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Home My Public Portal About6036 GOLDEN WEST AVE_BUILDING__ (2)TEMPLE CITY PERMIT NO. B17-33970 7 City of Temple City 1 9701 Las Tunas Drive I Temple City, California 91780 1 (626) 285-2171 1 www.templecity.us Address: 60*Golden West Avenue, Temple City, California 91780 Parcel: 5385-027-031 Permh:No: 817-33970 Type: Building Subtype: AR Alteration Repair Description: REMOVE TILE, INSTALL NEW FELT AND INSTALL TILE BACK Special HOUSE AND GARAGE ATTACHED Conditions: Issue Date: 04-11-2017 Expire Date: 10-08-2017 Extension: Extension: Permit expires on date shown 8: 1) work does not commence, or 2) work is suspended or abandoned, or 3) applicant fails to obtain code required inspection. - Contacts Owner Nancy Wu 6030 Golden West Avenue, Temple City, California 91780 Applicant Juan Telleda 12387 Clinton Street, EI Monte, California 91732 (626) 922-2234 Contractor Ato Jack Roofing 12387 Clinton Street, EI Monte, California 91732 (626) 922-2234 816608 Buildinq Details Structure 1: Residential 2: 3: 4: Construction Type: V -B Occupancy Group: R-3 Residential, one -and two-family New/Added Area: 0 0 0 0 Remociel/13 Area: 2000 0 0 0 New Dwelling Units: 0 0 0 0 Stories: 0 0 0 0 Fees _Total Valuation $7500.00 Strong Motion Fee $0.97 Approval Date Location/Setbacks _ Soils Engineer Foundation Forms Slab/Under Floor Raised Floor Framing Underfloor Insulation 1st Floor Sheathing 2nd Floor Sheathing Plan Check Fees $197.41 ParmR Fees $232.24 SB 1473 Fee $1,00 Parks Dev Fee $0.00 Sewer Const Fee $0.00 Inspoctor Approval Date, Root Sheathing Fire Dept Framing Bldg Dept Framing Shear Panels Sprinkler Hangars Insulation/Weather Strip Interior Lath/Drywall Exterior Lath Approval Date Rated Floor/Ceiling Rated Walls Rated _ Shafts T -Bar _ Ceilings Lot _ Drainage Smoke Detectors Fire Dept Approval FINAL Z Inspector 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 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 Contra or pursuant to the Contractors' State License Law). L) I am exempt from licensure under the Contractors' State License Law for the following reason: i By my signature below I acknowledge that, except for my personal residence In which I must have resided for at least one year priorl to completloq of the improvements covered by this permit, Icannot 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: htto://www.leginfo.ca.ciov/ralaw.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. -7-License Class c; 3g License Ng�o. 'i -Date tt tl t� Contractor Signaturz WORKERS' COMPENSATION WARNING: FAILURE TO SECURE WOR: R 'COMPENSATION COVERAGE IS UNLAWFUL, AND L SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES CI 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 ATTORNEYS 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 insuran uired by Section 3700 of the Labor Code, for th perfo ce o e work for which this permit is issued. My e 'corn nsatioq InslGgin ca 'rand policy number l Cartier c� 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 note emcp in any manner so as to become sub' the workers' mpensation laws of California, and ag that, if I should come subject to the orkers' comp ation provision ection 3700 of the Labor those provisions C, l i at f pplicant Date L BYIST 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 ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will th pplicent or future building occupant handle a hazardous mate or a mixture containing a hazardous material equal to or er 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 ❑ Ko ❑ % 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 owners behalf. I have read this application and the information 1 have provided is correct. I agree to comply with all applicable city and ordinances and state laws relating to uilding construction. I authorize representativeq'Of this county o enter the Signature of Pro�Owner orRutl)orized f gent I Company Name Date 1n uate 'C rt