HomeMy Public PortalAbout6251 AVON AVE_Building_8/21/2019_B19-38442TEMPLE CITY PERMIT NO, B19-38442
City of Temple City 1 9701 Las Tunas Drive 1 Temple City, California. 91780 1 (626)285-2171 1 www.templecity.us
' Address: 6251 Avon Avenue, San Gabriel, California 91775 Parcel: 5386-006-030
Permit No: B19-38442 Type: Building
Description: (1) REPLACE TWO (E) WINDOWS (2) REMODEL (E) KITCHEN (3) Special
CONVERT (E) GARAGE PORTION NON -HABITABLE STORAGE Conditions:
Issue Date: 08-21-2019
Permit expires on date shown
required inspection.
Contacts
}
Subtype: RR
Residential
Alteration
Expire 08-20-2020 Extension: Extension:
Date:
ork does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code
V Owner -Builder
Owner Rang Li
Applicant
Building Details
6251 Avon Avenue, San Gabriel, California 91775 (408) 805-2475
Structure 1: Residential 2: 3: 4:
Construction Type: V -B
Occupancy Group: R-3 Residential, one- and two-famlly
New/Added Area: 0 0 0 0
Remodel/TI Area: 0 0 0 0
New Dwelling Units: 0 0 0 0
Stories: 1 0 0 0
Fees Total
Valuation $10,000.00
Strong Motion Fee $1.30
Building Inspections
Plan Check Fees $281.73
581473 Fee $1.00
Permit Fees $331.45
Parks Dev Fee $0.00
Sewer Const Fee $0.00
Approval Date Inspector Approval Date Inspector
Location/Setbacks Roof Sheathing
Soils Engineer - Fire Dept Framing
Foundation Forms Bldg Dept Framing
Slab/Under Floor Shear Panels
Raised Floor Sprinkler Hangars
Framing Insulation/Weather ��
Underfloor Strip
Insulation Interior
1st Floor Lath/Drywall
Sheathing Exterior Lath
2nd Floor
Sheathing
Approval Date Inspector
Rated
Floor/Ceiling
Rated Walls
Rated Shafts
T -Bar
Ceilings
Lot Drainage
Smoke •
Detectors
Fire Dept
Approval
FINAL
*at
OWNER -BUILDER DECLARATI ON
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State Licen se Law for the reason(s) indicated
below by the checkm ark(s) I h ave placed next to the applicable
item(s) (Section 7031 .5, Busines s and Professions Code): Any
city or county that req uires a permit to construct, alter, improv e,
de molish, or repair any structure, prior to its issua nce, also
requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the pr ovisio ns of the
Contracto rs' State License Law (Ch apter 9 (c ommencing with
Se ction 7000) of Division 3 of th e Busi ness and Professions
Code) or that he or s he is exempt from licensure and the b asis
for the alleged exe mption . Any violation of Section 7031.5 by
any applican t for a permit subjects the applicant to a civil
penalty of not mo re than five hundred dollars ($500).):
U I, as owner of the property, or my employees with wages as
the ir sole compensation, will do Kali of or (_) p ortions of the
work, and the structure is no t inten de d or offered for sale
(Section 7044, Business and Professions Code: The
Contractors' State Lice nse Law doe s not apply to an owner of
property who, through employees' or personal effort, builds or
improves the property, provided that the improvements are not
intende d or offered for sale. If, however, the building -or
improv ement 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
license d Contra ctors to co ns truct the project (Section 7044,
Busine ss an d Profe ssions Code: The Contractors' State Licen se
Law does not apply to an owner of property who builds or
improves the reon, and who contracts fo r the projects with a
lice nsed Contr'aitor pursuant to the Contractors' State License
La w).
0:1 am exemlit from lic ensure u nder the Contractors' State
License Law for the follo wing reason:
By my signature belo w I a cknowledge that, except for my
personal residence in which I must have resided for at least
one year prior to completion of the improvements covered by
this pe rmit, I canno t legally sell a structure that I ha ve bu ilt as an
owner -builder f it has n ot been constructed in its en tirety by
licensed c ontra ctors. I understand that a copy of the applicable
la w, Section 7044 of 'the Business and Professions Code, is
available upon reque st when this application is submitted or at
the following Web site: htto://www. le oinfo.ca.gov/calaw. html.
e of Property Owne r or A uthorized Agent
LI CENSED CONTRACTOR'S DECLARATION
I hereby a ffirm under penalty of perjury that I am lic ensed under
provi sions of Chapter 9 (commencing with Section 7000) of
Division 3 of the : Busin ess and Pr of essio ns Cod e, and my
license is in full force and effect .
