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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»,