HomeMy Public PortalAbout9828 Garibaldi Ave_Building_2/9/2015_COUNTY OF LOS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
L ID:
6561 LT: 55 UN� .003
BECK INFORMATION NUMBER:
-027-003
TEL. NO:
�R. AN CHAD
9828 GARIBALDI AV
TEMP 917801712
APPLICANT:
TEL. NO -
CHARLES SLAUGRUND, AIA
(805) 529-1979-
14994 MARQUETTE ST
9701 LAS TUNAS
�OORPARK CA 93021
CONTRACTOR:
TEL. NO:
RP ASSOCIATES, INC.
(818) 879-5002-
1351 TOTTENHAM CT
LIC. NO
INK PARK CA 91377
740238 -
kRCHITRCT OR ENGINEER:
TEL. NO:
ZHARLES 131AUGPUND
(805) 529-1979-
L4994 MARQUETTE STREET
LIC. NO-
�OORPARK CA 93021
C25792
�P NO: SEWER MAP BOOK; PAGE:
FIRE ZONE: CMP:
V-13
3 00
qO. OF FAMILIES: DWELLING UNITS:
APT/COND : STAT CLASS:
0
NO 21
SCHOOL WITHIN HAZARDOUS
%IR QUALITY: 1000 FEET
MATERIALS
NO NO
NO
FEES PAID
FEE DESCRIPTION; QUANTITY: UOM
BI PLANCHECK W/ENERGY
TEMPLE CITY
VAL
AA BLDG PERMIT ISSUANCE
9701 LAS TUNAS
AB STATE GREEN BLDG FEE
TEMPLE CITY CA 91780
VAI,
AC STRONG MOTION REBID
PHONE: (626) 285-0498
EXT:
VAL
B2 PERMIT W/ENERGY
NO. OF
CONST
NEW
SQ. FT STORIES
TYPE
OCCUP GROUP
JSTRUCTURE-
44 - 8 1
V-13
R-3
GARAGE:
OTHER:
EXIST 13LDG USE:
USE ZONE:
IEXIST OCC
I
GRP:
SLUGS. NOW ON LOT:
VALUATION
i
30,000
FEES PAID
FEE DESCRIPTION; QUANTITY: UOM
BI PLANCHECK W/ENERGY
30000.00
VAL
AA BLDG PERMIT ISSUANCE
AB STATE GREEN BLDG FEE
30000.00
VAI,
AC STRONG MOTION REBID
30000.00
VAL
B2 PERMIT W/ENERGY
30000.00
VAI,
TOTAL FEES
- ADDITIONAL DATA ON FILE
REPORT ID: DPR261 ROUTE TO: ES0508
AMOUNT:
502.20
27.80
2.00
3.00
590-70
1,125.70
I
BUILDING PERMIT
RESIDENTIAL ADD/ALT/REP
BL 0508 1501050025
BUILDING ADDRESS:
9828 GARIBALDI AV
TEMP CA 917801712
NEAREST CROSS STREET: GOLDEN WEST
THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CA
ISSUED ON: PROCESSED BY:
02/09/15 SR
FI4AL DATE Pi By� CODE:
ED 'f7��F
6 WORK
REPAIR FIRE DAMAGE TO SINGLE EMILY DWELLING. REPAIR ROOF
STRUCTURE AND MINOR WALL FRAME DAMAGE- REPLACE INTERIOR SURF
ACES, REPLACE ELECTRICAL AS NEEDED, REPLACE FAU, REPLACE
SPECIAL CONDITIONS:
DATE INSPECTOR SIGNATURE
LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
FOUNDATION/TRENCH FORMS
SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
UNDERFLOOR INSULATION
1ST LEVEL FLOOR SHEATH
2ND LEVEL FLOOR SHEATH
ROOF SHEATHING
FIRE DEPT. FRAME INSPECTP
BLDG DEPT. FRAME INSPECI;r3,ft
SHEAR PANELS
INSULATION/WEATHER STRIP
INTERIOR LATH/DRWALL
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
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 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 Contrbctor pursuant .to the Contractors' State License
Law).
U. 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 which I must have resided for at least
one year priori to completion; 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: http://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 6 License No.
Date YfWContractor Signature
WORKERS' COMPENSATION DECLARATION
11
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 performa ce of the work for which this permit is issue . My
wor a ation insur nce carri41t V�T er
and policy be are'"
Carrier I Policy Number Expiration ate
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' compe sation provisions of Section 3700 of the Labor
Code, I shc3ll fqA with comply with those provisions
Signatti a 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 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
constructi
I author' e r presentatives of this county to enter the
above -i enti ed property for inspection purposes.