License Class Lice nse No .
Date Contractor Sign ature
WORKERS' CO MPENS ATI ON DECLARATION
W ARNI NG: FAILURE TO SECURE WORKERS' C OMPENSATI ON
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMPL OYER TO CRIMINAL PEN ALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF COMPENSATION, DAMAGES AS P ROVIDED
FOR IN SE CTION 3706 OF THE LAB OR CODE, INTEREST, AND
ATTORNEY'S FEES.
I hereby affirm under pen alty of p erjury one of the following
declar ations:
I h av e and will maint ain a certificate of consent to self -
insure for workers' compensation, issued by th e Dir ector of
Industrial Relations as pro vided for by Sectio n 3700 of the
Labor Code, for theperformance of the work for which this p ermit
is issued .
Policy No.
I have and will maintain workers' compensation
insuran ce, as required by Section 3700 of the Labor Code, for
the performan ce of the work for which this permit is issued. My
workers' compens ation insurance carrier and policy numb er are:
Carrie r
Policy Number Expir ation D ate
Name of Agent Phone Number
I c ertify that, in the p erformance of the work for which this
pe rmit is issued, I shall not employ any person in any mann er
so as to bec ome subject to the workers' compensati on l aws of
Califo rnia, and agree that, if I should become subject to the
workers' co mpensation provisions of Section 3700 of th e Labor
Code, I shall forthwith p, �q nply with thos e pro visi ons
ignature of Applicant Date
LOBBYIST'bRDINANCE CERTIFICATION
Co mplete this sectio n for pe rmits in
Unincorpo rate d Los Angele s Coun ty only
This is to certify that I, as pe rmit applican t, 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 a cting on behalf of myself complied and will continue
to comply therewith through the applicatio n process.
Applicant (Print Name) A pplicant Signatu re
Company Name Date
. JOB ADDRESS
LOCALITY
HAZARDOUS MATERIAL DECLARATI ON
Will the applicant or future building occupant handle a hazardous
m aterial or a mixture c ontaining a hazardous material equal to or
gr eater than th e amount specified on the hazardous materials
i nf ormation guide?
Yes ❑ No ❑
Will th e int end ed use of the building by the applicant or future
building occupant require a permit for construction or
modific ati on from the South Coast Air Quality Man agement
District (SCAQMD)? See permitting checklist for guid elin es . •
Yes 9 N .o 0
I have re adth e ha zardous materi als information guide and the
SCAQ MD permitting checklist, I understand my requirements
und er the Los Angeles County Code Title 2, Chapter 220'
Secti ons 220.100 through 220 .140 concerning hazardous
mat erial reporting and for obtaining a permit from the SC AQMD.
ASBESTOS NOTIFIC ATION
0 Notification letter sent to AQMD and/or EP A
0 I declare th at notificati on of asbestos removal is not
applicable to addressed project .
DECLARATION REGARDING CONSTRU CTI ON LENDING
AGENCY
I h ereby affirm und er pen alty of perjury that there is a
C onstruction le nding agency for the performance of the work for
which this permit is i ssued (Section 3097, Ci vil Code).
Le nd er' s N ame
Lender's Address
By my signature below, I certify to:each of the following:
I am th e prop erty owner or authoriz ed to act on the
property owner's behalf.
I ha ve read this application and the informati on I h ave
provided is correct .
I agree to comply with all applicable city and county
ordin ances and stat e l aws relating to building
construction.
I authori ze representatives of this county to ent er the
abo ve -id entified property for inspection purposes.
