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walaja4l ldwaxa s! a4s Jo aq IBM JO (apoO suo!ssalad pue ssauisng eqj to g uoisini(] 10 (OOOL uopoaS glim 6ulouawwoo) 6 aalde4O) men asuaolq sioloeiluoo eql to suoislnad eql of luensind pasuaoil sl aqs jo aq legl luawalels poubis a all of l!wjad eons aol lueoildde a4l saiinbei osle 'e enssi sll of joud 'einlonils Aue iiedej jo 'gsllowep 'anoadwi Salle 'lonulsuoo of 1lwied a saainbai 4o!gm Alunoo jo Apo Auy WOO suolssalad pue ssauisng 'g fEOL'oaS) uose916u1mopol 941 col men asuaolq saoloealuoO eqj wag ldwaxa we 1 1e41 AinGad to Alleuad aapun willle Agejeq I NOIIVU d1O3O a3Oling-a3NM0 �a� 6i ea o �rZ. 2� oN oiq sselO asuaolq goalie pue aojol pnl ul sl asuaoll Aw pue 'apoO suolssalad pue ssauisng a(4l to 6 uolSIAla 10 (OOOL uolloas gIlm 6ulouawwoo) 6 jaldeyO to suolsinad Aepun pasuaoil we 1 legl A.inbad to Alleuad japun while Agajay I NOIIVH d1O3O S.H01Oyd1N0O CIRSN3011 COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LA PUENTE 16005 CENTRAL AVENUE LA PUENTE CA PHONE: (818) 961-9611 EXT: LtUAL IV: NU. UY LvNz) TR: 51986 SQ. FT STORIES TYPE ASSESSOR INFORMATION NUMBER: STRUCTURE:. 0 0 VN TENANT: EXIST BLDG USE. R EXIST OCC GRP: R3 LEGACY HOMES AT DIAMOND CANYON LLC (814) 449-8100- 140 S LAKE AVE #308 PASADENA CA 91101 APPLICANT: TEL. NO: CROSBY MEAD BENTON AND ASSOCIATES (818) 343-5384- F7/ 5 BALBOA BLVD, SU ]NO CA 91007 l vly I RAI. I vR. I CL. lyv. PROVINCE REALITY ASSOCIATES INC (818) 449-8100- 140 S. LAKE AVENUE STE 308 LIC. NO PASADENA, CA 91101 723247 B LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 099H329 NONE 0 4 01 NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: 0 NO 19 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO # 0200 OCCUP GROUP R3 ULU65. NUW ON LUI: VALUATION: 0 15,770 FEES PAID BUILDING PERMIT NEW COMMERCIAL BL 0200 9601230021 DUPLICATE DUILUIIW7 AUUKCJJ: 0 51986 LCNT CA NEAREST CROSS STREET: BREA CANYON THOMAS PAGE: GRID: LOCALITY: ROWLAND HTS ISSUED ON: PROCESSED BY: EXPIRES ON: 09/27/96 FM 01/22/97 FINAL DATE FINAL BY: CODE: I lvly yr Wvmr, NG WALL #2A 85 FT LONG & AVERAGE 3 FT HIGH FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ACROSS FROM 28 & 29 D1 PLANCHECK W/0 EN-HC 1370.00 VAL 53.80 AA BLDG PERMIT ISSUANCE 18.50 ` SPECIAL CONDITIONS: AC STRONG MOTION RESID 3710.00 VAL 0.50 D1 D2 AC D1 D2 PLANCHECK W/O EN-HC PERMIT W/O EN-HC STRONG MOTION RESID PLANCHECK W/O EN-HC PERMIT:W/O EN-HC 3710.00 3710.00 15770.00 15770.00 15770.00 TOTAL FEES VAL VAL VAL VAL VAL 11.99 77.40 1.08 115.26 135.60 414.13 > APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL FOUNDATION TRENCH FORMS SLAB UNDER FLOOR RAISED FLOOR FRAMING REPORT ID: DPR261 UNDERFLOOR INSULATION FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH DRYWALL EXTERIOR LATH RATED FLOOR CELL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS LOT DRAINAGE ROUTE TO: BS0200 LICENStS 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 Lic. No. Contractor's AfTaKre Date OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).): ❑ 1 am exempt under Sec. , BA P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ❑ I as owner of the property, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such 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 he or she did not build or improve for the purpose of sale.). [ All Other Permits ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such 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 he or she did not build or improve for the purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (See. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Carrier �5�?� Policy Number�— ❑ 1 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 worker's compensation laws of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Applicant Signature Date WARNING: FAILURE TO SECURE WORKER'S 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. LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in 1 unincorporated Los Angeles County only J This is to certify that I, as permit applicant, am familiarwith the requirements of Los Angeles County Code Chapter 2.160 et 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 Owner Signature Date Company Name (if employed by an entity/agency) 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 for guidelines. Yes ❑ No ❑ have read the hazardous materials information guide and the SCAQMD. permitting checklist, I understand my requirements underthe Los