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Home My Public Portal About5325 GLICKMAN AVE_Building_12/1/2015_ (2)COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 10558 LT: 27 BL: .001 ASSESSOR INFORMATION NUMBER: 8585-003-006 OWNER: RUG, JAMES 5325 GLICKMAN AVE TEMPLE CITY CA 91780 APPLICANT: TA, DAVID 20300 E CARREY ROAD WALNUT CA 91789 CONTRACTOR: SUNSHINE ROOFING, INC. 516 N DIAMOND BAR BLVD #183 DIAMOND BAR CA 91765 OR ENGINEER: TEL. NO: TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE STRUCTURE: 5 V -S EXIST BLDG USE: DETAC USE ZONE: R-1 EXIST OCC GRP: �BLDGS. NOW ON LOT: VALUATION: 1 1,000 __IFEE DESCRIPTION: TEL. NO: (909) 598-8988- IAA BLDG PERMIT ISSUANCE JAB STATE GREEN BLDG FEE JAC STRONG MOTION RESID CD2 PERMIT W/O EN -HC TEL. NO: (909) 598 -8988 - LIC. NO 755126 TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO PERMIT EXPIRES 180 DAYS IF 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION - ADDITIONAL DATA ON FILE FEES PAID QUANTITY: UOM: AMOUNT: 34.40 1000.00 VAL 1.00 1000.00 VAL 0.50 1000.00 VAL 81.40 TOTAL FEES 117.30 ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT ALTERATION/REPAIR BL 0506 1512010070 BUILDING ADDRESS: 5325 GLICKMAN AV TEMP CA 917603329 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: 12/01/15 SR FINAL DATE /tTA CODE: N,/P (O A / DESCIiI PTI OF WORK 1/0 EXISTING ROOF MATERIAL INSTALL NEW 7/16" OSB PLYWOOD. INSTALL NEW GAF CLASS ^A" COMP SHINGLES. SHAKEWOOD COLOR DN DETACHED GARAGE SPECIAL CONDITIONS: (LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING (UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE DATE INSPECTOR SIGNATURE OWNER -BUILDER DECLARATION 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 Prdfessions 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 U 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 ContmVor pursuant Ito the Contractors' State License Law). LICENSED CONTRACTOR'S DECLARATION 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 ffect, License Class I License No. DatefContractor gnat WORKERS' COMPENSAT199 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: 1 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. l 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 brkgrs' corapensatio insft�g�carri�r gL!d polic number a •6, �fP I U(N� S r Carder Po cY umber Expiration ate Name of Agent Phone Number U I am exempt from licensure under the Contractors' State certify that, in the performance of the work for which this License Law for the following reason: permit is issued, I shall not employ any person in any manner so as to become subjectto the workers' compensation laws of California, and agree that, if I should become subject to the By my signature below I acknowledge that, except for my workers' compensation provisions of Section 3700 of the Labor Code, I shall fofthwith mply with those provisions personal residence in which I must have resided for at least /!i o one year prior) to completion of the improvements covered by /j this permit, IWnnot legally sell a structure that I have built as an !��' owner -builder If it has not been constructed In its entire y Signature of Ap Ic — Date licensed contractors. I understand that a copy of the applicable / law, Section 7044 of the Business and Professions Code, is C/ available upon request when this application is submitted or a the following Web site: htio:/lwww.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent t 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 applica' ocess. ''({tel � ?-,A--%�r[A`�A� A�i nt,(Print Na e) lAppll> cant !9'gnatue ompany arae � Data JOB ADDRESS 32_zT (T/ 7 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). 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 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 Property Cwner or Aylhoh d Agent Date AZ/ / / / 6