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Home My Public Portal About6042 PRIMROSE_Grading_1/20/2016_GR 0508 1508170001COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAPEIK / LAND DEVELOPMENT TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: GRADING PERMIT OR 0508 1508170001 (LEGAL ID: I BUILDING ADDRESS: ITR: 6561 LOT(S): 2616042 PRIMROSE AV UNIT A I I TEMP CA 917802033 ]ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15385-013-020 I ICUBIC YARDS HANDLED 819 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CAI I TENANT: GRADING NO I (SUPERVISED 1 ei•*•*' THIS IS A LIMITED TIME PERMIT FEES PAID TOWNER: TEL. NO: TISSUED ON: PROCESSED BY: ITIEN NHIEU LUONG;YAU JIE JOE - IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:101/20/16 SR 1 16042 PRIMROSE AV I I 1 ITEMP 917802033 I08 PLAN CHECK - B&S 819.00 CU 1,068.80 1 1 1 12A GRADING PERMIT 819.00 CU 1,110.70 EXP. EXTENDED TO: EXTENDED BY: I 12G PERMIT ISSUANCE FEE 34.40 ]APPLICANT: TEL. NO: TOTAL FEES 2,213.90 ] IBUI, RICHARD (626) 548-9719- ] 113812 GOLDEN WEST ST ] 1 I WESTMINISTER 92683I FIN(A.L/L LyJT/E/, FIg�, H CODE: i CONTRACTOR: TEL. NO: IAV CONSTRUCTION CO. (626) 548-9719- 1 DESCRIP ON F WORK 113812 GOLDEN WEST STREET #200 LIC. NO I IGRADING FOR A NEW SINGLE FAMILY DWELLING AND 2ND: UNIT IWESTMINSITER CA 92683 746394 ]ARCHITECT OR ENGINEER: TEL. N0: I 1SPECrnT. CONDITIONS: KAH NAM PRAM (714) 548-5588- 1 15202 VERMONT STREET LIC. NO: ] 1WESTMINISTER CA 92683 NONE (APPROVALS DATE INSPECTOR SIGNATURE I ISURETY BOND: $ BOND NO: I I (INITIAL GRADE PREP. I] 1 11 I I I ICOMPACTION REPORT RECD/-� �, COMPANY: %�_ ]SURETY ISUP. ENGNR'S CERT REC'DI ] I (DATE FILED: RECD BY: 1 1 I ofI IROUGH GRADING APPROVAL 1 ICASH DEPOSIT: DATE FILED: IIpr I I IPLANTING AND IRRIGATION 1 BY IREC'D I ISUP. ENG'S FINAL CERT (OTHER LEGAL IDS: 1 1 ] 1 I SURETY BOND RELEASED 1 I I I I (STATE HIWAY: USE ZONE: MAP NO: I 1 GEOLOGIC AND SOILS REPORTS FILED NO R-2 150H265 1 (TYPE PREPARED BY DATE RECEIVED APPROVED (PERMIT EXPIRES 180, DAYS IF 1 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION 1 ] 1 I IREPORT ID: DPR262 ROUTE TO: SS0508 I I I I I I I I I I_I I OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am exempt from I hereby affirm under penalty of perjury that I am licensed under the Contractors' State License Law for the reason(s) indicated provisions of Chapter 9 (commencing with Section 7000) of below by the checkmark(s) I have placed next to the applicable Division 3 of the Business and Professions Code, and my item(s) (Section 7031.5, Business and Professions Code): Any city or county that requires a permit to construct, alter, improve, license is in full force and effect. demolish, or repair any structure, prior to its issuance, also4—License Class License No. requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Date Contractor Signature Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions WORKERS' COMPENSATION CLARATION Code) or that he or she is exempt from licensure and the basis for the alleged exemption. Any violation of Section 7031.5 by WAf3NING: FAILURE TO SECURE WORKERS' COMPENSATION any applicant for permit subjects the applicant to a civil COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN penalty of not more an five hundred dollars ($500).): t than EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS( $100 000)IN ADDITION U I, as owner of the property, or my employees with wages as their sole compensation, will do (✓) all of or (_) portions of the work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who, through employees' or personal effort, builds or improves the property, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the Owner - Builder will have the burden of proving that it was not built or improved for the purpose of sale.). U I, as owner of the property, am exclusively contracting with licensed Contractors to construct the project (Section 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a licensed ContrA or pursuant to the Contractors' State License Law). U I am exempt from licensure under the Contractors' State License Law for the following reason: By my signature below I acknowledge that, except for my personal residence in whic.1 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 If it has not been constructed in its entirety by licensed contractors. I understand that a copy of the applicable law, Section 7044 of the Business and Professions Code, is available upon request when this application is submitted or at the following Web site: htto:/Avww.leciinfo.ca.gov/calaw.htmi. Date: Signature of Property Owner or Authorized Agent , TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier Policy Number Expiration Date Name of Agent Phone Number - A 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 o become subject to the workers' compensation laws of Cal'do is, and agree hat, if I should become subject to the work s' c pen on rovisions of Section 3700 of the Labor Cod , sh I o th mply with those provisions 15d_n#rAot Applicant, LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in Unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiar with the requirements of Los Angeles County Code Chapter 2.160 at seq., (relating to the Los Angeles County Lobbyist Ordinance) and that all persons acting on behalf of myself complied and will continue to comply therewith through the application process. JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials information guide? Yes ❑ N o ❑ Will the intended use of the building by the applicant or future building occupant require a permit for construction or modification from the South Coast Air Quality Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter $20 Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA ❑ I declare that notification of asbestos removal is not applicable to addressed project. DECLARATION REGARDING CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civil Code). Lender's Name Lender's Address By my signature below, I certify to each of the following: I an, the property owner or authorized to act on the property owner's behalf. 1 have read this application and the information I have provided is correct. I agree to comply with all applicable city and county ordinances and state laws relating to building construction. I authorizJ representatives of this county to enter the above-ider#ified property for inspection purposes. Applicant (Print Name) Applicant Signature Company Name Date Date or Authorized Agent