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Home My Public Portal About5472 Encinita Ave_Building_9/3/2014_ti COUNTY OF LOS ANGELES TEMPLE CITY # 0508 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BK: 207 PG: 76 PC: 2 SQ. FT STORIES TYPE STRUCTURE: 38 V-B ASSESSOR INFORMATION NUMBER: 8588-030-057 TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 EXIST OCC GRP: OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: AUINOS, REMEDIOS (626) 701-7946- 1 10,500 5472 ENCINITA AV TEMP 917803116 FEES PAID FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: TEL. NO: TRIGUEROS, CARLOS R (818) 679-9842- IAA BLDG PERMIT ISSUANCE 27.80 4180 TOLAND WAY IAB STATE GREEN BLDG FEE 10500.00 VAL 1.00 IAC STRONG MOTION REBID 10500.00 VAL 1.10 ID2 PERMIT W/0 EN-HC 10500.00 VAL 233.40 TOTAL FEES 263.30 CONTRACTOR: TEL. NO: A N R ROOFING (323) 982-9505- 5018 EAGLE ROCK BLVD LIC. NO IAS ANGELES CA 90041 874964 OR ENGINEER: TEL. NO: LIC. NO: NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT ALTERATION/REPAIR BL 0508 1409030049 BUILDING ADDRESS: 5472 ENCINITA AV TEMP CA 917803116 NEAREST CROSS STREET: THOMAS PAGE: 596 GRID: T4 LOCALITY: TEMPLE CITY ISSUED ON: PROCESSED BY: 09/03/14 SR FINAL nDATE FINAL BY: CODE: CR P ��' WORK TEAR OFF EXISTING ROOF & I STALL CLASS "A" COMP SHINGLES. ALONG WITH ATTACHED GARAGE SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/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 ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T -BAR CEILINGS IAT 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) 1 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 (_) 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 Contr9�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 whicf 1 must have resided for at least one year priorlto completion of the improvements covered by this permit, I cnnot 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. Date: Signature of Property Owner or Authorized Agent LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS I hereby affirm under penalty of perjury that I am licensed under I 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 G' R7y�bIL/ Will the applicant or future building occupant handle a hazardous Licenns. Cie License No. u L ��r matedal or a mixture containing a hazardous material equal to or Contractor Si ra reater than the amount specified on the hazardous materials Information guide? W RKERS' COMPENSATIO D ZRATION Yes ❑ No ❑ WARNING: FAILURE TO SECURE WORKERS' COMPENSATION Will the intended use of the building by the applicant or future COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN building occupant require a permit for construction or EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO modification from the South Coast Air Quality Management ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION District (SCAQMD)? See permitting checklist for guidelines. TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND Yes ❑ No ❑ errnonlrVq rrrq I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self - insure for workers' compensation, issued by the Director of Industrial Relations as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued._ Policy No. I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My wor ers' compqeannsation i surance r er d policy number are: S�Gt�P 1 rn Vl�I W c� —O 1 -1$ Carver Policy Number Ex 'ratio Date Cat, O' Tn4vet�s -67 �y2- Name of Agent J one 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 pro isions of Section 3700 oft a Labor Code, I shall forthwith co y with thos:—Da sion SignaSign— BBYIST ORDINANCE CERTIFICATION Complete this section for permits in VUnincorporated Los Angeles County only Thify 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 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 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-Qw r or Authorized Agent > ate 9/�ly