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Home My Public Portal About9250 LOWER AZUSA RD_BUILDING_4/1/2015_COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1503190040. PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1 ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 9250 LOWER AZUSA RD (STRUCTURE: 490 1 V -B U I GARAGE: I TEMP CA 91780 NEAREST CROSS STREET: TEMPLE CITY ASSESSORINFORMATION NUMBER: 8592-016-010 I OTHER: THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY CAI USE ZONE: R-2 TISSUED ON: PROCESSED BY: (TENANT: 1 104/01/15 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION; IF TE F BY CODE: 1 THE OLSON COMPANY 13010 OLD RANCH PRWY (5621 682-7422- I 10,000 1 l f ! (o BEACH CA 90740 FEES PAID JDESCRfPTIOS OF WORK ISEAL TCONSTRUCT SHADE STRUCTURE FOR THE PARK AREA I_- (FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:T (APPLICANT: TEL. N0: IBORLAND, CHRIS (562) 6BZ-7422- IAA BLDG PERMIT ISSUANCE 27.80 13010 OLD RANCH PRWY IAB STATE GREEN BLDG FEE 10000.00 VAL 1.00 1 SPECIAL CONDITIONS: ISEACH BEACH CA 90740 IDI PLANCHECK W/O EN -HC 10000.00 VAL 184.10 1 ID2 PERMIT W/O EN -HC 10000.00 VAL 216.60 TOTAL FEES 429.50 //��77 // .` P (/ k,5 / I N (APPROVALS D TE INSPECTOR SIGNATURE ICONTRACTOR: TEL NO: IOLSON URBAN HOUSING L P (562) 596-4770- 3010 OLD RANCH PARKWAY STE 100 LIC. NO t P��r�t,]O 1J�4_ '�� (LOCATION AND SETBACKS SEAL BEACH CA 90740 939166 v t (SOILS I I- PL �Sor�ioo�fi� I ENGINEER APPROVAL (FOUNDATION/TRENCH FORMS �- (ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: I SLAB/UNDER FLOOR 1 - RAISED FLOOR FRAMING (UNDERFLOOR INSULATION I i IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( I 3 001 1 1 I I 11ST LEVEL FLOOR SHEATH IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 0 NO 07 1 12ND LEVEL FLOOR SHEATH ROOF SHEATHING SCHOOL WITHIN HAZARDOUS QUALITY: 1000 FEET MATERIALS 1 (AIR NO NO NO I 1 (FIRE DEPT. FRAME INSPECT( 1BLDG DEPT. FRAME INSPECT ISHEAR PANELS I I I (INSOLATION/WEATHER STRIP NTERIOR LATH/DRYWALL I 1EXTERIOR LATH 1LOT DRAINAGE 1SMOKE DETECTION DEVICES I T (FIRE I DEPARTMENT APPROVAL( I I I REPORT ID: DPR261 ROUTE TO: BS0508 OWNER -BUILDER DECLARATION by affirm under penalty of perjury that I am exempt from mtractors' State License Law for the reason(s) indicated by the checkmark(s) I have placed next to the applicable (Section 7031.5, Business and Professions Code): Any county that requires a permit to construct, alter, improve, ish, or repair any structure, prior to its issuance, also as the applicant for the permit to file a signed statement e or she is licensed pursuant to the provisions of the rctors' State License Law (Chapter 9 (commencing with n 7000) of Division 3 of the Business and Professions or that he or she is exempt from licensure and the basis r alleged exemption. Any violation of Section 7031.5 by pplicant for a permit subjects the applicant to a civil V of not more than five hundred dollars ($500).): is owner of the property, or my employees with wages as ole compensation, will do (./)all of or (_) portions of the and the structure is not intended or offered for sale in 7044, Business and Professions Code: The ictors' State License Law does not apply to an owner of ty who, through employees' or personal effort, builds or ,as the property, provided that the improvements are not ed or offered for sale. If, however, the building or ement is sold within one year of completion, the Owner - r will have the burden of proving that it was not built or ,ad for the purpose of sale.). is owner of the property, am exclusively contracting with id Contractors to construct the project (Section 7044, :ss and Professions Code: The Contractors' State License oes not apply to an owner of property who builds or ,as thereon, and who contracts for the projects with a :d Contr9�tor pursuant to the Contractors' State License m exempt from licensure under the Contractors' State ,e Law for the following reason: signature below I acknowledge that, except for my ial residence in which I must have resided for at least ear priorlto completiony of the improvements covered by reit, I cannot legally sell a structure that I have built as an builder if it has not been constructed in its entirety by rd contractors. I understand that a copy of the applicable action 7044 of the Business and Professions Code, is ole upon request when this application is submitted or at owing Web site: htto:/Iwww.leginfo.ca.gov/calaw.html. ure 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. qq License Class U License No. 97y ko ate 14-1-1% Contractor Signature WORKERS' COMPENSATION DECLARATION WAF NTNG: 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 insu ncece �eVpo licy gunper are: Carrier r 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 ubject "a workers' compensation laws of California,a e , if should become subject to the workers' mp as ' pro ' ions of Section 3700 of the Labor Code shall rth h cc ly with those provisions Signature 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 ❑ 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 forguidelines. 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 120' 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 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-identifie rty for 1 ction purposes. Signatu of P rty or Aujboriza8 went