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Home My Public Portal About9826 DAINES DR_BUILDING_2/9/2016_COUNTY OF LOS ANGELES ' TEMPLE CITY N 0508 BUILDING PERMIT 'DEPARTMENT OF PUBLIC WORAS 9701 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1602090013 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 13805 LT: 77 I SQ. FT STORIES TYPE I 9826 DAINES DA 1 I ISTRUCTURE: 1500 TEMP CA 917802636 1 IASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN 18588-017-014 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI I I I ITENANT: EXIST BLDG USE: REBID USE ZONE: (ISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 102/09/16 SR I I I (OWNER: TEL. NO: IBLDGS. NOW ON IAT: VALUATION: IFINAL DATE F CODE: 1 IMAO, IVG/TAI 0 19826 DAINES DR - 9 , / (� ITEMP 917802636 FEES PAID IDESCITION F RK DEMO HOUSE AND GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (APPLICANT: TEL. NO: DO, JOSEPH (714) 837-2911- IAA BLDG PERMIT ISSUANCE 34.40 I 1 1934 E COTTONWOOD ST 102 DEMOLITION INSPECTN 203.30 ISPECIAL CONDITIONS: ONTARIO CA 91761 i TOTAL FEES 237.70 CONTRACTOR: TEL. NO: I1 (APPROVALS DATE INSPECTOR SIGNATURE JOSEPH CONSTRUCTION (7141 837-2911- 1 1934 E COTTONWOOD ST LIC. NO 1PEDESTRIAN PROTECTION (ONTARIO CA 91761 674654 B SEWER DISCONNECTION Q q� ARCHITECT OR ENGINEER: TEL. NO: I JABANDON PRIVATE DISPOSAL( lo(Q 1 LIC. NO: IUNDERGRND STRUCT REMOVAL( (AND SOIL RECOMPACTION IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 I 511 I IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I 1 NO 23 SCHOOL WITHIN HAZARDOUS (AIR QUALITY: 1000 FEET MATERIALS 1 1 NO NO NO I I I I I I I I I I I I I I I I I I I I I I I (PERMIT EXPIRES 180 DAYS IF 11) WORK DOES NOT COMMENCE, OR 12) WORK IS SUSPENDED OR ABANDONED, OR 1 1 13) FAILS TO OBTAIN CODE REQUIRED INSPECTION I I REPORT ID: DPR261 ROUTE TO: BS0508 I 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, after, 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).): (_) 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 Contra 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 14 License No. S Date 144 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. 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: Carder - Policy Number Expiration Date Name of Agent Phone Number (_) I am exempt 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 in I have for least workers' compensation provisions of Section 3700 of the Labor Code, I s II forthwith comply with those provisions personal residence which must resided at one year prion to completion, of the improvements covered by this permit. I cii owner -builder nnot legally sell a structure that I have built as an f it has not been in its by - q 'Zm t-4 Z constructed entirety Sign re of Applicant Date licensed contractors. 1 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.aovlcalaw.htmi. 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 JQBADDRESS. 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 ❑ 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 ❑ N ❑ !- 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 oonceming 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 of Property Owner or Authorized Agent Date