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HomeMy Public PortalAbout9336 BROADWAY_Building_5/12/2014_b COUNTY OF IAS'ANGELES' DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER: 8588-030-042 TENANT OWNER: MOUNT VERNON HOLDINGS, LLC 2831 ROSE PKNY 8290 HENDERSON NV 89052 APPLICANT: PERAZA, ERIK 3317 MENTONE AVE LOS ANGELES CA 90034 CONTRACTOR: DIVERSFIELD BUILDING CONTRACTORS 2416 FIFTH STREET LA VERNE CA 91750 ARCHITECT OR ENGINEER: TEL. NO: (909) 702 -6858 - TEL. NO: (310) 923 -5393 - TEL. NO: (909) 261 -0148 - LIC. NO 760941 TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO 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: REBID EXIST OCC GRP: �SLDGS. NOW ON LOT: USE ZONE: R-1 VALUATION: 25,000 FEES PAID FEE DESCRIPTION: QUANTITY: UOM B1 PLANCHECK W/ENERGY 25000.00 VAL AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE 25000.00 VAL AC STRONG MOTION REBID 25000.00 VAL B2 PERMIT W/ENERGY 25000.00 VAL FR INV WORK W/O PERMIT 688.00 DOL TOTAL FEES REPORT ID: DPR261 ROUTE TO: B50508 AMOUNT 438.10 27.80 1.00 2.50 515.50 688.00 1,672.90 BUILDING PERMIT ALTERATION/REPAIR BE 0508 1403190079 BUILDING ADDRESS: 9336 BROADWAY TEMP CA 917802403 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: 05/12/14 SR FI AL DATE FINAL Bj.A CODE: l; I�N�� WORK KITCHEN AND 3 BATHROOMS REHAB SPECIAL CONDITIONS: 9PPROVALS LOCATION AND SETBACKS FOUNDATION/TRENCH FORMS BLAB/UNDER FLOOR 3AISED FLOOR FRAMING INDERFLOOR INSULATION FLOOR SHEATHING 200F SHEATHING SHEAR PANELS FRAME INSPECTION ?IRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL ,XTERIOR LATH RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE J 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.). (_) 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 Contr6for 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 prior) to completior1 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.leainfo.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. --//qticense Class License No. /(.t7�%�� Date*_/_1 _ / Contractor Signature WORKERS' COMPENSAT O EC ON 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: 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' compensat! visions of Section 3700 of the Labor Code shall forth com ly with those provisions a r of t Dati� 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 X220' Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAOMD. 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 forthe 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 above -identified pe for inspection purposes. Signature�gfr�re�rty O err or Authorized Agent t COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BE 0508 1403190080 PHONE: (626) 285-0488 EXT: DUPLICATE LEGAL ID: NO. OF CONST 1 BUILDING ADDRESS: ON FILE 1 SQ. FT STORIES TYPE 1 9336 BROADWAY STRUCTURE: V -B TEMP CA 917802403 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-030-042 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY Ci TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 105/12/14 SR OWNER: TEL. NO: I JBLDGS. NOW ON LOT: VALUATION: i FIa DATE FIN3�L BY: CODE: MOUNT VERNON HOLDINGS, LLC (909) 702-6858- 1 6,000 1_LJ 2831 ROSE PKWY #290 1 1 HENDERSON NV 89052 J FEES PAID DESORIPTION O WORK (REMODEL RUMPUS ROOM IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT:) APPLICANT: TEL. NO: I I O-LAUGHLIN, BRIAN (909) 702-6853- IAA BLDG PERMIT ISSUANCE 27.80 1 P 0 BOX 487 JAB STATE GREEN BLDG FEE 6000.00 VAL 1,00 1SPECIAL CONDITIONS: LA VERNE CA 91750 JAC STRONG MOTION REBID 6000.00 VAL 0.60 J 1B2 PERMIT W/ENERGY 6000.00 VAL 164.30 1 TOTAL FEES 193.70 CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE DIVERSIFIED BUILDING CONTRACTORS (909) 261-0148- 1 2416 FIFTH STREET LIC. NO 1 1LOCATION AND SETBACKS 1 1 LA VERNE CA 91750 760941 (SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: 1 FOUNDATION/TRENCH FORMS 1 LIC. NO: SLAB/UNDER FLOOR IRAISED FLOOR FRAMING MAP NO: SEWER MAP HOOK: PAGE: FIRE ZONE: CMP:J I JUNDERFLOOR INSULATION 3 001 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 21 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS 1 SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS 1 1 NO NO NO (FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRI INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED SHAFTS/OPENINGS T -BAR CEILINGS IAT DRAINAGE ID: DPR261 ROUTE TO: HS0508 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 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�I 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: hftD://www.leainfo.ca.aov/calaw.htmi. 