HomeMy Public PortalAbout9915 BROADWAY_Building_6/17/2014_T
COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID
TR: 13805 LT: 10
ASSESSOR INFORMATION NUMBER:
8588-015-010
WEN, QI L
5327 LOMA AVENUE
TEMP 917802635
LIN, DAVID
5812 TEMPLE CITY BL
TEMPLE CITY CA 91780
EDMOND HANK KWONG
360 E FIRST STREET #500
TUSTIN CA 92780
ARCHITECT OR ENGINEER:
CHU, CHENG MING
18276 SENTENO ST
ROWLAND HEIGHTS CA 91748
TEMPLE CITY # 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
NO. OF CONST NEW
SQ. FT STORIES TYPE OCCUR GROUP
STRUCTURE: 2902 2 V -B R-3
GARAGE: 654 1 V -B U
OTHER: 162 1 V -B U
USE ZONE: R-1
TEL. NO: IBLDGS. NOW ON LOT:
(626) 822-1329- I
FEE DESCRIPTION:
TEL. NO:
(626) 928-4876- IBI. PLANCHECK W/ENERGY
IAA BLDG PERMIT ISSUANCE
JAB STATE GREEN BLDG FEE
JAC STRONG MOTION RESID
IB2 PERMIT W/ENERGY
TEL. NO: ID? ADDNL PLANCHECK FEE
(626) 926-4876- 108 CERTIF OF OCCUPANCY
LIC. NO
756780
TEL. NO:
(626) 922 -5550 -
LIC. NO:
NONE
NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 01
OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
1 NO 01
SCHOOL WITHIN HAZARDOUS
QUALITY: 1000 FEET MATERIALS
NO NO NO
REPORT ID: DPR261
VALUATION:
432,550
BUILDING PERMIT
NEW RESIDENTIAL
BL 0508 1402050042
BUILDING ADDRESS:
9915 BROADWAY
TEMP CA 917802635
NEAREST CROSS STREET: BALDWIN
THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY C
ISSUED ON: PROCESSED BY:
06/17/14 SR
CODE:
FEES PAID DtSCRIPTiON OF WORK
!NEW 2 -STORY SPD 6 BEDROOMS, 7.5 BATHROOMS, WITH ATTACHED
QUANTITY: DOM: AMOUNT :13 CAR GARAGE, FRONT PORCH AND REAR PATIO 493 SF.
432550.00 VAL 3,260.00
27.80 ISPECIAL CONDITIONS:
432550.00 VAL 18.00 FIRE SPRINKLERS REQUIRED
432550.00 VAL 43.30
432550.00 VAL 3,835.30
2.00 HOU 218.80 (APPROVALS DATE INSPECTOR SIGNATURE
101.40
TOTAL FEES 7,504.60 LOCATION AND SETBACKS
j }IV�i
SOI LS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
SLAB/UNDER 7LOOR /�f�1/✓/ _
RAISED FLOOR FRAMING )
UNDERFLOOR INSULATION I�
11ST LEVEL FLOOR SHEATH
i
2ND LEVEL FLOOR SHEATH /
ROOF SHEATHING 'I JAY �j/V\
FIRE DEPT. FRAME INSPECT( I
INSULATION/WEATHER STRIPPI -
INTERIOR LATH/DRYWALL
EXTERIOR LATH
SMOKE DETECTION DEVICES
_ FIRE DEPARTMENT APPROVAL
ROUTE T0: B50508
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 1 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 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 priorl to completion of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owner -builder if it has not been constructed in its entirety by
licensed contractors. I understand that a copy of the applicable
law, Section 7044 of'the Business and Professions Code, is
available upon request when this application is submitted or at
the following Web site: httD://www.lecinfo.ca.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. .p
License las D License No.
Date 11 Contractor Signature
WORKERS' COMPENSATION DECLARATI
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
wo rs' +P pensatton inrnU
C policy num
arrier Policy Numerer
Expirati n D to
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 ��(�((y
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 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 ❑ No ❑
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requiremnIS
under the Los Angeles County Code Title 2, Chapter T20'
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 Pr erty Own or Authorized Agent
Date t (
t
COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
JTR: 13805 LT: 10
ASSESSOR INFORMATION NUMBER:
8588-015-010
TENANT:
i
OWNER:
WEN, QI L
15327 LOMA AVENUE
TEMP 917802635
(APPLICANT:
ISCHANKERMAN, AARON
123 E CENTRAL AVENUE
MONROVIA CA 91016
CONTRACTOR:
CRAIG FIRE PREVENTION CO.
141341 AVENIDA LA CRESTA
IMURRIETA, CA 92562
JARCHITECT OR ENGINEER:
TEL. NO
TEL. NO:
(626) 357 -4045 -
TEL. NO:
(626) 712 -8862 -
LIC. NO
692823
TEL. NO:
LIC. NO:
TEMPLE CITY
#
0508
BUILDING PERMIT
9701 LAS TUNAS
FIRE SPRINKLER
TEMPLE CITY CA
91780
BL 0508 1508050083
PHONE: (626) 285-0488
EXT:
NUMBER OF ADDED/RELOCATED
BUILDING ADDRESS:
SQ. FT
SPRINKLER
HEADS 34
9915 BROADWAY
STRUCTURE: 2902
TEMP CA 917802635
NEAREST CROSS STREET: BALDWIN
THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAS
(EXIST BLDG USE:
(ISSUED ON: PROCESSED BY:
(EXIST OCC GRP:
JOS/05/15 SR
JBLDGS. NOW ON LOT:
VALUATION:
IFINAL D TE l FI AL CODE:
4,000
�Y
FEES PAIDDE�P'TTII1N
OF WORK
PRESIDENTIAL FIRE SPRINKLERS
FEE DESCRIPTION:
QUANTITY: UOM:
AMOUNT:
JAA BLDG PERMIT ISSUANCE
27.80
JAB STATE GREEN BLDG FEE
4000.00 VAL
1.00
ISPECIAL CONDITIONS:
JAC STRONG MOTION RESID
4000.00 VAL
0.50
IDO FIRE SPRINKLER PC
4000.00 VAL
98.40
ID2 PERMIT W/O EN -HC
4000.00 VAL
115.80
I
TOTAL FEES
243.50
(APPROVALS DATE INSPECTOR SIGNATURE
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J
001
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 20
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO I
PERMIT EXPIRES 180 DAYS IF
11) WORK DOES NOT COMMENCE, OR
12) WORK IS SUSPENDED OR ABANDONED, OR
13) FAILS TO OBTAIN CODE REQUIRED INSPECTION
REPORT ID: DPR261
ROUTE TO: BS0508
1
FIRE DEPARTMENT INSPECT
FIRE SPRINKLER HANGERS
(FIRE DEPARTMENT APPROVAL
I I I I
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' Slate 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 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 (✓) 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). '
(_) 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 prion to completion, of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owner -builder if it has not been constructed in its entirety by
licensed contractors. I understand that a copy of the applicable
law, Section 7044 of the Business and Professions Code, is
available upon request when this application is submitted or at
the following Web site: htto://www.leainfo.ca.aov/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.
-ticensye %ClassY !I'-1 (O License No. � P2 3
ate O/'7/'� 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 n b are:
M: _ r 3 115 X7
Cartier 7 licv a6iratibn 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 TrA/1 sr
Sifdof Applicant ale
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 ❑ No ❑ i
I have read the hazardous materials information guide and the
SCAOMD permitting checklist, I understand my requirem¢nts
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).
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 of r perry O er or Authorized Agent