HomeMy Public PortalAbout5842 GOLDEN WEST AVE_BUILDING_8/10/2016_- Contacts
irlm
Owner
Nguyen Long
TEMPLE CITY PERMIT NO. B16-32664
Phi
Applicant
Dillon
City of Temple Qty 1 9701 Las Tunas Drive
I Temple City, California 91780
1 (626) 285-2171 1 www.templecity.us
Address:
5842 Golden West Avenue, Temple City,
Parcel: 8587-027-018
California 91780
Permit No:
B16-32664
Type: Building
Subtype: CB
Combo
Building
Description:
Roof mounted Solar PV System, 5.83 KW,
Special
22 panels and 1 inverter
Conditions:
Issue Date:
08-10-2016
Expire Date: 02-06-2017
Extension: Extension:
Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to
obtain code required inspection.
- Contacts
irlm
Owner
Nguyen Long
Phi
Applicant
Dillon
Albanese
Contractor
SolarCity
Combo
System Qty 1
- Fees Total
Corporation
Solar Details
Area 330 Stories 1
02 Golden West Avenue, Temple City,
California 91780
3055 Clearview Way, San Mateo, California
94402
3055 Clearview Way, San Mateo, California
94402
(408)421-3001
(661)713-6316 888104
Valuation $12,900.00 Plan Check Fees $228.28 Permit Fees $268.56
Strong Motion Fee $0.00 SB 1473 Fee $1.00 Parks Dev Fee $0.00 Sewer Const Fee $0.00
- Buildi
Approval Date
Location/Setbacks _
Soils Engineer
Foundation Forms_
Slab/Under Floor
Raised Floor
Framing
Underfloor
Insulation
1st Floor
Sheathing
2nd Floor
Sheathing
Roof Sheathing _
Fire Dept Framing
Bldg Dept
Framing
Inspector
Approval Date
Shear Panels
Sprinkler Hangars
Insulation/Weather
Strip
Interior _
Lath/Drywall
Exterior Lath
Rated Floor/Ceiling
Rated Walls
Rated Shafts
T -Bar Ceilings
Lot Drainage
Smoke Detectors
Fire Dept Approval
FINAL
Inspector
(T;
CA
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 L) 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.).
L) 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).
L). I am exemi4t 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 prion 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: http,//www.leginfo.ca.ciov/calaw.html.
1
Date: d /6
Signature of arty caner or Au ort¢ed 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. 10 License No.
g• (trlG /
Date Contractor Signature
WORKERS' 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.
CAI cy 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' compersatign insurance carrier and policy number are:
�L..,.rc(.. Jtr�-�7c'n (--cu16?,01Y-i7u o /6
Carrier Policy Number Expiration Date
nl%h A)bg Qt c- Cqus yZl-5oa I
Name of Agent Phone Number
`%A 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
Coda-l-shaRf rthwith comply with those provisions
if lv ib
Signature of Applicant Date
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
Unincorporated Los Angeles County only
This is to certify that 1, as permit applicant, am familiar with the
requirements of Los Angeles County Code Chapter 2.160 et seq.,
(relating to the Los Angeles County Lobbyist Ordinance) and that
all persons acting on behalf of myself complie II continue
to comply therewith thro}rgh the applicatio ocess.
�llly� nG)-Q_
Applip t (Print ame) 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 ❑ No ❑
I have read the hazardous materials information guide and the
SCAQMD 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
❑ 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-identffied property for inspection purposes.
Date d�'10-16
or AM4rized Agent