Ang( County Code Title 2, Chapter 220 Sections 220.100 through 220.1 concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAQMD or EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec. 3097, Civ.C.). Lender's Lender's Address "°q? I certify that I have read this application and state under the penalty of perjury that the above information is correct. I agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above -mentioned proper or inspectio oses. Applicant or Agent Signature Date COUNTY OF LOS ANGELES LA PUENTE # 0200 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 16005 CENTRAL AVENUE BUILDING AND SAFETY / LAND DEVELOPMENT LA PUENTE CA BL 0200 9601230020 PHONE: (818) 961-9611 EXT: LEGAL ID: TR: 51986 ASSESSOR INFORMATION NUMBER: LEGACY HOMES AT DIAMOND CANYON LLC (818) 449-8100- 140 S LAKE AVE #308 PASADENA CA 91101 -`''�BY MEAD BENTON AND ASSOCIATES (818) 343-5384- BALBOA BLVD, SU (NO CA 91007 CONTRACTOR: TEL. NO: PROVINCE REALITY ASSOCIATES INC (818) 449-8100- 140 S. LAKE AVENUE STE 306 LIC. NO PASADENA, CA 91101 723247 B ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: C 099H329 NONE 0 4 NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLAS 0 NO 19 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO NO. OF CONSI NEW SQ. FT STORIES TYPE OCCUP GROUP STRUCTURE: 0 0 I R3 EXIST BLDG USE: RESID EXIST OCC GRP: M2 BLDGS.- NOW ON LOT: VALUATION: 0 12,840 FEES PAID FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: D1 PLANCHECK W 0 EN-HC 10980.00 VAL 130.72 AA BLDG PERMIT SSUANCE 18.50 AE STRONG MOTION OTHER: 12840.00 VAL 2.70 D1 PLANCHECK W/0 EN-HC 12840.00 VAL 21.51 D2 PERMIT; W/O ENN-HC 12840.00 VAL 179.10 352.53 4 r F 1 e5 rs REPORT ID: DPR261 ROUTE TO: BS0200 NEAREST CROSS STREET: BREA CANYON THOMAS PAGE: GRID: LOCALITY: ROWLAND HTS ISSUED ON: PROCESSED BY: EXPIRES ON: 07/16/96 FM 01/22/97 FINAL DATE,/, F A Y; CODE: �A.- DESCRIPTION OF WORK RETAINING WALL #3 150 FT LONG & AVERAGE 6 FT HIGH i {1rcL L`". SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE FLOOR SHEATHING INTERIOR LATH DRYWALL EXTERIOR LATH RATED FLOOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS LOT DRAINAGE LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapters (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class — Lic. No. 7 Z >an`� ractor'sractor's Signatu ate OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).): ❑ I am exempt under Sec. , B.& P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ] ❑ I, as owner of the property, will do the work, and the structure is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not applyto an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one yearof completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such 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 he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Carrier al'/i• /e��^—!�� Policy Number 1 :� —' ❑ 1 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 worker's compensation laws of California, and agree that if I should become subject to the worker's compensat' n provisions of Section 3700 of he Labor Co I shall f omply with those provisiogs. scant Signature Date WARNING: FAILURE TO SECURE WORKER'S COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), 1N ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LOBBYIST ORDINANCE CERTIFICATION Complete this section for permits in unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiarwith 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 Owner Signature Date Company Name (if employed by an entity/agency) 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 for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAC permitting checklist, I understand my requirements under the Los Ang County Code Title 2, Chapter 220 Sections 220.100 through 220. concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAQMD or EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec. 3097, Civ.C.). Lender's Name Lender's Address �41q? l certify that l have read this application and state under the penalty of perjury that the above information is correct. l agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above -mentioned property for insguct6c�p®ptlrposes. COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LEGAL ID: TR: 51986 TENANT: OWNER: TEL. NO: LEGACY HOMES AT DIAMOND CANYON LLC (818) 449-8100- 140 S LAKE AVE #308 PASADENA CA 91101 APPLICANT: TEL. NO: -"'BY MEAD BENTON AND ASSOCIATES (818) 