Signature of P pe
_>6ate
caner or Authorized Agent
TEMPLE CITY PERMIT NO. B19-38789
City of Temple City 19701 Las Tunas Drive I Temple City, California 91780 I (626)285-2171 I www.templecity.us
Address: 6251 Avon Avenue, San Gabriel, California 91775 Parcel: 5386-006-030
Permit No: B19-38789 Type: Building Subtype: RR Residential
Alteration
Description: CONVERT EXISTING LIVING ROOM INTO A BEDROOM, Special
BATHROOM AND CLOSET Conditions:
Issue Date: 10-30-2019 Expire Date: 10-29-2020 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
V Owner -Builder
Owner Rong Li
Applicant
Building Details
6251 Avon Avenue, San Gabriel, California 91775 (408) 805-2475
Structure 1: Residential
Construction Type: V -B
Occupancy Group: R-3 Residential, one -and two-family
New/Added Area: 0
Remodel/Tl Area: 0
New Dwelling Units: 0
Stories: 1
Fees Total
Valuation $6000.00
Strong Motion Fee $0.78
Building Inspections
Plan Check Fees $194.22
2:
3: 4:
O 0 0
O 0 0
O 0 0
O 0 0
Permit Fees $228.49
SB1473 Fee $1.00 Parks Dev Fee $0.00 Sewer Const Fee $0.00
Approval Date Inspector Approval Date Inspector Approval Date Inspector
Location/Setbacks Roof Sheathing Rated
Soils Engineer Flre Dept Framing
Foundation Forms Bldg Dept Framing /r
Slab/Under Floor Shear Panels
Raised Floor Sprinkler Hangars
Framing Insulation/Weather
Underfloor Strip �%���jq
Insulation Interior a
1st Floor Lath/Drywall
Sheathing Exterior Lath
2nd Floor
Sheathing
Floor/Ceiling
Rated Walls
Rated Shafts
T -Bar
Ceilings
Lot Drainage
Smoke
Detectors
Fire Dept
Approval
FINAL
OWNER -BUILDER DECLAR ATION
I hereby affirm under penalty of p erjury that I am exempt fr om
the Contractors' St ate Lic ense Law f or the reason(s) indicated
below by the checkmark(s) I h ave pl aced ne xt to the applicable
item(s) (Section 7031.5, Business and Professions Code): Any
c ity 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 provisio ns of th e
Contractors' State License Law (Chapter 9 (commencing with
Section 7000) of Div ision 3 of th e Business and Professions
C ode) or tha t he or she is exempt from licensure and the b asis
for the a lle ge d exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil
pen alty of not more than five hundred dollars ($500).):
(_) 1, as owner of the property, or my employees with wages as
their sole compensation, will do Mall of or U portions of the
work, and the structure is no t inte nded or offer ed for sale
(Section 7044, Business and Professio ns Cod e: Th e
Contractors' State License Law doe s not apply to an own er of
property who, through employees' or pe rsonal 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 tha t it wa s 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 fo r the projects with a
licensed Contractor pursuant to the Contractors' State License
Law).
U: I am exe mpt fro m licensure u nde r the Co ntrac tors' State
License La w for the follo wing reason:
By my signature below I ac knowle dge that, except for my
pe rs on al residence in which I must have resided for at le ast
one year prio r to completior of the impro ve me nts cove red by
this permit, I cannot legally sell a structure that I have built as an
own er -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
av ailable upon request when this application is submitte d or at
the following Web site: http://www.le oinfo.ca.co v/cala w.html.
Da te :
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under
provisi ons 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.
Lice nse Class Lic ens e No .
Dat e Contract or Signature
W ORKERS' COMPENSATION DECLARATION
WARNING: FAILURE TO SECURE WO RKERS' COMPENSATI ON
COVERAGE IS UNL AWFUL, AND SH ALL SUBJECT AN
EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF C OMPENSATI ON, D AMAGES AS PROVIDED
F OR IN SECTI ON 3706 OF THE LABOR CODE, IN TEREST, AND
ATTORNEY'S FEES.
I hereby affirm under penalty of p erjury one of the following
d eclaration s:
I have and will maint ain a certificate of c onsent 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 iss ued.
Policy No .
I have and will maintain workers' compens ati on
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
I certify that, in the perf orma nce of the work for which this
permit is issue d, I shall not empl oy any person in a ny man ner
so as to become subject to the workers' compensation l aws of
California, and agree tha t, if I should become subj ect to the
workers' compensation prov isions of Section 3700 of the Lab or
Code, I sha ll forthwith comply with those provisions
,t
Signature of Applicant Date
LOBBYIST ORDINANCE CERTIFICATION
Complete this section fo r permits in
Uninco rpo rated Los Angeles County o nly
This is to certify that I, as permit applicant, am familiar with th e
requirements of Los Angeles County Code Chapter 2.160 et seq.,
(re lating to the Lo s A ngeles County Lobbyist Ordinance) and that
a ll persons acting on behalf of myse lf complied and will continue
to comply the rewith through the a pplica tion process.
Applicant (Print Name) Applicant Signature
JOB ADDRESS
LOCALITY
HAZARDOUS MATERI AL DECLAR ATI ON
Will the applicant or future building occupant handle a haz ardous
material or a mixture containing a ha zard ous mat erial equ al to or
greater than the amount specified on the hazardous mat erials
inform ation guid e?
Yes ❑ N o•
❑
Will the intend ed use of the building by the applicant or futur e
building occupa nt require a permit for constructi on or
modification from the South Co ast Air Quality Managem ent
District (SCA QMD)? See permitting checklist for guidelines.
