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Home My Public Portal About5216 FARAGO AVE_BUILDING_5/9/2016_ (2)COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: Salb AaA6o # 0508 BUILDING PERMIT NEW RESIDENTIAL BL 0508 1504290038 (LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: ITR: 11497 IT: 4 BL: B SQ. FT STORIES' TYPE OCCUP GROUPI 5216 FARAGO AV STRUCTURE: 1620 2 GARAGE: 433 1 OTHER: 95 1 V -B V -B V -B R-3 U U I TEMP CA 917803529 I NEAREST CROSS STREET: FREER THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CA ASSESSOR INFORMATION NUMBER: 8574-009-025 (TENANT: USE ZONE: R-2 ISSUED ON: PROCESSED BY: 05/09/16 SR I (OWNER: CHANG, ANDY TEL. NO: BLDGS. NOW ON LOT: VALUATION: 239,457 _ IFINAL DA T• INAL CODE: 1 A // 130 W HUNTINGTON DR. I/5�^ �I /�? ARCADIA CA 91007 FEES PAID IDES I NN OF WO INEW 2 -STORY DETACHED CONDO 4 BEDROOMS, 3 BATHROOMS, WITH FSE DESCRIPTION: QUANTITY: DOM: AMOUNT:IATTACHED 2 CAR GARAGE AND COVERED PORCH. (APPLICANT: TEL. NO: IZHU, BENJAMIN 1111 S. WALNUT GROVE (626) 203-9639- IB1 PLANCHECK W/ENERGY JAA BLDG PERMIT ISSUANCE 239457.00 VAL 2,069.00 34.40 (SPECIAL CONDITIONS: (SAN GABRIEL CA 91776 GREEN BLDG 239457.00 VAL 1.00 SPRINKLERS REQUIRED IAB STATE RESIDE 239457.00 VAL 31.10 (FIRE JB2 PERMIT W/ENERGY E1 PC EXTENSION FEE 258 108 CERTIF OF OCCUPANCY 239457.00 VAL 517.25 DOL TOTAL FEES 3,041.80 517.25 125.80 5,829.35 1 CONTRACTOR: TEL. NO: IMAPLE BUILDERS, INC. (626) 358-2788- 111625 GOLDRING RD{• LIC. NO SAM (APPROVALS DATE INSPE E SIGNATURE VACATION AND SETBACKS ARCADIA CA 91006 609931 ISOILS ENGINEER APPROVAL IFOUNDATION/TRENCH FORMS "S ARCHITECT OR ENGINEER: TEL. NO: DAVID (626) 288-1216- I 1 l oe 1000 SAN GABRIEL BLVD #101 LIC. NO: SLAB/UNDER FLOOR IROSEMEAD CA 91770 609931 • RAISED FLOOR FRAMING I�I MAP NO: SEWER MAP HOOK: PAGE: FIRE ZONE: CP@:j UNDERFLOOR. INSULATION 3 02I 1ST LEVEL FLOOR SHEATH INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 4 YES 04C 2ND LEVEL FLOOR SHEATH II 1 SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO (FIRE DEPT. FRAME INSPECT( BLDG DEPT. FRAME INSPECT D (SHEAR PANELS INSULATION/WEATHER STRIP( (INTERIOR LATH/DRYWALL wr (EXTERIOR LATH ISMORE LOT DRAINAGE DfiTECTION DEVICES 1 PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 12) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION • ADDITIONAL DATA ON FILE FIRE DEPARTMENT APPROVAL(( f/7 (REPORT ID: DPR261 ROUTE TO: eS0508 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 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 Contactor pursuant So the Contractors' State License Law). U I am exemdt 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 whicf I must have resided for at least one year priori to completion of the improvements covered by this permit, I nnot legally sell a structure that I have built as an owner -builder K 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,//www.leginfO.ca.ciov/celaw.htmi. 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 iti LicenseNo. Dates -q-46 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 affirn 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. Pg icy No. /t 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 VW o rs' c wen anon u c e policy nu bei are: VW wen Cartier 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 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 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 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 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 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. Signature �ooftProperty Oywara( Authorized Agent �Datewc'C)