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Home My Public Portal About5031 __10/26/2016_ (5)TEMPLE CITY PERMIT NO. 816-11070 D I Approval Dab 1a City of Temple Cdy 1 9701 Las Tunas Drive I Temple Clty, California 91780 1 (626) 285-2171 1 www.templechy.us Fire Dept Framing Floor/Ceiling Bldg Dept Framinq S Address: 5031 GOLDEN WE ST AV, TEMPLE CITY, California 91780 Parcel: 8589-018-014 Rated Shaft Permit No: 816-11070 Type: Bullding Subtype: RR strip Lot Residential Alteration Description: HOUSE ADDITION 495 SQFT. RELOCATE KITCHEN, DINING ROOM, Special ADD LAUNDRY, BEDROOM, 2 BATHROOMS AND PATIO COVER Conditions: Issue Date: 10-26-2016 Expire 04-24-2017 Extension: 02-15-2017 Extension: Date: am Permit expires on date shown if: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant falls to obtain code required inspection. _ Contacts Owner Emily Phan 5031 Golden West Avenue, Temple City, California 91780 (818) 286-6349 Applicant lames Qlu 2201 Cathryn Place, Rosemead, California 91770 (626) 260-4600 Contractor J H Construction and Design Inc. 488 Wrangler Way, Walnut, California 91789 (626) 720-7999 1001522 Engineer lames Qiu 2201 Cathryn Place, Rosemead, California 91770 (626) 2604600 Building Details Structure 1: Residential 2: Covered Patio 3: 4: Construction Type: V -B V -B Occupancy Group: R-3 Residential, addition under 600 s.f. U Utility, miscellaneous New/Added Area: 495 175 0 0 Remodel/TI Area: 0 0 0 0 New Dwelling Units: 0 0 0 0 Stories: 1 0 0 0 Fees Total Valuation $95,660.00 Plan Check Fees 50.00 Permit Fees $1708.74 Strong Motion Fee $12.44 SB 1473 Fee $4.00 Parks Dev Fee $0.00 Sewer Const Fee $0.00 Building Inspections Approval Dab Inspector Location/Setbacks Soils Engineer Foundation Forms Slab/Under Floor Raised Floor Framing Under000r Insulation Ist Floor Sheathing 2nd Floor Sheathing d Approval D I Approval Dab Roof Sheathing / Rated _ Fire Dept Framing Floor/Ceiling Bldg Dept Framinq Rated Walls Shear Panels Rated Shaft Winkler Hangars InsuLatlon/Weather '_Ear: — Ceilins strip Lot Inspector inage Interior Dra_G�ll�_ Lath/Drywall (//�� 171f 7 414 Exterior Lath434 Smoke Detectors Fire Dep[ Approval I / � i FINAL O )0--, Ln 0 w 0 0 m 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 filea 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.). L) 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). (J I am exemi4t 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 1 must have resided for at least one year priorlto 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:/tw .leginfo.ca.gov/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..��ry — License No. I DJ I l ,J z Date O -A Co/ntiacor Signature Wul WORKERS'COMPENSATION WARNING: FAILURE TO SECURE WORKERS' COM�NSATION COVERAGE IS UNLAWFUL, AND SHALL SU ECT 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. 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 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 I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirem nts declarations: under the Los Angeles County Code Title 2, Chapter 220 I have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous insure for workers' compensation, issued by the Director of material reporting and for obtaining a permit from the SCAQMD. Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION is issued. Policy No. ❑ Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not the perfomrance of the work for which this permit is Issued. My applicable to addressed project. ori afs;F9mpen tion in rance�carder ao policy n� r a :U ( Carrier Iv Poi Number Expirati n Dat DECLARATION REGARDING CONSTRUCTION LENDING AGENCY Name of Agent Phone Number I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if 1 should become subject to the workers' compensa(on provisions of Section 3700 of the Labor Code, I shall f will comply with those provisions li� Signature of AppDate - t 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 Lobbyis Mine ce) and that all persons acting on behalf of myself cern and will cc If to comply therewith through the application Applicant (Print Name)Applica r rP ew�Styt.,rk� p�,, Cdfnpany Name Date CA11tX 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 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. 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 aboive-iclentifiey property for inspection purposes. Signature o or Authorized Agent Date QI A 1 —Z4i6