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Home My Public Portal About5109 __3/23/2016_ (3)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 (✓) 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.). (_) 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 which I must have resided for at least one year prion to completion, of the improvements covered by this permit, I c4nnot legally sell a structure that I have built as an owner -builder h 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: hfto://www.leginfo.ca.aovlc'alaw.htmi. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION 1 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 ClaspV License No. %Sb� 319316 Date Contractor Signature WORKERS' COMPENSATION DEC ON 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. P,IN No. �_ I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of toe work for which this permit is issued. My v[�erffL�.rs' m at n insu Ice r and poli_c� mb�r a Carder Policy N� Expiration atd/6 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 Code. I shall forthwith comply with those provisions 3 a3 i6 Signature of Applicant 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 compiled and will continue to comply therewith through the application process. Applicant (Print Name) Applicant Signature Company Name Date 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 ❑ 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 -identified property for inspection purposes. Signature of roperty or Authorized Agent F Date J a3 COUNTY OF,LOS AAGELES DEPARTMENT OF•PUBLIC_ WORKS BUILDING Ag6D SAFET( /,LAND 6EVBLOPMENT TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: 510q a,qL0L0N NO. BUILDING PERMIT NEW RESIDENTIAL BL 0508 1510280082 LEGAL ID: NO. OF CONST NEWBUILDING ADDRESS: JTR: 9481 LT: 2 BL: .001 ON: .002 SQ. FT STORIES TYPE OCCOP GROUPI 5109 BALDWIN AV STRUCTURE: 3759 GARAGE: 448 2 V -B 1 V -B R-3 U TEMP CA 917803902 NEAREST CROSS STREET: LA ROSA ASSESSOR INFORMATION NUMBER: 8589-007-003 OTHER: 229 1 V -B U THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CA TENANT: USE ZONE: R-1 1155 UE0 ON: PROCESSED 8Y: 103/23/16 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL DATEF AL CODE: HSIN NGAR MEI 5109 V 555.240 LI(� Q TEMPLEACIITYNCA 9 91778 0 I FEES PAID OF DES IPTZ/NWORK NEW 2 -STORY SFD: 5 BEDROOMS, 5.5 BATHROOMS, WITH ATTACHED 2 FEE DESCRIPTION: I QUANTITY: DOM: AMOUNT: CAR GARAGE ♦ ATTACHED 1 CAR GARAGE 227 SF. FRONT PORCH AND REAR PATIO 771 SF. APPLICANT: TEL. NO: YAN, VINCENT (213) 440-2120- JB1 PLANCHECK W/ENERGY 555240.00 VAL 4,019.00 5401 BALDWIN AVENUE BLDG PERMIT ISSUANCE 34.40 SPECIAL CONDITIONS: TEMPLE CITY CA 91780 IAA AB STATE GREEN BLDG FEE 555240.00 VAL 23.00 FIRE SPRINKLERS REQUIRED AC STRONG MOTION RESID 555240.00 VAL 72.20 1 B2 PERMIT W/ENERGY D7 ADDNL PLANCHECK FEE 555240.00 3.00 VAL HOU 5,926.90 408.90 CONTRACTOR: TEL. NO: APPROVALS DATEINSPECTOR SIGNATURE EDMOND HANK KWONG (714) 293-1576- OB CERTIF OF OCCUPANCY 125.80 360 E FIRST STREET #500 LIC. NO TOTAL FEES 10,610.20 LOCATION AND SETBACKS TUSTIN CA 92780 756780 ' (SOILS ENGINEER APPROVAL 1 (FOUNDATION/TRENCH FORMS ` ARCHITECT OR ENGINEER: TEL. NO: KWEZ CONSULTING ENGINEEA9 (949) 395-6954- 1315 S GRAND AVENUE #211 LSC. NO: (SLAB/UNDER FLOOR GLENDORA CA 91740 C72100 RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( JUNDERFLOOR INSOLATION 3 Oil 11ST LEVEL FLOOR SHEATH IND. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 NO 01 (2ND LEVEL FLOOR SHEATH ROOF SHEATHING tt SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS I o NO NO NO I FIRE DEPT. FRAME INSPECT1i1 C '7 144& iD �G BLDG DEPT. FRAME INSPECT .rI •NISHEAR PANELS IINSULATION/WEATHER STRIP O 1 INTERIOR LATH/DRYWALL / EXTERIOR LATH LOT DRAINAGE PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR ISMOKE DETECTION DEVICES 2) WORK IS SUSPENDED OR ABANDONED, OR ' 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION( I FIRE DEPARTMENT APPROVAL IREPORT ID: DPR261 ROUTE TO: SS0508