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Home My Public Portal About5009 BALDWIN AVE_Building__ (2) • WORKERS' COMPENSATION DECLARATION herewstA a boraa cla tiflcaffirm tte of Workers's' Compensation I have a certificate of Insuroancef APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) ` COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING gZ j/ ❑ Certified copy is hereby furnished. FOR APPLICANT TO F11L IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING ADDRESS �00 / Ve tion department. p Date Applicant CITY ZIPtP� Q 0 LOCALITY , NO. OF BLDGS. NEAREST ,^ �5•p CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS 5T. L/� Otr" COMPENSATION INSURANCE ASSESSOR eq (This section need not be completed if the permit is for one TRACT BLOCK LOT NO� MAP BOOK �$ PAGE PARCEL® (J hundred dollars ($100) or less.) _ TEL. pa USE ZONE MAP OWNER64 /(/ NO.o '� 3 NO. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS - SPECIAL CONDITIONS �� C a so as to become subject to the Workers'Compensation Laws. O CITY ZIP U Date - Applicant 'ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO DISTRICT GROUP TYPE FIRE PRO D BY Exemption, you should become subject to. the Workers' CONS w Compensation provisions.of the Labor Code, you must forth- ADDRESS a �O with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. N O. Z deemed revoked. CONTRACTOR NO. _ LICENSED CONTRACTORS DECLARATION dwN �� LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. (� CITY CLASS BK. PG. VALIDATION Jq SQ. F NO. OF NO. OF / CHECK License Number Lic.'Class A SIZE STORIES IFAMILIES 6. ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ E _-5 ❑ ��I am exempt under Sec. ® ADD 'e J' ALTER B.&P.C. for.this reason USE OF �V �� ry REPAIR ❑ $ Date: 23 EXISTING BLDG. DEMOL ❑ ss APPLICANT TEL, ACCT= Signature FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE 3303 50 501 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 1 ro ssions Code): PRESENT B 1, as owner of the property, or m employees with BUILDING y ACC =v P P Y� Y ^a wages as their sole compensation,will do the work and ADDRESS 3_e303 !110 17 the structure is not intended or offered for sale(Section LOCALITY t- 7044, Business and Professions Code.) MOVING TEL. pool " ' ' ' TTEN E] 1, NO.I, as owner of-the property, am exclusively contracting TOTAL '!E T A� �� :1 � 67with licensed contractors to construct the project (Sec- ADDRESS tion 7044; Business and Professions Code.) CHECK 761. 7 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CHANGE .00 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE. P.L. Lender's Name. QOLI0-0001 6/20/'96 P.C. Fee$ Q Permit Fee (o(r� d / LDMA Ref. # '7(i,=`2 1 AM 11a 1 Lender's Address Poo. 1 certify that I have read this application and state that the Issuance Fee �� LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee / 7 LDMA Perm. # a and hereby authorize repres ntatives of this County to enter upo he a ov - entioned ropert or, inspection purposes. Ob 1TI�7 SEE REVERSE FOR EXPLANATORY LANGUAGE. Signature of Applicant o ge Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT 'DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0509260005 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 9848 LT: 24 SQ. FT STORIES TYPE OCCUP GROUP 5009 BALDWIN AV STRUCTURE: 624 1 VN R3 TEMP CA 917804011 ASSESSOR INFORMATION NUMBER: GARAGE: 400 1 VN U1 NEAREST CROSS STREET: LA ROSA 8589-026-048 OTHER: 71 1 VN U1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/25/06 JK 08/20/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: F NAt D _7 FIN L Y: CODE: HUANG, HUEI-MING (626) 279-1382- 64,930 5009 BALDWIN AV TEMP 917804011 FEES PAID 15SSCRIPTION OF WORK ADD ONE MASTER BEDROOM, BA HROOM 624 S.F. W/ATTACHED 2 CAR ;FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: GARAGE 400 S.F. NEW PORCH 71 S.F. (E) KITCHEN TO FMLY ROOM APPLICANT: TEL. NO: HUANG (626) 279-1382- B1 PLANCHECK W/ENERGY 64930.00 VAL 887.63 5009 BALDWIN ATTE AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: TEMPLE CITY CA 91730 AC STRONG MOTION RESID 64930.00 VAL 6.49 B2 PERMIT W/ENERGY 64930.00 VAL 1,044.29 TOTAL FEES 1,966.16 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HUEIMING HUANG (626) 279-1382- 5009 BALDWIN LIC. NO - LOCATION AND SETBACKS TEMPLE CITY, CA 91780 NONE SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS WU, JOHN (626) 293-1001- 412 S. STONEMAN AVE. LIC. NO: SLAB/UNDER FLOOR ALHAMBRA, CA 91801 NONE RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CM2: UNDERFLOOR INSULATION 3 01 1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING A�� • AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE-DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP p q INTERIOR LATH/DRYWALL 1-2 EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL * ADDITIONAL DATA ON FILE R RT 1D: DPR261 ROUTE TO: BS0508