HomeMy Public PortalAbout4822 AGNES AVE_Building_7/2/2015_BL 0508 1505200006 encl front porch,convert bdrm,remod kitCOUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
ITR: 9848 LT: 11 ON: .002
ASSESSOR INFORMATION NUMBER:
18589-024-020
MAIPROSPECT PL.
CA 91789
SEANDEADALENA ST.
EAD CA 91770
CONTRACTOR:
WELLS DEVELOPMENT AND CONSTRUCTION
6727 N MUSCATEL AVENUE
SAN GABRIEL CA 91775
OR ENGINEER:
TEL. NO:
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT
NO. OF CONS
SQ. FT STORIES TYPE
STRUCTURE: 316 1 V -S
GARAGE: 98 1 V -B
OTHER:
EXIST BLDG USE:
EXIST OCC GRP:
BLDGS. NOW ON LOT:
BUILDING PERMIT
RESIDENTIAL ADD/ALT/REP
BL 0508 1505200006
T NEW I BUILDING ADDRESS:
OCCUP GROUP 4822 AGNES AV
R-3 I TEMP CA 917803906
U I NEAREST CROSS STREET: LOWER AZUSA
THOMAS PAGE: 597 GRID: BS LOCALITY: TEMPLE CITY CA
USE ZONE: JISSUED ON: PROCESSED BY:
107/02/15 SR
11
VALUATION: FIN ATE
FINAL
CODE:
43,410
NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
0 NO 21
SCHOOL WITHIN HAZARDOUS
QUALITY: 1000 FEET MATERIALS
NO NO NO
ERMIT EXPIRES 180 DAYS IF
L) WORK DOES NOT COMMENCE, OR
WORK IS SUSPENDED OR ABANDONED, OR
3) FAILS TO OBTAIN CODE REQUIRED INSPECTION
REPORT ID: DPR261 ROUTE TO: BS0508
JUKIDESA4F
ENCLOSING FRONT PORCH 160 SF. + CONVERTING PORTION OF GARAGE
AMOUNT:1146 SF. INTO BEDROOM, REMODEL KITCHEN, BATHROOM & ADD TO (E)
GARAGE 98 SF. NEW ROOF SPANISH TILES.
624.60
48.90 ISPECIAL CONDITIONS:
27.80
2.004.30
792.40 APPROVALS DATE INSPECTOR SIGNATURE
101.40 I
1,601.40 ]LOCATION AND SETBACKS 1(!,J•_i J (
SOILS ENGINEER APPROVAL J
FOUNDATION/TRENCH FORMS
ER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
I1ST LEVEL FLOOR SHEATH
12ND LEVEL FLOOR SHEATH
ROOF SHEATHING J/r=Jo
FIRE DEPT. FRAME INSPECT] ,
BLDG DEPT. FRAME INSPECT /
SHEAR PANELS L
INSULATION/WEATHER STRIP
INTERIOR LATH (RYWAL
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES
IFIRE DEPARTMENT APPROVALI I
FEES PAID
FEE DESCRIPTION: QUANTITY: UOM:
TEL. NO: 1
626) 638-9831- 1131 PLANCHECK W/ENERGY 40000.00 VAL
JB1 PLANCHECK W/ENERGY 43410.00 VAL
JAA BLDG PERMIT ISSUANCE
JAB STATE GREEN BLDG FEE 43410.00 VAL
1AC STRONG MOTION REBID 43410.00.VAL
TEL. NO: JB2 PERMIT W/ENERGY 43410.00 VAL
626) 926-1689- 108 CERTIF OF OCCUPANCY
LIC. NO I TOTAL FEES
700198
TEL. NO:
LIC. NO:
NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
0 NO 21
SCHOOL WITHIN HAZARDOUS
QUALITY: 1000 FEET MATERIALS
NO NO NO
ERMIT EXPIRES 180 DAYS IF
L) WORK DOES NOT COMMENCE, OR
WORK IS SUSPENDED OR ABANDONED, OR
3) FAILS TO OBTAIN CODE REQUIRED INSPECTION
REPORT ID: DPR261 ROUTE TO: BS0508
JUKIDESA4F
ENCLOSING FRONT PORCH 160 SF. + CONVERTING PORTION OF GARAGE
AMOUNT:1146 SF. INTO BEDROOM, REMODEL KITCHEN, BATHROOM & ADD TO (E)
GARAGE 98 SF. NEW ROOF SPANISH TILES.