Y es ❑ N.o ❑ ,
1 have read the haz ardous mat eri als inform ati on guide and the
SCAQMD permitting checklist, I underst and my requirements
under the Los Angeles County Code Title 2, Chapter 220'
Sections 220.100 through 220.140 concerning hazardous
materi al reporting and for obtaining a permit from the SCAQMD.
ASBESTOS NOTIFIC ATION
❑ Notification letter sent to AQMD and/or EPA
❑ I declare that notification of asbestos removal is not
applicable to address ed pr oj ect .
DECLAR ATI ON RE GARDING CONST RUCTION LENDING
AGENC Y
I hereby affirm under penalty of p erjury that there is a
Construction lending agency for the perform ance of the work for
which this permit is issued (Section 3097, Civil Cod e).
Lender's Name
L ender's Address
By my signature below, I c ertify to:each of the followi ng:
I am the property owner or authorized to act on the
property owner's b ehalf.
I hav e read this application and the information I have
provided is correct.
I agree to comply with all applicable city and county
ordina nces - and st ate laws rel ating to building
construction. -
I authorize repres entati ves of this county to enter the
abov e-identifiednproperty f or inspection purposes .
Sign ature off Pr operty Own er or Auth orized Agent
'D ate
Company Name Date
TEMPLE CITY PERMIT NO. E19-38832
City of Temple City 1 9701 Las Tunas Drive 1 Temple City, California 91780 ( (626) 285-2171 1 www.templecity.us
Address: 6251 Avon Avenue, San Gabriel, Parcel: 5386-006-030
California 91775
Permit No: E19-38832 Type: Electrical Subtype: Subtype: Residential
Description:- 30 OUTLETS, 5 LIGHT FIXTURES AND
EXHAUST FAN
Issue Date: 11-06-2019
- Contacts
Special
Conditions:
Expire Date: 11-05-2020 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.
Owner -Builder
Owner Rong Li 6251 Avon Avenue, San Gabriel, California 91775 (408) 805-2475
Applicant
Electrical Details
New Multifamily 0 New Single- 0
Family/Duplex
Carnival Ride: 0 Carnival Lighting 0
Mechanical System
Branch Circuit: 0
Lights
New Swimming 0 Spa, Hot Tub, 0 Carnival Ride: 0
Pool Alteration Electric
Temporary 0 Temporary 0 Branch 0
Power Pole Power System Circuit:
Outlets
Receptacle, 30 Light Fixture 5 Light Fixture: 0 Light Fixture: 0
Switch, Lighting Pole Mount Theatrical
Outlets
Residential 1 Non -Residential 0 Power 0 Power 0 Power 0
Appliance: 3 HP Appliance: 3 HP or Apparatus: 3- Apparatus: 10- Apparatus:
or less less 10 HP 50 HP 50-100 HP.
Power Apparatus: 0 Busway 0
Over 100 HP
Service: Over 0 Miscellaneous 0
1000 Amps
- Fees Total
Sign 0 Service: Under 0 Service: 400- 0
400 Amps 1000 Amps
Plan Check Fees $0.00 Permit Fees $110.16
Electrical Inspections
Approval Date Inspector Approval Date
Temp Pole Conduit
Underground Wiring
lifer Ground Water
Ground
Inspector
or
Approval Date Inspector
Utility
Release
FINAL 6
OWNE R -BUILDE R DE CLARATION
I hereby affirm under penalty of perjury that I am exempt fr om
the Contractors' Stat e Lic ense L aw for the reason(s) indicat ed
belo w by the checkmark(s) I h ave pl aced next to the applicable
ite m(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 stat ement
that he or she is licensed purs uant to th e pro visi ons of the
Contrac tors' State License Law (Ch apter 9 (commencing with
Se ction 7000) of Division 3 of the Busines s and Pr ofessions
Code) or tha t he or she is exempt from li cen sure and the basis
for the alle ged ex emption. Any violation of Section 7031.5 by
any a pplic an t fo r a permit subjects the applicant to a civil
penalty of not more than five hundre d 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 th e
work, and the structure is not intended or offered for sale
(Section 7044, Business and Professions Code: Th e
Contractors' State Lice nse Law doe s not a pply to an owner of
property who, thro ugh employees ' or pe rsona l effort, builds or
improve s the property, provided that the improv ements are not
intended or offered for sale. If, however, the building or
improvement is sold within one year of completio n, the Owne r -
Builder will hav e the burden of proving that ft was no t built or
improved for the purpose of sale.).
