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Home My Public Portal About5120 DALEVIEW AVE_Building_3/11/2015_{ COUNTY OF LOS ANGELES TEMPLE CITY LIC. NO 1 # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 1 TEL. NO: RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 15033110054 22638 1 PHONE: (626) 285-0488 EXT: 1MAP LEGAL ID: I NO. OF CONST 1 NEW I BUILDING ADDRESS: JTR: 14020 LT: 12 1 SQ. FT STORIES TYPE JAIR QUALITY: 1000 FEET OCCUP GROUP 5120 DALEVIEW AV NO NO STRUCTURE: 0 2 V -B R-3 TEMP CA 917803521 (ASSESSOR INFORMATION NUMBER: I GARAGE: NEAREST CROSS STREET: FREER 18574-007-012 I OTHER: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI (EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: 1TENANT: EXIST OCC GRP: 103/11/15 SR DOWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFINAL AT FINAL CODE: IMAISON DEVELOPMENT GROUP LLC (626) 215-8138- 1 3,000 1160 W VALLEY BLVD #B J 1 ISAN GABRIEL CA 91776 1 FEES PAID IDE�eCAiPtON OF WORK 1CREATING ADDITIONAL FULL BATHROOM FROM EXISTING BATHROOM IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:JALSO BL 1503110054 (APPLICANT: TEL. NO: I I ICHEN, STEVE (626) 215-8138- IAA BLDG PERMIT ISSUANCE 27.80 1 1160 W VALLEY BLVD #B JAB STATE GREEN BLDG FEE 3000.00 VAL 1.00 ISPECIAL CONDITIONS: ISAN GABRIEL CA 91776 IAC STRONG MOTION RESID 3000.00 VAL 0.50 JB1 PLANCHECK W/ENERGY 3000.00 VAL 92.60 1 JB2 PERMIT W/ENERGY 3000.00 VAL 108.90 I ICONTRACTOR TEL NO: I TOTAL FEES 230.80 JAPPROVALS DATE INSPECTOR SIGNATURE IC J L CONSTRUCTION INC. (213) 392-2293- J 1801 S. GARFIELD AVE., 1-238 LIC. NO 1 JALHAMBRA, CA 91801 492610 1 JARCHITECT OR ENGINEER: 1 TEL. NO: ICHIEN YEH (323) 268-2138- 11901 S ATLANTIC BLVD. #B LIC. NO: IMONTEREY PARK CA 91754 22638 1 � NO: SEWER MAP BOOK: PAGE: I FIRE ZONE: CMPo1 1MAP 0 I NO. OF FAMILIES: DWELLING UNITS: I APT//COND: STAT CLASS: 1 0 NO 21 1 SCHOOL WITHIN HAZARDOUS JAIR QUALITY: 1000 FEET MATERIALS NO NO NO I I* ADDITIONAL DATA ON FILE I I IREPORT ID: DPR261 I ROUTE TO: BS0508 I ILOCATION AND SETBACKS J i I � 1SOILS ENGINEER APPROVAL 1 1 IFOUNDATION/TRENCH FORMS I I JSLAB/UNDER FLOOR I IRAISED FLOOR FRAMING 1 1 I I I JUNDERFLOOR INSULATION I I 1ST LEVEL FLOOR SHEATH 1 1 I J I 12ND LEVEL FLOOR SHEATH I I I I I IROOF SHEATHING I I I I IFIRE DEPT. FRAME INSPECT I J I i JBLDG DEPT. FRAME INSPECTI I I I I (SHEAR PANELS I I I I I JINSULATION/WEATHER STRIPI I I I IINTERIOR LATH/DRYWALL I J I . 1EXTERIOR LATH I I I J I ILOT DRAINAGE J I (SMOKE DETECTION DEVICES J I I I I 1FIRE DEPARTMENT APPROVAL( I I 1 I I I 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 cityor county that requires a emit to construct alter, Improve, tY 9 P � 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 Contrh�tor pursuant to the Contractors' State License Law). U I am exemplt 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 priorl to completion. of the improvements covered by this permit, I cgnnot legally sell a structure that I have built as an owner -builder ff 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:/Mnvw.lecinfo.ca.covlcalaw.html. Date: Signature of Property Owner or Authorized Agent 1 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. License Class License No. Date �j contractor Signature i 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 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: 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 ❑ No ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirem�rnts 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 Carrier Policy Number Expiration Date AGENCY Name of Agent Phone Number C/ 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 Signature ofpp nt 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 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. Applicant (Print Name) Applicant Signature Company Name Date 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 Lenders Address By my signature below, 1 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 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. Signature of Pro a Owner or Authorized Agent Date 3 //( (/ ('J--