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Home My Public Portal About9170 CAMINO REAL AVE_Building_2/11/2015_COUNTY OF IAS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AMID SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 11993 IT: 1 ASSESSOR INFORMATION NUMBER: 5382-012-038 LIN, MTAO LIN 1414 FAIR OAKS STE 2 SOUTH PASADENA RAMIREZ/SLS DESIGN, STEPHEN 1414 FAIR OAKS STE 2 SOUTH PASADENA RAAA CORP 17078 COLIMA ROAD #317 HACIENDA HEIGHTS, CA 91745 ARCHITECT OR ENGINEER: SLS DESIGN 1414 FAIR OAKS AVE #2 SOUTH PASADENA CA 91030 TEL. NO: (626) 799-8818- TEL. NO: (626) 799-8818 TEL. NO: (909) 319 -7778 - LIC. NO 965553 TEL. NO: 1 (526) 799-8818-102 LIC. NO: C23755 NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 001 OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 12 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO NOW ON LOT: DESCRIPTION PLANCHECK W/O EN -HC BLDG PERMIT ISSUANCE STATE GREEN BLDG FEE STRONG MOTION REBID PERMIT W/O EN -HC ' ADDITIONAL DATA ON FILE ID: DPR261 USE ZONE: R-1 ISSUED ON: PROCESSED BY: 102/11/15 SR VALUATION: FIN�AL DA E FINyOB 30,833 / II1 FEES PAID DESL�ORE V BUILD DE ACHED 3 -CAR GARAGE QUANTITY: DOM: AMOUNT:( 30833.00 VAL 467.60 1 27.80 ISPECIAL CONDITIONS: 30833.00 VAL 2.00 30833.00 VAL 3.10 30833.00 VAL 550.10 LOCALITY: TEMPLE CITY CA CODE: TOTAL FEES 1,050.60 (APPROVALS DATE INSPECTOR SIGNATURE ROUTE TO: BS0508 LOCATION AND SETBACKS TEMPLE CITY I1{I/ # 0508 BUILDING PERMIT hV 9701 LAS TUNAS . NEW RESIDENTIAL TEMPLE CITY CA 91780 RAISED FLOOR FRAMING BL 0508 1404210028 UNDERFLOOR INSOLATION PHONE: (626) 285-0488 EXT: DUPLICATE NO. OF CONST NEW BUILDING ADDRESS: ROOF SHEATHING SQ. FT STORIES TYPE OCCUP GROUP 9170 CAMINO REAL STRUCTURE: 0 2 V -B R-3 SGAB CA 917752010 GARAGE: 670 1 V -B U NEAREST CROSS STREET: OAR OTHER: INSULATION/WEATHER STRIP THOMAS PAGE: 596 GRID: J1 NOW ON LOT: DESCRIPTION PLANCHECK W/O EN -HC BLDG PERMIT ISSUANCE STATE GREEN BLDG FEE STRONG MOTION REBID PERMIT W/O EN -HC ' ADDITIONAL DATA ON FILE ID: DPR261 USE ZONE: R-1 ISSUED ON: PROCESSED BY: 102/11/15 SR VALUATION: FIN�AL DA E FINyOB 30,833 / II1 FEES PAID DESL�ORE V BUILD DE ACHED 3 -CAR GARAGE QUANTITY: DOM: AMOUNT:( 30833.00 VAL 467.60 1 27.80 ISPECIAL CONDITIONS: 30833.00 VAL 2.00 30833.00 VAL 3.10 30833.00 VAL 550.10 LOCALITY: TEMPLE CITY CA CODE: TOTAL FEES 1,050.60 (APPROVALS DATE INSPECTOR SIGNATURE ROUTE TO: BS0508 LOCATION AND SETBACKS I1{I/ SOILS ENGINEER APPROVAL hV FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR . J RAISED FLOOR FRAMING UNDERFLOOR INSOLATION 1ST LEVEL FLOOR SHEATH 2ND LEVEL FLOOR SHEATH ROOF SHEATHING / nA FIRE DEPT. FRAME INS PECT��3_t� BLDG DEPT. FRAME INSPECT' SHEAR PANELS ll�AA'' INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH •II / ^ � LOT DRAINAGE SMOKE DETECTION DEVICES =IRE DEPARTMENT APPROVAL 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.). 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 Contractor pursuant .to the Contractors' State License Law). i (_) 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 prior) to completion of the improvements covered by this permit, I cannot 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: httD://www.leoinfo.ca.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 effect. License Class License No. -9, L,4 IS 3 Date _q� yontractor Signature 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. Policy 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 work s' mpe do insyr4nce carrier and policy number are: i) arrier Policy 4&nber Expiration Date Name of Agent Phone Number _ 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 with those provisions -7A 4 Signatur ant 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 et 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 ❑ 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 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 of pertv Offer or Authorized Agent Date