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Home My Public Portal About5334 Encinita Ave_Building_3/12/2014_' COUNTY SOF LOS ANGELES DEPARTMENT OF•PUHLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL. ID: TR: 11492 LT: 22 BL: A ASSESSOR INFORMATION NUMBER: 8590-001-026 TENANT SALDIVAR, DANIEL 5334 ENCINITA AV TEMP 917803114 SAME AS OWNER CONTRACTOR: SAME AS OWNER OR ENGINEER: TEL. NO: (626) 234 -1608 - TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE STRUCTURE: 149 1 V -H GARAGE: OTHER: EXIST BLDG USE: RESID EXIST OCC GRP: R-3 BLDGS. NOW ON LOT: # 0508 BUILDING PERMIT BL 0508 1403120020 NEW I BUILDING ADDRESS: OCCUP GROUP 5334 ENCINITA AV R-3 TEMP CA 917803114 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C (ISSUED ON: PROCESSED BY: 103/12/14 SR VALUATION: FI DPTE FI H CODE: 500 i FEES PAID FEE DESCRIPTION: QUANTITY: UOM: TEL. N0: - IAA BLDG PERMIT ISSUANCE IAB STATE GREEN BLDG FEE 500.00 VAL JAC STRONG MOTION RESID 500.00 VAL IE2 ADD INSPECT HRLY RTE 1.00000 HOU TOTAL FEES TEL. N0: LIC. NO TEL. NO: LIC. NO: NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 OF FAMILIES: DWELLING UNITS: APT/COND- STAT CLASS: 1 NO 99 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 DwIOLS OF WORK ITO FINALIZED EXPIRED PERMI�BL 0703160035, CP 0610160001, AMOUNT:IAND EL 0612010015 27.80 1.00 0.50 144.90 174.20 SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL 1 FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FRAME INSPECTION r FIRE SPRINKLER HANGERS � INSULATION/WEATHER STRIP�yy--�-�- INTERIOR LATH/DRYWALL( EXTERIOR LATH % _ C RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES 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 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). ' U I am exemiJt 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 priori 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.leoinfo.ca.cov/calaw.html. 7" Tate:"? -12 -/ -/ Sign re of P pert Owner or Authorized A ant V 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. 'f 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 forth omply with those provisions DL )2z-fq i natu ppfcantJ Dale' 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 A , 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 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 X120' 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 Lenders Address By my signature below, I certity 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 representatives of this county to enter the above -id 'led property for inspection purposes. Signa of Pr a ner or Authorized Agent COUNTY OF LOS ANCGBLES DEPARTMENT OF PPBLIC WORKS 'BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 11492 LT: 22 BL: A ASSESSOR INFORMATION NUMBER: 8590-001-026 TENANT: OWNER: SALDIVAR, DANIEL 5334 ENCINITA AV TEMP 917803114 APPLICANT: SAME AS OWNER CONTRACTOR: SAME AS OWNER ARCHITECT OR ENGINEER: TEL. NO: (626) 614 -1044 - TEL. NO: TEL. NO: LIC. NO TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 147H265 3 01 NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED TOTAL SETBACK FROM EXIST SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL - SIDE PL - TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE STRUCTURE: VN EXIST BLDG USE: REBID EXIST OCC GRP: BLDGS. NOW ON LOT: FEE DESCRIPTION: AA BLDG PERMIT ISSUANCE AC STRONG MOTION REBID D2 PERMIT W/0 EN -HC REPORT ID: DPR261 BUILDING PERMIT ALTERATION/REPAIR BL 0508 0612060031 BUILDING ADDRESS: 5334 ENCINITA AV TEMP CA 917803114 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C ROUTE TO: BS0508 USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: 12/06/06 JK 12/01/07 VALVATI3,040 FINAL DATE /^Ip Y: CODE: " FEES PAID DESCRIPTION OF WORK' S' X 19' TRELLIS QUANTITY: DOM: AMOUNT: 27.75 3040.00 VAL 0.50 SPECIAL CONDITIONS: 3040.00 VAL 115.80 TOTAL FEES 144.05 APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS `Y1 SLAE/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 ASHEN. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T -BAR CEILINGS LOT DRAINAGE ROUTE TO: BS0508 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 Lic. No. Contractor's Signature Date OWNER -BUILDER DECLARATION I hereby affirm under penally of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500) )' ❑ lam exempt under Sec. , BA PC for this reason: [ Electrical, Plumbing & Sewer Permits Only ❑ I, as owner of the property, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such 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 he or she did not build or improve for the purpose of sale.). [ All Other Permits I ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of properly who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who build improves and who contracts for such projects with a con ctor(s icen d purs nt to the Contractors License Law) WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations. ❑ 1 have and will maintain a certificate of consent to self -insure for workers compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 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 tamer and policy number are: Carrier _ PPoliiccyy Ny�tbar rM 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 worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those Zilgrature � ) Date WARNING: FAILURE TO SECURE WORKER'S 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. 