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Home My Public Portal About9634 BROADWAY_Building_6/9/2014_4 COUNTY OF LOS ANGELES DEPARTMENT OP PUBLIC -WORKS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY # 0508 BUILDING PERMIT 9701 LAS TUNAS RESIDENTIAL ADD TEMPLE CITY CA 91780 BL 0508 1306130045 PHONE: (626) 283-0488 EXT: LEGAL ID: NO. or CONST NEW I BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP] 9634 BROADWAY ISTRUCTURE: 264 1 V_B R-3 I TEMP CA 917803204 NSSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET: TEMPLE CITY 8588-023-032 OTHER: 104 1 V_B U I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C I TENANT- EXIST BI,DG USE: USE ZONE: JISSUED ON: PROCESSED BY: IEXIST OCC GRP: 106/09/14 SR I I DMER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL BY: CODE: DAVIS MARIA H (626) 309-2880- 1 41,110 1 9634 BROADWAY I I i n TEMP 917803204 FEES PAID IDESCRIPTIOWbIlfWQAA i"j.# 1264 SQ -FT. BEDROOM, 3/4 BATHROOM, HALLWAY AND COVERED PATIO IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1104 SQ.FT. kPPLICANT- TEL- 140: 1 1 MORENO, JOE (626) 350-5944- AA BLDG PERMIT ISSUANCE 27.80 1 AB STATE GREEN BLDG FEE 41110.00 VAL 2.00 JSPECIAL CONDITIONS- JAC STRONG MOTION REBID 41110.00 VAL 4.10 lCOVENANT RECORDED IB2 PERMIT W/ENERGY 41110.00 VAL 763.60 108 CERTIF OF OCCUPANCY 101.40 CONTRACTOR! TEL. NO; I TOTAL FEES 898.90 JAPPROVALS DATE INSPECTOR SIGNATURE MERIDIAN CONSTRUCTION COMPANY (800) 262-6365- 1 1 6910 13ERTRAND AVENUE LIC. NO I LOCATION AND SETBACKS I I RESEDA CA 91335 887326 1 1 I [SOILS ENGINEER APPROVAL I I ARCHITECT OR ENGINEER- TEL. NO: jbuuN��iluN/TRENCH FO EMS LI, DAVID (626) 288-1216- ---� / ^ if IV 1000 SAN GABRIEL BLVD LIC. NO: SLAB/UNDER FLOOR #101 887326 ROSEMEAD CA 91770 IRAISED FLOOR FRAMING I MAP NO: SEWER MAP BOOK: PAGE: FIRE ZUNE: CMP;l JUNDERFLOOR INSULATION 3 001 1 7* I JIST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND : STAT CLASS: I L 0 NO 21 1 12ND LEVEL FLOOR SHEAT'H�U4 I I SCHOOL WITHIN HAZARDOUS I IROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS 1 1 "01(4/ NO NO NO I IFIRE DEPT. FRAME INSPECT, I JBLDG DEPT. FRAME INSPECT SHEAR PANELS INSULATION/WEATHER STRI JINTERIOR LATH/DRYWALL I IEXTERIOR LATH I ILOT DRAINAGE I— ISMOKE DETECTION DEVICES I IFIRE DEPARTMENT APPROVAL I - ADDITIONAL DATA ON FILE I I ____i RT ID: DPR261 ROUTE TO: BS0508 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 1, as owner of the property, or my employees with wages as their sole compensation, will do (J) all of or L) 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 Contr'a4tor pursuant .to the Contractors' State License Law). (_): I 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 whict I must have resided for at least one year prior) to completioq 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 ofthe Business and Professions Code, is available upon request when this application is submitted or at the following Web site: httD://www.leoinfo.ca.cov/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. Fc/ 321!% Date O(0 Contractor Signature 1 / 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. Py7No. 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 rs' ompepeation Psup �carrieS� d polic umb �are:� e �� i �/ Carrier Po icy hum E ;ration 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 forthw' comply with those provisions SignatGe of 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 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 for Management District (SCAQMD)? See permitting checklist for guidelines. Yes ❑ No ❑ j I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my mquirsmgnts 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 ❑ 1 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 of Prope Owner or Authorized Agent XBate DE�o 9�Ily