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Home My Public Portal About981 HOWLAND DR_Building_5/12/2014_COUNTY OF LOS ANGELES _ DEPARTMENT OFPUBLIC 'WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 12830 IT: 12 ASSESSOR INFORMATION NUMBER: 8589-009-004 WH01'}b4f (OWNER: TEL. NO: (DAM, STEVEN (626) 625-5248- I9818. HOWLAND DR ITEMP 917803232 I (APPLICANT: TEL. NO: ILAI, KAMEN (626) 288-2651- 18748 E VALLEY BLVD K ROSEMEAD CA 91770 I (CONTRACTOR: TEL. N0: IDTS BUILDER CONSTRUCTION, INC. (626) 625-5248- 19320 RALPH AVENUE LIC. NO ROSEMEAD CA 91770 I 983279 (ARCHITECT OR ENGINEER: TEL. NO: ILEE, PETER (626) 280-9000- 18748 E VALLEY BLVD SUITE L LIC. NO: ROSEMEAD CA 91770 I 983279 (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: TEMP CA 917803232 3 01 ,NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 01 SCHOOL WITHIN HAZARDOUS SIR QUALITY: 1000 FEET MATERIALS NO NO NO BLDGS. NOW ON LOT: �9X�117N-Y�T77Si(�lu B1 PLANCHECK W/ENERGY AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE AC STRONG MOTION RESID B2 PERMIT W/ENERGY O8 CERTIF OF OCCUPANCY * ADDITIONAL DATA ON FILE REPORT ID: DPR261 05/12/14 SR VALUATION: FI L D BY: CODE: 560,370 FEES PAID QUANTITY: DOM: 560200.00 VAL 560370.00 VAL 560370.00 VAL 560370.00 VAL TOTAL FEES ROUTE TO: BS0508 N OF WORK NEW 2 -STORY SFD 5 BEDROOMS, 5 BATHROOMS, POWDER, W/ATTACHED AMOUNT: 3 -CAR GARAGE, 2ND: FLOOR BALCONY 82 SF., COVERED PORCH 142 SF. COVERED PATIO/BREEZEWAY 563 SF. AND WALK DECK 220 SF. 4,049.90 27.80 SPECIAL CONDITIONS: 23.00 FIRE SPRINKLERS REQUIRED 56.00 4,764.50 101.40 APPROVALS DATE INSPECTOR SIGNATURE 9,022.60 LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR I RAISED FLOOR FRAMING UNDERFLOOR INSULATION IST LEVEL FLOOR SHEATH 2ND LEVEL FLOOR SHEATH ROOF SHEATHING FIRE DEPT. FRAME INS PECT`" BLDG DEPT. FRAME INSPECT( SHEAR PANELS INSULATION/WEATHER STRIP( p (INTERIOR LATH/DRYWALL 1 O �� tv EXTERIOR LATH � LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL( TEMPLE CITY 8 0508 BUILDING PERMIT 9701 LAS TUNAS NEW RESIDENTIAL TEMPLE CITY CA 91780 BL 0508 1305290027 PHONE: (626) 285-0488 EXT: NO. OF CONST NEW BUILDING ADDRESS: SQ. FT STORIES TYPE OCCUP GROUP 9818 HOWLAND DR STRUCTURE: 3847 2 V -B R3 TEMP CA 917803232 GARAGE: 651 1 V -B U NEAREST CROSS STREET: OTHER: 142 1 V -B U THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CA USE ZONE: R-1 ISSUED ON: PROCESSED BY: BLDGS. NOW ON LOT: �9X�117N-Y�T77Si(�lu B1 PLANCHECK W/ENERGY AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE AC STRONG MOTION RESID B2 PERMIT W/ENERGY O8 CERTIF OF OCCUPANCY * ADDITIONAL DATA ON FILE REPORT ID: DPR261 05/12/14 SR VALUATION: FI L D BY: CODE: 560,370 FEES PAID QUANTITY: DOM: 560200.00 VAL 560370.00 VAL 560370.00 VAL 560370.00 VAL TOTAL FEES ROUTE TO: BS0508 N OF WORK NEW 2 -STORY SFD 5 BEDROOMS, 5 BATHROOMS, POWDER, W/ATTACHED AMOUNT: 3 -CAR GARAGE, 2ND: FLOOR BALCONY 82 SF., COVERED PORCH 142 SF. COVERED PATIO/BREEZEWAY 563 SF. AND WALK DECK 220 SF. 4,049.90 27.80 SPECIAL CONDITIONS: 23.00 FIRE SPRINKLERS REQUIRED 56.00 4,764.50 101.40 APPROVALS DATE INSPECTOR SIGNATURE 9,022.60 LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR I RAISED FLOOR FRAMING UNDERFLOOR INSULATION IST LEVEL FLOOR SHEATH 2ND LEVEL FLOOR SHEATH ROOF SHEATHING FIRE DEPT. FRAME INS PECT`" BLDG DEPT. FRAME INSPECT( SHEAR PANELS INSULATION/WEATHER STRIP( p (INTERIOR LATH/DRYWALL 1 O �� tv 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 I/) 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 ContrSctor pursuant.to the Contractors' State License Law). III (_) 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 which I must have resided for at least one year prion 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: httD://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 No. ...