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Home My Public Portal About5938 Kauffman Ave_Building_4/1/2015_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 6561 IT: 101 BE: .001 ASSESSOR INFORMATION NUMBER: 8587-025-902 TENANT: AT 6 T MOBILITY OWNER: CITY OF TEMPLE CITY 9701 LAS TUNAS DRIVE TEMPLE CITY CA 91780 APPLICANT: DAMIEN, PICHARDO 16150 SCIENTIFIC WAY IRVINE CA 92618 CONTRACTOR: CLEARSHOT MANAGEMENT 7215 OLD 215 FRAMAGE ROAD MORENO VALLEY CA 92553 ARCHITECT OR ENGINEER: JEFFREY ROME AND ASSOCIATES 131 INNOVATION DR #100 IRVINE CA 92617 TEL. NO: TEL. NO: (949) 336 -1550 - TEL. NO: (951) 807-7345- LIO_ NO NONE TEL. NO: (949) 760 -3929 - LIC. NO: NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 20 SCHOOL WITHIN HAZARDOUS AIR 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 STRUCTURE: 0 1 V -B GARAGE: OTHER: EXIST BLDG USE: COMME EXIST OCC GRP: U BLDGS. NOW ON LOT: # 0508 BUILDING PERMIT BE 0508 1503260056 NEW I BUILDING ADDRESS: OCCUP GROUP 5938 KAUFFMAN AV U I TEMP CA 91780 NEAREST CROSS STREET: WOODRUFF THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, ISSUED ON: PROCESSED BY: 04/01/15 SR VALUATION: 30,000 REPORT ID: DPR261 ROUTE TO: BS0508 FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE FEES PAID jD2SCSTP`TION OF WORK V SWAP (3) EXISTING ANTENNAS FOR (3) NEW ANTENNAS. INSTALL (6) DESCRIPTION: QUANTITY: UOM: AMOUNT:1NEW RRU-S AND (1) NEW SURGE SUPPRESSOR INSTALL NEW FIBER ANI JDC RUNS PLANCHECK W/O EN -HC 30000.00 VAL 456.50 1 BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: STATE GREEN BLDG FEE 30000.00 VAL 2.00 PERMIT W/O EN -HC 30000.00 VAL 537.00 TOTAL FEES 1,023.30 APPROVALS DATE INSPECTOR SIGNATURE ILOCATION AND SETBACKS REPORT ID: DPR261 ROUTE TO: BS0508 FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. 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). LICENSED CONTRACTOR'S DECLARATION 1, 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 R�8(� Will the applicant or future building occupant handle a hazardous License Class .LSCIo License o. material or a mixture containing a hazardous material equal to or greater than the amount specified on the hazardous materials �te 1f�Contractor Sign ation guide? WORKERS'COMPENSATI CLARATION Yes ❑ No ❑ 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: Cartier Policy Number Expiration Date Name of Agent Phone Number (_) I am exemdt from licensure under the Contractors' State — I certify that, in the performance of the work for which this License Law for the following reason: 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 By my signature below I acknowledge that, except for my workers' compensation provisions of Section 3700 of the Labor personal residence in which I must have resided for at least Code, shall forthwith comply with those provisions one year prior) to completion of the improvements covered by ca _ �� J/' �� 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`1 igria a of App ant Date 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.lecinfo.ca.cov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 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 ❑ �- i I have read the hazardous materials information guide anis 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 perlormance 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 dentified property for inspection purposes. Signal LP ner or dAgent D, 4l�v(S