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Home My Public Portal About9123 BROADWAY_Building_10/16/2014_COUNTY OF LOS ANGELES DATE INSPECTOR SIGNATURE TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS FOUNDATION/TRENCH FORMS 9701 LAS TUNAS SLAB/UNDER FLOOR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 UNDERFLOOR INSULATION FLOOR SHEATHING PHONE: (626) 285-0488 EXT: LEGAL ID: FRAME INSPECTION NO. OF CONST FIRE SPRINKLER HANGERS ON FILE INSULATION/WEATHER STRIP SQ. FT STORIES TYPE EXTERIOR LATH RATED FLOOR/CEZL ASSEM. STRUCTURE: 23500 V -B RATED WALL ASSEMBLIES ASSESSOR INFORMATION NUMBER: RATED SHAFTS/OPENINGS T -BAR CEILINGS 5387-021-001 � TENANT: IEXIST BLDG USE: CHURC USE ZONE: R-1 EXIST OCC GRP: OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FIRST LUTHERAN CHURCH OF TEMPLE CIT (818) 287-0968- 1 3 48,000 9123 BROADWAY TEMP 917802301 FEES PAID FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: TEL. NO: I MACIAS, JESSE M (562) 693-4532- IAA BLDG PERMIT ISSUANCE 27.80 593 CARSON CITY WAY IAB STATE GREEN BLDG FEE 48000.00 VAL 2.00 NORCO CA 92860 IAE STRONG MOTION OTHER 48000.00 VAL 10.10 ID2 PERMIT W/O EN -HC 48000.00 VAL 772.80 TOTAL FEES 812.70 CONTRACTOR: TEL. NO: ALPHA AND OMEGA ROOFING (562) 693-4532- 6715 GREGORY ST LIC. NO WHITTIER CA 90603 857106 ARCHITECT OR ENGINEER: TEL. N0: I LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 147H265 3 O1 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT ALTERATION/REPAIR BL 0508 1410160107 BUILDING ADDRESS: 9123 BROADWAY TEMP CA 917802301 NEAREST CROSS STREET: NOW% THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: 10/16/14 SR FIN`AALj'�J�DATE ,7y/' q BY: CODE: I�CRIPTION OF WORK INSTALL NEW 30 YR SHINGLES OVER EXISTING. REMOVE FLAT ROOF LAYER INSTALL A NEW COOL ROOF MODIFIED TORCH DOWN OVER FLAT ROOF AREAS SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING I eIL cz 421 S PANELS FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEZL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS IAT 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 (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 Contrbctor pursuant .to the Contractors' State License Law). (_) 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 residedfor at least one year priorito 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.aov/calaw.htmi. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS I hereby affirm under penalty of perjury that I am licensed under LOCALITY 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. HAZARDOUS MATERIAL DECLARATION I '1 Will the applicant or future building occupant handle a hazardous SC License Class '�//` r ' License No. ( G �/ material or a mixture containing a hazardous material equal to or to U j!' igntractor Si ;�.O_ /i,r greater than the amount specified on the hazardous materials �a 9q ----information guide. WORKERS' COMPENN DECLARATIO / Yes ❑ No ❑ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION Will the intended use of the building by the applicant or future COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN building occupant require a permit for construction or EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO modification from the South Coast Air Quality Management ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION District (SCAQMD)? See permitting checklist for guidelines. TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Yes ❑ No ❑ 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 eissued.�—_have andwill maintain workers' compensation , as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My walk c mpe ati n 1,n pran oa meicy number ar umk: Carrier Policy Nber Expiration bate 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 work ' compensation provisions of Section 3700 of the Labor Co shall forth th comply with those provisions G- %,-- ignature of Applfcant 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 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 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 jab -identified property for inspection purposes. m of Proper¢/bwner or Authorized Agent GG��1/-