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Home My Public Portal About6125 Encinita Ave_Building_11/18/2013_+ 1 COUNTY OF LOS ANGELES ' DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 5904 IT: 291 ASSESSOR INFORMATION NUMBER: 5384-012-024 TENANT OWNER: QI, WEI 6125 ENCINITA AV TEMP 917801637 Ql, WEI 6125 ENCINITA AVE TEMPLE CITY CA 91780 CONTRACTOR: MORA CONSTRUCTION 6634 OAK AVENUE TEMPLE CITY CA 91780 ARCHITECT OR ENGINEER: T AND W CONSULTING ENGINEERS 1168 N SAN GABRIEL BLVD #N ROSEMEAD CA 91770 UN: .002 TEL. NO: (626) 226-3614- TEL. NO: (626) 759-1188 TEL. NO: (626) 215 -5460 - LIC. NO 721700 TEL. NO: (626) 298-0757- LIO_ NO: NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 150H265 E 16 3 02 NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 2 YES 02A 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: 628 1 V -B GARAGE: 408 1 V -B OTHER: NOW ON IAT: FEE DESCRIPTION B1 PLANCHECK W/ENERGY AA BLDG PERMIT ISSUANCE AS STATE GREEN BLDG FEE AC STRONG MOTION RESID B2 PERMIT W/ENERGY 08 CERTIF OF OCCUPANCY REPORT ID: DPR261 N 0508 BUILDING PERMIT NEW RESIDENTIAL BL 0508 1302060049 NEW I BUILDING ADDRESS: OCCUR GROUP 6125 ENCINITA AV R3 TEMP CA 917801637 U NEAREST CROSS STREET: LONGDEN THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY C USE ZONE: R-1 ISSUED ON: PROCESSED BY: 111/18/13 SR VALUATION: IFINAL DUE FINAL Y: CODE: 103,179 j 1I, FEES PAID QUANTITY: UOM: 103179.00 VAL 103179.00 VAL 103179.00 VAL 103179.00 VAL TOTAL FEES ROUTE TO: BS0508 jtHAIPTION OF WORK jGUEST HOUSE 2 BEDROOMSTHROOMS WITH ATTACHED 2 CAR AMOUNT:jCAR GARAGE 1,229.70 j 27.80 jSPECIAL CONDITIONS: 5.00 jCOVENANT RECORDED 10.30 j 1,446.70 101.40 jAPPROVALS DATE INSPECTOR SIGNATURE 2,820.90 j j LOCATION AND SETBACKS j jSOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR jRAISED FLOOR FRAMING jUNDERFL0OR INSULATION j J15T LEVEL FLOOR SHEATH j2ND LEVEL FLOOR SHEATH j j IAOOF SHEATHING jFIRE DEPT. FRAME INSPECT11 �I BLDG DEPT. FRAME INSPECT,��L,%I� SHEAR PANELS INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVA 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 1, 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). I ' U. I am exeml t 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 prior) to completion of the improvements covered by this permit, I cq'nnot 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: http://www.leainfo.ca.cov/calaw.htm]. 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. �-y 7 License Class License No. / ' % / 0 Date /!� Contractor Signature WORKERS' COMPENSAT N DEC ION 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. Po)icy No. X 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 wrs' comp esti insures ce car ier and polic� n are: 11y,7 1Y 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 ll - /57' -- / 5 I ature of Applic-_01 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 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 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 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 roperty Owner or Authorized Agent Date 31 COUNTr OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAN[J DEVELOPMENT LEGAL ID: TR: 5904 IT: 291 UN: .002 ASSESSOR INFORMATION NUMBER: 5384-012-024 TENANT OWNER: TEL. NO: QI, WEI (626) 226-3614- 6125 ENCINITA AV PAID TEMP 917801637 APPLICANT: TEL. NO: Q11 NEI (626) 759-1188- 6125 ENCINITA AVE 1,347.00 TEMPLE CITY CA 91760 CONTRACTOR: TEL. NO: MORA CONSTRUCTION (626) 215-5460- 6634 OAK AVENUE LIC. NO TEMPLE CITY CA 91780 721700 ARCHITECT OR ENGINEER: TEL. NO: T AND W CONSULTING