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Home My Public Portal About6259 LOMA AVE_GRADING_2/17/2016_COUNTY OF LOS'ANGELES' DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND,DEVELORMENT LEGAL ID: TR: 5904 LOT(S): 242 ASSESSOR INFORMATION NUM13ER: 5384-009-018 TENANT: OWNER: TEL. NO: LIEU, .TAMES (626) 757-8033- 6259 LOMA AVENUE TEMPLE CITY CA 91780 APPLICANT: TEL. NO: LEE, JACK (714) 671-1050-11 576 E. LAMBERT ROAD BREA CA 92821 CONTRACTOR: TEL. NO: G R MARTINEZ INC. (626) 484-0033- 14164 JOANBRIDGE STREET LIC. NO PO BOX 929 863529 * BALDWIN PARK CA 91706 ARCHITECT OR ENGINEER: TEL. NO: CALLAND ENGINEERING, INC. (714) 671-1050- 576 E LAMBERT ROAD LIC. NO: BREA CA 92821 40870 C I I SURETY BOND: $ BOND N0: I I SURETY COMPANY: DATE FILED: RECD BY: CASH DEPOSIT: DATE FILED: IREC`D BY 1OTHER LEGAL IDS STATE HIWAY: USE ZONE: MAP NO: NO R-1 153X265 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 TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEE DESCRIPTION: QUANTITY: GUM OS PLAN CHECK - B&S 857.00 CU 2A GRADING PERMIT 857.00 CU 2G PERMIT ISSUANCE FEE TOTAL FEES * ADDITIONAL DATA ON FILE N 0508 GRADING PERMIT OR 0508 1510290002 REPORT ID: DPR262 ROUTE TO: BS0508 6259 LODMA AV TEMP CA 917801635 NEAREST CROSS STREET: LONGDEN THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY ******* THIS IS A LIMITED TIME PERMIT ******* AMOUNT:102/17/16 1,068.80 1 1,110.70 IEXP. EXTENDED TO: 34.40 1 2,213.90 SR EXTENDED BY: FOR A NEW SINGLE FAMILY DWELLING SPECIAL CONDITIONS: COVENANT AND AGREEMENT REGARDING THE MAINTENANCE OF LAW IMPACT DEVELOPMENT (LID) & NATIONAL POLLUTANT DISCHARGE INITIAL GRADE PREP. COMPACTION REPORT RECD SUP. ENGNR'S CERT RECD IROUGH GRADING APPROVAL PI.AN'fING AND IRRIGATION ISUP. ENG'S FINAL CERT nn SURETY BOND RELEASED I GEOLOGIC AND SOILS REPORTS FILED ITYPE PREPARED BY DATE RECEIVED APPROVED 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 1, 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 Contractor 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 whit I must have resided for at least one year priorl to completion of the Improvements coveredby 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.goy/calaw.htmi. 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 fyNiAtge end effect. /, License Class` CL!! License No.25 6 31�V�t y /DJe Contractor Signature Y/ WORKERS' COMPENS ON DECLARATION WAf NTNG: 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 ATTORNEYS 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. P licy No. I have and will maintain workers' compensation I surance, as required by Section 3700 of the Labor Code, for the erfo ance th work for which this permit is Issued. My wzee ' � Apyon�insurgrj0Rqrigr,art"olicy number are: Carrier Policy Numtiet " 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 provis ns of Section 3700 of the Labor Code, I 5hall forthwith comp th those provisions 77-17-1 ' nature A Icant 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 complied and will continue to comply therewith through the application process. Applicant (Print Name) Applicant Signature Company Name Date 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 ❑ 1001M I have read the hazardous materials information guide and the SCAOMD permitting checklist, I understand my requirements under the Los Angeles County Code Tide 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 ❑ 1 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 owners 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 i spection purposes. Signat4yf, gwrty O r Authorized Agent