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Home My Public Portal About10750 GRAND AVE_Building_10/20/2014_I,. -COUNTY OF IAS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 4902 LT: 1 BL: E ASSESSOR INFORMATION NUMBER: 8574-024-001 TENANT OWNER: TEL. NO: XIAO YAN, WEN (626) 988-3678- 10750 GRAND AV TEMP 917803544 APPLICANT: TEL. NO: LIN, ALLEN Y (626) 284-3260- 333 W GARVEY AVE MONTEREY PARK 91754 CONTRACTOR: TEL. NO: A M P B CONSTRUCTION INC. (626) 284-3260- 333 W GARVEY AVENUE B834 LIC. NO MONTEREY PARK CA 91754 863573 ARCHITECT OR ENGINEER: TEL. NO: LIU, TIENKUANG (626) 348-7137- 9698 TELSTAR AVENUE #306 LIC. NO: EL MONTE CA 91731 NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 NO 99 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE 809 1 V -B GARAGE: OTHER: ST BLDG USE: REBID ST OCC GRP: R-3 GS. NOW ON IAT DESCRIPTION: BLDG PERMIT ISSUANCE • ADDITIONAL DATA ON FILE REPORT ID: DPR261 # 0508 NEW OCCUP GROUP R-3 VALUATION 108, :730 FEES PAID QUANTITY: DOM: AMOUNT: 27.80 TOTAL FEES 27.80 ROUTE TO: BS0508 BUILDING PERMIT BL 0506 1410200079 BUILDING ADDRESS: 10750 GRAND AV TEMP CA 917803544 NEAREST CROSS STREET: PERSIMMON THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: 10/20/14 SR �'J/NAL DATFs FINAL BY: CODE: ' I�/�S(CJ/I(iy)7LP�/TyION OF WORK CHANGE FROM OWNER BUILDER TO CONTRACTOR SEE ALSO BL 1403270101 SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FIRE SPRINKLER HANGERS INSULATION/WEATHER STAIPI INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS ' LOT DRAINAGE 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 Contractor 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 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.leoinfo.ca.aovlcalaw.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 nd effect. �7 License Class License No. ) S / _ i Date t� � ��ContractoSignature_____ WORKERS' COMPENSATIO 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 ifis`urance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My w ers' compensati,�oqq insurance varier andpolicy nurgber are: er Policy Num er Expiration 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 forthwith comply with those provisions 6D -yo - r ignature of Applicant Date JOBADDRESS ; 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 ❑ N o ❑ 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 L Z By my signature below, I certify to each of the following: 71 am the property owner or authorized to act on the property owner's behalf. I have read this application and the information I have 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 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 erty Owner or Aut!Wzed Agent Date -1� COUNTY bF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 4902 IT: 1 BL: E ASSESSOR INFORMATION NUMBER: 8574-024-001 OWNER: TEL. NO: XIAO YAN, WEN (626) 988-3678- 10750 GRAND AV TEMP 917803544 RESIDENTIAL ADD APPLICANT: TEL. NO: SAME AS OWNER - CONTRACTOR: TEL. NO: SAME AS OWNER - NO. OF LIC. NO ARCHITECT OR ENGINEER: TEL. NO: LIU, TIENKUANG (626) 348-7137- 9698 TELSTAR AVENUE #308 LIC. NO: EL MONTE CA 91731 NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: GARAGE: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO TEMPLE CITY # 0508 BUILDING PERMIT 9701 LAS TUNAS RESIDENTIAL ADD TEMPLE CITY CA 91780 BL 0508 1403270101 PHONE: (626) 285-0488 EXT: NO. OF CONST NEW BUILDING ADDRESS: SQ. FT STORIES TYPE OCCUR GROUP 10750 GRAND AV STRUCTURE: 809 1 V -B R-3 I TEMP CA 917803544 GARAGE: I NEAREST CROSS STREET: PERSIMMON OTHER: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CA EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXIST OCC GRP: 108/25/14 SR SLOGS. NOW ON IAT: VALUATION: 108,730 (FINAL DATE FZ CODE: FEES PAID FEE DESCRIPTION: QUANTITY: COM B1 PLANCHECK W/ENERGY 108730.00 VAL AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE 108730.00 VAL AC STRONG MOTION RESID 108730.00 VAL B2 PERMIT W/ENERGY 108730.00 VAL 08 CERTIF OF OCCUPANCY TOTAL FEES ID: DPR261 ROUTE TO: BS0508 TWNDIS OF WORK �1 FRONT EXPANSION OF DINING & LIVING ROOM ® REAR TWO BEDROOMS AMOUNT:IBATHROOM, AND FAMILY ROOM 1,260.60 1 27.80 (SPECIAL CONDITIONS: 5.00 10.90 1,483.00 101.40 JAPPROVALS DATE INSPECTOR SIGNATURE 2,888.70 1 LOCATION AND SETBACKS SOILS ENGINEER APPROVAL (FOUNDATION/TRENCH FORMS JSLAB/UNDER FLOOR 2AISED FLOOR FRAMING INDERFLOOA INSULATION �� LST LEVEL FLOOR SHEATH I(z- 2ND LEVEL FLOOR SHEATH ZOOF SHEATHING ?IRE DEPT. FRAME INSPECT MEG DEPT. FRAME INSPECT iHEAR PANELS •�1 'j� f INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL :XTERIOR LATH :OT DRAINAGE SMOKE DETECTION DEVICES ?IRE DEPARTMENT APPROVAL -I I 1 � I 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).): (_) I, as owner of the property, or my employees with wages as their sole compensation, will do (,r) 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 Contrb�tor pursuant .to the Contractors' State License Law). U- I am exeml t 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 whicq 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 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: hHD://www.leoinfo.ca.aov/calaw.html. Date: R/, -V51141 Signature of Property` wOwner /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. 