HomeMy Public PortalAbout5708 OAK AVE_Building_12/9/2002_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
BK: 27 PG: 94 PC: 1
ASSESSOR INFORMATION NUMBER:
8587-010-032
TENANT:
OWNER:
YU;MONGENS C & ABIGAIL
5708 OAK AV
TEMP 917802430
APPLICANT:
SAME AS OWNER
CONTRACTOR:
SAME AS OWNER
ARCHITECT OR ENGINEER:
TEL. NO:
(626) 287 -4318 -
TEMPLE CITY
# 0508
BUILDING PERMIT
9701 LAS TUNAS
ALTERATION/REPAIR
REPLACE EXISTING FLAT ROOF (HOUSE ONLY)
TEMPLE CITY
CA 91780
AMOUNT:
BL 0508 0212090050
PHONE: (626)
285-0488
EXT:
VAL
0.50
SPECIAL CONDITIONS:
1500.00
NU. UH
CONST
BUILDING ADDRESS:
SQ. FT
STORIES
TYPE
5708 OAK AV
APPROVALS DATE INSPECTOR SIGNATURE
STRUCTURE:
VN
TEMP CA 917802430
NEAREST CROSS STREET: LIVE OAK
THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
EXIST BLDG USE: RES1D
USE
ZONE: R-1
ISSUED ON: PROCESSED BY:
EXPIRES ON:
EXIST OCC GRP:
12/09/02 JK
06/07/03
BLDGS. NOW ON LOT:
VALUATION:
FINAL DATE FINAL BY:
CODE:
1,500
FEE DESCRIPTION:
TEL. NO:
- AA BLDG PERMIT ISSUANCE
AC STRONG MOTION RESID
D2 PERMIT W/0 EN -HC
TEL. NO:
LIC. NO
TEL. NO:
LIC. NO:
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
147HH265 3 01
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
REQUIRED TOTAL SETBACK FROM EXIST
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL -
SIDE PL -
REPORT ID: DPR261 ROUTE TO: BS0508
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
LUT DRAINAGE
�1�J/Z U/ii
'WORK
FEES PAID
DESCRIPTION UF
REPLACE EXISTING FLAT ROOF (HOUSE ONLY)
QUANTITY:
UOM:
AMOUNT:
27.75
1500.00
VAL
0.50
SPECIAL CONDITIONS:
1500.00
VAL
82.20
TOTAL FEES
110.45
APPROVALS DATE INSPECTOR SIGNATURE
REPORT ID: DPR261 ROUTE TO: BS0508
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
LUT DRAINAGE
�1�J/Z U/ii
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions
of Chapter (commencing Nth Section 7000) of Division 3 of the Business
and Professions Code, and my license is in full force and effect
License Class Lis No
Contractor's Signature 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 Professions Code: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for such permit to file a signed
statement that he or she is licensed pursuant to the provisions of the
Contractors License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he or she is
exempt therefrom 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) )
❑ 1 am exempt under Sec , BA P.C. for this reason
( Electrical, Plumbing & Sewer Permits Only ]
❑ I, as owner of the property, will do the work, and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions Code:
The Contractors License Law does not apply to an owner of property who
builds or improves thereon, and who does such work himself or herself,
provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year o4 completion,
the owner -builder will have the burden of proving that he or she did not
build or improve for the purpose of sale )
[ All Other Permits ]
14 I, as owner of the property, or my employees with wages as their sole
c peasation, will do the work, and the structure is not intended or offered
for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or improves
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 If, however, the building or improvement is solo within
one year of completion, the owner -builder will have the burden of proving
that he or she did not build or improve for the purpose of sale )
❑ I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec 7044, Business and Professions
Code The Contractors License Law does not apply to an owner of property
who builds or improves thereon, and who contracts for such projects with
`ylaa contractors) licensed pursuant to the Contractors License Law )
Owner Signatur Date
WORKER'S COMPENSATION DECLARATION
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, as provided for by Section 3700 of the labor
Code, for the performance of the work for which this permit is issued.
❑ I have and will maintain workers compensation insurance, a$ 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.
Carrier
Policy Number
❑ 1 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 worker's compensation provisions of
Section 3700 of the Labor Code, I shall forthwith comply with those
provisions
Applicant Signature Date
WARNINGFAILURE TO SECURE WORKER'S 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 /N SECTION 3706
OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES
LOBBYIST ORDINANCE CERTIFICATION
r omplete this section for permits in
L uninCcorporated Los Angeles County only
This is to certitythat I, as permit applicant, am familiar with the requirements
of Los Angeles County Code Chapter 2.160 of 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 (if employed by an entity/agency) Date
JOB ADDRESS
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 ❑
1 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 forobtaining a permit from
the SCAQMD
ASBESTOS NOTIFICATION
❑ Notification letter sent to SCAQMD or EPA
❑ 1 declare that notification of asbestos removal is not applicable to
addressed project.,
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
(Sec. 3097, CivC.).
Lenders Name
Lenders Address
"i
I certify that 1 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.
/ v�g10 z
Applica gent Signature Date