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Home My Public Portal About5600 GRACEWOOD AVE_Building_5/13/2015_COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: BK: 94 PG: 46 PC: 1 ASSESSOR INFORMATION NUMBER: 8586-015-038 TENANT: T -MOBILE WEST CORP. OWNER: c TEL- NO: SANTA ANITA CONVELESCENT HOME, BUST (626) 579-0310- 5522 GRACEWOOD AVE. TEMPLE CITY CA 91780 APPLICANT: CROWN CASTLE, TINA LE BLANC 38 TECHNOLOGY DRIVE IRVINE CA 92618 CONTRACTOR: ALAMON TELCO INC. 315 WEST IDAHO KALISPELL, MT 59901 TEL. NO: (949) 885-8819 TEL. NO: (406) 752 -8838 - LIC. NO 652774 ARCHITECT OR ENGINEER: TEL. NO: NATIONAL ENGINEERGIN AND CONSULTING (949) 716-9997- 27 ORCHARD LIC. NO: LAKE FOREST CA 92630 NONE NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 3 00 OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: 0 NO 20 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO THIS PERMIT EXPIRES 6 MONTHS FROM DATE OF ISSUANCE OR FROM DATE OF LAST VALID INSPECTION. TEMPLE CITY 9701 LAS TUNAS TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: NO. OF CONST SQ. PT STORIES TYPE STRUCTURE: 0 1 V -B 1 GARAGE: 1 OTHER: (EXIST BLDG USE: HEALT 1EXIST OCC GRP: R-3 BLDGS. NOW ON LOT: # 0508 BUILDING PERMIT BL 0508 1504020084 NEW I BUILDING ADDRESS: OCCUP GROUPI 5600 GRACEWOOD AV R-3 TEMP CA 917800000 NEAREST CROSS STREET: HOGUE STREET THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, C ISSUED ON: PROCESSED BY: 105/13/15 SR VALUATION: FINAL DATE FINAL BY: CODE: 0 20,000 FEES PAID DESCRIPTION: QUANTITY: UOM PLANCHECK W/O EN -HC 20000.00 VAL BLDG PERMIT ISSUANCE STATE GREEN BLDG FEE 20000.00 VAL PERMIT W/O EN -HC 20000.00 VAL TOTAL FEES REPORT ID: DPR261 ROUTE TO: BS0508 71Sjr// S RI?OF WORK — 1 14 11NSTALL (3) NEW PANEL ANTENNAS. INSTALL (3) NEW RRUS PAINT AMOUNT:ITO MATCH 326.90 27.80 1.00 384.60 740.30 CONDITIONS: LOCATION AND SETBACKS 1 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 T -BAR CEILINGS LOT DRAINAGE DATE INSPECTOR SIGNATURE 1RATEI 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 (-v) 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 properly, 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 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 prior) to completion; of the improvements covered by this permit, I cq'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: hfD://www.leainfo.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. /I License Class C— '11 a License No. Date. -1 - l5 Contractor Signatur - ,0-01-- 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. Polic o. 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 nd olicy number are: 5 c`r� a_-- /2 -3 1— rs rrier, Policy Numbe Expiration Date f -C Name of Ag6nt 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 ther ith through the application process. Applicant (Print Nam�/ Applicant Si nature '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 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 X20' 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, 1 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 S-113 -- /S