HomeMy Public PortalAbout5031 GOLDEN WEST AVE_GRADING_10/26/2016_TEMPLE CITY PERMIT NO. G16-22360
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templeaty.us
Address: 5031 GOLDEN WE STAV Unit B, Parcel: 8589-018-014
TEMPLE CITY, California 91780
Permit No:
G16-22360
Type: Grading Subtype: Subtype: Residential
Description:
GRADING FOR NEW 2ND: UNIT
Special COVENANT AND AGREEMENT REGARDING THE MAINTENANCE OF LOW IMPACT
Report
Recd
&
Irrigation
Conditions: DEVELOPMENT (LID) & NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
Sup Eng
Cert Recd
(NPDES)BMPS
Issue Date:
10-26-2016
Expire 04-24-2017 Extension: 06-22-2017 Extension: '
Date:
Permitexpires on date shown if: 1)
work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain -
code required Inspection.
Contacts
Owner
Emily
5031 Golden West Avenue, Temple City, California (818) 286-6349
Phan
91780
Applicant
James
2201 Cathryn Place, Rosemead, California 91770 (626) 260-4600
Qiu
Contractor
) H Construction and
Design 488 Wrangler Way, Walnut, California 91789 (626) 720-7999 1001522
Inc.
Engineer James 2201 Cathryn Place, Rosemead, California 91770
Qiu
Grading Details
Supervised Grading
Cut 2 Fill 5 Over Excavation 216 Total Volume 223
Fees Total
Plan Check Fees $0.00 Permit Fees $502.32
Grading Inspections
Approval Data In
(a
Approval Da�Ins ep c[or. -
Rough —(/ i2J�n
Gradl
Grade Prep�pe����
Grading
%�
Compaction 1'-!-"
Planting
Report
Recd
&
Irrigation
Sup Eng
Sup Eng
Cert Recd
Final Cert 111 if
(626) 260-4600
Approval Date Inspector
Surety
Bond
Released
FINAL
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that 1 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 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 Contre?tor pursuant.to the Contractors' State License
Law).
U I am exem{it 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 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.l�info.m.coy/�Iaw.html/�law.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.
License -Cla 1ss --Z---Z—License No.
Datete,��6ontractor Signature
WORKERS' COMPENSATION DECLARATI
WARNING: FAILURE TO SECURE WORKERS' COMPE ATION
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.
PotNo.
I have and will maintain workers' compensation
in uran"
, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
workers' c mm sat' n in uran carierand4policy
On (i er
Came Poli Number Expirat n �I
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, andgree that, if 1 should become subject to the
workers' compnsation provisions of Section 3700 of the Labor
Code, I shall fo with.Qomply with those provisions
4
Date
LOBBVST ORDINANCE CERTIFICATION
Com tete this section for permits in
Uninco orated Los Angeles County only
This is to certify that 1, 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 OrdinancggVq� and that
all persons acting on behalf of myself complied and wo,l continue
to comply therewith through the application prFcops,
rme {
1t(�N
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 ❑ 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 o ❑
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 �20
Sections 220.100 through 220.140 conceming 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 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.
Signature of P er or uthorized Agent
--7
Date