343-5384- i'BALBOA BLVD, SU iNO CA 91007 CONTRACTOR: TEL. NO: PROVINCE REALITY ASSOCIATES INC (818) 449-8100- 140 S. LAKE AVENUE STE 306 LIC. NO PASADENA, CA 91101 723247 B LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 0994329 NONE 0 4 01 NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: 0 NO 19 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO LA PUENTE # 0200 16005 CENTRAL AVENUE LA PUENTE CA PHONE: (818) 961-9611 EXT: Nu. Vr LUNS SQ. FT STORIES TYPE STRUCTURE: 0 0 VN BUILDING PERMIT AL BL 0200 9601230022 NtW IbUILVINb AUVKt55: OCCUP GROUP R3 NEAREST CROSS STREET: BREA CANYON ITHOMAS PAGE: GRID: LOCALITY: ROWLAND HTS EXIST BLDG USE: RESID EXIST OCC GRP: R3 BLDGS. NOW ON LOT: VALUATION: 0 12,790 FEES PAID FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: D1 PLANCHECK W/O EN-HC 6340.00 VAL 94.35 AA BLDG PERMIT ISSUANCE 18.50 AE STRONG MOTION: OTHER 12790.00 VAL 2.69 D1 PLANCHECK W/O EN-HC. 12790.00 VAL 57.88 D2 PERMIT W/O EN-HC 12790.00 VAL 179.10 TOTAL FEES 352.52 ISSUED ON: PROCESSED BY: EXPIRES ON: 07/16/96 FM 01/22/97 FINAL DATE FINAL BYE CODE;coo DESCRIPTION OF WORK RETAINING WALL #4 120 FT LONG & AVERAGE 4 FT HIGH SPECIAL CONDITIONS; APPROVALS DATE INSPECTOR SIGNATURE SOILS ENGINEER APPROVAL FLOOR SHEATHING ROOF SHEATHING SHEAR PANELS FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION WEATHER STRIP INTERIOR LATH DRYWALL EXTERIOR LATH RATED FLOOR CEIL ASSEM. (REPORT ID: DPR261 ROUTE TO: BS0200 (LOT DRAINAGE LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penaltyof perjurythat I am licensed underprovisions 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 % Lic. No. 7 o roc s Sign Date OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).): ❑ 1 am exempt under Sec. , BA P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ] ❑ I, as owner of the property, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such 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 he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ [,as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such 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 he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:The Contractors License Law does not applyto an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 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: Carrier ,, s /' Policy Number / 3 6p/ 3 ❑ 1 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 worker's compensation provisions of Section 3700 of the Labor e, I shall fo hwith comply with those provisions. Applicart Signature Date WARNING: FAILURE TO SECURE WORKER'S 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 ATTORNEYS FEES. LOBBYIST ORDINANCE CERTIFICATION r Complete this section for permits in I L unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiarwith the requirements of Los Angeles County Code Chapter 2.160 et 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 Owner Signature Date Company Name (if employed by an entity/agency) Date JOB ADDRESS LOCALITY HAZARDOUS MATERIAL DECLARATION Will the applicant orfuture 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 for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAG permitting checklist, I understand my requirements under the Los And 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 SCAQMD or EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec. 3097, CIV.C.). Lenders Name Lenders Address I certify that I have read this application and state under the penalty of perjury that the above information is correct. l agree to comply with all City and County ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter upon the above -mentioned prope yforinspection urposes. Applicant or Agent Signature Date COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS BUILDING AND SAFETY / LAND DEVELOPMENT LrUAL lu; Tk: 51986 ASSESSOR INFORMATION NUMBER: TENANT: OWNER: TEL. NO: LEGACY HOMES AT DIAMOND CANYON LLC (818) 449-8100- 140 S LAKE AVE #308 PASADENA CA 91101 Mr f LI'MIY l . I LL. 14- CROSBY MEAD BENTON AND ASSOCIATES (818) 343-5384- F'=5 BALBOA BLVD, SU :NO CA 91007 CONTRACTOR: TEL. NO: PROVINCE REALITY ASSOCIATES INC (818) 449-8100- 140 S. LAKE AVENUE STE 308 LIC. NO PASADENA, CA 91101 723247 B ARCHITECT OR ENGINEER: TEL. NO: LIC. NO: MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 0994329 NONE 0 4 01 NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: 0 NO 19 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO