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Home My Public Portal About6260 GOLDEN WEST AVE_Building_10/29/2012_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 5385-022-022 TENANT OWNER: TEL. NO: DOHERTY DOROTHY D TR (818) 286-9382- 6260 GOLDEN WEST AV TEMP 917801701 APPLICANT: TEL. NO: SITU, MINEN (626) 705-0651- 621 N. BUSHNELL AVE ALHAI4BRA, CA 91801 CONTRACTOR: TEL. NO: MINEN CONSTRUCTION INC (626) 705-0651- 621 N BUSHNELL AVENUE LIG NO ALHAMBRA CA 91801 900971 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO TEMPLE CITY # 0508 BUILDING PERMIT 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP TEMPLE CITY CA 91780 BL 0508 1208300057 PHONE: (626) 285-0488 EXT: NO. OF CONST NEW BUILDING ADDRESS: SQ. FT STORIES TYPE OCCUP GROUP 6260 GOLDEN WEST AV STRUCTURE: 347 1 V -H R-3 I TEMP CA 917801701 GARAGE: I NEAREST CROSS STREET: LONGDON OTHER: I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: EXIST OCC GRP: 130/29/12 SR SLUGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: 1 68,940 1 FEES PAID DESCRIPTION OF WORK (ADD MASTER BEDROOM, BATHROOM 347 SQ.FT. AND REMODEL KITCHEN FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:IAND ONE BATHROOM B1 PLANCHECK W/ENERGY 68940.00 VAL 924.80 1 AA BLDG PERMIT ISSUANCE 27.80 SPECIAL CONDI AB STATE GREEN BLDG FEE 68940.00 VAL 3.00 COVENANT trintu AC STRONG MOTION RESID 68940.00 VAI, 6.90 1 B2 PERMIT W/ENERGY 68940.00 VAL 1,087.90 1 FR INV WORK W/O PERMIT 342.20 DOL 342.20 (APPROVALS DATE INSPECTOR SIGNATURE 08 CERTIF OF OCCUPANCY 101.40 1 TOTAL FEES 2,494.00 LOCATION AND SETBACKS l Y Y V,•l 1S0ILS ENGINEER APPROVAL /\` VV ll 1 1 l ` 1F0UNDATION/TRENCH FORMS 1 J 1SLAB/UNDER FLUOR RAISED FLOOR FRAMING I I i (UNDERFLOOR INSULATION 1 I I 115T LEVEL FLOOR SHEATH I I 12ND LEVEL FLOOR SHEATH I I IROOF SHEATHING I, 1 1FIRE DEPT. FRAME INSPECTI I (BLDG DEPT. FRAME INSPECTI'J SHEAR PANELS (INSULATION/WEATHER STRIP I (INTERIOR LATH/DRYWALL I I I EXTERIOR LATH I 1 LOT DRAINAGE I SM0KE DETECTION DEVICES I I (FIRE DEPARTMENT APPROVAL( • ADDITIONAL DATA ON FILE I REPORT ID: DPR261 ROUTE T0: HSO508 I 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 (_) 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.). (_) 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 Conhh9tor pursuant to the Contractors' State License Law). ' (_) 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 which I must have resided for at least one year prion to completion of the improvements covered by this permit, I c4nnot legally sell a structure that I have built as an owner -builder 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.leainfo.m.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS 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 effect. License Class 1; License No.� % cm cal % I Date I n tGentractor 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. Polic 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 num er are: m Car Po icy um er Expiration Date Name of Agent Phone 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 workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions _ , — i � / 'I Signa�f "Applicant 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 W�Ig9n��tture I.Alr1EP1d 4—UC7,_W INC_ 7'9, 2_1/l'L— Company Name Dat / 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 infornation 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 Lender's 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 �off�Property Owner or Authorized Agent Data