(_) 1, as o wner of the property, am ex clusively contracting with
lice nsed Contractors to co nstruct the project (Section 7044,
Busines s and Profe ssions Code: The Contractors' State License
'La w do es not apply to an owner of property who builds or
improv es thereon, and who contracts for the proje cts with a
licensed. Contractor pursuant to the Contracto rs' State Lice nse
Law). I
Li: I am exempt from lice ns ure unde r the Contractors' Sta te
License Law for the following rea so n:
By my signature be low I acknowledge that, e xce pt fo r my
personal residence in which I must have resided for at lea st
one year prior to completio n] of the improv ements cove re d by
this permit, I can no t le ga lly sell a structure tha t I hav e built as an
owner -builder If it has not be en con structed in its entirety by
lice nse d contrac tors. 1 unde rstand that a copy of the applicable
law, Section 7044 of 'the Business and Professions Code, is
av ailable upon request when this application is submitted or at
the following Web site: http://www.leciinfo.ca .gov/calaw.html.
.w -Da te: I//6 /21" i/
Signatt e of Pro pe rty er or Authorized Agent
LICE NSED C ONTRACTOR'S DECLARATION
I her eby affirm u nder penalty of perjury that I am licensed under
provisions of Ch apter 9 (commencing with Section 7000) of
Di vision 3 of the Business and Professions Code, and my
license is in full force and effect.
License Cl ass License No.
D ate C ontractor Signature
WORKERS' COMPENSATI ON DECLARATION
WARNING: F AILURE TO SECURE WORKERS' COMPENSATION
C OVER AGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMPLOYER TO CRI MIN AL PEN ALTIES AND CI VIL FINES UP TO
ONE HUNDRED THOUS AND DOLLARS ($100,000), IN ADDITION
TO THE COST OF CO MPENS ATION, DAMAGES AS PROVIDED
FOR IN SECTI ON 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
I h ereby affirm und er penalty of perjury one of the following
decl arations:
I ha ve 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
Poli cy Number E xpiration D at e
Na me of A gent Ph on e 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 subje ct to the workers' compensation laws of
California, and agree that, if I should become subject to th e
workers compensation pro visions of Se ction 3700 of the Labor
Code, I shall forthwith comply with those pro visio ns
( G120) l
-Signature of A pplican t Date /
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
Uninco rporate d Los Angeles County on ly
This is to certify that I, as pe rmit applicant, am familiar with the
requirements, of Lo s Angeles Co un ty Code Cha pter 2. 160 et s eq.,
(rela ting to the Lo s Angeles County Lo bbyist Ordina nce) a nd that
a ll persons a cting on behalf of myse lf co mplied and will co ntinue
to comply therewith through the application process.
Applicant (Print Name) A pplicant Signature
Company Name Date
. JOB ADDRESS
LOCALITY
HAZARD OUS MATERI AL DECL AR ATI ON
Will the applic ant or f uture building occ up ant handle a hazardous
m at eri al or a mixtur e cont aini ng a ha zard ous materi al equal to or
greater than the amount specified on the hazardous materi als
information guide?
Yes ❑ N o
•
Will th e int end ed us e 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 0 N.o ❑ %
I have read the h azardous materials informati on guid e and the
SCAQ MD permitting che cklist, I understand my requirements
u nder the L os Angel es C ounty C ode Title 2, Chapter 220'
Sections 220.100 through 220.140 concerning hazardous
material reporting and for obtaining a permit from the SCAQMD.
ASBESTOS NOTIFIC ATION
❑ Notification letter sent to AQ MD and/or EP A
❑ 1 declare that notification of asbestos removal is not
applicable to addressed project.
DECL ARATI ON REGA RDING CONSTRUCTION LENDING
AGENCY
I hereby affirm under penalty of p erjury 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 toeach 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 informati on I have
provided is correct .
I agre e to comply with all applic able city and county
ordinances and state laws relating to building
constru cti on.
I authorizerepresentatives of this county to enter the
above -identified property for inspection purposes .