[LL,--- ate�ontractor 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 Nae 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 f rthwi.lb comply with those provisions Signal re 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 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 JOBADDRESS� �,p� I�i� L LOCALITY �J� 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 ❑ j I have read the hazardous materials information guide and the SCAQMD permitting checklist, I understand my requirerrnts 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 penally 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 owners 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. Signet of P erty/ er or Authorized Agent te✓ _ r COUNTY OF IAS ANGELES TEMPLE CITY # 0508 DEPARTMENT OP PUBLIC'WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW TR: 12830 LT: 12 SQ. FT STORIES TYPE OCCUP GROUP STRUCTURE: 499 1 V-B R-3 ASSESSOR INFORMATION NUMBER: GARAGE: 8589-009-004 OTHER: TENANT: EXIST BLDG USE: PATIO EXIST OCC GRP: R-3 OWNER: TEL. NO: REUSS. NOW ON LOT: VALUATION: DAM, STEVEN (626) 625-5248- 9,466 9818 HOWLAND DR TEMP 917803232 FEES PAID IEEE DESCRIPTION: QUANTITY: VOM: AMOUNT: APPLICANT: TEL. NO: LAI, KAMEN (626) 288-2651- IDI PLANCHECK W/O EN-HC 9466.00 VAL 184.10 8748 E VALLEY BLVD K AA BLDG PERMIT ISSUANCE 27.80 ROSEMEAD CA 91770 JAB STATE GREEN BLDG FEE 9466.00 VAL 1.00 JAC STRONG MOTION RESID 9466.00 VAL 1.00 ID2 PERMIT W/O EN-HC 9466.00 VAL 216.60 CONTRACTOR: TEL. NO: TOTAL FEES 430.50 DTS BUILDER CONSTRUCTION, INC. (626) 625-5248- 9320 RALPH AVENUE LIC. NO ROSEMEAD CA 91770 983279 ARCHITECT OR ENGINEER: TEL, NO: LEE, PETER (626) 280-9000- 8748 E VALLEY BLVD SUITE L LIC. NO: ROSEMEAD CA 91770 983279 w MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 NO 20 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT BL 0508 1305290031 BUILDING ADDRESS: 9818 HOWLAND DR TEMP CA 917803232 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A4 ISSUED ON: PROCESSED BY: 05/12/14 SR F AL DAT °FINAL BY: DESz ON OF WORK DETACHED COVERED PATIO SPECIAL CONDITIONS: LOCALITY: TEMPLE CITY CA CODE: APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS --7 -1 SOILS ENGINEER APPROVAL FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FRAME INSPECTION �1 FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP 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 I hereby affirm under penalty of perjury that I am exempt from I hereby affirm under penalty of perjury that I am licensed under the Contractors' State License Law for the reason(s) indicated provisions of Chapter 9 (commencing with Section 7000) of below by the checkmark(s) I have placed next to the applicable Division 3 of the Business and Professions Code, and my item(s) (Section 7031.5, Business and Professions Code): Any license is in full force and effect. �)) city or county that requires a permit to construct, alter, improve,�C demolish, or repair any structure, prior to its issuance, also License Class License No. JLA requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' Signature - Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions WORKERS' COMPENSATION DECLARATION Code) or that he or ah Ia 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 Contrti?tor 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 which I must have resided for at least one year prior) to completior3 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: htto://www.leainfo.ca.aov/calaw.html. Date: Signature of Property Owner or Authorized Agent 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 carder and policy number are: Carder 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 rth ' h comply with those provisions Signature of Applicant ate 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 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 JOBADPRESS 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 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. Sign a ape wrier or Authorized Agent Date —C71�(�' COUNTY OF LOS ANGELES TEMPLE CITY i! 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1407020020 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 12830 IT: 12 SQ. FT STORIES TYPE OCCUP GROUP 9818 HOWLAND DR STRUCTURE: 561 2 V-B R-3 I TEMP CA 917803232 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8589-009-004 OTHER: 11 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY C TENANT: IEXIST BLDG USE: PHOTO ISSUED ON: PROCESSED BY: EXIST OCC GRP: R-3 107/02/14 SR OWNER: TEL. NO: SLUGS. NOW ON LOT: VALUATION: I 1FINAL DATE FINAL BY: CODE: DAM, STEVEN (626) 625-5248- 1 33,000 1i , J 'l\ 9818 HOWLAND DR C TEMP 917803232 FEES PAID II P CRIPT O OF WORK I 11NSTALL 28 SOLAR PANELS ON THE ROOF TOP 7 KW (DC) PV SYSTEM DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: TEL. NO: iFEE NG, STELLA (626) 922-7411- AA BLDG PERMIT ISSUANCE 27.80 9040 TELSTAR AVE AB STATE GREEN BLDG FEE 33000.00 VAL 2..00 1SPECIAL CONDITIONS: EL MONTE CA 91731 P1 RES PV PO<lOKW 153.90 1P2 INSPCT RES PV 11OKW 138.00 1 