ENGINEERS (626) 298-0757- 1168 N SAN GABRIEL BLVD kN LIC. NO: ROSEMEAD CA 91770 NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 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: 765 2 V -B GARAGE: 418 1 V -B OTHER: EXIST BLDG USE: EXIST OCC GRP: BLDGS. NOW ON LOT: T FEE DESCRIPTION B1 PLANCHECK W/ENERGY AA BLDG PERMIT ISSUANCE AS STATE GREEN BLDG FEE AC STRONG MOTION REBID B2 PERMIT W/ENERGY 08 CERTIF OF OCCUPANCY 1 REPORT ID: DPR261 G 0508 NEW OCCUP GROUP R-3 U USE ZONE. ROUTE TO: BS0508 BUILDING PERMIT RESIDENTIAL ADD BL 0508 1302060048 BUILDING ADDRESS: 6125 ENCINITA AV TEMP CA 917801637 NEAREST CROSS STREET: LONGDEN THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY C ISSUED ON: PROCESSED BY: 11/18/13 SR sFINAL DATTEE/j-� FINAL BY: CODE: C�� OF WORK '�-�,y'_\\\\V/J\/� ADD 3/4 BATHRM ON FIRST FLOOR AND 2ND: FLOOR MASTER BEDRM, MASTER BATHRM, LAUNDRY, DEMO (E) CARPORT AND BUILD ATTACHED 2 CAR GARAGE, CONVERT EXIST STUDY TO BEDRM SPECIAL CONDITIONS: APPROVALS DATE J INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMSbm� SLAB/UNDER FLOOR RAISED PLOOR FRAMINGUNDERFLOOR INSULATION �� 11 1ST LEVEL FLOOR SHEATH V 2ND LEVEL FLOOR SHEATH ROOF SHEATHING FIRE DEPT. FRAME INSPECT/ BLDG DEPT. FRAME INSPECT - SHEAR PANELS I I INSULATION/WEATHER STRIPJ-, INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVALS 122,050 FEES PAID QUANTITY: BOM: AMOUNT: 122050.00 VAL 1,347.00 27.80 122050.00 VAL 5.00 122050.00 VAL 12.20 122050.00 VAL 11,584.70 101.40 TOTAL FEES 3,078.10 ROUTE TO: BS0508 BUILDING PERMIT RESIDENTIAL ADD BL 0508 1302060048 BUILDING ADDRESS: 6125 ENCINITA AV TEMP CA 917801637 NEAREST CROSS STREET: LONGDEN THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY C ISSUED ON: PROCESSED BY: 11/18/13 SR sFINAL DATTEE/j-� FINAL BY: CODE: C�� OF WORK '�-�,y'_\\\\V/J\/� ADD 3/4 BATHRM ON FIRST FLOOR AND 2ND: FLOOR MASTER BEDRM, MASTER BATHRM, LAUNDRY, DEMO (E) CARPORT AND BUILD ATTACHED 2 CAR GARAGE, CONVERT EXIST STUDY TO BEDRM SPECIAL CONDITIONS: APPROVALS DATE J INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMSbm� SLAB/UNDER FLOOR RAISED PLOOR FRAMINGUNDERFLOOR INSULATION �� 11 1ST LEVEL FLOOR SHEATH V 2ND LEVEL FLOOR SHEATH ROOF SHEATHING FIRE DEPT. FRAME INSPECT/ BLDG DEPT. FRAME INSPECT - SHEAR PANELS I I INSULATION/WEATHER STRIPJ-, INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVALS OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION JOB ADDRESS 'r 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).): L) I, as owner of the property, or my employees with wages as their sole compensation, will do (.r) 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.). L) 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). L). I am exeml t 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 prior) to completion; of the improvements covered by this permit, Ic 'nnot 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.00v/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. License Class License No. / 7 0 Date I l - l l Contractor Signature'— WORKERS' COMPENSAT N DEC TION 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. Xicy 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' comp nsati n insurance carrier and polis number are: . ti r c�2 'R7 � 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 nature of Appii nt 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 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 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 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 Property Owner or Authorized Agent �.��/./ tip