Signs - Prro Owner or Authorized Age nt
TEMPLE CITY PERMIT NO. M19-38833
City of Temple City 1 9701 Las Tunas Drive 1 Temple City, California 91780 (626)285-2171 1 www.templecityus
Address: 6241 Avon Avenue, San Gabriel, California 91775 Parcel: 5386-006-030
Permit No: M19-38833 Type: Mechanical Subtype: Subtype: Residential
Description: ONE VENTILATION FAN Special Conditions:
Issue Date: 11-06-2019 Expire Date: 11-05-2020 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
*1 Owner -Builder
Owner Rong Li 6251 Avon Avenue, San Gabriel, California 91775 (408) 805-2475
Applicant
- Mechanical Details
Compressor/Furnace/Etc 0
up to 100k BTU
Appliance Vent 0
Ventilation Fan 1
Fireplace 0
a Fees Total
Compressor/Furnace/Etc 0
100-500k BTU
Air Handler up to 2,000 0
CFM
Compressor/Furnace/Etc 0
over 500k BTU
Air Handler 2-10,000 0
CFM
Ventilation System 0 Kitchen Hood/Spray 0
Booth
Air 0 OR Floor 0
Inlet/Outlet Area
Qty
Air Handler 0 Evaporative 0
over10,000 Cooler
CFM
Fire 0 Duct 0
Damper Alteration
Plan Check Fees $0.00 Permit Fees $22.20
- Mechanical Inspections
Approval Date Inspector Approval Date Inspector Approval Date Inspector
FAU/Wall Furnace AC/Compressor Smoke
Combustion Air Thermostat Detectors
Openings Commercial
lib y i/ 4 Hood Fire Dampers
Duct Work n rI
FINAL /Q / 4
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the re ason(s) indicated •
below by the checkmark(s) I have placed next to the applicable
item(s) (Section 7031 .5, Bu siness a nd Professions C od e): Any
city or county that requir es a permit to co nstruct, alter , impr ove, .
demo lish, or re pair any structure, prior to its iss uance, 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 S ection 7031 .5 by
an y applica nt for a permit s ubjects the applicant to a civil
pe na lty of n ot more than five hundred dollars ($500).):
U I, as o wne r of the property, or my employees with w ages as
the ir so le compensa tion, will do &nail 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 pro pe rty, provide d that the improve ments are not
inte nded or o ffered for sale. If, however, the bu ilding or
improve ment is s old within o ne year of completion, the Owner -
Builder will hav e the burden of proving that it was not built or
improved for the purpose of sale. ).
L) I, as owner of the property, am exclusively contrac ting with
licensed Contractors to construct the project (Section 7044,
Business and Professions Co de : The Contracto rs' State License
Law does not apply to an owner of pro perty who builds or
improve s the reon, and who c ontrac ts for the pro jects with a
license d Con tr'a9tor pursua nt to the Contractors' Sta te License
La w).
0: I am exempt from licensure under the Contractors' State
License Law for the following reason:
i
By my signature below I acknowledge that, ex cept for my
personal residence in which I must have resided for at least
one year prior to completion] of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owner -builder f it has not been constructed in its entire ty by
licensed contractors. I understand tha t a copy of the applicable
law, Section 7044 of the Bu sine ss and Profe ssions Code, is
available upo n reque st when this application is su bmitte d or at
the fo llowin g Web site: htto://www.leginfo. ca.00v/calaw. html.
Date: I i/t? /2-v•
2 17
Signature�o f Pro pe rty Owne r or A uthorized Age nt
d / 7 —
LICENSED C ONTRACTOR'S DECLARATION
I her eby 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 Clas s License No .
D ate Contr actor Signature
•
WOR KE RS' C OMPENSATI ON DECLARATI ON
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION
CO VERA GE IS UNLAWFUL , AND SH ALL SUBJECT AN
E MPL OYER TO CRI MINAL PEN ALTIES AND CI VIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF COMPENSATION, D AM AGES AS P ROVIDED
FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATT ORNEY'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 f or by Section 3700 of the
Labor C od e, for the performanc e of the w ork f or whi ch this p ermit
is is su ed. .
Policy No.
I have and will maintain workers' compensation
insurance, as required by Section 3700 of.the Labor Code, f or
the performance of the work for which this permit is issued. My
workers' compensati on insur ance c arrier and policy number are:
Carrier P olicy Numb er
Expir ation Date
Name of Agent Phone N umber
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 bec ome subject to the w orkers' c ompensation laws of
California, and agree that, if I should become subject to the
workers' compensation prov isions of Section 3700 of the Labor
Co de , I sha ll fo rthwith co mply with those provisi ons
• (7
Signa ture of Applicant Date
a/ 1
LOB BYIST ORDINA NCE CERTIFICA TION
Complete this section for permits in
. Uninc orpo rated Los Ange les Coun ty only
This is to certify tha t I, as permit applica nt, am familiar with the
re quirements of Los Angeles County Code Chapte r 2.160 et seq.,
(re la ting to the Lo s Angeles Co unty Lo bbyist Ordina nce) a nd that
all persons acting on behalf of myself complied and willcontinue
to comply therewith through the application process.
Applicant (Print Name) Applicant Signature
Company Na me Date
J OB ADD RESS
L OCALITY
HAZARDOUS MATERIAL DECLAR ATION
Will the applicant or future building occupant handle a h azardou s
mat erial or a mi xture containing a hazardous material equal to or
greater tha n the amount sp ecified on the hazardous materials
informati on guide?
