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Home My Public Portal About4433 ELLIS LN_Building_8/25/2014_COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT -DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 SL 0508 1406110090 PHONE: (626) 285-0488 EXT: LEGAL ID: 1 NO. OF CONST NEW BUILDING ADDRESS: TR: 12998 LT: 87 SQ, FL STORIES TYPE OCCUP GROUPI 4433 ELLIS LN ISTRUCTURE: .16,70. •2 V -B ' R3 I TEMP CA 917804205 ASSESSOR INFORMATION NUMBER: I GARAGE: 444 - 1 V -B ,•U I NEAREST CROSS STREET: LOWER AZUSA 8592-001-016 OTHER: _ •t�`\i i THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY, C TENANT: USE ZONE: R-3 11SSUED ON: PROCESSED BY: 108/25/14 SR I I OWNER: TEL. NO: BLDG'S. NOW ON LOT: VALUATION: )FINAL D TE / FINAL�@Y: CODE: 1740 N, TOM (323) 864-2965- 244,880 /��,JJJ Q//n//^�L. 1790 N. SANTA ANZTA 1 IV� ARCADIA, CA 91006 FEES PAID DE 2/ P OF RK IN£W STORY CONDO 4 BEDROOMS, 3 BATHROOMS WITH ATTACHED 2 IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:ICAR GARAGE WITH LAUNDRY SPACE APPLICANT: TEL. NO: I I LAI, KAMEN (626) 288-2651- ID7 ADDNL PLANCHECK FEE 2.00 HOD 218.80 1 8748 VALLEY BLVD. #K AA BLDG PERMIT ISSUANCE 27.80 )SPECIAL CONDITIONS: ROSEMEAD, CA 91770 IAB STATE GREEN BLDG FEE 244880.00 VAL 10.00 )FIRE SPRINKLERS REQUIRED IAC STRONG MOTION RESID 244880.00 VAL 24.50 1 IB2 PERMIT W/ENERGY 244880.00 VAL 2,470.40 1 CONTRACTOR: TEL. NO: 108 CERTIF OF OCCUPANCY 101.40 (APPROVALS DATE INSPECTOR SIGNATURE VM DEVELOPMENT INC. (626) 908-1618- 1 TOTAL FEES 2,852.90 1923 S MYRTLE AVENUE LIC. NO )LOCATION AND SETBACKS MONROVIA CA 91016 978855 (SOILS ENGINEER APPROVAL 1 III ARCHITECT OR ENGINEER: TEL. NO: 1 ]FOUNDATION/TRENCH FORMS V LEE, PETER (626) 280-9000- I 1 8748 E VALLEY BLVD SUITE L LIC. NO: 1 ISLAB/UNDER FLOOR I ROSEMEAD CA 91770 978855 + IRAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:) ]UNDERFLOOR INSULATION 1 144H269 U 160 3 021 1 1 )1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 5 YES 04C i 12M LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS I IROOF SHEATHING 1 AIR QUALITY: 1000 FEET MATERIALS I I NO NO NO 1 IFIRE DEPT. FRAME INSPECT) 1 I I I BLDG DEPT. FRAME INSPECT. lfsxrr 7 j(SHEAR PANELS i I'/ 1 11NSULATION/WEATHER STRIP �J I INTERIOR LATH/DRYWALL ]EXTERIOR LATH ] I IiLOT DRAINAGE I I ISMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL) I+ ADDITIONAL DATA ON FILE ]REPORT ID: DPR261 ROUTE TO: BS050S _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 (J) all of or L) 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 1, 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 forthe projects with a licensed Contnti for pursuant to the Contractors' State License Law). I ' L. I am exemdt 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 which I must have resided for at least one year priorlto completion of the improvements covered by this permit, I c'nnot 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.aov/calaw.htmi. 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. Yynl i License Class J3 License No. ��' Date ry //� Contractor Signature WORKERS' COMPENSATION DECLARATION 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 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 surance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My w 4 ars' compe to ms an /f/artier and polic num_be are: Carrie " o c Number Expiration 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 Co;�7�— hwith comply with those provisions 151b� S4Datefe 6f Applicant Date — / 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 et 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. Applicant (Print Name) 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 ❑ No ❑ 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 ❑ N o ❑ 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 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 ❑ 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 am the property owner or authorized to act on the property owners behalf. I have read this application and the infonnation 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-identif property for inspection purposes. Signet �y r party O er or Authorized Agent Date A J