HomeMy Public PortalAbout9903 BROADWAY_BUILDING_3/4/2015_ (2). COUNTY ,OF LAS ANGELES
DEPAR}MEC? OF PUBLIC WORKS
BUILDING AND SAFETY / I M pEVELOPMENT
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
dMo3 UoAi)wAy
N 0508 BUILDING PERMIT
NEW RESIDENTIAL
HL 0508 1406260092
LEGAL ID:
TEL.
NO:
NO. OF
CONST
NEW
BUILDING ADDRESS:
1R: 13805 LT: 12
I
SQ. FT
STORIES
TYPE
OCCUP
GROUPI 9903 BROADWAY
STRUCTURE:
2843
2
V -B
R-3
I TEMP CA 917802635
ASSESSOR INFORMATION NUMBER:
GARAGE:
641
1
V -B
U
NEAREST CROSS STREET: GOLDEN WEST
8558-015-012
OTHER:
129
1
V -B
U
THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CA',
TENANT:
IAA BLDG PERMIT ISSUANCE
USE
ZONE: R-1
TISSUED ON: PROCESSED BY:
IAB STATE GREEN BLDG FEE
418010.00 VAL 17.00
103/04/15 SR
V..X;
TEL.
NO:
BLDGS. NOW ON LOT:
VALUATION:
TANG, WILLIAM
(626) 823-7575-
418,010
9903 BROADWAY
TEMP 917802635
FEES PAID
(FEE DESCkIPTION:
QUANTITY: QOM: AMOUNT:
APPLICANT:
TEL.
N0:
LAI, KAMEN
(626) 288-2651-
IB1 PLANCHECK W/ENERGY
418010.00 VAL 3,173.60
8748 E VALLEY BLVD K
IAA BLDG PERMIT ISSUANCE
27.80
ROSEMEAD CA 91770
IAB STATE GREEN BLDG FEE
418010.00 VAL 17.00
IAC STRONG MOTION REBID
418010.00 VAL 41.80
IB2 PERMIT W/ENERGY
418010.00 VAL 3,733.60
CONTRACTOR:
TEL.
NO:
IDS CER IF OF 0 CUPANCI'Y
1�01A0
TOBI5823NZAPATARPLACEN INC.
(909)
LIC.9173- NO
�O/(1�0�41(/f TIA
� Iu.(CT(,�j ve`'�/K9�
RANCHO CU CAM NGA, CA
' •�,�O�n^ _
i
ARCHITECT OROENGINEER91737
TEL.
N093678
��`-�I^^TT��//
HOUNG, SHAO-MING
(626)
336-8769-
16505 EMBER GLEN RD.
LIC. NO:
HACIENDA HEIGHTS, CA 91745
593678
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 01
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
1 NO 01
QUALITY: 1000 FEET MATERIALS
NO NO NO
EXPIRED
• ADDITIONAL DATA ON FILE
ID: DPR261 ROUTE TO: BS0508
FINAL DATE
DESCRIPTION OF WORK
NEW 2 -STORY SFD: 5 BEDROOMS, 4 BATHROOMS, 1 POWDER, 2ND:
FLOOR DEN, WITH ATTACHED 3 CAR GARAGE, COVERED PORCH AND
COVERED PATIO 209 SF
SPECIAL CONDITIONS:
FIRE SPRINKLERS REQUIRED
8-9-i,7
APPROVALS DATE INSPECTOR SIGNATURE
AND SETBACKS
FOUNDATION/TRENCH FORMS
FLOOR
(RAISED FLOOR FRAMING
I
(UNDERFLOOR INSOLATION
11ST LEVEL FLOOR SHEATH
12ND LEVEL FLOOR SHEATH
I r�- IROOF SHEATHING
IFIRE DEPT. FRAME INSPECT(BLDG DEPT. FRAME INSPECTSHEAR PANELS A
INTERIOR
EXTERIOR
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL(
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 (J) 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 Contra or pursuant.to the Contractors' State License
Law).
(_) 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 whicF I must have resided for at least
one year priori to 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.leninfo.ca.gov/calaw.html.
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.
--kicense Class A]i f5 License No. 5Ci 3 (o •7-
TVate�-t t5 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 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.
PpI' No.
7 1 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
workeI
ompensay, n insure ce car an iol'cy number are: �)
o --x
Carder r olicy Number &piration 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
)9gde, I shall forthwith comply with those provisions
plicant 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
- if.
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 spectfied 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).
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-identifiedj property for inspection purposes.
;Signe e oferty- or Authorized Agent
tee