TOTAL FEES 321.70 CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE GEO SOLAR, INC. (626) 922-7411- 1 16025 ARROW HIGHWAY # E LIC. NO 1 1LOCATION AND SETBACKS 1 IRWINDALE CA 91706 988464 (SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: I 1FOUNDATION/TRENCH FORMS 1 1 LSC. N0: 1 1SLAB/UNDER FLOOR I I 1RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMOoi iUNDERFLOOR INSULATION FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 NO 20 [ROOF SHEATHING SCHOOL WITHIN HAZARDOUS 1SHEAR PANELS 1 AIR QUALITY: 1000 FEET MATERIALS NO NO NO 1 1FRAM E INSPECTION 1 FIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIP 1 INTERIOR LATH/DRYWALL 1 1 1 (EXTERIOR LATH 1 1 RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS 1LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS 0508 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.). 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 Contractor 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 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 1 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. q#4 Z- 0 Date? y/W Contractor Signature �4' Y r.► 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. t9C= 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 r I'c o pens tion insurance carrier and pof numberare: artiPoli umber 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 7/,7 y Signatuire of Applicant Date LOBBYIST ORDINANCE 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 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 ❑ 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. Signature of Property Owner or Authorized Agent Date L COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: JTR: 12830 LT: 12 1 ASSESSOR INFORMATION NUMBER: 18589-009-004 TENANT: TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NUMBER OF ADDED/RELOCATED SQ. FT SPRINKLER HEADS 37 STRUCTURE: 4498 EXIST BLDG USE: EXIST OCC GRP: (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: DAM, STEVEN 4,500 19818 HOWLAND DR i TEMP 917803232 FEES PAID (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: PAN, AMANDA (626) 822-1030— JAA BLDG PERMIT ISSUANCE 27.80 10105 RIO HONDO PKWY JAB STATE GREEN BLDG FEE 4500.00 VAL 1.00 JEL MONTE CA 91733 IDO FIRE SPRINKLER PC 4500.00 VAL 112.70 ID2 PERMIT W/O EN—HC 4500.00 VAL 132.60 TOTAL FEES 274.10 CONTRACTOR: TEL. NO: IGF FIRE PROTECTION INC. (626) 350-3196- 110105 RIO HONDO PKWY LIC. NO JEL MONTE CA 91733 975442 ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 001 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 20 1 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO THIS PERMIT EXPIRES 6 MONTHS FROM DATE OF ISSUANCE OR FROM DATE OF LAST VALID INSPECTION. REPORT ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT FIRE SPRINKLER BL 0508 1506110071 BUILDING ADDRESS: 9818 HOWLAND DR TEMP CA 917803232 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI SUED ON: PROCESSED BY: e11/15 SR 41�L DATE FESYST : CODE: 3ttRIP ION OF WORK STALL FIRE SPRINKLER =AL CONDITIONS: ?ROVALS tE DEPARTMENT INSPECT LE SPRINKLER HANGERS tE DEPARTMENT APPROVAL DATE INSPECTOR SIGNATURE OWNER -BUILDER DECLARATION LICENSED CONTRACTOR'S DECLARATION I 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 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 ContrhFtor 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 which I must have resided for at least one year priorlto completior4 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: bftp://www.Iecinfo.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 C- A License No. %7J_aV-z-- _ r -Date a-//&�1JContractorSignature W&—am4 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 ATTORNEYS 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. I Ilk 2 ZI _ I Policy No. 7 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: LIb I tL LD/o3 ?ate Carer r� olicy umber 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, IIs/shall forthwith comply with those provisions Signature of Appli¢nt 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 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 ❑ 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 conceming 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 penally 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 -identified property for inspection purposes. Signature of Prope Ownor Authorized Agent � &e-&A-J,J>-., >c17I ate bh-rl-7.oIJ� &4 (