HomeMy Public PortalAbout10743 FREER ST_Building_3/19/2014_+ COUNTY OF IAS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID
TR: 13613 LT: 31
ASSESSOR INFORMATION NUMBER:
8573-005-019
TENANT:
OWNER: TEL. NO:
CHANG, ARTHUR (626) 551-1688
10743 FREER ST
TEMP 917803533
APPLICANT: TEL. NO:
SAME AS OWNER
f
CONTRACTOR: TEL. NO:
SAME AS OWNER -
LIC. NO
FEE DESCRIPTION
AA BLDG PERMIT ISSUANCE
AS STATE GREEN BLDG FEE
AC STRONG MOTION RESID
B1 PLANCHECK W/ENERGY
B2 PERMIT W/ENERGY
FR INV WORK W/O PERMIT
ARCHITECT OR ENGINEER:
TEMPLE CITY
# 0508
DESCRIPTION OF WORK
9701 LAS TUNAS
NO:
TEMPLE CITY CA 91780
MAP
NO: SEWER MAP BOOK: PAGE:
PHONE: (626) 285-0488 EXT:
CMP -
AMOUNT:
NO. OF
CONST
NEW
NO.
SQ. FT STORIES
TYPE
OCCUP GROUP
STRUCTURE:
0 1
V -B
R-3
GARAGE:
SCHOOL WITHIN HAZARDOUS
AIR
OTHER:
MATERIALS
23500.00
VAL
EXIST BLDG USE:
USE
ZONE:
EXIST OCC
GRP:
23500.00
VAL
IBLDGS. NOW ON LOT:
VALUATION:
23,500
FEE DESCRIPTION
AA BLDG PERMIT ISSUANCE
AS STATE GREEN BLDG FEE
AC STRONG MOTION RESID
B1 PLANCHECK W/ENERGY
B2 PERMIT W/ENERGY
FR INV WORK W/O PERMIT
ARCHITECT OR ENGINEER:
TEL. NO:
DESCRIPTION OF WORK
LIG
NO:
MAP
NO: SEWER MAP BOOK: PAGE:
FIRE ZONE:
CMP -
AMOUNT:
WINDOWS CHANGE OUT OF
3
00
NO.
OF FAMILIES: DWELLING UNITS:
APT/CONDI STAT
CLASS -
ADJACENT TO GARAGE (4)
0
NO
21
SCHOOL WITHIN HAZARDOUS
AIR
QUALITY: 1000 FEET
MATERIALS
23500.00
VAL
NO NO
NO
SPECIAL CONDZTIf
BUILDING PERMIT
RESIDENTIAL ADD/ALT/REP
BL 0508 1403190028
BUILDING ADDRESS:
10743 FREER ST
TEMP CA 917803533
NEAREST CROSS STREET: PERSIMMON
THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY CA
ISSUED ON: PROCESSED BY:
03/19/14 SR
FINAL DATE FINAL BY: CODE:
FEES
PAID
DESCRIPTION OF WORK
(1) KITCHEN REMODEL CHANGE OUT CABINETS
& FIXTURES (2)
QUANTITY:
BOM:
AMOUNT:
WINDOWS CHANGE OUT OF
13 WINDOWS (3) 3/4
BATHROOM CONVERSION
ADJACENT TO GARAGE (4)
REMODEL EXISTING
BATHROOM
27.80
23500.00
VAL
1.00
SPECIAL CONDZTIf
23500.00
VAL
2.40
23500.00
VAL
422.40
Xpj
23500.00
VAL
497.00
344.00
DOL
344.00
APPROVALS
IREQ
CTOR SIGNATURE
TOTAL FEES
1,294.60
LOCATION AND SETBACKS
REPORT ID: DPR261 ROUTE TO: BS0508
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLOOR
UNDERFLOOR INSULATION
IST LEVEL FLOOR SHEATH
2ND LEVEL FLOOR SHEATH
ROOF SHEATHING
FIRE DEPT. FRAME INSPECTI
BLDG DEPT. FRAME INSPECT
SHEAR PANELS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES
FIRE 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) 1 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).):
L) I, as owner of the property, or my employees with wages as
their sole compensation, will do (✓) 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 Contractor pursuant .to the Contractors' State License
Law).
L) 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 c nnot legally sell a structure that I have built as an
owner -builder 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.00v/calaw.html.
Date: t%�Y
Signature of Property Owner or,iplihortzed 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.
Date Contractor 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
workers' compensation insurance carrier and policy number are:
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 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 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.
Carder Policy Number Expiration Date DECLARATION REGARDING CONSTRUCTION LENDING
AGENCY
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
fSignatu � icant�/ 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
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 of PropertyOwner Aut%gent
Dat ------- 2-1ee