: (LIEU, JAMES I 23,010 I 16259 LOMA AVENUE a/' TEMPLE CITY CA 91780 FEES PAID IDE�PTI OF WORK �" I IDETACHED STORAGE ROOM IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( (APPLICANT: TEL. NO: (LIEU, JAMES (626) 757-8033- ID1 PLANCHECK W/O EN-HC 23010.00 VAL 384.00 1 19040 STEELE STREET IAA BLDG PERMIT ISSUANCE 34.40 ISPECIAL CONDITIONS: 'ROSEMEAD CA 91770 IAB STATE GREEN BLDG FEE 23010.00 VAL 1.00 (COVENANT RECORDED IAC STRONG MOTION REBID 23010.00 VAL 3.00 ID2 PERMIT W/O EN-HC 23010.00 VAL 564.40 CONTRACTOR: TEL. NO: I TOTAL FEES 986.80 (APPROVALS DATE INSPE R SIGNATURE J AND J GROUP CONSTRUCTION, INC. (626) 757-8033- 1 9040 STEELE STREET LIC. NO AND SETBACKS ROSEMEAD CA 91770 958027 iLOCATION {I/ ISOILS ENGINEER APPROVAL 1 ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS 1 LEE, EY (626) 280-90 1 VALLEY 8740 VALLEY BLVD pL LIC. NO: (SLAB/ONOfiR FLOOR I ROSfiMEAD, CA 91770 53948 L� I RAISED FLOOR FRAMING I I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I 3 001 1 (1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: 0 NO 07 12ND LEVEL FLOOR SHEATH 1 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO IFIAE DEPT. FRAME INSPECT( I BLDG DEPT. FRAME INSPECT( /D / D V ISHEAR PANELS I I I (INSULATION/WEATHER STRIP( PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION ID: DPR261 ROUTE TO: BS0508 LOT DRAINAGE FIRE OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the reason(s) indicated below by the checkmark(s) I have placed next to the applicable item(s) (Section 7031.5, Business and Professions Code): Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt from licensure 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 penalty of not more than five hundred dollars ($500).): U I, as owner of the property, or my employees with wages as their sole compensation, will do (✓) all of or U portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner - Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed Contr$dor pursuant -to the Contractors' State License Law). U: I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in which I must have resided for at least one year priori to completion; of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner -builder if it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: htto�//www.lecinfo.ce.00v/c�alaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License C ss ay/ License No. L Date ontractor Signature WORKERS' COMPENSATIO CLARATION WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, Issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Po_ Hcy No. 7P I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the perforignance of the work for which this permit is issued. My w d• rs' V mpe a ion i urance ca r o ' nymber r : /, Carder Policy Number Expiration Date Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' 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 h II forthwith comply with those provisions Si a pplicant Date LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits In Unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself co ied and will continue to 5coTply therewith through the applicati n pr ess. NP 1 Applicant (PrintName) Appli ig a re Company Name DW r. JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ No ❑ Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorize representatives of this county to enter the above -identified property for inspection purposes. ,vp d�f�A1.