HomeMy Public PortalAbout9659 Garibaldi Ave_Building_1/16/2015_ (3)T
• COUNTY OF LOS ANGELES TEMPLE CITY„ 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1501150079
PHONE: (626) 285-0488 EXT:
LEGAL ID: 1 NO. OF CONST BUILDING ADDRESS: I
TR: 13277 LT: 15 UN: .002 1 SQ. FT STORIES TYPE 9659 GARIBALDI AV
ASSESSOR INFORMATION NUMBER:
5385-017-022
TENANT:
OWNER:
MAKAHA PROPERTIES
1666 MAIN STREET
SANTA ANA CA 92705
APPLICANT:
TAUGNEY, GEOFF
12062 VALLEY VIEW
GARDEN GROVE
(CONTRACTOR:
IGMT CONSTRUCTION
112062 VALLEY VIEW 127A
IGARDEN GROVE CA 92845
ARCHITECT OR ENGINEER:
(STRUCTURE: V -B I TEMP CA 917801738 1
I
I
I
(EXIST BLDG USE: RESID
1EXIST OCC GRP:
I
TEL. NO: JBLDGS. NOW ON LOT:
(714) 541-1002- 1
I
I
IFEE DESCRIPTION:
TEL. NO: 1
(714) 917-2935- JB1 PLANCHECK W/ENERGY
JAA BLDG PERMIT ISSUANCE
IAB STATE GREEN BLDG FEE
JAC STRONG MOTION RESID
JB2 PERMIT W/ENERGY
TEL. NO: JFR INV WORK W/O PERMIT
(562) 522 -3190 -
LIC. NO 1
869082
TEL. NO:
LIC. NO:
� I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I
1 3 001
I �
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: j
1 NO 21 I
I SCHOOL WITHIN HAZARDOUS
JAIR QUALITY: 1000 FEET MATERIALS
I NO NO NO
I
I
IREPORT ID: DPR261
I
ROUTE TO: BS0508
ILOCATION AND SETBACKS I I
I I I
ISOILS ENGINEER APPROVAL I I
I I I
IFOUNDATION/TRENCH FORMS I I
I I I
ISLAS/UNDER FLOOR I I
I I I
IRAISED FLOOR FRAMING I I
I i I
jUNDERFLOOR INSULATION I I
t I I
(FLOOR SHEATHING I J
1 I I
IROOF SHEATHING I I
I I I
1SHEAR. PANELS
I I I
IFRAME INSPECTION
I I I
IFIRE SPRINKLER HANGERS I I
I I I
JINSULATION/WEATHER STRIPI I
I I I
JINTERIOR LATH/DRYWALL
1 1:1141
EXTERIOR LATH I
I � I
IRATED FLOOR/CEIL ASSEM. J
I � I
(RATED WALL ASSEMBLIES I I
I � I
IRATED SHAFTS/OPENINGS I I
I � I
IT -BAR CEILINGS I I
I I I
ILOT DRAINAGE I
I I I
NEAREST CROSS
STREET: I
THOMAS PAGE: 597
GRID: A2 LOCALITY: TEMPLE CITY CAI
USE ZONE: R-1
I I
(ISSUED ON: PROCESSED BY: 1
101/16/15
SR 1
VALUATION:
I
(FINAL ATE
I
FINAL BY: CODE: J
15,000
FEES PAID
ID SAIRI OF WORK
IREMODEL 2 BATHROOMS,
REPLAC 9 WINDOWS AND DRYWALL 1
QUANTITY: UOM:
AMOUNT:(
I
I
15000.00 VAL
281.10
I
27.80
ISPECIAL CONDITIONS:
I
15000.00 VAL
1.00
I
I
15000.00 VAL
1.50
I
I
15000.00 VAL
330.70
J
I
344.00 DOL
344.00
JAPPROVALS
DATE INSPECTOR SIGNATURE I
TOTAL FEES
986.10
I
I
ROUTE TO: BS0508
ILOCATION AND SETBACKS I I
I I I
ISOILS ENGINEER APPROVAL I I
I I I
IFOUNDATION/TRENCH FORMS I I
I I I
ISLAS/UNDER FLOOR I I
I I I
IRAISED FLOOR FRAMING I I
I i I
jUNDERFLOOR INSULATION I I
t I I
(FLOOR SHEATHING I J
1 I I
IROOF SHEATHING I I
I I I
1SHEAR. PANELS
I I I
IFRAME INSPECTION
I I I
IFIRE SPRINKLER HANGERS I I
I I I
JINSULATION/WEATHER STRIPI I
I I I
JINTERIOR LATH/DRYWALL
1 1:1141
EXTERIOR LATH I
I � I
IRATED FLOOR/CEIL ASSEM. J
I � I
(RATED WALL ASSEMBLIES I I
I � I
IRATED SHAFTS/OPENINGS I I
I � I
IT -BAR CEILINGS I I
I I I
ILOT DRAINAGE I
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 (,/) 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 exem�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 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.leoinfo.ca.aov/calaw.htmi.
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. WJE b
p,��
Z
Date 111f16 Contractor Signature
WORKERS' COMPENSATION RATION
WARNING: FAILURE TO SECURE WORKER ' 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.
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
_i 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 o the workers' compensation laws of
California, .a d agree th if I should become subject to the
worker4' pensatio r visions of Section 3700 of the Labor
Code. I Lh forthwit o ly with those provisions
�m 1& Is
of qplicantf Datb t
LOBBYISTjORDINANCE CERTIFICATION
Complete this section for permits in
Unincorporated Los Angeles County only
This is to certify that 1, as permit applicant, am familiar with the
requirements of Los Angeles County Code Chapter 2.160 et seq.,
(relating to the Los Angeles County Lobbys rdinance) and that
all persons acting on behalf of myself corZd and will continue
to comply thereWh through the applicatioi i cess.
Appl' ant (Print ,IkI�ame) App i1 -h -t g to--LA^'T L-&ATr1A-Li to
Company Name
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 ❑ No ❑
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 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 authorize repre a tives of this county to enter the
above -identified arty for inspection purposes.
Signature of Pr r or Authorized Agent
Datev!