Signatur of erty Owner or Authorized Agent
i'
Date ti C
COUNTY OF IAS ANGELES
DEPARTMENT OF PUBLIC WORKS
BUILDING AND SAFETY / LAND DEVELOPMENT
LEGAL ID:
TR: 6561 LT: 55 UN: .003
ASSESSOR INFORMATION NUMBER:
5385-027-003
TENANT
OWNER:
TEL.
NO:
MR. AN CHAO
AS STATE GREEN BLDG FEE
3000.00
9828 GARIBALDI AV
VAL
AC STRONG MOTION REBID
TEMP 917801712
VAL
APPLICANT:
TEL.
NO:
PARTON, BRUCE
(818) 879-5002-
TOTAL FEES
1351 TOTTENHAM CT
OAK PARK CA 91377
CONTRACTOR:
TEL.
NO:
HP ASSOCIATES, INC.
(818)
879-5002-
1351 TOTTENHAM CT
LIC. NO
OAK PARK CA 91377
740238
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:
3 00
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
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: 15 V -B
# 0508
EXIST BLDG USE: REBID USE ZONE: R-1
EXIST OCC GRP:
SLOGS. NOW ON LOT: VALUATION:
3,000
FEES PAID
FEE DESCRIPTION: QUANTITY: DOM
AA BLDG PERMIT ISSUANCE
AS STATE GREEN BLDG FEE
3000.00
VAL
AC STRONG MOTION REBID
3000.00
VAL
D2 PERMIT W/O EN -HC
3000.00
VAL
TOTAL FEES
• ADDITIONAL DATA ON FILE
REPORT ID: DPR261 ROUTE TO: BS0508
AMOUNT:
27.80
1.00
0.50
99.00
128.30
BUILDING PERMIT
ALTERATION/REPAIR
BL 0508 1503300100
BUILDING ADDRESS:
9828 GARIBALDI AV
TEMP CA 917801712
NEAREST CROSS STREET: GOLDEN WEST
THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY C
ISSUED ON: PROCESSED BY:
03/30/15 SR
F1/I/WWTT"E,
FIN CODE:
D $F WORK
TEAR OFF REROOF WITH COMPOSI ION SHINGLES
SPECIAL CONDITIONS:
DATE INSPECTOR SIGNATURE
LOCATION AND SETBACKS
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 L
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T -BAR CEILINGS
LOT DRAINAGE
OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION . JOB ADDRESS
by affirm under penalty of perjury that I am exempt from
mtractors' State License Law for the reason(s) indicated
by the checkmark(s) I have placed next to the applicable
(Section 7031.5, Business and Professions Code): Any
county that requires a permit to construct, alter, improve,
ish, or repair any structure, prior to its issuance, also
as the applicant for the permit to file a signed statement
e or she is licensed pursuant to the provisions of the
actors' State License Law (Chapter 9 (commencing with
n 7000) of Division 3 of the Business and Professions
or that he or she is exempt from licensure and the basis
alleged exemption. Any violation of Section 7031.5 by
pplicant for a permit subjects the applicant to a civil
V of not more than five hundred dollars ($500).):
is owner of the property, or my employees with wages as
ole compensation, will do (,i) all of or (_) portions of the
and the structure is not intended or offered for sale
m 7044, Business and Professions Code: The
actors' State License Law does not apply to an owner of
ty who, through employees' or personal effort, builds or
,es the property, provided that the improvements are not
ed or offered for sale. If, however, the building or
,ement is sold within one year of completion, the Owner -
r will have the burden of proving that it was not built or
,ed for the purpose of sale.).
is owner of the property, am exclusively contracting with
►d Contractors to construct the project (Section 7044,
:ss and Professions Code: The Contractors' State License
oes not apply to an owner of property who builds or
tes thereon, and who contracts for the projects with a
)d Contrb�tor pursuant .to the Contractors' State License
m exem�t from licensure under the Contractors' State
;e Law for the following reason:
signature below I acknowledge that, except for my
ial residence in which I must have resided for at least
.ar prion to completion; of the improvements covered by
rmit, I c 'nnot legally sell a structure that I have built as an
builder If it has not been constructed in its entirety by
:d contractors. I understand that a copy of the applicable
action 7044 of 'the Business and Professions Code, is
ole upon request when this application is submitted or at
owing Web site: http://www.leainfo.ca.00v/calaw.html.
ure 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 l / License No� V
413
Date4� Contractor 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 perfgqnance of the work for which this permit is issued. My
worker p ation inqolicy
[ r� e� car�ier aAd policy � are,
Carrier 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
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 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'
I have read the hazardous materials information guide and the
SCAQMD permitting checklist, I understand my requirem�nts
under the Los Angeles County Code Title 2, Chapter 2220'
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 toeach 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 authori rep sentatives of this county to enter the
above -i fled roperty for inspection purposes.
Signatur Ir
7 el Owner or Authorized Agent
�„n I
Date ` l