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Home My Public Portal About4911 PERSIMMON AVE_Building_4/25/2016_COUNTY OF IAS ANGELES TEMPLE CITY p 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1604200068 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: 1 ITR: 4902 LT: 29 BL: F ON: .002 I SQ. FT STORIES TYPE OCCUP GROUPI 4911 PERSIMMON AV I (STRUCTURE: 274 1 V -B R-3 TEMP CA 917804105 1 (ASSESSOR INFORMATION NUMEER: GARAGE: I NEAREST CROSS STREET: 8574-025-023 I OTHER: I THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI TENANT° EXIST BLDG USE: USE ZONE: (EXIST TISSUED ON: PROCESSED BY: i OCC GRP: 104/25/16 SR I0 ER TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: JOANNTHI TRAM 40,620 1 I 14911 14911 PERSIMMON AV I ITEMP 917804105 I FEES PAID IDESCRIPTION OF WORK I ADD NEW BMD (FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: (APPLICANT: TEL. NO: ISAME AS OWNER JB1 PLANCHECK W/ENERGY 40620.00 VAL 790.60 ( r S ' I JAA BLDG PERMIT ISSUANCE 34.40 (SPECIAL CONDITIONS: 1 JAB STATE GREEN BLDG FEE 40620.00 VAL 2.00 1 JAC STRONG MOTION REBID 40620.00 VAL 5.30 I IB2 PERMIT W/ENERGY 40620.00 VAL 930.10 J (CONTRACTOR: TEL. NO: 108 CERTIF OF OCCUPANCY 125.80 [APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I TOTAL FEES 1,888.20 1 I LIC. NO I ILOCATTON ANO RP.TBACKR II eu 1. lbeiOx ENUINEER: TEL. NO: VINCENT DINH (949) 232-8273- 244 E 21ST STREET LIC. NO: COSTA MESA CA 92627 NONE MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP - 3 00 0 NO 21 SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS NO NO NO EXPIRED SLAB/UNDER FLOOR (UNDERFLOOR INSULATION I I I I I T15T LEVEL FLOOR SHEATH I 12ND LEVEL FLOOR SHEATH 1 1 1 I (ROOF SHEATHING J I IFIRE DEPT. FRAME INSPECTI I I IBLDG DEPT. FRAME INSPECT I ISHEAR PANELS INTERIOR LATH EXTERIOR LATH PERMIT EXPIRES 180 DAYS IF i I i 1) WORK DOES NOT COMMENCE, OR I 1SMOKE DETECTION DEVICES 2) WORK IS SUSPENDED OR ABANDONED, OR 3) FAILS TO OBTAIN CODE REQUIRED INSPECTION (FIRE DEPARTMENT APPROVAL( ID: DPR261 ROUTE TO: SS0508 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 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 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 completior�qq of the improvements covered by this permit, I cannot legally sdll 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.lecinfo.ca.Dov/calaw.html. Date: ,r S�nature of �rj ysyrerrop rodzed 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. Date Contractor 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 carder 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 permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Celifomia, nd agree that, if I should become subject to the workersssrr; �pensation provisions of Section 3700 of the Labor Code, I aha I forOlWl'th cQm�lyWdh Nose provision �lll/ �(J�'IhAVAI j fI ll/1J, w )l ? Signature of Applicant Date LOBBYIST RD�ERTIFICATION 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 perk 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 pemitting checklist, I understand my requirements under the Los Angeles County Code Title 2, Chapter $,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 perk 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. 1 authorize representatives of this county to enter the abov , citified ppopedy-for inspection purposes. Sign I ture of ad Agent Date