HomeMy Public PortalAbout6139 Encinita Ave_Combination__t
COUNTY OF LOS ANGELtS
DEPARTMENT OF PQBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 5904 LT: 289
ASSESSOR INFORMATION NUMBER:
5384-012-022
OWNER: TEL. NO:
LEE, DANNY (626) 216-9110-
6139 ENCINITA AVE
TEMPLE CITY CA 91780
APPLICANT: TEL. NO:
EORENSON, MIKE (626) 712-8429-
433 W ALLEN AVE #105
SAN DIMAS CA 91773
CONTRACTOR: TEL. NO:
CALIFORNIA POOLS (626) 712-8429-
433 W ALLEN AVE SUITE 105 LIC. NO
SAN DIMAS CA 91773 18.5102
ARCHITECT OR ENGINEER: TEL. NO:
PATRELL ENGINEERING (626) 335-4362-
751 SUNNY GROVE LANE LIC. NO:
GLENDORA CA 91741 185102
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 31
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:
]POOL TYPE: RESIDENTIAL/SPA
SIZE: 487 • SQJ�T CONST TYPE: V -B .
USE ZONE: �-1
VALUATION:''
30.000
# 0508
FEES PAID
FEE DESCRIPTION: QUANTITY: DOM:
AMOUNT:
AB STATE GREEN BLDG FEE 30000.00 VAL
2.00
02 PERMIT ISSUANCE FEE
27.80
04 COME POOL STD PC 70% 30000.00 VAL
351.90
06 COMB POOL PERMIT 30000.00 VAL
1,180.60'
08 STRONG MOTION RESID 30000.00 VAL
3.00
16 POOL BARRIER - FENCE
92.30
TOTAL FEES
1,657.60
'FEOGI:��oo��E6w6lDF,
L� 158 JtjtrT(A(46
A 00
• ADDITIONAL DATA ON FILE
REPORT ID: DPR268 ROUTE TO: BS0508
COMBINATION SWIMMING POOL PERMIT
CP 0508 1411170006
BUILDING ADDRESS:
6139 ENCINITA AV
TEMP CA 917801637
NEAREST CROSS STREET:
THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CA
SUED ON: PROCESSED BY:
/17/14 SR
SR
�jF WORK CODE:
SCRIPTION
W POOL & SPA W/STANDARD PLAN #26070-14
CONDITIONS:
DATE INSPECTOR SIGNATURE
SPA/POOL LOCATION ]
HEATER LOCATION
OVERHEAD CONDUCTOR CLEAR
LIGHT CONDUIT
ELECTRICAL BONDING
FIRE DEPT HYDRANT APPROV]
STEEL & FORMS ] ]
GAS LINE I ]
CONDUIT/ELECTRICAL ]
SEWER
ANTI -SYPHON VALVE
FENCING AND GATES ( y.[y��.4IQ
-M
/, fr/�
LIJ��/
GAS TEST
I _
P-TRAP/BACKWASH
I I
AECEPTORI
SPA/POOL COVER
I
FINAL FIRE DEPT
APPROVAL]
FINAL ELECTRICAL/ . �nr
� I
I
I I
a4 (\
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 rile 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 dollais ($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 Contncor 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 I must have resided for 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: httb:/lwww.leoinfo.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.
-"censeClass
�� License N,2. / 110 Z
Date aff Contractor Signa
WORKERS' COMPENSATI D LARATION
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
wtfkers' co�ndi
sation insurance ram d icy nymber ire:
lAl�lili�,Y2umb
Carrier o icy lumber
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 a ee that, if I should become subject to the
workers' com ns ion provisions of Section 3700 of the Labor
`C/ode, I sh f rt dh comply with those previsions
t�
'Sig tune of pplic t 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.
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
❑ 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
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 re esentatives of this county to enter the
above-identiproperty for inspection purposes.
Signal r o erty Owner
or Authorized Agent
Applicant (Print Name) Applicant Signature
Company Name Date