HomeMy Public PortalAbout5750 CLOVERLY AVE_Building_10/9/2014_COUNTY OF IAS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 6561 LT: 697 UN: .002
ASSESSOR INFORMATION NUMBER:
8587-011-017
021J0Zk4
OWNER: TEL. NO:
NEVAREZ, CHRTISTINE
5750 CLOVERLY AV
TEMP 917802551
.1111�w:
RODRIGUEZ, PHIL
600 E FIG AVENUE
MONROVIA CA 91016
CONTRACTOR:
VISTA WINDOW MFG, INC.
600 E FIG AVE
MONROVIA CA 91016
ARCHITECT OR ENGINEER
TEMPLE CITY # 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
NO. OF CONST
SQ. FT STORIES TYPE
STRUCTURE: V -B
EXIST BLDG USE: RESID
EXIST OCC GRP:
BLDGS. NOW ON LOT:
FEE DESCRIPTION:
TEL. NO:
(626) 759-7600- 1 A BLDG PERMIT ISSUANCE
JAB STATE GREEN BLDG FEE
AC STRONG MOTION RESID
D1 PLANCHECK W/O EN -HC
ID2 PERMIT W/O EN -HC
TEL. NO: JFR INV WORK W/O PERMIT
(626) 359 -3600 -
LIC. NO
894762
TEL. NO:
LIC. NO:
N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21
SCHOOL WITHIN HAZARDOUS
QUALITY: 1000 FEET MATERIALS
NO NO NO
• ADDITIONAL DATA ON FILE
REPORT ID: DPR261
USE ZONE: R-1
ROUTE TO: BS0508
BUILDING PERMIT
ALTERATION/REPAIR
BL 0508 1410090067
BUILDING ADDRESS:
5750 CLOVERLY AV
TEMP CA 917802551
NEAREST CROSS STREET: LAS TUNAS
THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
ISSUED ON: PROCESSED BY:
110/09/14 SR
Fj/It��'A/I, DATE FIjJAh BY: CODE:
D S i` I N OF WORK
!LIKE FOR LIKE SIZE RETRO CHANGE OUT 16 WINDOWS
SPECIAL CONDITIONS:
1NV
A DATE
LOCATION AND SETEACM
SOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLUOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
FLOOR SHEATHING
ROOF SHEATHING
SHEAR PANELS
FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIPI
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T -BAR CEILINGS
LOT DRAINAGE I
INSPECTOR SIGNATURE
VALUATION:
5,000
FEES
PAID
QUANTITY:
GUM:
AMOUNT:
27.80
5000.00
VAL
1.00
5000.00
VAL
0.50
5000.00
VAL
112.70
5000.00
VAL
132.60
344.00
DOL
344.00
TOTAL FEES
618.60
ROUTE TO: BS0508
BUILDING PERMIT
ALTERATION/REPAIR
BL 0508 1410090067
BUILDING ADDRESS:
5750 CLOVERLY AV
TEMP CA 917802551
NEAREST CROSS STREET: LAS TUNAS
THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
ISSUED ON: PROCESSED BY:
110/09/14 SR
Fj/It��'A/I, DATE FIjJAh BY: CODE:
D S i` I N OF WORK
!LIKE FOR LIKE SIZE RETRO CHANGE OUT 16 WINDOWS
SPECIAL CONDITIONS:
1NV
A DATE
LOCATION AND SETEACM
SOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLUOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
FLOOR SHEATHING
ROOF SHEATHING
SHEAR PANELS
FRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIPI
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T -BAR CEILINGS
LOT DRAINAGE I
INSPECTOR SIGNATURE
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 sheds 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 Contra?tor 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 prion 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.lecinfo.ca.Dov/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. Q -f
?,�l.icense Class C• I—) License No.c_-
Date
Contractor Signatur �A..i
WORKERS;416N 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.
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 checklistfor guidelines.
Yes ❑ No ❑
I have read the hazardous materials information guide and the
I hereby affirm under penalty of perjury one of the following SCAQMD permitting checklist, I understand my requirements
declarations: under the Los Angeles County Code Title 2, Chapter 220'
I have and will maintain a certificate of consent to self- Sections 220.100 through 220.140 concerning hazardous
Insure for workers' compensation, issued by the Director of material reporting and for obtaining a permit from the SCAQMD.
Industrial Relations as provided for by Section 3700 of the
Labor Code, for the performance of the work for which this permit ASBESTOS NOTIFICATION
is issued.
Policy No. ❑ Notification letter sent to AQMD and/or EPA
I have and will maintain workers' compensation
Asurani surance, as and
by Section 3700 of the Labor Code, for ❑ I declare that notification of asbestos removal is not
the performance of the work for which this permit is issued. My applicable to addressed project.
workers' corn nsa' ms ance crier o umber are, _
C11ih !! � n �COO A — � �J DECLARATION REGARDING CONSTRUCTION LENDING
Cartier Policy Number Expiration ate 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' pensation provisions of Section 3700 of the Labor
Code, h fo with comply with those provisions
re of Applicant D -5%,E
is
E
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).
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.
Signa f Props Owner or Authorized Agent