HomeMy Public PortalAbout9250 LOWER AZUSA RD_BUILDING_4/1/2015_ (2)COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1503190040.
PHONE: (626) 285-0488 EXT:
LEGAL ID:
I NO. OF CONST NEW
I BUILDING ADDRESS:
1
ON FILE
I SQ. FT STORIES TYPE OCCUP GROUPI
9250 LOWER AZUSA RD
(STRUCTURE: 490 1 V -B U
I GARAGE:
I TEMP CA 91780
NEAREST CROSS STREET: TEMPLE
CITY
ASSESSORINFORMATION NUMBER:
8592-016-010
I OTHER:
THOMAS PAGE: 596 GRID: H5
LOCALITY: TEMPLE CITY CAI
USE ZONE: R-2
TISSUED ON: PROCESSED BY:
(TENANT:
1
104/01/15 SR
(OWNER:
TEL. NO:
IBLDGS. NOW ON LOT: VALUATION;
IF TE F BY
CODE: 1
THE OLSON COMPANY
13010 OLD RANCH PRWY
(5621 682-7422-
I 10,000
1 l f ! (o
BEACH CA 90740
FEES PAID
JDESCRfPTIOS OF WORK
ISEAL
TCONSTRUCT SHADE STRUCTURE FOR THE
PARK AREA
I_-
(FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:T
(APPLICANT: TEL. N0:
IBORLAND, CHRIS
(562) 6BZ-7422-
IAA BLDG PERMIT ISSUANCE 27.80
13010 OLD RANCH PRWY
IAB STATE GREEN BLDG FEE 10000.00 VAL 1.00
1 SPECIAL CONDITIONS:
ISEACH BEACH CA 90740
IDI PLANCHECK W/O EN -HC 10000.00 VAL 184.10
1
ID2 PERMIT W/O EN -HC 10000.00 VAL 216.60
TOTAL FEES 429.50
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(/ k,5 / I N
(APPROVALS D TE
INSPECTOR SIGNATURE
ICONTRACTOR: TEL NO:
IOLSON URBAN HOUSING L P (562) 596-4770-
3010 OLD RANCH PARKWAY STE 100
LIC. NO
t P��r�t,]O 1J�4_ '��
(LOCATION AND SETBACKS
SEAL BEACH CA 90740
939166
v t
(SOILS I I-
PL �Sor�ioo�fi�
I
ENGINEER APPROVAL
(FOUNDATION/TRENCH FORMS �-
(ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO:
I
SLAB/UNDER FLOOR
1 -
RAISED FLOOR FRAMING
(UNDERFLOOR INSULATION I
i
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:(
I
3 001
1
1
I
I
11ST LEVEL FLOOR SHEATH
IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
1 0
NO 07
1
12ND LEVEL FLOOR SHEATH
ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS
QUALITY: 1000 FEET
MATERIALS
1
(AIR
NO NO
NO
I
1
(FIRE DEPT. FRAME INSPECT(
1BLDG DEPT. FRAME INSPECT
ISHEAR
PANELS I I
I
(INSOLATION/WEATHER
STRIP
NTERIOR LATH/DRYWALL
I
1EXTERIOR
LATH
1LOT
DRAINAGE
1SMOKE
DETECTION DEVICES
I
T
(FIRE
I
DEPARTMENT APPROVAL(
I I
I
REPORT ID: DPR261 ROUTE TO: BS0508
OWNER -BUILDER DECLARATION
by affirm under penalty of perjury that I am exempt from
mtractors' State License Law for the reason(s) indicated
by the checkmark(s) I have placed next to the applicable
(Section 7031.5, Business and Professions Code): Any
county that requires a permit to construct, alter, improve,
ish, or repair any structure, prior to its issuance, also
as the applicant for the permit to file a signed statement
e or she is licensed pursuant to the provisions of the
rctors' State License Law (Chapter 9 (commencing with
n 7000) of Division 3 of the Business and Professions
or that he or she is exempt from licensure and the basis
r alleged exemption. Any violation of Section 7031.5 by
pplicant for a permit subjects the applicant to a civil
V of not more than five hundred dollars ($500).):
is owner of the property, or my employees with wages as
ole compensation, will do (./)all of or (_) portions of the
and the structure is not intended or offered for sale
in 7044, Business and Professions Code: The
ictors' State License Law does not apply to an owner of
ty who, through employees' or personal effort, builds or
,as the property, provided that the improvements are not
ed or offered for sale. If, however, the building or
ement is sold within one year of completion, the Owner -
r will have the burden of proving that it was not built or
,ad for the purpose of sale.).
is owner of the property, am exclusively contracting with
id Contractors to construct the project (Section 7044,
:ss and Professions Code: The Contractors' State License
oes not apply to an owner of property who builds or
,as thereon, and who contracts for the projects with a
:d Contr9�tor pursuant to the Contractors' State License
m exempt from licensure under the Contractors' State
,e Law for the following reason:
signature below I acknowledge that, except for my
ial residence in which I must have resided for at least
ear priorlto completiony of the improvements covered by
reit, I cannot legally sell a structure that I have built as an
builder if it has not been constructed in its entirety by
rd contractors. I understand that a copy of the applicable
action 7044 of the Business and Professions Code, is
ole upon request when this application is submitted or at
owing Web site: htto:/Iwww.leginfo.ca.gov/calaw.html.
ure 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. qq
License Class U License No. 97y ko
ate 14-1-1% Contractor Signature
WORKERS' COMPENSATION 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
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.
Policy No.
I have and will maintain workers' compensation
insurance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
workers' compensation insu ncece �eVpo licy gunper are:
Carrier r 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 ubject "a workers' compensation laws of
California,a e , if should become subject to the
workers' mp as ' pro ' ions of Section 3700 of the Labor
Code shall rth h cc ly with those provisions
Signature of Applicant 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 forguidelines.
Yes ❑ N o ❑
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 120'
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
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-identifie rty for 1 ction purposes.
Signatu of P rty or Aujboriza8 went