HomeMy Public PortalAbout5420 ARDEN AVE_Building_6/17/2014_COUNTY OF IAS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
ILEGAL ID
ON FILE
ASSESSOR INFORMATION NUMBER:
18586-028-035
1
TENANT:
OWNER:
GALLAHER, MR/MRS SCOTT
5420 ARDEN DR
TEMP 917802731
APPLICANT:
IO'LEARY, TOM
15828 AGNES AVENUE
ITEMPLE CITY CA 91780
I
CONTRACTOR:
TOM O'LEARY CONSTRUCTION
5823 AGNES AVENUE
TEMPLE CITY CA 91780
ARCHITECT OR ENGINEER:
TEL. NO:
FEE DESCRIPTION:
TEL. NO:
- AA BLDG PERMIT ISSUANCE
AB STATE GREEN BLDG FEE
AC STRONG MOTION RESID
B2 PERMIT W/ENERGY
TEL. NO:
(626) 287 -0927 -
LIC. NO
489354 +
TEL. NO:
LIC. NO:
I
IMP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
TEMPLE CITY
# 0508
BUILDING PERMIT
A1121
9701 LAS TUNAS
PAID
-ALTERATION/REPAIR
TEMPLE CITY CA 91780
BL 0508 1406170007
PHONE: (626) 285-0488
EXT:
QUANTITY:
DOM:
NO. OF
CONST
BUILDING ADDRESS:
SQ. FT STORIES
TYPE
5420 ARDEN DR
STRUCTURE:
V -B
TEMP CA 917802731
SPECIAL CONDITIONS:
14000.00
NEAREST CROSS STREET:
1.40
THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY CA
EXIST
BLDG USE: RESID
USE ZONE: R-1
ISSUED ON: PROCESSED BY:
EXIST
OCC GRP:
342.40
06/17/14 SR
BLDGS.
NOW ON LOT:
VALUATION:
FINAL DATE FINAL Y: CODE:
APPROVALS DATE
14,000
FEE DESCRIPTION:
TEL. NO:
- AA BLDG PERMIT ISSUANCE
AB STATE GREEN BLDG FEE
AC STRONG MOTION RESID
B2 PERMIT W/ENERGY
TEL. NO:
(626) 287 -0927 -
LIC. NO
489354 +
TEL. NO:
LIC. NO:
I
IMP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
INSPECTOR SIGNATURE
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES 1
RATED SHAFTS/OPENINGS 1�
T -BAR CEILINGS
ADDITIONAL DATA ON FILE
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508
I I
A1121
FEES
PAID
OF WORK
BATHROOM REMODEL
QUANTITY:
DOM:
AMOUNT:
27.80
14000.00
VAL
1.00
SPECIAL CONDITIONS:
14000.00
VAL
1.40
14000.00
VAL
312.20
TOTAL FEES
342.40
APPROVALS DATE
LOCATION AND SETBACKS
1
SOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORKS
SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
� I
UNDERFLOOR INSULATION
�
I
FLOOR SHEATHING
ROOF SHEATHING
SHEAR PANELS
FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
INSPECTOR SIGNATURE
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES 1
RATED SHAFTS/OPENINGS 1�
T -BAR CEILINGS
ADDITIONAL DATA ON FILE
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508
I I
.
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 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 Contrbctor pursuant .to the Contractors' State License
Law). i
U- I am exempt from licensure under the Contractors' State
License Law for the following reason:
By my signature below 1 acknowledge that, except for my
personal residence in whicl1 I must have resided for at least
one year priori to completioq of the improvements covered by
this permit, I c nnot 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: http://www.leoinfo.ca.aovlcalaw.htmi.
Date:
Signature of Property Owner 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.
&V
C C
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
workZI
'compensation insurance caarryr and policy n mber are:
S14, a 7 7 �"S
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 s rthwith comply with those provisions
e::2'/00?
