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HomeMy Public PortalAbout6125 Encinita Ave_Mechanical_11/18/2013_w COUNTY OF LOS•ANgELES ' TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1311180025 BUILDING AND SAFETY /'LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: TR: 5904 IT: 291 ON: .002 ASSESSOR INFORMATION NUMBER: 5384-012-024 TENANT OWNER: TEL. NO: QI, WEI (626) 226-3614- 6125 ENCINITA AV TEMP 917801637 APPLICANT: TEL. NO: MORA, JUAN (626) 215-5460- 6634 OAK AVENUE TEMPLE CITY CA 91780 CONTRACTOR: TEL. N0: 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 #N LIC. NO: ROSEMEAD CA 91770 NONE FEES PAID FEE DESCRIPTION: QUANTITY: GUM: 01 PERMIT ISSUANCE FEE 02 COMPRSR < 100 KBTU OB FURNACE/HEATER <100 30 AIR INLETS/OUTLETS 41 VENTILATION FAN REPORT ID: DPR264 1.00 COM 1.00 UNI 9.00 UNI 2.00 FAN TOTAL FEES ROUTE TO: SS0508 AMOUNT: 27.80 27.00 27.00 39.60 31.60 153.00 BUILDING ADDRESS: 6125 ENCINITA AV TEMP CA 917801637 NEAREST CROSS STREET: LONGDEN THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CP ISSUED ON: PROCESSED BY: PLAN BY: 11/18/13 SR FINAL D TE FINAL BY: CODE: //�1y►n1^/ DE CR ON 6)? WORK GUEST HOUSE INSTALL A/C AND HEATING SYSTEM, 9 AIR INLETS AND 2 VENTILATION FANS SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE FAU/WALL FURNACE ` COMBUSTION AIR OPENINGS _ DUCT WORK A 4 AC/COMPRESSOR 1' THERMOSTAT FIRE DAMPERS SMOKE DETECTION DEVICES COMMERCIAL HOOD I 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 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 Contrbrtor pursuant .to the Contractors' State License Law). U71 am exemat 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 completioq of the improvements covered by this permit, I c '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: httq://www.leainfo.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. License Class_ License AONDECLARATION 7O O Date j i rL-, bontractor Signatur�11-4— WORKERS' COMPENSA 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. 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 w ' c mpen eon i surance carrjerl policy umber 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 forthwith comply with those provisions al C, -t- //- /5/, /3 S' ature of App lint 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 w 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 ❑ 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 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 i!-%� D//- / Sr- 13 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1311180026 BUILDING AND SAFETY / LAN6 DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 291 UN: .002 6125 ENCINITA AV IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917801637 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 5384-012-024 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY C, 103 COMPRSR 101 500 KBTU 1.00 COM 52.20 TENANT: 109 FURNACE 101 500 KBTU 1.00 UNI 52.20 (ISSUED ON: PROCESSED BY: PLAN BY: 130 AIR INLETS/OUTLETS 12.00 UNI 52.80 111/18/13 SR 141 VENTILATION FAN 2.00 FAN 31.60 I OWNER: TEL. N0: TOTAL FEES 216.60 D FTf1AjBY: CODE: QI, WEI (626 226-3614- iFINAL 6125 ENCINITA AV AIR TEMP 917801637 B WORK (MAIN HOUSE INSTALL A/C AND HEATING SYSTEM, 12 AIR INLETS AND 2 VENTILATION FANS APPLICANT: TEL. NO: MORA, JUAN (626) 215-5460- 6634 OAK AVENUE ISPECIAL CONDITIONS: TEMPLE CITY CA 91780 CONTRACTOR: TEL. NO: (APPROVALS DATE ` S* SIGNA URE MORA CONSTRUCTION 6634 OAK AVENUE (626) 215-5460- LIC. NO (� IFAU/WALL FURNACE TEMPLE CITY CA 91780 721700 i 1j COMBUSTION AIR OPENINGS ARCHITECT OR ENGINEER: TEL. NO: IDUCT WORK T AND W CONSULTING ENGINEERS (626) 298-0757- 1168 N SAN GABRIEL BLVD #N LIC. NO: IAC/COMPRESSOR ROSEMEAD CA 91770 NONE ITHERMOSTAT IFIRE DAMPERS I � SMOKE DETECTION DEVICES � COMMERCIAL HOOD I I I REPORT ID: DPR264 ROUTE T0: BSO508 I I i OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION 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 (,r) 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 Contra?tor pursuant ' .to the Contractors' State License Law). (_): 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 completionk 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.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. License Class\3License No. 7O a Date l/ i k'- 13Contractor Signature WORKERS' COMPENSA ON 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 work o 'mpepsation ins nce carneya d policy umber are: ,4, Carrier �PollcyNumber Expiration D to 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 s II forthwith comply with those provisions ol �i' ature of Appli p"ii 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 ❑ 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. Signatur f Property Owner or Authorized Agent Com.