HomeMy Public PortalAbout10808 GRAND AVE_Building_10/19/2015_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
ITR: 4902 LT: 1 BL: D UN: .002
1
ASSESSOR INFORMATION NUMBER:
18574-023-013
1
(TENANT:
OWNER: TEL. NO:
IROMINI, JUDITH
110808 GRAND AV
TEMPLE CITY
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
NO. OF CONST
SQ. FT STORIES TYPE
(STRUCTURE: 1900 V -B
EXIST BLDG USE: RESID
EXIST OCC GRP:
BLDGS. NOW ON LOT:
# 0508
USE ZONE: R-1
VALUATION:
5,000
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO 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
REPORT ID: DPR261
ROUTE TO: BS0508
BUILDING PERMIT
ALTERATION/REPAIR
BL 0508 1510190074
BUILDING ADDRESS:
10808 GRAND AV
TEMP CA 917803548
NEAREST CROSS STREET: EL MONTE
THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI
ISSUED ON: PROCESSED BY:
10/19/15 SR
FINAL PATE FINALB�.V CODE:
DESc PTIOI OF WORK
TEAR -OFF (2) LAYERS OF EXISTING COMPOSITION SHINGLE APPLY
30 LB FELT OVER EXISTING SHEETING APPLICATION OF A CLASS "A"I
FIRE RATED COMPOSITION SHINGLE
SPECIAL CONDITIONS:
APPROVALS
LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
FLOOR SHEATHING
ROOF SHEATHING
SHEAR PANELS
FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
IT -BAR CEILINGS
LOT DRAINAGE
DATE INSPECTOR SIGNATURE
TEMP 917803548
FEES
PAID
FEE DESCRIPTION:
QUANTITY:
UOM:
AMOUNT:
APPLICANT:
TEL. NO:
ICOGHLAN,
TIM
(626) 857-0592-
IAA BLDG PERMIT ISSUANCE
27.80
833 W HERBER STREET
JAB STATE GREEN BLDG FEE 5000.00
VAL
1.00
IGLENDORA
CA 91741
JAC STRONG MOTION
RESID 5000.00
VAL
0.70
ID2 PERMIT W/O EN
-HC 5000.00
VAL
132.60
TOTAL FEES
162.10
CONTRACTOR:
TEL. NO:
V I P ROOFING
(626) 857-0592-
�M c�
P(co(ItTo fLh
833 W. HEBER STREET
LIC. NO
IGLENDORA, CA 91741
696625039
ARCHITECT OR ENGINEER:
TEL. NO:
I
LIC. NO:
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO 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
REPORT ID: DPR261
ROUTE TO: BS0508
BUILDING PERMIT
ALTERATION/REPAIR
BL 0508 1510190074
BUILDING ADDRESS:
10808 GRAND AV
TEMP CA 917803548
NEAREST CROSS STREET: EL MONTE
THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI
ISSUED ON: PROCESSED BY:
10/19/15 SR
FINAL PATE FINALB�.V CODE:
DESc PTIOI OF WORK
TEAR -OFF (2) LAYERS OF EXISTING COMPOSITION SHINGLE APPLY
30 LB FELT OVER EXISTING SHEETING APPLICATION OF A CLASS "A"I
FIRE RATED COMPOSITION SHINGLE
SPECIAL CONDITIONS:
APPROVALS
LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
FLOOR SHEATHING
ROOF SHEATHING
SHEAR PANELS
FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
IT -BAR CEILINGS
LOT DRAINAGE
DATE INSPECTOR SIGNATURE
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 Contrhptor 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 priorlto completion of the improvements covered by
this permit, I choot legally sell a structure that I have built as ark
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.leoinfo.ca.cov/calaw.html.
Date:
Signature of Property Owner or Authorized Agent
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perj th t I am licensed under
provisions of Chapter 9 (comme cing ith Section 7000) of
Division 3 of the Business an Profs sions Code, and my
license is in f, t d effect..- �
`LikIen Cla (yy✓t Lice `se No.
/ DiV5ntractor Si nature
/—
WORKERS' COMPENSATI E ARATION
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
FORIN 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:
Carrie Policy Number Expiration Date
Na of Agent Phone Number
certify that, in the performance of the work for which this
rmit Is issued, I shall not employ any person in any manner
o
as/ty as/te ome subject to the workers' compensation laws of
%Calif ia, a d agree that, if L�should become subject to the
% w r rs' co pensation pr ions of Section 3700 of the Labor
sh forthwith cy
2n-a_tuFe
ply with those provisionsI�
of Abdicant 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
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 ❑ 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.
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
jrird,d is correct.tocomplywith all applicable city and county
oces and state laws relating to building
of this county to enter the
inspection purposes.
or Authorized Agent
Date C �Ij