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 owner Signature Dat%FeCompany Name (if employed by an entitylagency) Date 1 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 220 Sections 220.100 through 220.140 concerning hazardous material reporting and for obtaining a permit from the SCAOMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAQMD or EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec. 3097, Ci¢C.). Lenders Name Lender's Address I certify that I have read this application and state under the penalty of perjury that the above information is correct. I agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentione roper for inspection purposes. Applic t or Agent Signature Date COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT L ID: 11492 IT: 22 BL: A SSOR INFORMATION NUMBER: -001-026 OWNER: TEL. NO: SALDIVAR, DANIEL (626) 614-1044- 5334 ENCINITA AV TEMP 917803114 APPLICANT: TEL. NO: SALDIVAR (626) 614-1044- 5334 ENCINITA AVE TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: SALDIVAR, DANIEL (626) 614-1044- 5334 ENCINITA AVE. LIC. NO TEMPLE CITY, CA 91780 NONE OR ENGINEER: TEL. NO: LIC. 00: �n( 16003.00 VAL AA BLDG PERMIT ISSUANCE TEMPLE CITY # 0508 BUILDING PERMIT 16003.00 9701 LAS TUNAS B2 PERMIT W/ENERGY RESIDENTIAL ADD VAL TEMPLE CITY CA 91780 TOTAL FEES BL 0508 0703160035 PHONE: (626) 285-0488 EXT: NO. OF CONST NEW BUILDING ADDRESS: SQ. FT STORIES TYPE OCCUP GROUP 5334 ENCINITA AV STRUCTURE: 149 1 VN R3 I TEMP CA 917803114 GARAGE: I NEAREST CROSS STREET: OTHER: I THOMAS PAGE: 596 GRID: T4 LOCALITY: TEMPLE CITY, C EXIST BLDG USE: USE ZONE: JISSOSD ON: PROCESSED BY: EXPIRES ON: (EXIST OCC GRP: 03/16/07 SK 03/10/08 1 JBLDGS. NOW ON LOT: VALUATION: 1 FINAL DATE FINAL BY: CODE: 1 16,003 XP� NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 01 OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REQUIRED TOTAL SET13ACK FROM EXIST SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL - SIDE PL - FEES PAID FEE DESCRIPTION: QUANTITY: DOM B1 PLANCHECK W/ENERGY 16003.00 VAL AA BLDG PERMIT ISSUANCE AC STRONG MOTION REBID 16003.00 VAL B2 PERMIT W/ENERGY 16003.00 VAL TOTAL FEES REPORT ID: DPR261 ROUTE TO: BS0508 DESCRIPTION 6@0RKEE .ED FAMILY ROOM EXTENSION 149 S.F. AMOUNT: 312.48 27.75 (SPECIAL CONDITIONS: 1.60 367.62 709.45 DATE INSPECTOR SIGNATURE :ON AND SETBACKS ENGINEER APPROVAL ,TION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION IST LEVEL FLOOR SHEATH 2ND LEVEL FLOOR SHEATH 200E SHEATHING �;� FIRE DEPT. FRAME INSPEC9 3LDG DEPT. FRAME INSPECT( 3HEAR PANELS ENSULATION/WEATHER STRIPY 1r INTERIOR LATH/DRYWALL ��jl` 1 / G+ A 3XTERI0R LATH :OT DRAINAGE 3N0KE DETECTION DEVICES 'IRE DEPARTMENT APPROVAL( 9 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 Lic. No. Contractor's Signature Date OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).): ❑ 1 am exempt under Sec. , B.& P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ] ❑ I, as owner of the property, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such 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 he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such 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 he or she did not build or improve for the purpose of sale ). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law) 1 . � WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Carrier Policy Number ❑ 1 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 worker's compensation laws of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Applicant Signature Date WARNING: FAILURE TO SECURE WORKER'S 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 /N SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 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 el 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 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 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 SCAQMD or EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec. 3097, Civ.C.). Lender's Name Lender's Address "Qq? if certify that I have read this application and state under the penalty of perjury that the above information is correct. l agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. Owner Signature Dale Company Name (if employed by an entity/agency) Date Applicant or Agent Signature Date COUNTY OF LOS ANGELES DEPARTMENT OF lk'BLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 11492 IT: 22 BL: A ASSESSOR INFORMATION NUMBER: 8590-001-026 TENANT OWNER: SALDIVAR, DANIEL 5334 ENCINITA AV TEMP 917803114 APPLICANT: SAME AS OWNER CONTRACTOR: SAME AS OWNER ARCHITECT OR ENGINEER: TEL. NO: (626) 