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Home My Public Portal About6214 ENCINITA AVE_Building_10/19/2015_COUNTY OF LOS ANGELES TEMPLE CITY R 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 L ID: ON FILE SSOR INFORMATION NUMBER: OWNER: CHOW LIANG CHIU;JEN SIU 6214 ENCINITA AV TEMP 917801639 APPLICANT: RODRIGUEZ, ISMAEL E 3965 COAST OAK CIRCL CHINO HILLS CA CONTRACTOR: WRECK AGE DEMOLITION 3965 COAST OAK CIRCLE CHINO HILLS CA 91709 ARCHITECT OR ENGINEER PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE (STRUCTURE: 420 EXIST BLDG USE: SWIMM USE ZONE: EXIST OCC GRP: TEL. NO: SLOGS. NOW ON LOT: VALUATION: 1 0 TEL. NO: (626) 523 -1307 - TEL. NO: (909) 393 -6937 - LIC. NO 890096 TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 24 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 FEES PAID FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: AA BLDG PERMIT ISSUANCE 27.80 TOTAL FEES 27.80 V ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT DEMOLITION BL 0508 1510190024 BUILDING ADDRESS: 6214 ENCINITA AV TEMP CA 917801639 NEAREST CROSS STREET: LONGDEN THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY C ISSUED ON: PROCESSED BY: 10/19/15 SR FINAL DATEFINAL BY: CODE: DESCRIPTION OFOW RK FROM OWNER BUILDER TO CONTRACTOR TO REMOVE EXISTING G POOL AND BACKFILL CONDITIONS: PEDESTRIAN PROTECTION SEWER DISCONNECTION ABANDON PRIVATE DISPOSAL JUNDERGRND STRUCT REMOVAL AND SOIL AECOMPACTION I 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 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 U portions of the r LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under i 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. 1g d License Class //L-21i� License No. O% Dates /4 204ontractor Signature, WORKERS' COMPERSA ION 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 FORIN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. work, and the structure is not intended or offered for sale (Section 7044, Business and Professions Code: The I hereby affirm under penalty of perjury one of the following Contractors' State License Law does not apply to an owner of declarations: property who, through employees' or personal effort, builds or 1 have and will maintain a certificate of consent to self - improves the property, provided that the improvements are not insure for workers' compensation, issued by the Director of intended or offered for sale. If, however, the building or Industrial Relations as provided for by Section 3700 of the improvement Is sold within one year of completion, the Owner- Labor Code, for the performance of the work for which this permit Builder will have the burden of proving that it was not built or is issued. improved for the purpose of sale.). Policy No. I have and will maintain workers' compensation U I, as owner of the property, am exclusively contracting with insurance, as required by Section 3700 of the Labor Code, for licensed Contractors to construct the project (Section 7044, the performance of the work for which this permit is issued. My Business and Professions Code: The Contractors' State License workerr�ompensation insu.r??nce carder and policy number are: Law does not apply to an owner of property who builds o ' Li,Forv�cL .Yv.Sw ra�cJz c,o r-1(�-$$;i fCr-c'I-6'- D V fol �ao� improves thereon, and who contracts for the projects with a Carr jp1c icy Number Expiration Date licensed Contractor pursuant to the Contractors' State License ' \ P -Agent Law). Name of Phone Number U 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 whict♦ I must have resided for at least one year priorlto completion; of the improvements covered by this permit, 1 c4nnot legally sell a structure that I have built as an owns 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.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 wi se provisions re o Applic 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 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 ❑ N o ❑ Will theintended 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 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 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 owner's 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 o Property Owner Authorized Agent ate 16117 JAr