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 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 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 ❑ 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 X20' 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 Property Owner or Authorized Agent Date %l_OUNTY 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 91700 BL 0508 1405210067 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE I SQ. FT STORIES TYPE 9336 BROADWAY (STRUCTURE: V-B TEMP CA 917802403 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 8588-030-042 I I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: ]EXIST OCC GRP: 105/21/14 SR OWNER: TEL. N0: I 18LDG5. NOW ON IAT: VALUATION: ON: I F DATE FI CODE: ;Ekg MOUNT VERNON HOLDINGS, LLC (909) 702-6858- �� 2831 ROSE PKWY #290 I�Jid I V' HENDERSON NV 89052 FEES PAID - IDASCRIPTION OF WORK ICO NVERT EXISTING CLOSET TO BATHROOM IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:( APPLICANT: TEL. NO: I I O'LAUGHLIN, BRIAN (90.9) 702-6853- IAA BLDG PERMIT ISSUANCE 27.80 I PO BOX 487 IAB STATE GREEN BLDG FEE 1500.00 VAL 1.00 ISPECIAL CONDITIONS: LA VERNE CA 91750 IAC STRONG MOTION REBID 1500.00 VAL 0.50 1 IB1 PLANCHECK W/ENERGY 1500.00 VAL 90.30 IB2 PERMIT W/ENERGY 1500.00 VAL 90.40 (nr�'4ic (bmjpvf4 CONTRACTOR: TEL. NO: 1 TOTAL FEES 210.00 IAPPWALS - INSPECTOR DIVERSIFIED BUILDING CONTRACTORS (909) 261-0148- I gdNATURE v 2416 FIFTH STREET LIC. NO _ (LOCATION AND SETBACKS LA VERNE CA 91750 760941 ISOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I LIC. NO: 1SLAB/UNDER FLOOR I RAISED FLOOR FRAMING 1 MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:(. 1 (UNDERFLOOR INSULATION 1 1 3 OOI IFLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I NO 21 1 IROOF SHEATHING I SCHOOL WITHIN HAZARDOUS (SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO i (FRAME INSPECTION FIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIP, 1 11NTEAIOR LATH/DRYWALL I iEXTERIOR LATH L I (RATED FLOOR/CEIL ASSEM. ]RATED WALL ASSEMBLIES I I 1RATED SHAFTS/OPENINGS 1 T-BAR CEILINGS LOT DRAINAGE (REPORT ID: DPR261 I ROUTE TO: BS0508 i I 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).): 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 ContraFtor pursuant.to the Contractors' State License Law). ( 1 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 whict 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.leainfo.ca:aov/calaw.html. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS I hereby affirm under penalty of perjury that 1 am licensed under I 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 License Classes License No. %(oAQI Will the applicant or future building occupant handle a hazardous material or a mixture containing a hazardous material equal to or Date 2f r Contractor Signature than the amount specified on the hazardous materials information guide? WORKERS'COMPENS D ION Yes ❑ No ❑ WAAM. NG: FAILURE TO SECU 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 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: Carrier Policy Number Expiration Date Name of Agent Phone Number I certify that, in the performance of the work for which this it is issued, I shall not employ any person in any manner so as to become subject to e -w ers' compensation laws of California, and agree if I shou d become subject to the workers' compensation pr isions of Section 3700 of the Labor Code hall forth ccmply it those provisions _7 ZSigture p/ 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 Yes ❑ N o ❑ r 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 owners 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 represen tives of this county to enter the pro idefner tgfoperty fo'inspectionAeerposes. Sgnatu COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ON FILE ASSESSOR INFORMATION NUMBER - 8588 -030-042 RUNT VERNON HOLDINGS, LLC 831 ROSE PKWY #290 ENOERSON NV 89052 TZ, JUAN 6 FIFTH STREET VERNE CA 91750 ERSIFIED BUILDING CONTRACTORS 6 FIFTH STREET