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Home My Public Portal AboutOAK AVE___ (7)COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MECHANICAL PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ME 0508 1606070007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: L .. 17200 IT; 26 88-013-032 UWNGH: TEL. NO: TOVOSLAN, ANA (626) 475-9099- 9932 LIVE OAK AV TEMP 917802613 APPLICANT: TEL. NO: VILLANUEVA, CARLOS (562) 577-8447- 2460 OCEANVIEW DR UPLAND CA 91784 CONTRACTOR: TEL. NO: VILLANUEVA CONSTRUCTION AND HOME (562) 577-8447- 2460 OCEANVIEW DRIVE LIC. NO UPLAND CA 91784 820124 OR ENGINEER: TEL. NO: LIC. NO: EXPIRED PERMIT EXPIRES 180 DAYS IF �•31 ' 1) WORK DOES NOT COMMENCE, OR 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION FEE DESCRIPTION 01 PERMIT ISSUANCE FEE 02 REFRIG COMP < 100 RB 08 FURNACE/HEATER < 100 30 AIR INLETS/OUTLETS REPORT ID: DPR264 QUANTITY: DOM: AMOUNT: 34.40 1.00 COM 33.70 1.00 UNI 33.70 7.00 IN/ 37.10 TOTAL FEES 138.90 ROUTE TO: SS0508 BUILVINU AUUHESN: 9932 LIVE OAK AV TEMP CA 917802613 NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CA ISSUED ON: PROCESSED BY: PLAN BY: 06/07/16 SR FINAL DATE FINAL BY: CODE: DESCRIPTION OF WORK HVAC REPLACEMENT, HEATING 6 AIR AND DUCTS SPECIAL COND runingn 1-31-17 APPROVALS DATE INSPECTOR SIGNATURE FAU/WALL FURNACE COMBUSTION AIR OPENINGS DUCT WORK AC/COMPRESSOR THERMOSTAT FIRE DAMPERS SNORE DETECTION DEVICES COMMERCIAL HOOD 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 (_) 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). II L,) 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 completioq of the improvements covered by this permit, I cannot legally still a structure that I have built as an owner -builder {f 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/ralaw.htmi. Date:� Signa hof pertyGwn orAuthorized 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 License Class g C2 d License No. O-01 Date 7//l 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' oompensafion insurance carrier and policy number are: Cartier Policy Number Expiration Date Name of Agent Phone Number I certify that, in the performance of the work for which this eit ris 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 1 should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forth%with y e provisions 7 (o Sidpature 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 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 ❑ 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. Signature of Property wr0e thonzed Agent ate