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Home My Public Portal About9180 BIDWELL ST_Building_4/28/2014_r COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 12977 LT: 14 ASSESSOR INFORMATION NUMBER: 5387-018-010 OWNER: TEL. NO: RAO, DAVID (626) 374-3777- 9160 BIDWELL ST SQ. FT TEMP 917802454 TYPE APPLICANT: TEL. NO: MICHAEL LIU/PMDC DEVELOPMENT (626) 641-8208- 2550 W MAIN ST #211 R-3 ALHAMBRA CA 91801 GARAGE: 430 CONTRACTOR: TEL. NO: SKYWALK CONSTRUCTION INC. (626) 863-6323- 1317 N. LAS TUNAS DRIVE LIC. NO SAN GABRIEL, CA 91776 906987 ARCHITECT OR ENGINEER: TEL. NO: LAM, GARY (213) 928-7746- 2550 W MAIN STREET #211 LIC. NO: ALHAMBRA CA 91801 71544 MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 104/28/14 SR 3 00 NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: BUILDING PERMIT RESIDENTIAL ADD/ALT/REP BL 0508 1312230077 FEE DESCRIPTION B1 PLANCHECK W/ENERGY AA BLDG PERMIT ISSUANCE AS STATE GREEN BLDG FEE AC STRONG MOTION EESID B2 PERMIT W/ENERGY D7 ADDNL PLANCHECK FEE 08 CERTIF OF OCCUPANCY FEES PAID QUANTITY: UOM: 267670.00 VAL 267670.00 VAL 267670.00 VAL 267670.00 VAL 2.00 HOU TOTAL FEES ADDITIONAL DATA ON FILE i ID: DPR261 ROUTE TO: BS0508 P Ibescai� ON OF WORK ADD NEW MASTER SUITE (2ND:FLR) + NEW MUSIC ROOM (1ST:FLR)NEH AMOUNT:IBATH & LAUNDRY. REMODEL EXISTING LIVING RM, FAMILY RM, KITCH JEN, DINING RM, 2 BEDRMS, 2 BATHRMS & ATTACHED 2 CAR GARAGE, 2,241.80 27.80 SPECIAL CONDITIONS: 11.00 26.80 2,637.40 218.80 JAPPROVALS DATE INSPECTOR SIGNATURE 101.40 5,265.00 ILOCATION AND SETBACKS SOILS ENGINEER APPROVAL (FOUNDATION TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING i/ UNDERFLOOR INSULATION �15T LEVEL FLOOR BREATH �) 2ND LEVEL FLOOR SHEATH (ROOF SHEATHING �/. FIRE DEPT. FRAME INS PECTI BLDG DEPT. FRAME INSPECTi SHEAR PANELS (INSULATION/WEATHER STRIP'• -,/`(6/ �l it INTERIOR LATH/DRYWALL ' EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL NO. OF CONST NEW I BUILDING ADDRESS: SQ. FT STORIES TYPE OCCUP GROUP 9180 BIDWELL ST STRUCTURE: 886 2 V -B R-3 I TEMP CA 917802454 GARAGE: 430 1 V -B U I NEAREST CROSS STREET: ENCINITA OTHER: 1610 2 V -B R-3 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CA EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXIST OCC GRP: 104/28/14 SR SLUGS. NOW ON LOT: VALUATION: IF N FINAL BY: CODE: 1 267,670 rfATE FEE DESCRIPTION B1 PLANCHECK W/ENERGY AA BLDG PERMIT ISSUANCE AS STATE GREEN BLDG FEE AC STRONG MOTION EESID B2 PERMIT W/ENERGY D7 ADDNL PLANCHECK FEE 08 CERTIF OF OCCUPANCY FEES PAID QUANTITY: UOM: 267670.00 VAL 267670.00 VAL 267670.00 VAL 267670.00 VAL 2.00 HOU TOTAL FEES ADDITIONAL DATA ON FILE i ID: DPR261 ROUTE TO: BS0508 P Ibescai� ON OF WORK ADD NEW MASTER SUITE (2ND:FLR) + NEW MUSIC ROOM (1ST:FLR)NEH AMOUNT:IBATH & LAUNDRY. REMODEL EXISTING LIVING RM, FAMILY RM, KITCH JEN, DINING RM, 2 BEDRMS, 2 BATHRMS & ATTACHED 2 CAR GARAGE, 2,241.80 27.80 SPECIAL CONDITIONS: 11.00 26.80 2,637.40 218.80 JAPPROVALS DATE INSPECTOR SIGNATURE 101.40 5,265.00 ILOCATION AND SETBACKS SOILS ENGINEER APPROVAL (FOUNDATION TRENCH FORMS SLAB/UNDER FLOOR RAISED FLOOR FRAMING i/ UNDERFLOOR INSULATION �15T LEVEL FLOOR BREATH �) 2ND LEVEL FLOOR SHEATH (ROOF SHEATHING �/. FIRE DEPT. FRAME INS PECTI BLDG DEPT. FRAME INSPECTi SHEAR PANELS (INSULATION/WEATHER STRIP'• -,/`(6/ �l it INTERIOR LATH/DRYWALL ' EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL 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).): (_) I, as owner of the property, or my employees with wages as their sole compensation, will do (J) 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 prion to completion of the improvements covered by this permit, I cinnot 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: httq://www.leainfo.