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Home My Public Portal About6212 AVON AVE_Building__ WORKERS COMPENSATION DECLARATION 4 APPLICATION FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to self , insure or a certificate of Workers Compenstion Insurance or a cert fled c py hereo (S 800 Lab C ) 01 f - COUNTY OF LOS ANGELES BUILDING AND SAFETY Pol pan Certified cop is he f h BUILDING �r"P��1.6okpFTRACT /e�_ff� FOR APPLICANT TO FILL IN ADDRESS Certified copy' is file ith t e c unty ui di i tion department LOCALITY _ ��)-,/, NEAREST Date pphcan, ♦,f.� , ZIP CROSS ST ' CERTIFICATE OF EXEMPTION FR WORKERS - ` NO OF BLDGS ASSESSOR COMPENSATION INSU ANCE NOW ON LOT MAP BOOK PAGE PARCEL ~ ` USE ZONE OP C \ (This section need not be completed if the permit is for one BLOCK LOT NO hundred dollars ($100)or less ) TEL ( SPECIAL I certify that in the performance of the work for which this OWNER 1 CONDITIONS O permit is issued I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PRO SSED BY (� ' AD n� CONST ZONE so as to become subject to the W rkers mpensahon aws �( �r r Appltca , CITY ZIP STATISTICAL CLAS IFICATION V APT CONDO O ARC C OR TEL I OTICE O APPL A T If a ter king this C tificate of ENGINEER NO W Exemption you should become subject to the Workers CLASS NO DWELL UNITS 0. Compensation provisions of the Labor Code you must forth N ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be r � } — deemed revoked c ¢ CONTR T '� NL BK PG/40 1-- VALIDATION , ` LICENSED CONTRACTORS DECLARATION L I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC Profe Bions Code and my license is in full force and effect CITY CLAS $ (/ SQ T NO OF NO OF C CK Lice umbe Lic Cla SIZE STORIES FAMILIES ONE � cC F � Co t c Date / DESCRIPTION OF WORK J L4. 1 NEW ❑ $ t h ADD ❑ a exemp the licensing requirements as I am a 1tt 1 " I ensed architect or a registered professional engineer or ALTER ❑ FINAL' acting in my professional capacity (Section 7051 4,1A A hi A It DATE 4 L REPAIR Business and Professions Code) AF P FINAL EXISTING BLDG DEMOL ❑ B C f Lic or Reg No Date APPLICANT �, TEL Y OWNER BUILDER DECLARATION PRINT NO I hereby affirmtEShat I am exempt from the Contractor s License — Law for the following reason (Section 7031 5 Business and ADDRr. Professions Code) PRESENT (�O BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work and v the structure is not intended or offered for sale (Section LOCALITY 7044 Business and Professions Code) MOVING TEL 1 68.9 A I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec ADDRESS # e o 0 0 0 1 tion 7044 Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 2 0 0 6 1 0 0 I hereby affirm that there is a construction lending agency for FRONT 1 } the performance of the work for which this permit is issued P L �v U � S� oto 0 6 1 0 0 (sec 3097 Civ C > SIDE 10 2 6t 8 1 Lender s Name _Lender s Address P C Fee$ Permit Fee w I certifcy that I have read t pplication and state that the Issuance Fee i aoboe i motion is come I a ee to comply with all County Investigation Fee 0 ordi c and State la rela ing to building construction To Fee an ere y outho re esent fives of t is County to enter au th above ntion pr erty for nspection purposes / t a / r- / SEE REVERSE FOR EXPLANATORY LANGUAGE We e p t r Agen Date s Pr APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELS: S BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESSZ I hereby affirm that I have a certificate of consent to self insure, BUIL 1 1 ADDR SS rl��a / 4/ or a certificate of Workers' Compensation Insurance,or a certified 2 VOA copy thereof Sec.3800,Lab.C.) ` CI Y / ZIP IS" /_ � A't� LOCALITY Policy No. 3s'Z ^f L Company T SIZE O LO-T vL( / NO. BLDGS.NOW ON LOT �] Certified copy is hereby furnished. 5-0 -- ^ / yQ I NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. _�a� /�'J„ CUSE ZONE MAP NO. L"�Z_ �A�/-{�� ASSESSOR MAP BOOK PAGE PARCEL DateApplicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' o R EL NO. COMPENSATION INSURANCE red /goo l S5'—7-' WITHIN 1000 FT.OF SCHOOL? Yes No (This section need not be completed if the permit is for one hundred ADD ESS ,7, ,Q dollars ($100)or less.) l z /v - DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY CITY )� ZIP I certify that in the performance of the work for which this permit e 1 �� y' _ � �� is issued, I shall not employ any person in any manner so as to ARCHITE T OI3�,p.�GINE R TEL NO. Q become subject to the Workers'Compensation Laws. r�i0 Imo(/ �'�u^Cp y G!y) EL NO. J/ STATISTICAL CLASSIFICATION APT CONDO Date Applicant AD RESS77 !(/ v 1 l / l/ '[ CLASS NO.- ;;z DWELL UNITS NOTICE TO APPLIC4NT.