HomeMy Public PortalAbout5728 ROSEMEAD BLVD_Building_11/17/2016_TEMPLE CITY PERMIT NO. B16-33236
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us
Address:
5728 Rosemead Blvd. Unit 106, Temple City, California
Parcel:
5387-013-031
91780
Permit No:
B16-33236
Type:
Building Subtype: SI
Sign
Description:
2 SETS CHANNEL LETTERS SIGNS LED ILLUMINATED
Special
Conditions:
Issue Date:
11-17-2016
Expire Date:
05-16-2017 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
Owner The Gateway LP 1005 East Las Tunas Drive, San Gabriel, California 91776
Applicant Terry To 1438 Santa Anita Avenue, South EI Monte, California 91733 (626) 443-3333
Contractor Signs Express Mfg. Co. 1438 Santa Anita Avenue, South EI Monte, California 91733 (626) 443-3333 552097
- Fees Total
Valuation $4900.00 Plan Check Fees $142.95 Permit Fees $168.17
Strong Motion Fee $0.00 SB 1473 Fee $1.00 Parks Dev Fee $0.00 Sewer Const Fee $0.00
- Sign Inspections
Approval Date Inspector Approval Date Inspector Approval I spe or
Location/Setbacks Foundation FINAL
Soils Engineer Forms
Support
Structure
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
items) (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 appli nt to a civil
penalty of not more than five hundred dollars ($5PD).):
U I, as owner of the property, or my employ*s with wages as
their sole compensation, will do/Pro
of o (_) portions of the
work, and the structure is noe or offered for sale
(Section 7044, Business asalons Code: The
Contractors' State License Lawt apply to an owner of
property who, through employeersonal effort, builds or
improves the property, providede improvements are not
Intended or offered for sale.wever, the building or
Improvement is sold within one completion, the Owner -
Builder will have the burden of that it was not built or
improved for the purpose of sale
U I, as owner of the prope , am exclusively contracting with
licensed Contractors to
wct the project (Section 7044,
Business and Professions C de: The Connectors' State License
Law does not apply to a owner of property who builds or
improves thereon, and w o contracts for the projects with a
licensedContrA�tor purl ant .to the Contractors' State License
Law).
U: I am exempt from icensure under the Contractors' State
License Law
for the f ng
reason:
By my signature below I acknowledge that, except for my
personal residence in whicl] I must have resided for at least
one year priorlto wmpletiory 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,/lw m.leciinfo.ca.aov/calaw.htm].
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 full force and effect.
License Class �ZLsLicense No.
Date A /7 /L"ontractor Signature
WO KERS' COMPENSATION DECLARATION
WAAMNG: 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.
o icy No.
P
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
coo kers' wmpeggatinn insurance c 'er an ppllcy n��b /a
LZ /
Carrier Policy mbei VE
o ate
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
Signature of Applicant
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 proce
Applicant (Print N ne) Appli nt Sa /
Company Name DAtA 7 -
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 ❑ N o ❑
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 ❑ 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 Title 2, Chapter 720'
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 tai;each of the following:
I am the property owner or authorized to act on the
property owner's behaff.
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 Property
Date /r // 7 /2d /,