234-1608- TEMPLE CITY $ 0508 BUILDING PERMIT 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP TEMPLE CITY CA 91780 BL 0508 1402270012 PHONE: (626) 285-0488 EXT: NO. OF CONST NEW BUILDING ADDRESS: SQ. FT STORIES TYPE OCCUP GROUPI 5334 ENCINITA AV STRUCTURE: 0 1 V -B R-3 TEMP CA 917803114 GARAGE: NEAREST CROSS STREET: OTHER: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXIST OCC GRP: 103/18/14 SR BLDGS. NOW ON LOT: VALUATION: T F NAL Y: CODE: 15,000 1 FEES PAID FEE DESCRIPTION: QVANTITY: UOM: TEL. N0: I - JB1 PLANCHECK W/ENERGY 15000.00 VAL AA BLDG PERMIT ISSUANCE JAB STATE GREEN BLDG FEE 15000.00 VAL JAC STRONG MOTION REBID 15000.00 VAL IB2 PERMIT W/ENERGY 15000.00 VAL TEL. NO: I TOTAL FEES LIC. NO TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO ID: DPR261 ROUTE TO: BS0508 DESW PTI d OF WORK IKITCHEN REMODELING AND (E) 1/2 BATHROOM, LAUNDRY TO BE AMOUNT:JRELOCATED (N) SKYLIGHT AT (E) KITCHEN AREA 281.10 I 27.80 (SPECIAL CONDITIONS: 1.00 1 1.50 330.70 1 642.10 JAPPROVALS .TION AND SETBACKS ,S ENGINEER APPROVAL IDATION/TRENCH FORMS /UNDER FLOOR 'ED FLOOR FRAMING IRFLOOR INSULATION LEVEL FLOOR SHEATH LEVEL FLOOR SHEATH SHEATHING DEPT. FRAME INSPECT DEPT, FRAME INSPECT INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH / LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL DATE INSPECTOR SIGNATURE 4v 4y 7 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 (J) 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 Contr'a�tor 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 priorlto completion of the improvements coveredby 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-.. gate: Signatur rope O ner or thorized Agent r. 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 fort '! mply with those provisions _ Sig _ pelican 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 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 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 1 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. Sign uthonzed Agent _><�Date Z-10%' 1(--f COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 11492 IT: 22 BE: A ASSESSOR INFORMATION NUMBER: 8590-001-026 TENANT OWNER: SALDIVAR, DANIEL 5334 ENCINITA AV TEMP 917803114 APPLICANT: SAME AS OWNER CONTRACTOR: SAME AS OWNER ARCHITECT OR ENGINEER: TEL. NO: (626) 234 -1608 - FEE DESCRIPTION: TEL. NO: - AA BLDG PERMIT ISSUANCE AS STATE GREEN BLDG FEE AC STRONG MOTION REBID B1 PLANCHECK W/ENERGY B2 PERMIT W/ENERGY TEL. NO: LIC. NO TEL. NO: LIC. NO: MAP 140: 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 REPORT ID: DPR261 TEMPLE CITY # 0508 BUILDING PERMIT 9701 LAS TUNAS ALTERATION/REPAIR DESCR P ION OF WORK TEMPLE CITY CA 91780 BE 0508 1407030012 PHONE: (626) 285-0488 EXT: AMOUNT: DOOR NO. OF CONST BUILDING ADDRESS: SQ. FT STORIES TYPE 5334 ENCINITA AV STRUCTURE: V -B TEMP CA 917803114 2000.00 VAL 0.50 NEAREST CROSS STREET: 2000.00 VAL THOMAS PAGE: 596 GRID: S4 LOCALITY: TEMPLE CITY, C EXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXIST OCC GRP: 107/03/14 SR BLDGS. NOW ON LOT: VALUATION: FIry D T FI CODE: INSPECTOR SIGNATURE 2,000 1 LOCATION AND SETBACKS 1 FEE DESCRIPTION: TEL. NO: - AA BLDG PERMIT ISSUANCE AS STATE GREEN BLDG FEE AC STRONG MOTION REBID B1 PLANCHECK W/ENERGY B2 PERMIT W/ENERGY TEL. NO: LIC. NO TEL. NO: LIC. NO: MAP 140: 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 REPORT ID: DPR261 /N FEES PAID DESCR P ION OF WORK ADD SKYLIGHT IN BATHROOM, CHANGE TILE, AND ADD NEW SHOWER QUANTITY: DOM: AMOUNT: DOOR 27.80 � 2000.00 VAL 1.00 SPECIAL CONDITIONS: 2000.00 VAL 0.50 2000.00 VAL 90.30 2000.00 VAL 90.40 TOTAL FEES 210.00 APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS 1 SOILS ENGINEER APPROVAL 1 FOUNDATION/TRENCH FORMS SLAB/UNDER FLUOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS 1 FRAME INSPECTION £IRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS LOT DRAINAGE 1 ROUTE TO: 850508 / (fu.`•�-f'r�(�o�'�� le (lee 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).): (_) 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 Contrb for 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 whicf? I must have resided for at least one year priori to 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.leainfo.ca.aov/calaw.html. yDateZe Si of Proler Oxer or Authorized Agent i 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 ATTORNEYS 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 carder and policy number are: Carder 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 worke ompensation provisions of Section 3700 of the Labor We, I sha orthyAlli c—c'nnply with those provisions Sig ticifST� 'nate 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 ❑ N o ❑ 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 I have read the hazardous materials information guide and the SCAQMD 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). 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 aboD'fied p for inspection purposes. pe 1O r or Authortzed Agent /t6ate 7