HomeMy Public PortalAbout9932 DAINES DR_BUILDING_9/16/2015_ (2)COUNTY OF LOS'ANGELES
DEPARTMENT OF PUBLIC WORK'} ,
BUILDING AND SAFETY'/ LAND DEVELOPMENT
LEGAL ID:
JIB: 13805 IT: 87
(ASSESSOR INFORMATION NUMBER:
8588-018-019
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
3�, DAlN�S
# 0508 BUILDING PERMIT
NEW RESIDENTIAL
BL 0508 1504270028
SQ. FT STORIES TYPE OCCUP GROUP 9932 DAINES DR
UCTURE: 2802 2 V -B R-3 TEMP CA 917602638
GARAGE: 688 1 V -B U NEAREST CROSS STREET:
OTHER: 40 1 V -B U THOMAS PAGE: 597 GRID: A3
R-1 JISSUED ON: PROCESSED BY:
09/16/15 SR
OWNER:
TEL. NO:
JBLOGS. NOW ON LOT: VALUATION:
9932 DAINES LLC
419,860
1168 SAN GABRIEL BL
ROSEMEAD CA 91770
FEES PAID
PEE DESCRIPTION: QUANTITY: UDM: AMOUNT:
APPLICANT:
TEL. NO:
CORTEZ, GERMAN
(626) 482-0956-
IB1 PLANCHECK W/ENERGY 419860.00 VAL 3,179.80
1168 SAN GABRIEL BL.
IAA BLDG PERMIT ISSUANCE 27.80
ROSEMEAD CA 91770
JAB STATE GREEN BLDG FEE 419860.00 VAL 17.00
JAC STRONG MOTION RESID 419860.00 VAL 54.60
JB2 PERMIT W/ENERGY 419860.00 VAL 3,740.90
CONTRACTOR:
TEL. NO:
108 CERTIF OF OCCUPANCY 101.40
CS HOME INC.
(626) 664-1985-
1 TOTAL FEES 7,121.50
1608 E BANYAN CT
LIC. NO
L
16 DVKfto C& ,-
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ONTARIO CA 91761
961219 B
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ARCHITECT OR ENGINEER:
WU, HAROLD P
TEL. NO:
(714) 746-6810-
•-l�aLS F.n�. �4PP2o�-e(-t�vo//a��'�
1168 SAN GABRIEL BLVD
SUITE N
LIC. NO:
961219 B
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ROSEMEAD CA 91770
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MAP NO: SEWER MAP BOOK: PAGE:
FIRE ZONE: CMP:
3 all�7f}Zu_I0BS_I�¢ce��c-'f
NO. OF FAMILIES: DWELLING VNITS:
I
APT/GOND: STAT CLASS:
NO 01
1 /._ /�,/�� / s411)/AP&X0
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
I ✓v -
ADDITIONAL DATA ON FILE
ID: DPR261 ROUTE TO: BS0508
LOCALITY: TEMPLE CITY
CODE:
ISCRIPTION OF WORK '
IW 2 -STORY SFD: 4 BEDROOMS, 4.5 BATHROOMS, WITH ATTACHED
CAR GARAGE, ENTRY PORCH AND PATIO 572 SF.
SPRINKLERS REQUIRED
LOCATION AND SETBACKS
�1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the reasons) 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 Contractor 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 which I must have resided for at least
one year priorl 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://w leginfo.m.00v/calaw.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 tJ License No. c) Vg
Datet�b Contractor Signa
WORKERS' COMPENSATIO ECLARATION
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 performanee of the work for whiqh this permit
is issued,
Policy No.
I have and will maintain workers' compensation
insura4ce, 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
Califo ,and agr that, If I should become subject to the
worker omens
on provisions of Section 3700 of the Labor
Code, I all forth comply with those provisions
Signatu plica 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)
Company Name
Applicant Signature
Date
HAZARDOUS MATERI/U_ 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 specked 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 req uirem nfs
under the Los Angeles County Code Title 2, Chapter20'
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
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.
1 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
aboveWdentified prpperty for inspection purposes.
Date
or Authorized Agent