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Home My Public Portal About8602 WORTHINGTON DR - BUILDING - 2016-01-27 - BL 0508 1601270053+ COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT TR: 25341 LT: 9 ASSESSOR INFORMATION NUMBER: 5386-007-051 TENANT: OWNER: TEL. NO: TRAY, WILLIE 8602 WORTHINGTON DR SGAB 917752647 (ARCHITECT OR ENGINEER: TEL. NO: I - I LIC. NO: 1 J J (MAP NO: SEWER MAP HOOK: PAGE: FIRE ZONE: CMP:( 1 3 001 J J IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 21 J I SCHOOL WITHIN HAZARDOUS 1 JAIR QUALITY: 1000 FEET MATERIALS 1 I NO NO NO EXPIRED 6-01- I (1) REPLACE 9 WINDOWS, 1 SLIDING DOOR (2) REMODEL KITCHEN X34 40 '(3) RIng 10 2.00 ISPECIl NSM 00 4.00 639.10 751.90 4o, 7 - I 1 427.00 JAPPROVALS DATE INSPECTOR SIGNATURE 1,856.40 INSULATION PANELS ASSEMBLIES IPERMIT EXPIRES 180 DAYS IF 11) WORK DOES NOT COMMENCE, OR JRATED 12) WORK IS SUSPENDED OR ABANDONED, OR 13) FAILS TO OBTAIN CODE REQUIRED INSPECTION I IT -BAR REPORT ID: DPR261 ROUTE TO: SS0508 TEMPLE CITY N 0508 BUILDING PERMIT :CANT: 9701 LAS TUNAS I ALTERATION/REPAIR AS OWNER TEMPLE CITY CA 91780 IAA BLDG PERMIT ISSUANCE BL 0508 1601270053 PHONE: (626) 285-0488 EXT: 31000.00 VAL NO. OF CONST 31000.00 VAL BUILDING ADDRESS: SQ. FT STORIES TYPE 8602 WORTHINGTON DR STRUCTURE: V -S ACTOR: SGAB CA 917752647 JFR INV WORK W/O PERMIT 344.00 DOL AS OWNER - NEAREST CROSS STREET: BURTON TOTAL FEES LIC. NO I THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY EXIST BLDG USE: REBID USE ZONE: R-1 ON: PROCESSED BY: EXIST OCC GRP: TISSUED 01/27/16 SR BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 31,000 1 (ARCHITECT OR ENGINEER: TEL. NO: I - I LIC. NO: 1 J J (MAP NO: SEWER MAP HOOK: PAGE: FIRE ZONE: CMP:( 1 3 001 J J IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 21 J I SCHOOL WITHIN HAZARDOUS 1 JAIR QUALITY: 1000 FEET MATERIALS 1 I NO NO NO EXPIRED 6-01- I (1) REPLACE 9 WINDOWS, 1 SLIDING DOOR (2) REMODEL KITCHEN X34 40 '(3) RIng 10 2.00 ISPECIl NSM 00 4.00 639.10 751.90 4o, 7 - I 1 427.00 JAPPROVALS DATE INSPECTOR SIGNATURE 1,856.40 INSULATION PANELS ASSEMBLIES IPERMIT EXPIRES 180 DAYS IF 11) WORK DOES NOT COMMENCE, OR JRATED 12) WORK IS SUSPENDED OR ABANDONED, OR 13) FAILS TO OBTAIN CODE REQUIRED INSPECTION I IT -BAR REPORT ID: DPR261 ROUTE TO: SS0508 IEEE DESCRIPTION: QUANTITY: DOM: :CANT: TEL. NO: I AS OWNER - IAA BLDG PERMIT ISSUANCE IAB STATE GREEN BLDG FEE 31000.00 VAL IAC STRONG MOTION REBID 31000.00 VAL IBI PLANCHECK W/ENERGY 31000.00 VAL JB2 PERMIT W/ENERGY 31000.00 VAL ACTOR: TEL. NO: JFR INV WORK W/O PERMIT 344.00 DOL AS OWNER - I TOTAL FEES LIC. NO I (ARCHITECT OR ENGINEER: TEL. NO: I - I LIC. NO: 1 J J (MAP NO: SEWER MAP HOOK: PAGE: FIRE ZONE: CMP:( 1 3 001 J J IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 21 J I SCHOOL WITHIN HAZARDOUS 1 JAIR QUALITY: 1000 FEET MATERIALS 1 I NO NO NO EXPIRED 6-01- I (1) REPLACE 9 WINDOWS, 1 SLIDING DOOR (2) REMODEL KITCHEN X34 40 '(3) RIng 10 2.00 ISPECIl NSM 00 4.00 639.10 751.90 4o, 7 - I 1 427.00 JAPPROVALS DATE INSPECTOR SIGNATURE 1,856.40 INSULATION PANELS ASSEMBLIES IPERMIT EXPIRES 180 DAYS IF 11) WORK DOES NOT COMMENCE, OR JRATED 12) WORK IS SUSPENDED OR ABANDONED, OR 13) FAILS TO OBTAIN CODE REQUIRED INSPECTION I IT -BAR REPORT ID: DPR261 ROUTE TO: SS0508 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 (_) 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 Contredor pursuant.to the Contractors' State License Law). U I am exempt 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 priori to completion of the improvements covered by this permit, I�gnnot 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.ca.gov/calaw.htmi. Date: 27 /ro Signa f pe eror 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 License Date Contractor WORKERS' COMPENSATION DECLARATION WAFINING: 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 workers' compensation insurance carrier and policy number are: Carrier 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall 06rfhwith comply with those provisions Si ature of Applicant ate 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 ❑ 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 ❑ 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 I20' 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 ❑ 1 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). Lenders Name Lenders 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 -identified property for inspection purposes. Signoy eAqh�eFac tthorized Agent Date 9Z