HomeMy Public PortalAbout5936 LOMA AVE_Building_6/23/2016_BL 0508 1606230024COUNTY OF I ANGELES
DEPARTMENT OF UBLIC WORKS
BUILDING AND SAFETY/ LAND DEVELOPMENT
GAL ID:
: 5904 LT: 366
SESSOR INFORMATION NUMBER
84-013-004
GONZALEZ LOUIS J;VICTORIA
15936 LAMA AV
ITEMP 917801923
JAPPLICANT:
ITARANTO, JOSEPH
IPO BOX 1857
(UPLAND CA 91785
1
I
[CONTRACTOR':
ITARANTO CONSTRUCTION, INC
11252 MONTE VISTA AVE.,
(SUITE M5
UPLAND, CA 91786
TEL. NO:
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LVV. Vk LVq I'1
SQ. PT STORIES TYPE
STRUCTURE- V -S
EXIST OCC GRP:
CEG.[ YAlU
[FEE DESCRIPTION: QUANTITY: DOM:
TEL. NO: 1
(909) 917-4312- 1 A BLDG PERMIT ISSUANCE
JAB STATE GREEN BLDG FEE 9500.00 VAL
JAC STRONG MOTION REBID 9500.00 VAL
ID1 PLANCHECK W/O EN -HC 9500.00 VAL
ID2 PERMIT W/O EN -HC 9500.00 VAL
TEL. NO: I TOTAL FEES
(909) 931 -3233 -
LIC. NO
876297
LIC. NO:
EMAP VU: JGWCK MAP BUUX: PAUS: FIRE TONE: CMP:
J 3 001
I
IND. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1
NO 21 I
SCHOOL WITHIN HA2ARDOU9
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
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
JDESCRIPTJOF OF WORK - -/ I
[REPLACEMENT WINDOW INSTALLATION (16) TOTAL
AMOUNT:J
34.40
1.00 [SPECIAL CONDITIONS:
1.20 [
229.80 J
270.40 1
536.80 JAPPROVALS DATE INSPECTOR
ILOCATION AND SETBACKS [
I
JSOIL3 ENGINEER APPROVAL
(FOUNDATION/TRENCH FORMS
I I
JSLAB/UNDER FLOOR
I
IRAISED FLOOR FRAMING J 1
I
JUNDERFLOOR INSULATION I1
I 111
IFLOOR SHEATHING I
—1-1
IROOF SHEATHING [ 1
ISHEAR PANELS [
IT -BAR CEILINGS
1LOT DRAINAGE
REPORT ID: OPR261 ROUTE TO: BS0508 �i L_- tt ♦ n
59 3p komor
$ 0508
BUILDING PERMIT
ALTERATION/REPAIR
BL 0508 1606230024
BUILDING ADDRESS:
1 5936 LOMA AV
-
TEMP CA 917801923
I NEAREST CROSS STREET: GARIBALDI
.
� THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CA
ZONE: R-1
I
TISSUED ON: PROCESSED BY:
106/23/16 SR
UATION:FINAL
jPATE FAL CODE:
9,500
l0/ 1& /,
CEG.[ YAlU
[FEE DESCRIPTION: QUANTITY: DOM:
TEL. NO: 1
(909) 917-4312- 1 A BLDG PERMIT ISSUANCE
JAB STATE GREEN BLDG FEE 9500.00 VAL
JAC STRONG MOTION REBID 9500.00 VAL
ID1 PLANCHECK W/O EN -HC 9500.00 VAL
ID2 PERMIT W/O EN -HC 9500.00 VAL
TEL. NO: I TOTAL FEES
(909) 931 -3233 -
LIC. NO
876297
LIC. NO:
EMAP VU: JGWCK MAP BUUX: PAUS: FIRE TONE: CMP:
J 3 001
I
IND. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1
NO 21 I
SCHOOL WITHIN HA2ARDOU9
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
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
JDESCRIPTJOF OF WORK - -/ I
[REPLACEMENT WINDOW INSTALLATION (16) TOTAL
AMOUNT:J
34.40
1.00 [SPECIAL CONDITIONS:
1.20 [
229.80 J
270.40 1
536.80 JAPPROVALS DATE INSPECTOR
ILOCATION AND SETBACKS [
I
JSOIL3 ENGINEER APPROVAL
(FOUNDATION/TRENCH FORMS
I I
JSLAB/UNDER FLOOR
I
IRAISED FLOOR FRAMING J 1
I
JUNDERFLOOR INSULATION I1
I 111
IFLOOR SHEATHING I
—1-1
IROOF SHEATHING [ 1
ISHEAR PANELS [
IT -BAR CEILINGS
1LOT DRAINAGE
REPORT ID: OPR261 ROUTE TO: BS0508 �i L_- tt ♦ n
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 IV) all of or i_) 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 Con" or pursuant to the Contractors' State License
Law).
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 No. '8114 24 - /
)'Date` ti' Contr or Signature �fi
WORKERS' C 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.
Poli_y 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 nuryper are:
S i wTe tc~b t/ a �.
Carder Policy Number Expiration Date
Name of Agent Phone Number
U I am exemdt from licensure under the Contractors' State — I certify that, in the performance of the work for which this
License Law for the following reason: 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
By my signature below I acknowledge that, except for my workers' compensation provisions of Section 3700 of the Labor
personal residence in which I must have resided for at least Code, I shall fo Shwith comply with rovisions
one year prior) to oompletiory of the improvements covered by _ ` /Z� //f
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 b Si ure of Applicant Date
licensed contractors. I understand that a copy of the appli% e
law, Section 7044 of the Business and Professions Code, '
available upon request when this application is submitted or at
the following Web site: htto://www.leginfo.ca.gov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
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 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).
Lenders 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 of