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: Carrier Policy Number Expiration 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 forthwith comply with those provisions 04___L� Y. r7-;- / lam Signature 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 ❑ 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 ❑ N.o ❑ 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 120' 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 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 Date �?�/ -COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 4902 LT: 1 BL: E ASSESSOR INFORMATION NONE ER; 8574-024-001 TENANT OWNER: XIAO YAN, WEN 10750 GRAND AV TEMP 917603544 LIN, ALLEN Y 333 W GARVEY AVE MONTEREY PARK 91754 CONTRACTOR: A M P B CONSTRUCTION INC 333 W GARVEY AVENUE B834 MONTEREY PARK CA 91754 ARCHITECT OR ENGINEER: LIU, TIENKUANG 9698 TELSTAR AVENUE #308 EL MONTE CA 91731 TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0468 EXT: NO. OF CONST SQ. FT STORIES TYPE (STRUCTURE: 80 1 V -B GARAGE: OTHER; IEXIST BLDG USE: IEXIST OCC GRP: TEL. NO: SLUGS. NOW ON LOT: (626) 988-3678- I TEL. NO: (626) 284 -3260 - TEL. NO: (626) 284 -3260 - LIC. NO 863573 TEL. NO: (626) 348 -7137 - LIC. NO: NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( 3 001 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO DESCRIPTION BLDG PERMIT ISSUANCE STATE GREEN BLDG FEE STRONG MOTION RESID PERMIT W/O EN -HC ADDNL PLANCHECK FEE ' ADDITIONAL DATA ON FILE ID: DPR261 # 0508 BUILDING PERMIT RESIDENTIAL ADD BL 0508 1410200077 NEW ) BUILDING ADDRESS: OCCUR GROUP 10750 GRAND AV U I TEMP CA 917803544 NEAREST CROSS STREET: PERSIMMON THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY USE ZONE: TISSUED ON: PROCESSED BY: 110/20/14 SR VALUATION000: FI AL DATE FI{AL_BY: CODE: e, -Gr^Vl(/' FEES PAID n IPTION OF WORK CONVERT EXISTING PATIO INTO STORAGE ROOM ATTACHED TO THE QUANTITY: GUM: AMOUNT:IDETACHED GARAGE 27.80 8000.00 VAL 1.00 (SPECIAL CONDITIONS: 8000.00 VAL 0.80 8000.00 VAL 183.00 1.00 HOD 109.40 TOTAL FEES 322.00 APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS I - All ISOZLS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS I'L%�C SLAB/UNDER FLOOR U I I IRAISED FLOOR FRAMING (UNDERFLOOR INSULATION / I15T LEVEL FLOOR SHEATH I 2ND LEVEL FLOOR SHEATH I 1ROOF SHEATHING I /� (FIRE DEPT. FRAME INS PECTI I I 1BLDG DEPT. FRAME INSPEC (SHEAR PANELS I I (INSULATION/WEATHER STRI [INTERIOR LATH/DRYWALLollt [EXTERIOR LATH (LOT DRAINAGE (SMOKE DETECTION DEVICES I I (FIRE DEPARTMENT APPROVAL( I I I ROUTF. TO: 13SO508 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 (J) 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 Contractor pursuant .to the Contractors' State License Law). U 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 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. ^„ Licen�e5l.ssLicense No.Dat4r 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. JOBADDRESS 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 ❑ N o ❑ I have read the hazardous materials IntOrmatlon guioe ano me 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. Po icy No. ❑ Notification letter sent to AQMD and/or EPA I have and will maintain workers' compensation Insurance, as required 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. wp�r vers' compensatio7surance carrier and policy number are: I rt.'6`O'y✓r-ii� / ✓!/- �, i� C!/3 [-/, S DECLARATION REGARDING CONSTRUCTION LENDING Carrier Policy Number Expiration Date 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 personal residence in which I must have resided for at least Cade, I shall forthwith comply with those provisions one year prior) 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 byIgnature of Applicant 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.leainfo.ca.aov/calaw.htmi. Date: Signature of Property Owner or Authorized Agent 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. �!P/pli/ce�nt(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 Pr rty Owner or Authorized Agent Date COUNTY OW LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 SL 0508 1502110032 PHONE: (626) 285-0488 EXT: LEGAL ID: TR: 4902 LT: 1 BL: E ASSESSOR INFORMATION NUMBER: 8574-024-001 YAN, WEN GRAND AV 917803544 ALLEN Y W GARVEY AVE 'EREY PARK 91754 M P B CONSTRUCTION INC. 33 W GARVEY AVENUE B834 ONTEREY PARK CA 91754 OR ENGINEER: TEL. NO: (626) 988 -3678 - TEL. NO: (626) 284 -3260 - TEL. NO: (626) 284 -3260 - LIC. NO 863573 TEL. NO: LIC. NO: N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: NO 21 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO NO. OF CONST SQ. FT STORIES TYPE STRUCTURE: V -B EXIST BLDG USE: REBID USE ZONE: R-1 EXIST OCC GRP: BLDGS. NOW ON LOT: VALUATION: 1 7,500 FEES PAID FEE DESCRIPTION: QUANTITY: UOM AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE 7500.00 VAL AC STRONG MOTION RESID 7500.00 VAL D2 PERMIT W/O EN -HC 7500.00 VAL TOTAL FEES ADDITIONAL DATA ON FILE ID: DPR261 ROUTE TO: BS0508 AMOUNT: 27.80 1.00 0.80 183.00 212.60 BUILDING ADDRESS: 10750 GRAND AV TEMP CA 917803544 NEAREST CROSS STREET: PERSIMMON THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: 02/11/15 SR F AL/DATE FI�BY: CODE: PT� OF WORK RE -STUCCO ENTIRE HOUSE SPECIAL CONDITIONS: APPROVALS DATE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE � INSPECTOR SIGNATURE OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 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 I, as owner of the property, or my employees with wages as their sole compensation, will do (,i) 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 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 Contractor pursuant .to the Contractors' State License Law). U 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 which I must have resided for at least one year prior) to completion; of the improvements covered by this permit, I cannot legally sell a structure that 1 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: hfD://www.leainfo.ca.ciov/calaw.htmi. 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. p License Class License No. o ��' 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. olicy No. I have and will maintain workers' compensation i surance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My w kers' compensate insurance carrier and policy number ar Carrier Policy Number Expiration 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 forthwith comply with those provisions nature leant 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 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 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. Signur of Property Owner or Authorized Agent Date,) —1l- ?x (`)7— COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1504080062 PHONE: (626) 285-0488 EXT: LEGAL ID: IR: 4902 LT: 1 BL: E ASSESSOR INFORMATION NUMBER: 8574-024-001 OWNER: TEL. NO: XIAO YAN, WEN (626) 988-3678- 10750 GRAND AV TEMP 917803544 APPLICANT: TEL. NO: WONG, GEORGE (626) 780-2199- 516 N. MOORE AVE#E VAL, MONTEREY PARK 91754 CONTRACTOR: TEL. NO: A M P B CONSTRUCTION INC. (626) 284-3260- 333 W GARVEY AVENUE B834 LIC. NO MONTEREY PARK CA 91754 863573 ARCHITECT OR ENGINEER: TEL. NO: 183.00 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 NO. OF CONST BUILDING ADDRESS: SQ. FT STORIES TYPE 10750 GRAND AV STRUCTURE: V -H TEMP CA 917803544 EXIST BLDG USE: DETAC EXIST OCC GRP: BLDGS. NOW ON IAT: FEE DESCRIPTION AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE AC STRONG MOTION REBID D1 PLANCHECK W/O EN -HC D2 PERMIT W/O EN -HC * ADDITIONAL DATA ON FILE NEAREST CROSS STREET: PERSIMMON THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 04/08/15 SR VALUATION: IFINAL..DATE' FIvnr, BY: CODE: B, 000 FX \1(\.� FEES PAID DESCRIPTION OF WORK NEW PITCH ROOF, DEMO OLD GARAGE ROOF. (DETACHED GARAGE QUANTITY: DOM: AMOUNT:(REMAIN FLOOR PLAN) ID: DPR261 ROUTE TO: BS0508 SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE ON AND SETBACKS ENGINEER APPROVAL TION/TRENCH FORMS RAISED FLOOR FRAMING 27.80 8000.00 VAL, 1.00 8000.00 VAL 0.80 j 8000.00 VPS. 155.60 i 8000.00 VAL 183.00 TOTAL FEES 368.20 ID: DPR261 ROUTE TO: BS0508 SPECIAL CONDITIONS: DATE INSPECTOR SIGNATURE ON AND SETBACKS ENGINEER APPROVAL TION/TRENCH FORMS RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS Y FRAME INSPECTION j FIRE SPRINKLER HANGERS INSULATION WEATHER STRIP i INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. f RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE 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 items) (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 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 Contrha for pursuanLto the Contractors' State License Law). (_) I am exem{ t 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 �f 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.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. @h f. License Class License No. O� f / �i 1- )a6late � 8 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. 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: Cartier Policy Number Expiration 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 forthwith comply with those provisions t`�- Signatufe 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 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. 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 ❑ N.o ❑ I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirem@nis 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). 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. Signature Propertycaner or A�(torized Agent Applicant (Print Name) Applicant Signature Company Name Date <late <l-�-u rr