LA PUENTE # 0200 16005 CENTRAL AVENUE LA PUENTE CA PHONE: (818) 961-9611 EXT: SQ. FT STORIES TYPE OCCUP GROUP STRUCTURE: 0 0 VN R3 BUILDI�16 PERMIT NEW COMMERCIAL' BL 0200 9601230022 DUPLICATE BUILDING ADDRESS: 0 51986 LCNT CA NEAREST CROSS STREET: BREA:CANYON THOMAS PAGE: GRID: LOCALITY: ROWLAND HTS EXIST BLDG USE: RESID EXIST OCC GRP: R3 ISSUED ON: -PROCESSED BY: 09/27/96 FM EXPIRES ON: 01/22/97 - BLDGS. NOW ON LOT: VALUATION: 0 17,000 FINAL DATE FI - w - "' CODE: 41 W6 �, FEES PAID FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: D1 PLANCHECK W/0 EN-HC 6340.00 VAL 94.35 AA BLDG PERMIT TISSUANCE 18.50 AE STRONG MOTION OTHER ' 12790.00 VAL 2.69 D1 PLANCHECK W/O EN-HC 12790.00 VAL 57.88 D2 PERMIT W/O EN-HC 12790.00 VAL 179.10 AE STRONG MOTION 'OTHER" 17000.00 VAL'` 0.88 D1 PLANCHECK W/0 EN-HC - 17000.00 VAL 38.42 D2 PERMIT W/O E -HC 17000.00 VAL 45.20 TOTAL FEES 437.02 7 ��! } i- )ROOF �� C! FT tclem 7 V/�v�' REPORT ID: DPR261 ROUTE TO: BS0200 DESCRIPTION Or WORK - RETAINING WALL AC 159 FT LONG & AVERAGE 6 FT HIGH ACROSS FROM 23 & 24 SPECIAL CONDITIONS: APPROVALS DATE INSPECTOR SIGNATURE LOCATION AND SETBACKS SOILS ENGINEER APPROVAL' FOUNDATION TRENCH FORMS SLAB UNDER FLOOR RAISED FLOOR FRAMING UNDERFLOOR INSULATION FLOOR SHEATHING SHEATHING SHEAR PANELS FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION WEATHER STRIP INTERIOR LATH DRYWALL EXTERIOR LATH RATED F OOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS LOT DRAINAGE LICENSED CONTRACTOR'S DECLARATION I herebyaffirm underpenaltyof perjurythat I am licensed underprovisions of Chapter9 (commencing with Section 7000) of Division 3 of the Business and Professions Code y license is in full forrccee and effect. Z_ License Class —7c. No. � 2-i � ` Contra`ctor's Signature Date OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom 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).): ❑ I am exempt under Sec. , BA P.C. for this reason: [ Electrical, Plumbing & Sewer Permits Only ] ❑ I, as owner of the property, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself, provided that such 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 he or she did not build or improve for the purpose of sale.). [ All Other Permits ] ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such 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 he or she did not build or improve for the purpose of sale.). ❑ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractors License Law.). WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a certificate of consent to self -insure for worker's compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ 1 have and will maintain worker's compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Carrier ✓/ 6 Policy Number ❑ 1 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 worker's compensation laws of California, and agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Applicant Signature Date WARNING: FAILURE TO SECURE WORKER'S 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 ATTORNEYS FEES. LOBBYIST ORDINANCE CERTIFICATION r Complete this section for permits in I L unincorporated Los Angeles County only This is to certify that I, as permit applicant, am familiarwith the requirements of Los Angeles County Code Chapter 2.160 et 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 Owner Signature Date Company Name (if employed by an entity/agency) Date JOB ADDRESS I -- I 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 for guidelines. Yes ❑ No ❑ I have read the hazardous materials information guide and the SCAQI•A^ permitting checklist, I understand my requirements underthe Los Ang( County Code Title 2, Chapter 220 Sections 220.100 through 220.14., concerning hazardous material reporting and for obtaining a permit from the SCAQMD. ASBESTOS NOTIFICATION ❑ Notification letter sent to SCAQMD or EPA ❑ 1 declare that notification of asbestos removal is not applicable to addressed project. 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 (Sec.3097, Civ.C.). Lender's Name Lender's Address I certify that I have read this application and state under the penalty of perjury that the above information is correct. I agree to comply with all City and County ordinances and State laws relating to . building construction, and hereby authorize representatives of this County to enter upon the above -mentioned property for inspection oses. /'a-&"� I plicant or Agent Signature Date