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Home My Public Portal About9523 BLACKLEY ST_BUILDING_6/23/2014_COUNTY OF LOS 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: BUILDING PERMIT ALTERATION/REPAIR BL 0508 1406230001 LEGAL ID: NO. OF CONST BUILDING ADDRESS: 17190 LT: 9 SQ. FT STORIES TYPE I 9523 SLACKLEY ST ITR: STRUCTURE: 21 V -B TEMP CA 917803143 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY 18590-005-011 I ' THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CA JEXIST BLDG USE: REBID USE ZONE: R-1 ON: PROCESSED BY: (TENANT: JEKIST OCC GRP: (ISSUED 06/23/14 SR OWNER: TEL. NO: SLOGS. NOW ON LOT: VALUATION:�F ATE FINAL H CODE: HOFELING LAWRENCE L;MARJORIE J 1 (626) 285-7693- 2,730 /� 9523 BLACKLEY STC TEMP 917803143 FEES PAID IDESC IPTION OF WORK NEAR OFF EXISTING ROOF INSTALL O.C. TRU DEF SHINGLES, NO I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:JSHEATING APPLICANT: TEL. NO: DIAZ, JOSE A (818) 760-0070- IAA BLDG PERMIT ISSUANCE 27.80 6005 VINELAND AVE IAB STATE GREEN BLDG FEE 2730.00 VAL 1.00 ISPECIAL CONDITIONS: N HOLLYWOOD CA 91606 IAC STRONG MOTION REBID 2730.00 VAL 0.50 ID2 PERMIT W/O EN -HC 2730.00 VAL 99.00 I TOTAL FEES 128.30 (CONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE IJAD ROOFS INC (818) 760-0070- 1 16005 VINELAND AVENUE #205 LIC. NO I ILOCATION AND SETBACKS INORTH HOLLYWOOD CA 91606 852824 SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS ILIC. N0: SLAB/UNDER FLOOR IRAISED FLOOR FRAMING NO: SEWER MAP BOOR: PAGE: FIRE ZONE: CMP:( INSULATION (MAP - 3 OOI (UNDERFLOOR FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: (ROOF SHEATHING 1 NO 21 1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS 1AIR QUALITY: 1000 FEET MATERIALS I I NO NO NO I (FRAME INSPECTION I IFIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIP (INTERIOR LATH/DRYWALL I I 6XTEAIOR LATH I (RATED FLOOR/CEIL ASSEM. (RATED WALL ASSEMBLIES (RATED SHAFTS/OPENINGS IT -BAR CEILINGS iI ILOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BSO508 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 1, as owner of the property, or my employees with wages as their sole compensation, will do (-/)ail 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 Contm or 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 which I must have resided for at least one year priorlto completion, of the improvements covered by this permit, I cEinnot 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: hfti)://www.leqinfo.ca.aovlcalaw.html. Dale: 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 Class ,`C-5 I License No. Z Date 'd-3WContractor Signature - WORKERS' COMPENSATI ON W4i�NING: FAILURE TO SECURE WORKERS' OMPENSATION 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 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. X 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 work rs'mpe .on in ra Fs center d licy�mbe rare'. Carrier Policy u er 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 California, and agree that, if I should become subject to the workers' compensationrovisions of Section 3700 of the Labor Code, I sha1hIe5§WMrcoqi'PIy with those provisions Date —ZOBRWSM1 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 ❑ 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 220' Sections 220.100 through 220.140 conceming hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to AQMO 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 s unty to enter the above -identified prope Insp ' n purposes. Signature of Property 9lpvnergl9btl16rized Agent