HomeMy Public PortalAbout9913 LOWER AZUSA RD_BUILDING_6/13/2016_ (2)1•
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COUNTY OF LOS AN9.EL%S
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 1501220161
PHONE: (626)
285-0488 EXT:
LEGAL ID:
N0.
OF CONST
HEW
BUILDING ADDRESS:
ITR: 9848 IT: 12
SQ. FT STORIES TYPE
OCCOP GROUPI 9913 LOWER AZUSA RD
1
STRUCTURE: 1554
2 V -B
R-3
TEMP CA 917804041
(ASSESSOR INFORMATION NUMBER:
GARAGE: 432
1 V -B
U
NEAREST CROSS STREET:
18589-024-024
OTHER:
THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY CAI
I
TENANT:
1
USE ZONE: R-2
ISSUED ON: PROCESSED BY:
1
1
106/13/16 SR
OWNER:
TEL.
NO:
[BLDGS. NOW ON LOT:
VALUATION:
JFFIVAL ATE FINAL BY:
CODE:
WEI SHARON
15593 ANGELUS AVE
1228,742
/
`3
{Ay�n)
L w / q
ITEMP917804041
FEES PAID
[DES IPTI OF WORK
INEW 2 -STORY DETACHED C99M 4 BEDROOMS,
3 BATHROOMS, WITH
IFEE DESCRIPTION:
QUANTITY: DOM:
AMOUNT:
ATTACHED 2 CAR GARAGE
APPLICANT:
TEL.
NO:
1
[TSOI, VINCENT
(626) 799-8818-
ID4 STANDARD PC W/ EN
228742.00 VAL
1,400.80
11414 FAIR OAKS #2
1E1 PC EXTENSION FEE 25k
350.20 DOL
350.20
ISPECIAL CONDITIONS:
1
ISOUTH PASADENA 91030
AA BLDG PERMIT ISSUANCE
34.40
IFIRE SPRINKLERS REQUIRED
1
1AB STATE GREEN BLDG FEE
228742.00 VAL
10.00
JAC STRONG MOTION REBID
228742.00 VAL
29.70
CONTRACTOR:
TEL.
NO:
JB2 PERMIT W/ENERGY
228742.00 VAL
2,941.40
(APPROVALS DATE INSPECTOR SIGNATURE
IMCWONG HOLDING CO.
(626)
570-9969-
108 CERTIF OF OCCUPANCY
125.80
1
809 S ATLANTIC BLVD, STE 201
LIC. NO
TOTAL FEES
4,892.30
VOCATION AND SETBACKS
[MONTEREY PARK. CA 91754
685220
1 1115//A�
/ I
ARCHITECT OR ENGINEER: TEL. NO:
SPACE LIGHT STRUCTURE DESIGN (626) 799-8818-
1414 FAIR OAKS AVE STE 2 LIC. NO:
SOUTH PASADENA, CA 91030 23755
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 02
NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS:
5 YES 04C
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
PERMIT EXPIRES 180 DAYS IF
1) WORK DOES NOT COMMENCE, OR
2) FORK IS SUSPENDED OR ABANDONED, OR
3) FAILS TO OBTAIN CODE REQUIRED INSPECTION
REPORT ID: DPR261 ROUTE TO: BS0508
Iir,a �awriva�wrxanzn ai niel10/11
INTERIOR LATH/DRYWALL
EXTERIOR LATH
LOT DRAINAGE
(SMOKE DETECTION DEVICES
(�1 (FIRE DEPARTMENT APPROVAL(/n/,,/!71 /J�rd)
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 taw (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).):
(-.) I, as owner of the property, or my employees with wages as
their sole compensation, will do (J) all of or (_) 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). '
(_); I am exempt from licensure under the Contractors' State
License Law for the following reason:
By my signatur below I acknowledge that, except for my
personal reside ce in which I must have resided for at least
one year prior to oompletiony of the improvements covered by
this permit, Icannot legally sell a structure that I have built as an
owner-builderif 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.leginfo.m.aov/calaw.html.
Date: � ( ( -),;o I G�
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 Class � License No. 1O0 vim`-'
Dateontractor Signat S
WO ERS' COMPENSATION DECLARATION
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.
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
ompensation Insu n e d poli umbo a
Carrier r- Policy Number pi do 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 shall forthwith comply with those provisions
�G C, 0 S :X
g ature 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 throw h the appli tion process.
� ��
tlpplicent (P,rint Nipie) _ ceht 'gnalura i .
Company Namb ) DaaTe' ' - l ' -
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 SCARMD.
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 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 inspection purposes.
Signature of P party r or Authorized yet
/T S
Date I