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Home My Public Portal About9828 KEY WEST ST_Swimming Pool_9/13/2015_' COUNTY JF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 14908 IT: 8 Ip, c,Op 1SFOR::I:'_'D OWNER: TEL. NO: VAN DE CAR, HOLLY (626) 286-4479- 9828 KEY WEST ST TEMP 917803918 APPLICANT: TEL. NO: JOYA, RICARDO (909) 477-0373- 9292 NINTH STREET RANCHO CUCAMONGA CONTRACTOR: TEL. NO: SECARD POOLS (909) 980-6744- 9292 NINTH STREET LIC. NO RANCHO CUCAMONGA, CA 91730 233403 C53 ARCHITECT OR ENGINEER: TEL. NO: MANALO, RAMIL (818) 484-1587- 8532 THUNDERBIRD DRIVE LIC. NO: NORTH HILLS CA 91343 NONE NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 31 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO TEMPLE CITY 8 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: COMBINATION SWIMMiING POOL PERMIT CP 0508 1505130002 POOL TYPE: RESIDENTIAL BUILDING ADDRESS: SIZE: 448 SQ.FT CONST TYPE: V -B I 9828 KEY WEST ST TEMP CA 917803918 FEE DESCRIPTION AB STATE GREEN BLDG FEE 02 PERMIT ISSUANCE FEE 06 COMB POOL PERMIT 14 COMB POOL PLAN CHECK 16 POOL BARRIER - FENCE REPORT IO: DPR268 I I NEARRS'I CROSS STRE_ I - EYi?. ..,:25 P...... 597 _. _... A, ..JAL.. .. __ ..i'_ CA: .... -A' 17,000 ISSUED ON: PROCESSED BY: 105/13/15 SR FEES PAID I QUANTITY: UOM: 17000 00 VAL 17000.00 VAL 17000.00 VAL TOTAL FEES ROUTE TO: BSO508 CODE: AMOUNT:1 oil 1.00 DES R1� F WORK 27.60 INEW IN GROUND VINYL LINER SWIMMING POOL 14 X 32. NO SPA 738.90 IND HEATER. 314.00 92.30 1,174.00 SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE FINAL FIRE DEPT APPROVAL FINAL (E�LEC�1ttICAL 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 ilem(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 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 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 personal residence in which 1 must have resided for at least one year prior) to completion of the improvements covered by this permit, I Onnot 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.leainfo.ca.aov/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 Cjla9ss C,-53 License No. 233 yO- -�Date Contractor Signature aC/ 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: Carder Policy Number Expiration Date Name of Agent Phone Number 1 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' com enation provisions of Section 3700 of the Labor Cod s all fo wit those provisions igna re of pplic"DDa e 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 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 LOBBYIST ORDINANCE CERTIFICATION provided is correct. Complete this section for permits In I agree to,comply with all applicable city and county Unincorporated Los Angeles County only ordinances and state laws relating to building This is to certify that I, as permit applicant, am familiar with the construction. requirements of Los Angeles County Code Chapter 2.160 at seq., I authorize representatives of this county to enter the (relating to the Los Angeles County Lobbyist Ordinance) and that p ty all persons acting on behalf of myself cc 'ed and u above -identified property for inspection purposes. t ly there Ith th gh the app)' on pro e � yy�� nature o e Agent Brea✓dei /�,/, Applicant (Print Name (G pp tSlgnature Company Name Date