HomeMy Public PortalAbout6042 PRIMROSE_Building_2/24/2016_.,+
COUNTY OF LOSS ANGELES
DEPARTMENT OF PUBLIC WORKS'
BUILDING AND SAFETY / LAND DEVELOPMENT
TEMPLE CITY # 0508
9701 LAS TUNAS
TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
604A PRwR05E
BUILDING PERMIT
NEW RESIDENTIAL
BL 0508 1508170100
duui+ A)
LEGAL ID:
NO.
OF CONST
NEW
1 BUILDING ADDRESS:
ITR: 6551 LT: 261
UN: .002
SQ. FT STORIES TYPE
OCCUP GROUP
6042 PRIMROSE AV UNIT A
STRUCTURE: 2874
GARAGE: 406
2 V -B
1 V -B
R-3
U
TEMP CA 917802033
NEAREST CROSS STREET:
ASSESSOR INFORMATION NUMBER:
15385-013-020
OTHER: 108
1 V -B
U
1 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY CAI
]TENANT:
USE
ZONE: R-2
JISSUED ON: PROCESSED BY:
102/24/16 SR
OWNER:
ITIEN NHIEU LUONG;YAU JIE JUE
TEL. NO:
SLUGS. NOW ON LOT:
VALUATION:FINALkTE
412,310
FW CODE:
16042 PRIMROSE AV
5 77
TEMP 917802033
FEES PAID
JDESCR P IONF� WORK
INEW 2 -STORY SFD: 4 BEDROOMS, 3.5 BATHROOMS WITH ATTACHED 2
FEE DESCRIPTION:
QUANTITY: DOM:
AMOUNT:ICAR
GARAGE, COVERED PATIO, PORCH (1) 84 BE. PORCH (2) 73 SF.1
AND BALCONY 117 BE.
APPLICANT: TEL. NO:
BUI, RICHARD
(626) 548-9719-
B1 PLANCHECK W/ENERGY
412310.00 VAL
3,136.50
1
113812 GOLDEN WEST ST
IAA BLDG PERMIT ISSUANCE
34.40
1SPECIAL CONDITIONS:
WESTMINISTER 92683
IAB STATE GREEN BLDG FEE
412310.00 VAL
17.00
IFIRE SPRINKLERS REQUIRED
1
IAC STRONG MOTION REBID
412310.00 VAL
53.60
1
JB2 PERMIT W/ENERGY
108 CERTIF OF OCCUPANCY
1
412310.00 VAL
TOTAL FEES
4,621.30
125.80
7,988.60
(CONTRACTOR: TEL. NO:
IAV CONSTRUCTION CO. (626) 548-9719-
(APPROVALS DATE INSPE OR SIGNATURE
1 1
113812 GOLDEN WEST STREET #200
LIC. NO
ILOCATION AND SETBACKS
1
IWESTMINISTER CA 92683
746394
]SOILS ENGINEER APPROVAL
IFOUNDATION/TRENCH FORMS
ARCHITECT OR ENGINEER: TEL. NO:
]TMC ENGINEERS
(714) 829-5053-
1
19542 PACIFIC
LIC. NO:
]SLAB/UNDER FLOOR
(ANAHEIM CA 92804
72324
1
151 1
1
IRAISED FLOOR FRAMING
1
I I
]MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1
]UNDERFLOOR INSULATION
3 021
1
I
11ST LEVEL FLOOR SHEATH
2ND LEVEL FLOOR SHEATH
ROOF SHEATHING
]
]
IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
1 2 YES 02A ]
SCHOOL WITHIN HAZARDOUS 1
(AIR QUALITY: 1000 FEET
MATERIALS
1 NO NO
NO 1
'''•••
FIRE DEFT. FRAME INSPECTI�
(BLDG DEPT. FRAME INSPECT(``!'{'
I I
1
]SHEAR
PANELS
]INSULATION/WEATHER
STRIP(
_
NTERIOR LATH/DRYWALL
N (O
]EXTERIOR
LATH 1
ILOT
DRAINAGE
I
1
PERMIT EXPIRES 180 DAYS IF
1) WORK DOES NOT COMMENCE, OR
]SMOKE
DETECTION DEVICES
I
2) WORK IS SUSPENDED OR ABANDONED,
OR
4.
3) FAILS TO OBTAIN CODE REQUIRED INSPECTION
FIRE DEPARTMENT APPROVAL
(�A
`°�•`� ' ��
]REPORT
ID: DPR261
ROUTE TO: BS0508
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from
the Contractors' State License Law for the mason(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 Contmctor 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 whicf I must have resided for at least
one year pnorl to completions of the improvements covered by
this permit, I gnnot 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: hftp://www.leginfo.ca.gov/calaw.htmi.
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
lassy License No.
Dafe��l ntractor Signature
WO ERS' COMPENSATION DE
WAi'3NING: 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:
Cartier 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' mpensation poi of Section 3700 of the Labor
Code, I s II rth ly with those provisions
r
Signat o pli ant '
( \I ABBYIST 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
JOB ADDRFSS
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 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-ident' ed property for i9gpection purposes.
Signature of gr#per#Ja*fiiW9(Authorized Agent
Company Name Date Date V