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 Classfo License No. 6 I 97 DateLHIR I Contractor Signature, -i 4<2 WORKERS' COMPENSATION DECLARATION jNARNING: 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 X 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 ❑ 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 ❑ 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. Signat r of Property er or Authorized Agent Date. COUNTY OF LOS •ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: JTR: 12977 LT: 14 1 ASSESSOR INFORMATION NUMBER: 5387-018-010 1 TENANT: OWNER: TEL. NO: JHAO, DAVID (626) 374-3777- 19180 BIDWELL ST TEMP 917802454 1 TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE (STRUCTURE: 715 2 V -B GARAGE: OTHER: # 0508 NEW OCCUP GROUP R-3 EXIST BLDG USE: USE ZONE: EXIST OCC GRP: IBLDGS. NOW ON LOT: VALUATION: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS I NO NO NO REPORT ID: DPR261 11,500 FEE DESCRIPTION: APPLICANT: TEL. NO: UOM: MICHAEL LIU/PMDC DEVELOPMENT (626) 641-8208- IB1 PLANCHECK W/ENERGY 2550 W MAIN ST #211 JAA BLDG PERMIT ISSUANCE JALHAMBRA CA 91801 VAL 1.00 JAB STATE GREEN BLDG FEE VAL 1.20 11500.00 JAC STRONG MOTION RESID 275.20 344.00 DOL JB2 PERMIT W/ENERGY CONTRACTOR: TEL. NO: JFR INV WORK W/O PERMIT ISKYWALK CONSTRUCTION INC. (626) 863-6323- 11317 N. LAS TUNAS DRIVE LIC. NO SAN GABRIEL, CA 91776 906987 ARCHITECT OR ENGINEER: TEL. NO: LAM, GARY (213) 928-7746- 12550 W MAIN STREET #211 LIC. NO: IALHAMBRA CA 91801 71544 MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 0 NO 21 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS I NO NO NO REPORT ID: DPR261 ROUTE TO: BS0508 BUILDING PERMIT RESIDENTIAL ADD BL 0508 1407210061 BUILDING ADDRESS: 9180 BIDWELL ST TEMP CA 917802454 NEAREST CROSS STREET: ENCINITA THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: 08/25/14 SR F NAL DATE FAL BY: CODE: Lktlf� C-l� DE'SCIZIPTION OF WORK REMODEL EXISTING 2ND: FLOOR REMOVE AND REPLACE WALLS, CEILING AND ROOF FRAMING SPECIAL CONDITIONS: APPROVALS 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 INSPECT BLDG DEPT. FRAME INSPECT SHEAR PANELS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL DATE INSPECTOR SIGNATURE 11,500 FEES PAID QUANTITY: UOM: AMOUNT: 11500.00 VAL 234.00 27.80 11500.00 VAL 1.00 11500.00 VAL 1.20 11500.00 VAL 275.20 344.00 DOL 344.00 TOTAL FEES 883.20 ROUTE TO: BS0508 BUILDING PERMIT RESIDENTIAL ADD BL 0508 1407210061 BUILDING ADDRESS: 9180 BIDWELL ST TEMP CA 917802454 NEAREST CROSS STREET: ENCINITA THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: 08/25/14 SR F NAL DATE FAL BY: CODE: Lktlf� C-l� DE'SCIZIPTION OF WORK REMODEL EXISTING 2ND: FLOOR REMOVE AND REPLACE WALLS, CEILING AND ROOF FRAMING SPECIAL CONDITIONS: APPROVALS 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 INSPECT BLDG DEPT. FRAME INSPECT SHEAR PANELS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL DATE INSPECTOR SIGNATURE 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 1, 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 intendedor 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 forthe projects with a licensed Contractor pursuant .to the Contractors' State License Law). U 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 c9nnot legally sdll 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: htto://www.lecinfo.ca.cov/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. I. JOB ADDRESS LOCALITY 6 � HAZARDOUS MATERIAL DECLARATION Will the applicant or future building occupant handle a hazardous -�ticense Class � License No. material or a