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Home My Public Portal About9550 LIVE OAK AVE_Mechanical_12/23/2014_ME 0508 1408270023COUNTY OF LOS ANGLES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: # 0508 MECHANICAL PERMIT ME 0508 1408270023 LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 8588-007-004 TENANT: OWNER: LI, JASSON 9550 LIVE OAK AV TEMP 917802513 TEL. NO: (213) 308 -7788 - APPLICANT: QIU LIN 9087 LAS TUNAS DRIVE TEMPLE CITY CA 91780 TEL. NO: (626) 269 -2668 - CONTRACTOR: TEL. NO: T AND J CONSTRUCTION (626) 703-6653- 5628 N GLADYS AVE LIC. NO SAN GABRIEL CA 91776 993453 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: FEES PAID FEE DESCRIPTION: QUANTITY: UOM: 01 PERMIT ISSUANCE FEE 30 AIR INLETS/OUTLETS 41 VENTILATION FAN 47 ALTER EXIST DUCT SYS 2.00 UNI 1.00 FAN 1.00 SYS TOTAL FEES REPORT ID: DPR264 ROUTE TO: BS0508 AMOUNT: 27.80 8.80 15.80 27.00 79.40 BUILDING ADDRESS: 9550 LIVE OAK AV TEMP CA 917802513 NEAREST CROSS STREET: TEMPLE CITY THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 08/27/14 SR FINAL DATE DESCRIPTION 0g WORK ALTERATION OF EXIST DUCT SYSTEM, VENTILATION FAN FINAL BY: CODE: TWO AIR INLETS AND ONE SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE FAU/WALL FURNACE COMBUSTION AIR OPENINGS DUCT WORK AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD OWNER -BUILDER DECLA RA TIO N 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): A ny city or county that require s a permit to construct, alter, improve, demo lish, or re pair any structure, prior to its issuance, also re quire s the a pplicant for the permit to file a signed sta tement that he or she is licensed pursuant to the provisions of the Contracto rs' State License La w (Cha pter 9 (commencing with Section 7000) of Div ision 3 of the Business and Pro fessions Code) or that he or she is exe mpt 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 the ir sole compensation, will do (I) a ll of or L) portions of the work, and the structure is not intended or offe re d for sale (Section 7044, Busine ss and Professions Code: The Contractors' State Lice nse Law doe s no t apply to an owner of property who, through employees' or personal effort, builds or improves the prope rty, provided that the improv ements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner - Builder will hav e the burden of prov ing that it wa s not built or improved for the purpose of sale. ). U I, as owner of the property, am exclusive ly contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' Sta te License Law does not apply to an owner of prope rty who builds or improves thereon, and who contra cts for the projects with a licensed Contractor pursuant .to the Contractors' State License Law). ' (_): I am e xempt from licensure under the Contractors' State License Law for the following reason: By my signature below I ackno wle dge that, except for my personal residence in which I must hav e resided for at least o ne year priori to completion; of the improvements covered by this permit, I cinnot legally sell a structure tha t I have built as an owner -builder if it has not been constructed in its entirety by licensed contra ctors. 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. leginfo.ca.gov /calaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECL ARATI ON I hereby affirm unde r pe nalty of perjury th at I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Div ision 3 of the Business and Professions Code, and my license is in full force and effect. License Class f License No . elg3'1-5 . Co ntractor Signature WORKERS' COM PENSATION DECLAR ATION WARN ING: FAILURE TO SECURE WORKERS' COMPENSATION COV ERAG E IS UNLAWFUL, AND SH ALL SUBJECT AN EM PLOY ER TO CRIM INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSA ND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATI ON, DA MAGES 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' compe nsation, issu ed 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 issue d. Policy No. I hav e and will maintain workers' compensation in surance, as required by Section 3700 of the Labor Code, for the performance of the wo rk for which this permit is issued. My workers' co mpensation insurance carrier and policy number are: Carrier Policy Numb er 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 thos e pr ovisions Signature of Applicant 6/Zz/l`t Date LOBBYIST ORDINANCE CERTIFIC ATI ON Co mplete this sectio n f or per mits in Un in co rpora ted Los Angeles C ounty 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 a ll persons acting on behalf of mys elf complied and will continue to comply therewith through the application process. Applicant (Print Name) Applicant Signature Company Name Date JOB ADDRESS LOCALITY HAZ ARDOUS MATERIAL DECL ARATION 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 h azardous 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 modific ation from the South C oast Air Qu ality Management District (SCAQMD)? See permitting checklist for guidelines . Yes El N .o ❑ I have read the hazardous m aterials informati on guide and the SC AQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter 220 ' Sections 220 .100 through 220.140 conc erning hazardous material reporting and for obtaining a permit from the SCAQ MD . ASBEST OS NOTIFIC ATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asb estos removal is not applicable to addressed project. DECL AR ATION REGARDING C ONSTRUCTI ON LENDING AGENCY I hereby affirm under pen alty of perjury that there is a Construction lending agency for the performance of the w ork for which this permit is issued (Section 3097, Civil Code) . Lender's Name Lend er's Address By my signature below, I certify t o,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 agr ee to comply with all applicable city and county ordinances and state l aws r elating to building construction . I authorize repres entati ves of this county to enter the abo ve -identified property for inspection purpos es . Signature Pro Owner or Authorized Agent Date 15/27/4 ( •