HomeMy Public PortalAbout5348 Buttons Ave_Building_8/5/2015_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 22127 LT: 11
ASSESSOR INFORMATION NUMBER:
8590-004-004
TENANT:
OWNER:
ITOMOVICH DANILO M;KRISTINE
5348 BUTTONS AV
(TEMP 917803103
APPLICANT:
SYLVIS, GREG
500 BELLMORE WAY
PASADENA CA 91103
CONTRACTOR:
GREG SYLVIS GENERAL CONTRACTOR
500 BELLMORE WAY
PASADENA, CA 91103
ARCHITECT OR ENGINEER:
TEMPLE CITY # 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
BUILDING PERMIT
BL 0508 1508050026
NO. OF CONST NEW I BUILDING ADDRESS:
SQ. FT STORIES TYPE OCCUP GROUP 5348 BUTTONS AV
STRUCTURE: 0 1 V -B R-3 I TEMP CA 917803103
GARAGE: I NEAREST CROSS STREET: OLIVE
OTHER: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CA
EXIST BLDG USE: RESID JISSUED ON: PROCESSED BY:
EXIST OCC GRP: R-3 108/05/15 SR
TEL. NO: JBLDGS. NOW ON LOT: VALUATION:FIIN,A,L%DAT / FINAL CODE:
2,500 i�1 / J �_
FEES PAID IDESC4IPTION OF WORK
IVOLUNTAR SEISMIS UPGRADE PER LA CITY STANDARD
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
TEL. N0:
(626) 628-5781- JAA BLDG PERMIT ISSUANCE 27.80 1
JAB STATE GREEN BLDG FEE 2500.00 VAL 1.00 ISPECIAL CONDITIONS:
JAC STRONG MOTION RESID 2500.00 VAL 0.50
IDI PLANCHECK W/O EN -HC 2500.00 VAL 84.20
ID2 PERMIT W/O EN -HC 2500.00 VAL 99.00
TEL. NO: TOTAL FEES 21 .50 APPROVALS DATE INSPECTOR SIGNATURE
(626) 449-6118-
LIC.
49-6118- i �� l/ pi�j'`��OLIC. NO �t /1 / x0o
11l?Nn'1' 1�LOCATION AND SETBACKS
443627 B
"Ao'AlWOOOILS ENGINEER APPROVAL
TEL. NO: OUNDATION/TRENCH FORMS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I
JUNDERFLOOR INSULATION
3 001
I
1
(FLOOR SHEATHING
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
1 NO 20
1 IROOF SHEATHING
SCHOOL WITHIN HAZARDOUS
ISHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
IFRAME INSPECTION
FIRE SPRINKLER HANGERS
INSULATION/WEATHER STRIP
JINTERZOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
PERMIT EXPIRES 180 DAYS IF
11) WORK DOES NOT COMMENCE, OR
IRATED SHAFTS/OPENINGS
12) WORK IS SUSPENDED OR ABANDONED, OR
13) FAILS TO OBTAIN CODE REQUIRED INSPECTION
IT -BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I JOB ADDRESS
I hereby affirm under penalty of perjury that 1 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 (✓) 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 Contrh?Wr 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 whicil I must have resided for at least
one year priorl to completion of the improvements covered by
this permit, Icannot 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.lecinfo.ca.cov/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 IF I License No. ,62'7
ate �V' 7 )��kn'tractor 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
AI certify that, in the performance of the work for which this
ermit 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' comgg��,,nsation provisions of Section 3700 of the Labor
Code, I shall Jpyl�with comply with those provisions
Signature of Applicant 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 Or 'nance) and that
all persons acting on behalf of myself com and ill continue
to comply therewith through the applicatio ess.
G 12�Ci S _ L U,
Il (,Prim Nam) pplicant Sjgnaturreel
Company Nante 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 requirem@nts
hapter 220
under the Los Angeles County Code Title 2, C'
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 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-identifie p operty for inspection purposes.
Signaturer�o y Owner or Authorized Agent
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