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Home My Public Portal About9917 LOWER AZUSA RD_MECHANICAL_6/13/2016_ (2)COUNTY OF LOS ANGELES DEPAjTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT EGAL ID: R: 9848 LT: 12 SSESSOR INFORMATION NUMBER 589-024-024 TEL. N0: IWEI SHARON 15593 ANGELUS AVE ITEMP917804041 APPLICANT: -- TEL. NO: [WONG, KAM (626) 570-9969- 1809 S ATLANTIC BLVD. MONTEREY PARK 91754 CONTRACTOR: TEL. NO: IMCWONG HOLDING CO. (626) 570-9969- 1809 S ATLANTIC BLVD, STE 201 LIC. NO MONTEREY PARK, CA 91754 685220 ARCHITECT OR ENGINEER: TEL. NO: SPACE LIGHT STRUCTURE DESIGN (626) 799-B818- 11414 FAIR OAKS AVE STE 2 LIC. NO: SOUTH PASADENA, CA 91030 23755 'ERMIT EXPIRES 180 DAYS IF .) WORK DOES NOT COMMERCE, OR !) WORK IS SUSPENDED OR ABANDONED, OR ') FAILS TO OBTAIN CODE REQUIRED INSPECTION TEMPLE CITY k 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID FEE DESCRIPTION: QUANTITY: DOM: O1 PERMIT ISSUANCE FEE 02 REFRIG COMP < 100 KS 1.00 COM 08 FURNACE/HEATER < 100 1.00 UNI 30 AIR INLETS/OUTLETS 15.00 IN/ 41 SINGLE REGISTER PANS 6.00 FAN TOTAL FEES REPORT ID: DPR264 ROUTE TO: BS0508 MECHANICAL PERMIT ME 0508 1606130040 BUILDING ADDRESS: 9917 LOWER AZUSA RD AMOUNT: TEMP CA 917804041 NEAREST CROSS STREET: 34.40 THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY CA 33.70 33.70 JISSUED ON: PROCESSED BY: PLAN BY: 79.50 06/13/16 SR 118.80 300.10 FIVALADATE / FINAL BY: CODE: F WORK SYSTEM FO NEW DETACHED CONDO 1.3.M1YA 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 fora 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 ContrkfWr pursuant.to the Contractors' State License Law). U:I am exerri 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 whicl I must have resided for at least one year priorl to completioryry of the improvements covered by this pertnD, I nnot legally sdll a structure that I have built as an own 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: hftp�/AArww.lecinfb.�.aov/calaw.html. Date: rb Signature of�LProperty lOwner orAuthorized A ant LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed unde- 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 �a__ License No. Date 1 Z �-ntrector Signature ' WORKERS' COMPENSATION DECLARATION WAR ZING: 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 Ion VAI%% urep ce car arCariar adcy Num11$4ber or and policy bee re: Fxm nr at7 Name of AgeriLl 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 forthwi S omply with those provisions lig ature o cant D to 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 comolv4terev h D=ugh tthe applica' n p�ess. o r��Namel pI cant S' nate CompanyName I Date I ,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 constructlon or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklistfor guidelines. Yes ❑ N o ❑ i I have read the hazardous materials information guide and the SCAQMD permitting checklist I understand my requirem nts under the Los Angeles County Code Tile 2, Chapter �L�20- 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 forthe performance of the work for which this permit is Issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, 1 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. gn re of of operyy or Authorized Agent Authorized Agent Date V