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HomeMy Public PortalAbout6453 TRELAWNEY AVE_BUILDING_5/4/2016_APPLICANT: TEL. NO: TRUJILLO, CAROLINE (661) 713-6316- 3055 CLEARVIEW WAY PANELS I INVERTER SAN MATEO CA 94402 COUNTY OF LOS ANGELES CONTRACTOR: TEMPLE CITY # 0508 PHOTOVOLTAIC PERMIT DEPARTMENT OF PUBLIC WORKS 888104/C10 9701 LAS TUNAS AB STATE GREEN BLDG FEE 16800.00 VAL BUILDING AND SAFETY / LAND DEVELOPMENT SPECIAL CON ' TEMPLE CITY CA 91780 AC STRNG MTN RSDNTAL 16800.00 VAL CB 0508 1604120024 1 PHONE: (626) 285-0488 EXT: 120.70 (LEGAL ID: �/� �• 02 PERMIT ISSUANCE FEE NO. OF CONST NEW BOILDING ADDRESS: TR: 12706 IT: 17 TOTAL FEES SQ. FT STORIES TYPE OCCUP GROUPI 6453 TRELAWNEY AV I STRUCTURE: 0 1 V -B I TEMP CA 917801315 (ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 15382-014-018 OTHER: THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY CAI (TENANT: EXIST BLDG USE: PHOTO JISSUED ON: PROCESSED BY: 1 EXIST OCC GRP: 05/04/16 SR TOWNER: TEL. N0: IBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: 1 PATTERSON DANIEL C;KATHLEEN A 16,800 16453 TRELAWNEY AV ITEMP 917801315 FEES PAID IDESCRIPTION OF WORK APPLICANT: TEL. NO: TRUJILLO, CAROLINE (661) 713-6316- 3055 CLEARVIEW WAY PANELS I INVERTER SAN MATEO CA 94402 QUANTITY: UOM: CONTRACTOR: TEL. NO: SOLARCITY CORPORATION (661) 713-6316- 3055 CLEARVIEW WAY LIC. NO SAN MATEO CA 94402 888104/C10 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: 0 NO 20 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO ALL GROUNDING AND BONDING OF THE PV SYSTEM SHALL COMPLY WITH IAS ANGELES COUNTY REQUIREMENTS. NOTE: WEEB PLATES . WASHERS. AND SIMILAR DEVICES ARE NOT ACCEPTED. EXPIRED PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION SOILS ENGINEER APPROVAL (UNDERFLOOR INSULATION IFLOOR SHEATHING I IROOF SHEATHING SHEAR PANELS IFRAME INSPECTION (FIRE SPRINKLER HANGERS RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES ILOT DRAINAGE I REPORT ID: DPR261 ROUTE TO: BS0508 I IPV SOLAR ROOF INSTALL 8.48 KW 32 PANELS I INVERTER FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( P4 PV PC RES ROOF <15KW 223.80 AB STATE GREEN BLDG FEE 16800.00 VAL 1.20 SPECIAL CON ' AC STRNG MTN RSDNTAL 16800.00 VAL 2.20 1 P5 PV PRMT RES ROOF<15K 120.70 1 �/� �• 02 PERMIT ISSUANCE FEE 34.40 TOTAL FEES 382.30 (APPROVALS DATE INSPEC C�1R SIG'. SOILS ENGINEER APPROVAL (UNDERFLOOR INSULATION IFLOOR SHEATHING I IROOF SHEATHING SHEAR PANELS IFRAME INSPECTION (FIRE SPRINKLER HANGERS RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES ILOT DRAINAGE I REPORT ID: DPR261 ROUTE TO: BS0508 I 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 Contractor pursuant to the Contractors' State License Law). U: I am exemiJt 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 priorlto 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: htto://www.leginfo.m.00v/calaw.html. Date: Signature of Property Owner or Authorized Agent i 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. 1� �icense Clats��sC�((License No. `/Date c3 4' )U Contractor Signature / S_ 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 ATTORNEYS 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. C3_ 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' compensation insurance carrier and policy numbeare: R..( Car�rtter 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 Ignathra,alf 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 r7 - •K 14' Ya�tfLW Q 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 ❑ WIII 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 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 �{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 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 tp pe mer or Authorized Agent X 1 ate ti 1