Yes ❑ No
Will the i ntended us e of the building by the applicant or future
building occup ant r equir e a p ermit for con struction or
modifi catio n from th e South Co ast Air Quality Ma nagement
District (SCAQMD)? See p ermitting checklist for g uid elin es.
Yes 0 N. o 0
I h ave re ad the hazardous materials information guide and the
SCA QMD permitting ch ecklist, I understand my requiremgnts
under th e L os Angeles County Code Title 2, Chapter 220 '
S ecti ons 220.100 thr ough 220.140 concerning hazardous
material r eporting a nd f or obtaining a p ermit fr om the SC AQMD.
ASBESTOS NOTIFICATION
0 Notific ation l ett er sent to AQMD and/or EP A
0 I declare that notification of asbestos rem oval is not
applicable to addressed project.
DECLARATION REGARDING CONSTRUCTION LENDING
A GENCY
I h er eby affirm under penalty of p erjury th at th er e is a
Construction lending agency for the perf ormance of the work for
which this permit is issued (S ecti on 3097, Civil Code).
Lender's Name
Lender's Address
By my sign ature below, I certify to; e ach of the following:
.l am the property owner or a uth oriz ed to act on the
pr operty owner's beh alf .
I h ave read this application and th e inform ation I have
pr ovid ed is corr ect .
I agr ee to comply with all applic abl e city and county
ordinances and state law s relating to building
c onstruction. -
I authori ze representatives of this county to ent er the
abo ve -id entified property for inspection purposes .
Sig of, erty Owner or Authori zed Agent
Da te it/lv/7111
TEMPLE CITY PERMIT NO. P19-38834
City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 I (626)285-2171 1 www.templecity.us
Address: 6251 Avon Avenue, San Gabriel, California 91775 Parcel: 5386-006-030
Permit No; P19-38834 Type: Plumbing Subtype: Subtype: Residential
Description: SHOWER, LAVATORIE AND WATER CLOSET Special Conditions:
Issue Date: 11-06-2019 Expire Date: 11-05-2020 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
J Owner -Builder
Owner Rong Li
Applicant
- Plumbing Details
6251 Avon Avenue, San Gabriel, California 91775 (408) 805-2475
Backwater 0 Backflow 0
Valve Device
Drinking 0
Fountain
Lavatory/Sink 1
Pool Trap 0
Floor Drain 0
Miscellaneous 0
Trap Primer 0
Gas: Low 0 Gas: 0
Press Med/High
Press
Greywater 0 Pipe 0
System Replacement
Other: over 3 0 Sewer: 0
inches Connection
Sewer: 0 Sewer: Pit 0
Pit/Drainfield Extension
Bathtub/Shower 1
Floor Sink 0
Pressure 0
Regulator
Water Closet 1
Gas Meter 0
Future Branches 0
Sewer: Manhole 0
Sewer: 0
Alteration
Clothes 0
Washer
Hose Bibb 0
Roof Drain 0
Water 0
Heater
Gas 0
Regulator
Other:1.5 0
Inches or
less
Sewer: 0
Addition
Sewer: 0
Tap&Saddle
Dishwasher 0
Interceptor/Clarifier 0
Solar Water Heater 0
Water Treatment 0
Alteration/Repair 0
Other: 2-3 inches 0
Sewer: Private 0
Connection
'Combo
Waste/Vent Earthquake Chemical Rainwater Greywater
Shutoff Waste
- Fees Total
Plan Check Fees $0.00
Permit Fees $67.68
Plumbing Inspections
Approval t p or
Under Slab //Da// Insy//y
Work
Water Service
Plastic Y/N
Metal
Rough / b y/
% /
Plumbing
• Sewer Inspections
Approval
Gas Piping
Gas Vent
Hot Water
Heater
Plumbing
Fixtures
Lawn
Sprinklers
Date Inspector
Approval
Gas Test
Utility Co
Notified
CWV
Gray Water
System
FINAL
Date Inspector
.r
Approval Date Inspector Approval Date Inspector Approval Date Inspector
New House Drywell Backfill
Sewer Alter/Repair Tank/Pit
Connect Add'I Disconnect/Plug Gray Water
Septic Tank/Pit System
FINAL
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt fr om
the Contractors' Stat e 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 c onstruct, alter, improve, .
demolish, or repair any structure, prior to its issuance, also
require s the a pplicant for the permit to fil e a sign ed statement
tha t 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 b asis
for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a ci vil
penalty of not more than five hundred dollars ($500).):
o I, as owner of the property, or my employees with wage s as
their sole c ompens atio n, will do (✓ ) all of or L) portio ns of the
work, a nd the structure is no t 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, howe ver, the budding or
improvement is sold within one ye ar of co mpletion, the Owner -
Builder will have the burde n of prov ing that it was no t built or
improve d for the purpose of sale.).
o 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 do es no t apply to an owner of pro perty who builds or
improves there on, a nd who con tracts fo r the pro jects with a
lic ensed Contracto r pursuant to the Contrac tors' State Licen se
Law).
