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Home My Public Portal About9468 BROADWAY_Building_6/20/2016_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 8588-027-001 TENANT OWNER: COMMUNITY OF CHRIST CHURCH 9468 BROADWAY TEMPLE CITY CA 91780 APPLICANT: KING, LEX 8599 VENICE LOS ANGELES CA 90034 CONTRACTOR: RELIANCE HOME SERVICES, INC. 8599 VENICE BLVD STE A IAS ANGELES, CA 90034 ARCHITECT OR ENGINEER SEWER MAP BOOK: PAGE: TEL. NO: (626) 285-4500 TEL. NO: (310) 945 -4645 - TEL. NO: (310) 945 -4645 - LIC. NO 997575 TEL. NO: LIC. 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 TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: SEWER / SEPTIC: SEWER EXIST OCC GRP: SLUGS. NOW ON IAT: CONNECTION TYPE: ORIGINATION: LENGTH FII, TO PL: STATION: MANHOLE REFERENCE: UPPER/LOWER: COUNTY IMPROVEMENT NUMBER: PLAN CHECK NUMBER: JOB NUMBER: TRUNK PERMIT NUMBER: ROAD PERMIT NUMBER: AFFADAVIT: NO WAIVER: NO EASEMENT: NO # 0508 DEPTH: RECORD INSTRUMENT HER: RECORD DATE: HIGHWAY/STREET WIDENING: STATE ENCROACHMENT PERMIT NUMBER: FEES PAID FEE DESCRIPTION: QUANTITY: DOM O1 PERMIT ISSUANCE FEE 15 ALT/REP HOUSE SEWER 1.00 EAC TOTAL FEES ID: DPR266 ROUTE TO : BS0508 AMOUNT: 34.40 37.70 72.10 SEWER PERMIT BE 0508 1606200005 BUILDING ADDRESS: I 9468 BROADWAY TEMP CA 917802445 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAl ISSUED ON: PROCESSED BY: 06/20/16 SR FINAL DATE FI JAL CODE: L1 � DESC IPT ON OF WORK L INSTALLING 4- CLEANOUT IN FRONT YARD CONDITIONS: HOUSE SEWER [ECT ADDITIONAL ,DING OR WORK 'IC TANK, SEEPAGE OR DRAIN FIELD EPA SEWER POSAL SYST NECT PLUG AND N HOUSE SEWER LL SEPTIC TANKS PIT CESSPOO TER SYSTEM DATE INSPECTOR SIGNATURE L PITT OR -� I OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS 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 1, as owner of the property, or my employees with wages as their sole compensation, will do (✓) all of or U 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 1, 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 Contrh�tor pursuant.to the Contractors' State License Law). (_): 1 am exempt 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 priorlto compleliory of the improvements covered by this permit, I cannot legally sell a structure that I have built as an owner-huilder 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.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 ClassC 3 � License No. Date(Q/,24,)//4ntractor 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. P7li No. 1 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 workco ensation insureA a carrier and policy number are: Comer Policy Number F�tpi tf�n ate 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 coEnplyylth those provisions Signature o 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 cpfnplied and will continue to tomcat�thh�eviiththro gh the applica on processryApicanatu e`Cothpany Name C_. 0 ry , 1,615 DGl 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 Ia 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 Q ality Management District (SCAQMD)? See permitting cklist for guidelines. Yes El 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 conceming hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMD and/or EPA 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 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. Signal re of Property O r Authorized Agent Date7iiT