HomeMy Public PortalAbout5002 ARDSLEY DR_Photovoltaic_6/1/2016_COUNTY OF LOS ANGELES
TEMPLE CITY
M 0508
DEPARTMENT OF PUBLIC WORKS
9701 LAS TUNAS
17
BUILDING AND SAFETY / LAND DEVELOPMENT
TEMPLE CITY CA 91780
FOUNDATION/TRENCH FORMS
PHONE: (626) 285-0488 EXT:
LEGAL ID:
NO. OF CONST
NEW
TR: 13329 IT: 63
SQ. FT STORIES TYPE
OCCUP GROUP
ROOF SHEATHING
]STRUCTURE: 252 1 V -B
ASSESSOR INFORMATION NUMBER:
GARAGE:
8590-015-020
OTHER:
INSULATION/WEATHER STRIP
TENANT:
JEXIST BLDG USE: PHOTO
EXTERIOR LATH
EXIST OCC GRP:
iRATED
OWNER: TEL. N0:
BLOCS. NOW ON LOT:
VALUATION:
WHELAN, LARRY & DONNA
j
7,840
5002 ARDSLEY DA
TEMP 917803806
FEES PAID
FEE DESCRIPTION: QUANTITY:
DOM: AMOUNT:
APPLICANT: TEL. NO:
ESPARZA, JASMINE (661) 210-7846-
JAB STATE GREEN BLDG FEE 7840.00
VAL 1.20
21616 GOLDEN TRIANGL
1AC STRNG MTN RSDNTAL 7840.00
VAL 1.00
SANTA CLARITA 91350
1AE STRONG MOTION OTHER 7840.00
VAL 2.20
JP4 PV PC RES ROOF <15KW
223.80
JP5 PV PRMT RES ROOF<15K
120.70
CONTRACTOR: TEL. NO:
102 PERMIT ISSUANCE FEE
34.40
PETERSENDEAN INC. (661) 414-7010-
1 TOTAL FEES
383.30
21616 GOLDEN TRIANGLE RD LIC. NO
SANTA CLARITA, CA 91350 468117
1
ARCHITECT OR ENGINEER: TEL. NO:
VINCI, JAMES (805) 496-2100-
175 WILBUR RD STE 103 LIC. NO:
THOUSAND OAKS CA 91360 54411
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 001
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
0 NO 20
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
ALL GROUNDING AND BONDING OF THE PV SYSTEM SHALL COMPLYI
WITH LOS ANGELES COUNTY REQUIREMENTS. NOTE: WEEK PLATES]
, WASHERS, AND SIMILAR DEVICES ARE NOT ACCEPTED.
I
PERMIT EXPIRES 180 DAYS IF
11) WORK DOES NOT COMMENCE, OR
12) WORK IS SUSPENDED OR ABANDONED, OR
13) FAILS TO OBTAIN CODE REQUIRED INSPECTION
ID: DPR261 ROUTE TO: BS0508
PHOTOVOLTAIC PERMIT
CB 0508 1606010012
BUILDING ADDRESS:
5002ARDSLEY DR
TEMP CA 917803806
NEAREST CROSS STREET:
THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY
ISSUED ON: PROCESSED BY:
06/01/16 SR
FINAL ATEEI \/(f p / CODE:
DE�01 OF WORK /
ROOF MOUNT SOLAR 14 MODULES, 3.92 KW
CONDITIONS:
APPROVALS
DATE INSPECTOR SIGNATURE
/'/
LOCATION AND SETBACKS17#
17
SOILS ENGINEER APPROVAL
,kll
'
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
FLOOR SHEATHING
ROOF SHEATHING
FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
FLOOR/CEIL ASSEM.
iRATED
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T -HRR CEILINGS
LOT DRAINAGE
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 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 ContrhTtor 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 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: hffn://www.lecinfb-m.00v/calaw.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. pp
License Class NO License No.�_Voll�
Date (D Contractor Signatu
WORKERS' COMPENSA N DEC TION
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 is ued.
' cy 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
ke pen ion msuurann�c _ TIolicy nu bar
Cam'er Po11 Nuinier � Expi on Date
Nam 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 1 should become subject to the
worker ' ompensation provisions of Section 3700 of the Labor
Cod , I all f ith comply with those provisions
"' Io�I�I�P
S nater of pplicant Da,e (
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 Lobb ist Ordinance) and that
all persons acting on behalf of myself1combIled and will continue
to comply therewith through the appl' ' proi
J�MItT�SPAYtt1.� grt y
�t Pr' tNaPr' _ e) (ppli v11 I.0
Company ame Dale
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
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my require -Tis
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
❑ 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).
Lenders 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 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.
F175,er or Authorized Agent