624.60
48.90 ISPECIAL CONDITIONS:
27.80
2.004.30
792.40 APPROVALS DATE INSPECTOR SIGNATURE
101.40 I
1,601.40 ]LOCATION AND SETBACKS 1(!,J•_i J (
SOILS ENGINEER APPROVAL J
FOUNDATION/TRENCH FORMS
ER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
I1ST LEVEL FLOOR SHEATH
12ND LEVEL FLOOR SHEATH
ROOF SHEATHING J/r=Jo
FIRE DEPT. FRAME INSPECT] ,
BLDG DEPT. FRAME INSPECT /
SHEAR PANELS L
INSULATION/WEATHER STRIP
INTERIOR LATH (RYWAL
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES
IFIRE DEPARTMENT APPROVALI I
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the reason(s) indicated
below by the checkmark(s) I have placed next to the applicable
item(s) (Section 7031.5, Business and Professions Code): Any
city or county that requires a permit to construct, alter, Improve,
demolish, or repair any structure, prior to its issuance, also
requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions
Code) or that he or she is exempt from licensure and the basis
for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).):
U I, as owner of the property, or my employees with wages as
their sole compensation, will do () all of or (_) 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 Contrb?tor pursuanLlo the Contractors' State License
Law).
I am exempt from licensure under the Contractors' State
License Law for the following reason:
By my signature below I acknowledge that, except for my
personal residence in whicq I must have resided for at least
one year priorlto completion, of the improvements covered by
this permit, Icannot 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://www.leoinfo.ca.covlcalaw.html.
Date:
Signature of Property Owner or Authorized Agent
I hereby affirm under penalty of perjury that I am licensed under
provisions of Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, and my
license is in full force and effect.
BC',G i{rcLicenaCIs7_icense No.
t .
Date Contractor Signature
WORKERS' COMPENSATION D CLARATION
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION
COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN
EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION
TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED
FORIN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
I hereby affirm under penalty of perjury onp 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.
Poli y 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' compensaq'on insurance carrier and policy nu a are:
ZZIT,r " X1 9-*7.2-zm w 1 z (5
Cartier policy Number Expiration Date
Name of Agent Phone Number
I certify that, in the performance of the work for which this
permit is issued, I shall not employ any person in any manner
so as to become subject to the workers' compensation laws of
California, and agree that, if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions
vi,('qISIgnatuofApplicantDate'
LOBBYIST ORDINANCE CERTIFICATION
Complete this section for permits in
Unincorporated Los Angeles County only
This is to certify that 1, 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 corn ly Ahen wntmrough the application process.
Appf Print Applicant Signature
Company Name Date
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 w"Itll/
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 c(tpckllst for guidelines.
Yes No XYI
i
I have read the hazardous matedals information guide and the
SCAQMD permitting checklist, I understand my requirements
under the Los Angeles County Code Title 2, Chapter 220'
Sections 220.100 through 220.140 concerning hazardous
material reporting and for obtaining a permit from the SCAQMD.
ASBESTOS NOTIFICATION
Notification letter sent to AQMD and/or EPA
ty I declare that notification of asbestos removal is not
fit applicable to addressed project.
DECLARATION REGARDING CONSTRUCTION LENDING
AGENCY
I hereby affirm under penalty of perjury that there is a
Construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civil Code).
Lenders Name
Lenders Address
By my signature below, I certify to;each of the following:
I am the property owner or authorized to act on the
property owner's behalf.
I have read this application and the information I have
provided is correct.
I agree to comply with all applicable city and county
ordinances and state laws relating to building
construction.
I authorize representatives of this county to enter the
above -identified property for inspection purposes.
S'ature f operty Owner or Authorized Agent
I h
fl
Date