HomeMy Public PortalAbout6253 A Encinita Ave_Building__COUNTY OF LOS ANGELES TEMPLE CITY R 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL
9UILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1307110101
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
IF: 5904 LT: 279 I SQ. FT STORIES TYPE OCCUP GROUPI 6253 ENCINITA AV
STRUCTURE: 3180 2 V -B R-3 I TEMP CA 917801640
ASSESSOR INFORMATION NUMBER: GARAGE: 351 1 V -B U NEAREST CROSS STREET:
5384-011-017 OTHER: 296 1 V -B U THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CA
TENANT: USE 20NE: R-1 JISSUED ON: PROCESSED BY:
108/05/14 SR
ZHAO, TEL. NO: BLDGS. NOW ON LOT: VALUATION: iFIWAL ATE FINpL BY: CODE:
ZHAO, JOEY (626) 688-2307- 466,100 '/'/w3f -O`rf I tJAL{l�\V
6253 ENCINITA AV //
TEMP 917801640 FEES PAID 3H CR N OF WORK
INEW 2 -STORY SFD 5 BEDROOMS, 5 BATHROOMS, 1 POWDWER, 2ND:
IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:IFLOOR WALK DECK, WITH ATTACHED 3 CAR GARAGE, COVERED PATIO
APPLICANT: TEL. NO: I (AND COVERED PORCH 165 SF.
LAI, KAMEN (626) 288-2651- IB1 PLANCHECK W/ENERGY 466100.00 VAL 3,469.80 1
9748 E VALLEY BLVD K ID9 PC EXTENSION FEE 867.45 DOL 867.45 (SPECIAL CONDITIONS:
BOSEMEAD CA 91770 IAA BLDG PERMIT ISSUANCE 27.80 FIRE SPRINKLERS
JAR STATE GREEN BLDG FEE 466100.00 VAL 19.00 1_
IAC STRONG MOTION RESID 466100.00 VAL 46.60
2ONTRACTOR: TEL. NO: IB2 PERMIT W/ENERGY 466100.00 VAL 4,062.10 APPROVALS DATE INSPECTOR SIGNATURE
KINGDOM CONSTRUCTION, INC. (626) 912-8795- 108 CERTIF OF OCCUPANCY 101.40 1_
2589 DAYTONA AVENUE LIC. NO TOTAL FEES 8,614.15 ILOCATION AND SETBACKS
3ACIENDA HEIGHTS CA 91745 NONE / efv q
I (SOILS ENGINEER APPROVAL '1
ARCHITECT OR ENGINEER: TEL. N0: (FOUNDATION/TRENCH FORMS
1U, HAROLD P (626) 288-0708-
L168 SAN GABRIEL BLVD LIC. NO: (SLAB/UNDER FLOOR
SUITE N NONE
20SEMEAD CA 91770 IRAISED FLOOR FRAMING
4AP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION
3021 1
(IST LEVEL FLOOR SHEATH
30. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I-
2 YES 02A I 12ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS (ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS I I
NO NO NO FINE DEPT. FRAME INSPECT.
I
BLDG DEPT. FRAME INSPECT(
SHEAR PANELS
(INSULATION/WEATHER STRIPI
(INTERIOR LATH/DRYWALL L`
I /Y7
EXTERIOR LATH
(LOT DRAINAGE
(SMOKE DETECTION DEVICES
(FIRE DEPARTMENT APPROVAL
ADDITIONAL DATA ON FILE
(REPORT ID: DPR261 ROUTE T0: B50508
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 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 Contrba for 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 priorlto completion; of theImprovements 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.leoinfo.ca.aov/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. ) Q�j
License Class � License No. 751 7 C! I
f Date L* Contractor Signatures -
WORKERS' COMPENS`A'f10 . ECLARAT N
'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
in urance, as required by Section 3700 of the Labor Code, for
the performance of the work for which this permit is issued. My
wo��rk/f✓� mp s on sura /ijt ca ier; an policy nnu�ber�e�: (/
aCarrier G Policy ber 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 1 should become subject to the
workers' compensation provisions of Section 3700 of the Labor
Code, I shall to With co ith those provisions
�
of Applic t Dat I
LOB YIST ORDINANCE CERTIFICATION
omplete 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
r
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
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 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 oofJf�/Pl1roo/� L� r �ojzed Agent
Date Z41r 7/l ¢
" C O U N T Y O F L O S A N G E L E S
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S C H O O L W I T H I N
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N O
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T H O M A S P A G E : 5 9 6 G R I D : J 2 L O C A L I T Y : T E M P L E C I T Y C
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M A I N H O U S E I N S T A L L F I R E S P R I N K L E R S
S P E C I A L C O N D I T I O N S :
F I R E D E P A R T M E N T I N S P E C T
I i i i ; i a ��Y 1 H T i W Y S h I i Y Y
D A T E I N S P E C T O R S I G N A T U R E
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 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 1, 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 priorlto completiory of the improvements covered by
this permit, I cannot legally sell a structure that I have built as an
owner -builder (f 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.leoinfo.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.
4-LicenseClass/% License No. S �
/batep/ ",Contractor Signature
" / - U
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:
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.
.f 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
w rkers' mpen 3ati suran ler and polic number are:
J 1-16
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
- Zt �/�
Signatr�iifFFFApplicant � 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 requirements
under the Los Angeles County Code Title 2, Chapter 1120'
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�or Authorized Agent
I
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