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Home My Public Portal About5703 OAK AVE_Building_9/27/2005_A1.OUNTY 0 LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 EL 0508 0507210019 PHONE: (626) 285-0488 ERT: LEGAL ID: N0. OF CONST NEW BUILDING ADDRESS: IN: 6561 IT: 729 SQ. FT STORIES TYPE OCCUP GROUP 5703 OAK AV STRUCTURE: 154 1 VN R3 TEMP CA 917802431 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: LIVE OAK 8587-005-002 OTHER: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 09/27/05 JK 09/22/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: 'FINAL DATE FIN BY: CODE: FULCO NORMAN J;DOROTHY J - 32,750 5703 OAK AV TEMP 917802431 FEES PAID -DESCRIPTION OF WORK - ADDITION TO (E) BEDROOM 154 SF. AND KITCHEN REMODEL APPLICANT: TSL. NO: PEE DESCRIPTION: QUANTITY: DOM: AMOUNT: F^w-� n SIEMPRE CONSTRUCTION INC. (626) 792-3727- B1 PLANCHECK W/ENERGY 32750.00 VAL 538.42 Q- Fi.� 1827 SAN PASQUAL ST. AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: PASADENA, CA 91107 AC STRONG MOTION REBID 32750.00 VAL 3.28 B2 PERMIT W/ENERGY 32750.00 VAL 633.44 TOTAL FEES 1,202.89 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SIEMPRE CONSTRUCTION INC. (626) 792-3727- 1827 SAN PASQUAL STREET LIC. NO LOCATION AND SETBACKS I'�; PASADENA, CA 91107 805704B �a" SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS JIM H. KUHN (818) 446-7000- 125 WHEELER AVE, SUITE F LIC. N0: SLAB/UNDER FLOOR ARCADIA, CA 91006 NONE RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 IST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK YARD: WHY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP /; INTERIOR LATH/DRYWALL �21V-tt- EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 LICENSED CONTRACTOR'S DECLARATION herebyallire underperialty of perjury that i am licensed underprovLsions of Chapterg (mmrorrchrgw9h Section 7000) of Divislon 3 of the Business . and Prolessbrs Code. and my license is In folfforce and effect. ns Licee Class//_ice Oc. No. -2-7-0S� I Date OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt. from the Contractors License Law for the following reason (Sec. 7031.5, Business and Proressiom Code: Any city or county which requires a permit to construct, after. improve, demolish, or repair arty stmcJym, prior to its n issuace, also requires the applicant for such permit to 01e a signed statement that. he orsheis licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prorasslons Code) or that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 70315 by any applicant for a permit subjects the applicant to a kiwi penalty of not more than roe hundred dollars ($500).): ❑ I am exempt under Sea —. , 6A P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ) ❑ I, as owner of the property, will do the weir, and the structure Is not Wended or offered for sale (Sec. 7044, Business and Professions Cole: The Conbade" Licerse Law does not apply to an owner of property who builds or Irgaovas thereon and who does such work himself or herself, provided that suchImprovements am not intended or offered for sale. It, thowerver, the bulling orinprovement is sold within one year o7 cortlpletion. the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sate.). [ All Other Permits ) ❑ I, as owner of the propeft or my employees with wages as their sole compensation. will do the work, and the structure is rot intended oroflered [or sale (Sec 7D44, Business aro Professions Code: The Contractors Licosa Lawdoas np( apply to an owner d property who builds orimproves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It however, the holding or improvement is sold wimin one year al completion, the owner -builder will have the burden of proving that he or she did not bund or improve for the purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed rnrttracters to constrrel Iho-proiect (Sec 7044.13 -inose and Professions Code:The Contractors License Law does rot apply to an ovmerol property who hnlds or improves thereon. and who cbntracts lor.such projects with a contraclor(s) Iloensed pursuant to We Contractors License Law.). Owner Signalure Dale WORKER'S COMPENSATION DECLARATION I hereby afffmh underpenagy, of perjury ore of the following declarations: ❑ 1 have and will maintain a ceraricete of consent to seffa,sum for wodmre compensation, as provided for by Section 3700 or the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and wll maintain wodrefs compensation Insurance, as inquired by Section 3700 of the Labor Code, for this performance of the work for which this permit Is issued My workers compensation ksumn cx carder and policy number are: Carie, 671,\-m F— u 11,40 Policy Number 1.833 Com' — Z C) O ❑ I ce,dfy Umt fn Uhe pedomiarwa of due work for which tlJs perm is issued, I shell Trot employ any person In any manner so as to become subject to the workWs cornpensaton laws of California, and agree Ihal if I should become 'subject to the workers compensation previsions of Section 3700 of the Labor Code, I shalt forthwith comply with those FInl�(,2Skpha Data WARNING: FAILURE TO SECURE WORKER'S COMPENSA77ON covEn4GE Is UNLAWFiIL AND SHALL sLwscr AN EwpLo1:ER TO CRIMINAL PENAf77FS AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN AMMON 70 THE COST OF CompENsAnoN, DAMAGE AS PnowDEr.FOR IN SECTION 3706 OF THE LABOR CODE INTEREST, AND ATTDRNEY'S FEES. LOBBYIST ORDINANCE CERTIFICATION [Complete this section for penults in unincorporated Los Angeles County only This is to ceNfy mal I, as perk applicant, run brwla r widi the requirements of Los Angeles Coumy Code Chapter also et seq., (relating to the Los Angeles County Lobbyist Onrmsoca) and that all persons acting on behalf of myself complied and will continue to comply therewith through the aPPlication ri— Applicant (Print Name) Applicant Signature Company Name (ft employed by an entftylagaxy) Dale JOB ADDRESS LOCAL17Y HAZARDOUS MATERIAL DECLARATION Val are applicant or future hurdling ocarparht handle a tia}ardous matedal or a rribftm confeiring a t—dous malarial equal to er greater than the amount sped on'Ihe Ihaoardots materials information guide? Yes ❑ No ❑ Will the Wended use of the building by the applicant or future buadi g occupanl require a permit for coristrvction ornwdrrauon from the Soum Coast Air Quality Management Dlsldct (SCAOMD)? See Perinitlirlg checklist for guidelines. Yes ❑ No ❑ I have read the hasardous materials information guide and the SCAOMD perhi ling checklist, l understand my requirements raderdw LmAngeles County Code Tide 2, Chapter 220 Sections 220.100 through 220.140 concerning ha>ardous material reporting and forobtain ing a permit Iran the SCAOMD. . ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAQMD of EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. CONSTRUCTION LENDING AGENCY I hereby of no under penalty of perjury mal them is a construction lendlig agency [or the performance of the work for which -this penal is issued (Sec. 3097, Civ.C.). Lenders Nam - Lenders Addrer7 . r "—`G I certify that I have read this application and state under the penalty of perjury that the above information is correct: I agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentioned property forinspection purposes. CieantaAgent Signature Date