VERNE CA 91750 ARCHITECT OR ENGINEER: TEL. NO: (909) 702 -6858 - TEL. NO: (909) 201 -0148 - TEL. NO: (909) 261 -0148 - LIC. NO 760941 TEL. NO: LIC. NO: 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 HXIST BLDG USE: RESID USE ZONE: R-1 EXIST OCC GRP: BLDGS. NOW ON LOT: VALUATION: 1 15,000 MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 3 001 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FEES PAID FEE DESCRIPTION: QUANTITY: DOM: AMOUNT AA BLDG PERMIT ISSUANCE 27.80 AB STATE GREEN BLDG FEE 15000.00 VAL 1.00 AC STRONG MOTION RESID 15000.00 VAL 1.50 B1 PLANCHECK W/ENERGY 15000.00 VAL 281.10 B2 PERMIT W/ENERGY 15000.00 VAL 330.70 TOTAL FEES 642.10 ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT ALTERATION/REPAIR BL 0508 1408250086 DUPLICATE BUILDING ADDRESS: 9336 BROADWAY TEMP CA 917802403 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: S4 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: 08/25/14 SR F DAT�E.}`r FINAJ. Fes': CODE: G-IPT IONWORKX\ -/➢_nIL\`r/' REMODEL MASTER BEDROOM AND UNDRY ROOM CONDITIONS: APPROVALS DATE LOCATION AND SETBACKS li 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. 1 RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE I 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 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 intendedor 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 forthe 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 whicf I must have resided for at least one year priorlto completioq 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.leeinfo.ca.cov/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. fLicense Class License No. ✓ / `Date�L /J Contractor Signature i WORKERS'COMPENSAFTION DECLARATION WARtJING: 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 s II forthwith with those provisions gre 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. 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 ❑ 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 ❑ 1 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. Si ature f r r Authorized Agent - pyx COUNTY OF LOS AftELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: I ON FILE ASSESSOR INFORMATION NUMBER: 18588-030-042 1 TENANT: OWNER : CHIN, YU 9336 BROADWAY TEMP 917802403 APPLICANT: (SAME AS OWNER I CONTRACTOR: SAME AS OWNER JARCHITECT OR ENGINEER: TEL. NO: TEMPLE CITY 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: - JAA BLDG PERMIT ISSUANCE JAB STATE GREEN BLDG FEE JAC STRONG MOTION RESID ID1 PLANCHECK W/O EN -HC ID2 PERMIT W/O EN -HC TEL. NO: JFR INV WORK W/O PERMIT LIC. NO TEL. NO: 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 # 0508 BUILDING PERMIT ALTERATION/REPAIR _ BL 0508 1507130057 BUILDING ADDRESS: USE ZONE: R-1 VALUATION: 2,100 FEES PAID QUANTITY: UOM: AMOUNT: 1 27.80 2100.00 VAL 1.00 2100.00 VAL 0.50 2100.00 VAL 84.20 2100.00 VAL 99.00 344.00 DOL 344.00 TOTAL FEES 556.50 I ROUTE TO: BS0508 9336 BROADWAY TEMP CA 917802403 NEAREST CROSS STREET: ALESSANDRO THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI ISSUED ON: PROCESSED BY: 07/13/15 SR FINAL DAT ( FINAL 8/�� CODE: D�IIfI� DESCRIPTYON dF WORK REPLACE WINDOW AND DRYWALL AT THE SIDE OF THE HOUSE I SPECIAL CONDITIONS: >PROVALS DATE )CATION AND SETBACKS )ILS ENGINEER APPROVAL )UNDATION/TRENCH FORMS ,AB/UNDER FLOOR USED FLOOR FRAMING IDERFLOOR INSULATION AOR SHEATHING 0F SHEATHING TEAR PANELS AME INSPECTION RE SPRINKLER HANGERS SULATION/WEATHER STRIP TERIOR LATH/DRYWALL TERIOR LATH TED FLOOR/CEIL ASSEM. TED WALL ASSEMBLIES TED SHAFTS/OPENINGS BAR CEILINGS T DRAINAGE I I INSPECTOR SIGNATURE 0 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 Contrbctor 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 priorito 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: hfD://www.leainfo.ca.aov/calaw.htmi. --t-ate: Signature of Prope 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 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 Califomia, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall fo w h comply with those provis_io_n.,s/J 7 'Signature of pylic t Dat / 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 ❑ 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 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 o�POwner or Authorized Agent ,�Aate '