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Home My Public Portal About4946 Ardsley Dr_Building_2/26/2015_s COUNTY OF IAS ANGE&S TEMPLE CITY N 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC •BUILDING WORKS 9701 LAS TUNAS AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 CB 0508 1502240014 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 14647 LT: 48 SQ. FT STORIES TYPE OCCUR GROUPI 4946 ARDSLEY DR STRUCTURE: 0 1 V-B I TEMP CA 917803805 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8590-015-003 OTHER: THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY CA TENANT: EXIST BLDG USE: PHOTO JISSUED ON: PROCESSED BY: IEXIST OCC GRP: 02/26/15 SR OWNER: LAU, ALFRED TEL. NO: - BLDGS. NOW ON LOT: VALUATION: 12,700 IFINAJ, DATE FS,NAL BY: CODE: � 444946 ARDSLEY DR / TEMP 917803805 FEES PAID DtSCIZIPTION OF WORK 15.72 KW 22 PANEL PV SYSTEM IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:J APPLICANT: TEL. NO: I I TIFFANY (626) 560-8360- JP4 PV PC RES ROOF<15KW 223.80 1 3055 CLEARVIEW WAY JAB STATE GREEN BLDG FEE 12700.00 VAL 1.00 (SPECIAL CONDITIONS: SAN MATEO CA 94402 JAE STRONG MOTION OTHER 12700.00 VAL 3.60 J IP5 PV PRMT RES ROOFc15K 181.10 1 102 PERMIT ISSUANCE FEE 28.60 _ CONTRACTOR: TEL. NO: I TOTAL FEES 438.10 JAPPROVALS DATE INSPECTOR SIGNATURE SOLAR CITY CORP (650) 963-5630- 1 1 3055 CLEARVIEW WAY LIC. NO I ILOCATION AND SETBACKS SAN MATEO, CA 94402 888104 1 1 1 1SOILS ENGINEER APPROVAL 1 ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS 1 LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I JUNDERFLOOR INSULATION 3 001 I FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: I 1 NO 20 1 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO IFRAME INSPECTION IFIRE SPRINKLER HANGERS JINSULATION/WEATHER STRIP J JINTERIOR LATH/DRYWALL (III I IEXTERIOR LATH (RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS T-BAR CEILINGS ILOT DRAINAGE (REPORT ID: DPR261 ROUTE TO: PS0508 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 (_) 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). I ' (_) I am exe4 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 completions 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.Ieainfo.ca.aov/calaw.htmi. Date: -Z Signature of Property O 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 C(0 License No. Date ZrVI'`5Contractor Signature �f 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 insurancg �..er a oliicy nu r 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' compensationens of Section 3700 of the Labor Code, I shall fort comply mp y with those provisions 4Ngnature 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 et seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and wi 'nue to comply therewith through the application pry Applicant (Print Name Applicant STne /�_ Company Name Dattd h� JOB ADDRESS" Ab of q -(e A /A �'(QL 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 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 pen -nit 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 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 Pro er or Authorized Agent Date