HomeMy Public PortalAbout4867 ARDSLEY DR_BUILDING_1/24/2018_TEMPLE CITY PERMIT NO. B18-35583
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 917801 (626)285-2171 1 www.templecity.us
Address: 4867 Ardsley Drive, Temple City, California
parcel: 8590-017-021
91780
Permit No: 81835583
Type: Building Subtype:
RA Residential
Addition
Description: 252 SO.FT. PATIO COVER
Special
Conditions:
s
Issue Date: 01-24-2018
Expire Date: 01-24-2019 Extension:
Extension:
Permit expires 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
r
Owner Mrs. & Mr. David
4867 Ardsley Drive, Temple City, California 91780
Chien
Applicant Tom O'Leary
5823 Agnes Avenue, Temple City, California
(626)201-1469
91780
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Contractor Tom O'Leary
5823 Agnes Avenue, Temple City, California
(626)201-1469 489354
Construction
91780
Buildink Details
.Structure
_
l: Patio Cover 2:
3: 4.
Construction Type: V-8
OccupancyGroup: U Utility, miscellaneous
New/Added Area: 252 0
0 0
Remodel/Tl Area: 0 0
0 0
New Dwelling Units: 0 0
0 0
Stories: 0 0
0 0
Fees Total
Valuation $11,571.84 Plan Check Fees $305.04 Permit Fees $358.87
Strong Motion Fee $1.50 SB 1473 Fee $1.00 Parks Dev Fee SO DO Sewer Const Fee
$0.00
Building Inspections
Approval Da�¢ Inspe
Approval Date Inspector
Approval
Date Inspector
Location/Setbacks �/pa.{,4a
Soils Engineer )�O
Roof Sheathing
Fire Dept FramingGot:Floor/Ceiling
Rated
Foundation Forms
Bldg Dept Framing
Rated Walls
Slab/Under Floor
Shear Panels
Rated Shafts
Raised Floor
Sprinkler Hangars
T -Bar
Framing
tlon/VVeather
Ceilings
Underfloor
Strip
Strip
Drainage
Lot raina g
Insulation
Interior
Smoke
1st Floor
Lath/Drywall
Detectors
Sheathing
2nd Floor
Exterior lath
Fire Dept
Approval
Sheathing
FINAL
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the mason(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 Contrb�tor pursuant to the Contractors' State License
Law).
U: 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 whicf I must have resided for at least
one year priorl to completioq of the Improvements covered by
this permit, Innot legally sell a structure that I have built as an
If owner-buildef 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:/Aw .leoinfo.ca.aov/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 P9 I � License No. "` y L -� r
DateContractor 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
wor rs' cern ensation insurance carrier and policy number are:
5�Y1 7�is£�G G—/!!�
Cartier Policy Number Expiration Date
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
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
allpersons acting on behalf of myself complied and will continue
to comply therewith through the application process.
Applicant (Print Name) Applicant Signature
Company Name
Date
JOB ADDRESS
LOCA6ITY -
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 requiremgnts
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 SCAOMD.
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.
Signal Prope wmeyor Authorized Agent
Da et