HomeMy Public PortalAbout5546 Baldwin Ave_Building_11/24/2014_ (2)-+ COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 16957 IT: 11
ASSESSOR INFORMATION NUMBER:
8586-022-011
OWNER:
TEL. NO:
LE, PHIL
(626) 320-2911-
5546 BALDWIN AVENUE
TEMPLE CITY CA 91780
APPLICANT:
TEL. NO:
SAME AS OWNER
-
CONTRACTOR:
TEL. NO:
SAME AS OWNER
-
S I¢ ON OF WORK
LIC. NO
ARCHITECT OR ENGINEER:
TEL. NO:
FRANK NGUYEN AND ASSOCIATES
(626) 523-0366-
1711 MAGELLAN ST
LIC. NO:
WEST COVINA CA 91791
NONE
MAP NO: SEWER MAP BOOK: PAGE:
FIRE ZONE: CMP:
3 00
NO. OF FAMILIES: DWELLING UNITS:
APT/CON➢: STAT CLASS:
0
NO 21
SCHOOL WITHIN
HAZARDOUS
AIR QUALITY: 1000 FEET
MATERIALS
NO NO
NO
TEMPLE CITY # 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
NO. OF CONST NEW
SQ. FT STORIES TYPE OCCUP GROUP
STRUCTURE: 253 1 V -B R-3
GARAGE:
OTHER: 266 1 V -B U
EXIST BLDG USE: USE ZONE:
EXIST OCC GRP:
BLDGS. NOW ON LOT: VALUATION
40,:
000
FEES PAID
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
B1 PLANCHECK W/ENERGY 40000.00 VAL 624.60
AA BLDG PERMIT ISSUANCE 27.80
AS STATE GREEN BLDG FEE 40000.00 VAL 2.00
AC STRONG MOTION RESID 40000.00 VAL 4.00
B2 PERMIT W/ENERGY 40000.00 VAL 734.80
O8 CERTIF OF OCCUPANCY 101.40
TOTAL FEES 1.494.60
REPORT ID: DPR261 ROUTE TO: BS0508
BUILDING PERMIT
RESIDENTIAL ADD/ALT/REP
BL 0508 1408250046
BUILDING ADDRESS:
5546 BALDWIN AV
TEMP CA 917802627
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: B4
LOCALITY: TEMPLE CITY
ISSUED ON: PROCESSED BY:
11/24/14 SR
FINAL ATE/F N BY:
CODE:
S I¢ ON OF WORK
ADD FULL BATHROOM TO BEDROOM #3 AND
CONVERT (E) PORCH INTO
FAMILY ROOM AND COVERED PATIO
SPECIAL CONDITIONS:
APPROVALS DATE INSPECTOR SIGNATURE
LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
II
FOUNDATION/TRENCH FORMS
IJ
SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
IST LEVEL FLOOR SHEATH
ONO LEVEL FLOOR SHEATH
ROOF SHEATHING
FIRE DEPT. FRAME INSPECT IT - `
i
HLLKi DEPT. FRAME INSPECT
SHEAR PANELS
INSULATION/WEATHER STRIP'
INTERIOR LATH/DRYWALL
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES -
FIRE DEPARTMENT APPROVAL
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS
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 (J) all of or L) 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).
L) I am exemplt 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 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://www.lecinfo.ca.aov/calaw.html.
Date:
Signature of Prp�eArty Airier or Authorized Agent
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 License No.
Date 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:
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
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
Signet re o AppkanTTT D to
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
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 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).
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
above -identified property for inspection purposes.
Signature of Proops ✓ er r uthorized Agent
Date ll LV
1
J
1
COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 16957 LT: 11
ASSESSOR INFORMATION NUMBER:
8586-022-011
TENANT:
OWNER: TEL. NO:
LE, PHIL (626) 320-2911-
5546 BALDWIN AVENUE
TEMPLE CITY CA 91780
APPLICANT: TEL. NO:
SAME AS OWNER -
CONTRACTOR: TEL. NO:
SAME AS OWNER -
LIC. NO
ARCHITECT OR ENGINEER: TEL. NO:
FRANK NGUYEN AND ASSOCIATES (626) 523-0366-
1711 MAGELLAN ST LIC. NO:
WEST COVINA CA 91791 NONE
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 001
NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
TEMPLE CITY
# 0508
BUILDING PERMIT
9701 LAS TUNAS
ALTERATION/REPAIR
TEMPLE CITY CA
91780
BL 0508 1503090072
PHONE: (626) 285-0488 EXT:
NO. OF CONST
I BUILDING ADDRESS: I
SQ. FT STORIES TYPE
( 5546 BALDWIN AV 1
STRUCTURE:
V -B
I TEMP CA 917802627
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
EXIST BLDG USE: RESID
USE ZONE: R-1
I
(ISSUED ON: PROCESSED BY: I
EXIST OCC GRP:
103/09/15 SR
BLDGS. NOW ON LOT:
VALUATION:
IFINAL DATE IN BY: CODE: 1
500
g
FEES PAID
I`Y 1
IdE CRIPTION OF WORK
ILAUNDRY ROOM SEE ALSO BL 1408250046
FEE DESCRIPTION:
QUANTITY: UOM:
AMOUNT:(
AA BLDG PERMIT ISSUANCE
27.80
I
AB STATE GREEN BLDG FEE
500.00 VAL
1.00
ISPECIAL CONDITIONS:
AC STRONG MOTION RESID
500.00 VAL
0.50
B2 PERMIT W/ENERGY
500.00 VAL
48.10
TOTAL FEES
77.40
(APPROVALS DATE INSPECTOR SIGNATURE
ILOCATION AND SETBACKS
I I I I
ISOILS ENGINEER APPROVAL
I I I
IFOUNDATION/TRENCH FORMS I I I
I I I I
ISLAB/UNDER FLOOR I
I I I
IRAISED FLOOR FRAMING I I I
I I I
(UNDERFLOOR INSULATION I
I I I
IFLOOR SHEATHING I I I
IROOF
I I I
SHEATHING I I I
I
ISHEAR
I I
PANELS I
I
I I I
FRAME INSPECTION
IFIRE
SPRINKLER HANGERS
I
IINSULATION/WEATHER
I I
STRIPI I
I
(INTERIOR
I I I
LATH/DRYWALL I I 1
(EXTERIOR
i I
LATH
I
IRATED
I I
FLOOR/CEIL ASSEM. I I I
I
IRATED
I I I
WALL ASSEMBLIES
I
IRATED
I I I
SHAFTS/OPENINGS
I
IT
I I I
-BAR CEILINGS ( I I
I
I I I
LOT DRAINAGE
REPORT ID: DPR261
ROUTE TO: BS0508
i
I I
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS
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 (_) 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 Contncor pursuant to the Contractors' State License
Law).
(_) I am exemdt 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 priorlto completiork 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: httD://www.leainfo.ca.aov/calaw.html.
/Date: °i
Signature of Property 0 nerr Au orized Agent
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 License No.
Date 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:
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
California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith ycomply with those provisions
ZtL/��—
Signet, of Apphc' ant D to
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
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 ❑ N o ❑
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
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 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 Pro a 0 er��()q�uthorized Agent
T_Fr/�pr�1y�A.�
sate ' "