L): I am exempt from ['censure under the Co ntractors' State
License Law for the following rea son:
By my s igna ture be lo w I a ckno wledge that, except for my
perso nal residence in which I must hav e resided for at least
o ne year prior to completion' of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owner -builder f it has not been constructed in its entirety by
licensed contractors. I understand that a copy of the applicable .
law, Section 7044 of the Busine ss a nd Professions Code, is
available upon request when this applica tion is su bmitted or at
the following Web site : http://www.leoinfo.ca. 00v /calaw.html.
Date: 11/6 /2'01 ?
Signature of Property Owner or Authorized A gent
y /�
LICE NSED CONTR ACTOR'S DECLARATION
I hereby affirm u nder penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Secti on 7000) of
Di vision 3 of the Business and Professions Code, and my
license is in full force and effect .
Licens e Class Lic ense No.
D ate Contr actor Signature
WORKERS' COMPENSATI ON DECLAR ATION
WARNI NG: FAILURE TO SECURE W ORKERS' COMPENSATION
CO VER AGE I5 UNLAWFUL, AND SHALL SUBJE CT AN
EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE C OST OF COMPENS ATION, D AMAGES AS PROVIDED
F OR IN SECTION 3706 OF THE LAB OR C ODE, INTE REST, AND
ATTORNEY'S FEES.
I h ereby affirm under penalty of perj ury one of the f oll owing
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 perform ance of th e w ork for which this permit
is is sued.
Policy No .
I ha ve and will maintai n w orkers' compensation
insurance, as required by Section 3700 of.the Labor Cod e, for
the performance of the work for which this p ermit is issued . My
workers' compensation insurance carrier and policy number are:
Carrier
Policy Number Expiration Date
Na me of A ge nt Ph on e Numb er
I certify that, in the performance of the work for which this
permit is issued, I shall not employ any person in any mann er
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
Co de , I shall forthwith comply with those provisions
.ti/b/
Date
7
LOBB YIST ORDINANCE CERTIFICATION
Complete this section for permits in
. Unincorporated Los A ngeles Co unty o nly
This is to certify that I, as permit applica nt, am familiar with the
requirements of Los Angeles Co unty Code Chapter 2. 160 et seq.,
(re lating to the Lo s A ngeles Co un ty Lo bbyist O rdinance ) and that
all perso ns a cting on behalf of myself complied a nd will. continue
to c omply the re with through the applica tion process.
Applicant (Print Name) Applicant Signature
Company Name Date
. JOB ADDRESS
LOCALITY
HAZARDOUS M ATERIAL DECLARATION
Will the applicant or future building occupant handle a hazardous
mat erial or a mature containing a hazardous material equal to or
gre ater than the amount specified on the hazardous materials
inf orm ation guide?
Yes ❑ N d
Will the intended use of the building by the applicant or future
building o cc upant req uire a permit for construction or
modification from th e S outh Coast Air Quality Management
District (SC AQMD)? Se e permitting checklist for guidelines.
Yes 0 N.o ❑ r
1 have read the hazardous materials information guide and the
SC AQMD . permitting checklist, I understand my requirem ernts
under th e Los Angeles County Code Title 2, Chapter 220'
S ecti ons 220.100 through 220.140 concerning hazardous
mat erial reporting and for obtaining a permit fr om the SCAQMD .
ASBESTOS N OTIFI CATI ON
0 Notification letter sent to AQMD and/or EPA
❑ I declare that notification of asbestos removal is not
applicable to addressed project.
DECLARATION REGARDING C ONSTRUCTI ON LENDIN G
AGENCY
I hereby affirm under penalty of perjury that there is a
C onstructi on lending agen cy f or the performance of the work for
which this permit is issu ed (Section 3097, Ci vil Code).
Lender's Name
Lender's Address
By my signature bel ow, I certify t o',each of the following:
I am the property owner or authorized to act on the
property owner's behalf.
I h ave r ead this application and the inform atio n I hav e
pr ovid ed is correct.
I agree to comply with all applicable city and county
ordinances and state laws relating to building
constructi on .
I authori ze represe ntatives of this c ounty to enter the
abo ve -identified property for inspection purposes .
Sign at ur rope kr2 OWner or Authorized Agent
Date II4/1»,