mixture containing a hazardous material equal to or f / 7 greater than the amount specified on the hazardous materials �Date� Contractor Signature information guide? WORKERS'COMPENSATIO /IECLARATION Yes ❑ No ❑ 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. Pglicy No. ,+X_ 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 cars' om ensatio Ins a carter and policy/�}/)ma e:7// Carder Potic ExpirationnDaai 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 ith those provisions _)'V1� S�ureof (cant 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 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 under the Los Angeles County Code Title 2, Chapter 2,20' 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). Lenders 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 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. Signature of Property Owner or Authorized Agent \ Date 2-4144 1 ,COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: ITR: 12977 LT: 14 1 (ASSESSOR INFORMATION NUMBER: 15387-018-010 I (TENANT: I I I I (OWNER: TEL. NO: IHAO, DAVID (626) 374-3777- 19180 BIDWELL ST (TEMP 917802454 (APPLICANT: TEL. NO: IHAO, DAVID (626) 374-3777- 19180 BIDWELL ST (TEMPLE CITY CA 91780 (CONTRACTOR: TEL. NO: ISKYWALK CONSTRUCTION INC. (626) 863-6323- 11317 N. LAS TUNAS DRIVE LIC. NO ISAN GABRIEL, CA 91776 906987 (ARCHITECT OR ENGINEER: I TEL. NO: I ILAM, GARY (213) 928-7746- I 12550 W MAIN STREET #211 LIC. NO: I IALHAMBRA CA 91801 I 71544 I I I IMAP NO: SEWER MAP BOOK: PAGE: I FIRE ZONE: CMP:I 3 00 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I NO 21 I SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS I NO NO NO I TEMPLE CITY # 0508 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. FT STORIES TYPE (STRUCTURE: V -B EXIST BLDG USE: RESID USE ZONE: R-1 EXIST OCC GRP: BLDGS. NOW ON LOT: VALUATION: 800 FEE DESCRIPTION: AA BLDG PERMIT ISSUANCE AB STATE GREEN BLDG FEE AC STRONG MOTION RESID B1 PLANCHECK W/ENERGY B2 PERMIT W/ENERGY REPORT ID: DPR261 FEES PAID QUANTITY: UOM 800.00 VAL 800.00 VAL 800.00 VAL 800.00 VAL TOTAL FEES ROUTE TO: BS0508 AMOUNT: 27.80 1.00 0.50 155.20 74.05 258.55 JAPPROVALS 1 (LOCATION AND SETBACKS I ISOILS ENGINEER APPROVAL I (FOUNDATION/TRENCH FORMS I ISLAB/UNDER FLOOR I IRAISED FLOOR FRAMING (UNDERFLOOR INSULATION IFLOOR SHEATHING I � IROOF SHEATHING (SHEAR PANELS I IFRAME INSPECTION (FIRE SPRINKLER HANGERS IINSULATION/WEATHER STRIPI I I (INTERIOR LATH/DRYWALL I I (EXTERIOR LATH I I (RATED FLOOR/CEIL ASSEM. I I (RATED WALL ASSEMBLIES I i (RATED SHAFTS/OPENINGS I I i IT -BAR CEILINGS I i LOT DRAINAGE BUILDING PERMIT ALTERATION/REPAIR BL 0508 1411180046 BUILDING ADDRESS: 9180 BIDWELL ST TEMP CA 917802454 NEAREST CROSS STREET: ENCINITA I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI ISSUED ON: PROCESSED BY: I 11/18/14 SR 1 FI AL AFINBY: CODE: I I SCRIPTION OF WORK REPLACING EXISTING FIRST FLOOR WALL KITCHEN AND LIVING ROOM AND DINING ROOM i i SPECIAL CONDITIONS: I DATE INSPECTOR SIGNATURE 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).): (_) 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 Contragtor 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 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: httD://www.leoinfo.ca.00v/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 License No. Date 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 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 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 ❑ 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 ❑ 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 ❑ 1 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