The URL can be used to link to this page

Home My Public Portal About5333 Camellia Ave_Building_12/15/2014_COUNTY OF LOS ANGELES l DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 17780 LT: 6 ASSESSOR INFORMATION NUMBER: 8589-001-022 OWNER: TEL. NO: CHEVALIER JAMES J;PATRICIA A (626) 286-8548- 5333 CAMELLIA AV TEMP 917803245 APPLICANT: TEL. NO: BERANCH, JUSTIN (877) 237-6477 22741 VENTURA BLVD. WOODLAND HILLS 91364 CONTRACTOR: TEL. NO: ADR ELECTRIC (818) 223-8344- 22741 VENTURA BLVD LIC. NO WOODLAND HILLS CA 91367 696338 � OR ENGINEER: TEL. NO: LIC. N0: NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 20 SCHOOL WITHIN HAZARDOUS 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: 210 1 V -B GARAGE: OTHER: EXIST BLDG USE: REBID EXIST OCC GRP: R-3 BLUES. NOW ON LOT: FEE DESCRIPTION AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE P1 RES PV PC<10KW P2 INSPCT RES PV <10KW ADDITIONAL DATA ON FILE REPORT ID: DPR261 # 0508 BUILDING PERMIT BL 0508 1412150066 NEW I BUILDING ADDRESS: OCCUP GROUP 5333 CAMELLIA AV R-3 TEMP CA 917803245 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A4 ISSUED ON: PROCESSED BY: 12/15/14 SR VALUATION: (FINAL DATE FINAL 14,000 t (-�' FEES PAID QUANTITY: DOM: 14000.00 VAL TOTAL FEES ROUTE TO: BS0508 AMOUNT 27.80 1.00 153.90 138.00 320.70 DESCRIPTION OF Wdl�k V SOLAR 14 PANELS SPECIAL CONDITIONS: APPROVALS 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 LOCALITY: TEMPLE CITY CODE: DATE INSPECTOR SIGNATURE RATED SHAFTS/OPENINGS T -BAR CEILINGS 1 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 (_) 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.). (_) 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 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 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: hfD://www.leginfo.ca.gov/calaw.htmi. 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 Clas#llo � License No. � Datda;6� Contractor Signature WORKERS' COMPENSATION D`JCLA N WARNING: FAILURE TO SECURE WORKERS' OMPENSATION 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 issuep. My W rke s' pensatio insurance carne and policy nue,5 Carrier Policy I u r Expirat�o Da 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 Califo and agree that, if I should become subject to the workersc sation provisions f Section 3700 of the Labor Code, I sha ort ith comply wit those provisions 2Date(2- Date LOBBYIST Oi)DINANCE CERTIFICATION Complete is section for permits in Unincorporated Los Angeles County only This is to certify that I, as permit applica t, am familiar with the requirements of Los Angeles County Code ter 2.160 et seq., (relating to the Los Angeles County Lobbyis Or ance) and that all persons acting on behalf of myself compli d ill continue to cam y therewith SS rough the application pro ss. Appli nit ) L Applican't'Sign ure . `. , v Company Name Da 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 ❑ 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 th all applicable city and county ordinances and s to laws relating to building construction. I authorize representati o his county to enter the above -identified property f insp ction purposes. Signature of Property Owner or A thorizedge t Date ��