Sign re of App nt Date
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
Unincorporated 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 et 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 ❑
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 L20'
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
❑ 1 declare that notification of asbestos removal is not
applicable to addressed project.
DECLARATION REGARDING CONSTRUCTION LENDING
AGENCY
I hereby affirm under penalty of pedury 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.
Signat roperty O ger o Authorized Agent
Date�� % i
COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
ON FILE
ASSESSOR INFORMATION NUMBER:
8586-028-035
GALLAHER, MR/MRS SCOTT
5420 ARLEN DR
TEMP 917802731
DAMON PRICE
1087 N ALLEN AVE
PADADENA CA 91004
TEL. NO:
TEL. NO:
(626) 338-2200
CONTRACTOR: TEL. N0:
QUALITY CRAFT HOME IMPROVEMENT (626) 338-2200-
1087 N ALLEN AVENUE LIC. NO
PASADENA CA 91104 596849
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
QUALITY: 1000 FEET MATERIALS
NO NO NO
TEMPLE CITY # 0508 BUILDING PERMIT
9701 LAS TUNAS ALTERATION/REPAIR
TEMPLE CITY CA 91780 BL 0508 1406300125
PHONE: (626) 285-0488 EXT:
NO. OF CONST BUILDING ADDRESS:
SQ. FT STORIES TYPE 5420 ARDEN DR
STRUCTURE: V -S TEMP CA 917802731
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY CA
EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY:
EXIST OCC GRP: 106/30/14 SR
BLDGS. NOW ON IAT: VALUATION: FINAL DATE FINAL By: CODE:
1,000 D JP
,` `
FEES PAID D$SCR PTION'OF WORK
(CHANGE MASTER BEDROOM WINDOW WITH CUT DOWN TO MEET EGRESS
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
I I
IAA BLDG PERMIT ISSUANCE 27.80 1
IAB STATE GREEN BLDG FEE 1000.00 VAL 1.00 ISPECIAL CONDITIONS:
JAC STRONG MOTION RESID 1000.00 VAL 0.50
ID2 PERMIT W/O EN -HC 1000.00 VAL 65.40 1
TOTAL FEES 94.70
IAPPROVALS DATE INSPECTOR SIGNATURE
ID: DPR261
ROUTE TO: BS0508
LOCATION AND SETBACKS
TOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
iLAB/UNDER FLUOR
iAISED FLOOR FRAMING
INDERFLOOR INSULATION
FLOOR SHEATHING
200F SHEATHING
iHEAR PANELS
FRAME INSPECTION 1
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
tATED FLOOR/CEIL ASSEM.
iATED WALL ASSEMBLIES
UITED SHAFTS/OPENINGS
C -BAR CEILINGS
LOT DRAINAGE
� 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 ($500).):
U I, as owner of the property, or my employees with wages as
their sole compensation, will do (✓) all of or (_) portions of the
work, and the structure is not intended or offered for sale
(Section 7044, Business and Professions Code: The
Contractors' State License Law does not apply to an owner of
property who, through employees' or personal effort, builds or
improves the property, provided that the improvements are not
intended or offered for sale. If, however, the building or
improvement is sold within one year of completion, the Owner -
Builder will have the burden of proving that it was not built or
improved for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with
licensed Contractors to construct the project (Section 7044,
Business and Professions Code: The Contractors' State License
Law does not apply to an owner of property who builds or
improves thereon, and who contracts for the projects with a
licensed Contr$ptor 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 whicF 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: httD://www.lecinfo.ca.cov/calaw.html.
Date:
Signature of Property Owner 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 _S License No. 5����
,_g)ate 6441 Contractor Signature 'Iig '
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
paI certify that, in the performance of the work for which this
—mit 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 f o pl 'th those proovisiioons 1�
Signature of Applicant
< Dafe /
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 ❑ 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'feach 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 o ope wner o odzed Agent
�T
date/7d lS