� If, after making this Certificate Of G /'`0 /v ��aG� G �yu�P� REQUIRED TOTAL SETBACK FROM EXIST Exemption, you ShOUId become Subject t0 the Workers' C,�f�TR TOR /1 �a�C,� ! TEL NO. 3 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /l OPS ` ( :J y�-S FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS WC.NO. PL LICENSED CONTRACTORS DECLARATION 111v- S,�S� 3 SIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 u 4^ SEWER MAP } (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.91 STORIES I NO.OF FAMILIES CI- Professions Code,and my licenseisin full force an effect. NEW ❑ BK -," PG IPA- CD License Number `S S s�3 LLic. Class DESC/F��IPTION OF WORK / r / ADD ❑ VALUATION ® Q: Contractor /�-�v•'�r>� L•(¢fpate 7��'1 "qZ� [�dGi✓1 !�dptT�'�!(7, [ F/� jbJty $ ��, fl'0 O ALTER. ❑ W ElI am exempt under Sec. r a REPAIR El $ z BAP.C. for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APP (CANT(PRINT) TEL NO. LDMA Perm# - s. : n ❑.I,:as owner of the property, or my employees with wages as 4'b e, C 4�?y C7t y) ~`3 ��^ O t-• V, -e their sole compensation, will do the work and the structure is AD KESS not intended or offered for sale (Section 7044, Business and G ' r ��/��/P r'(+y FINAL DATE Q �44. Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL +L I ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ J El 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY itA licensed contractors to construct the project (Section 7044, Elf s•._1_; ° YES NO D Business and Professions Code.) �;�. -, _ WILL THE INTENDED USE'OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING L� - .j.:if l•1• -y -- OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMDI SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for 'YES❑ NO[2 a the performance of the work for which this permit is issued(Sec. e t'-P Vit- e -- s ° 3097,CIV.C. HAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N ) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, !'(.SC; TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATE IALS ORTING AA�TAINING A PERMIT FROM THE SCAOMD. a. o Lender's Address 0 OWNER OR AGENT _ o I certify that I have read this application and state under penalty v 0 of perjury that the above information is correct.I agree to comply P.C.FEE Yv PERMIT FEE - d 9 pY �D �7 1t1- (is+_!i a with all county ordinances and State laws relating to building r '''` ''- construction, and hereby authorize representatives of this County ISSUANCE FEECO i ro to ter u on t e above-men' ned property for inspection purposes. T �/ 7—y INVESTIGATION FEE TOTAL FEE g,,u,B,,,A,,,-nt Or A,,,, t SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1403100057 PHONE (626) 285 0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ITR 5903 LT 42 UN 002 SQ FT STORIES TYPE 6212 AVON AV STRUCTURE 1000 V B SGAB CA 917752608 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LONGDEN 15386 009 014 THOMAS PAGE 596 GRID G2 LOCALITY TEMPLE CITY CAI ITENANT IEXIST BLDG USE RESID USE ZONE R 1 IISSUFD ON PROCESSED BY IEXIST OCC GRP 103/10/14 SR (OWNER TEL NO 1BLDGS NOW ON LOT VALUATION IFIN%. ATE FINAL Y CODE 1 IMOTTA JAMMY (877) 214 4004 1 2 500 1_ �(/) 5v y 16212 AVON AV I' ( /I ISGAB 917752608 FEES PAID IDESCPI T ON'OF WORK ITEAR OFF AND INSTALL O S B PLYWOOD ON 600 SQFT AND REROOF IFEE DESCRIPTION QUANTITY UOM AMOUNT 11000 SQFT USING 20 YR THREE TAB SHINGLES WHITE (APPLICANT TEL NO I I IMATIARENA MANUEL (626) 444 4910 IAA BLDG PERMIT ISSUANCE 27 80 1 14425 ROWLAND AVENUE JAB STATE GREEN BLDG FEE 2500 00 VAL 1 00 1SPECxAL CONDITIONS 1 1EL MONTE CA 1AC STRONG MOTION RESID 2500 00 VAL 0 50 1 1 ID2 PERMIT W/O EN HC 2500 00 VAL 99 00 IFR INV WORK W/O PERMIT 344 00 DOL 344 00 CONTRACTOR TEL NO TOTAL FEES 472 30 (APPROVALS DATE INSPECTOR SIGNATURE IGOLDSTAR ROOFING INC (626) 444 4910 1 14425 ROWLAND AVENUE LIC NO ILOCA ION AND SETBACKS + 1 1UNIT D 741676 * 1 1EL MONTE CA 91731 ISOIL, ENGINEER APPROVAL ARCHITECT OR ENGINEER TEL NO I 1FOUN,ATION/TRENCH FORMS I LIC NO I ISLAB/UNDER FLOOR 1RAIS D FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I 1UNDE FLOOR INSULATION 3 001 1 IFLOOF SHEATHING INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I I I I NO 21 IROOF I SHEATHING SCHOOL WITHIN HAZARDOUS I ISHEAP PANELS 1 1AIR QUALITY 1000 FEET MATERIALS 1 1 1 1 NO NO NO 1 1FRAM" INSPECTION I 1 IFIRE SPRINKLER HANGERS I 1 I INSULATION/WEATHER STRIP( I 1 (INTERIOR LATH/DRYWALL I _ 1EXTERIOR LATH IRATED FLOOR/CEIL ASSEM I RATED WALL ASSEMBLIES I 1 RATEL SHAFTS/OPENINGS 1 I I I I I I IT BAF CEILINGS 1 1 * ADDITIONAL DATA ON FILE I 1 1 1 ILOT DRAINAGE 1 I I I I I I I REPORT ID DPR261 ROUTE TO BS0508 1 1 1 1 T' �v :Jirr.l� "+�� T C"+moi�� 4� �j � t� t �-tM Y + <w+♦ t.? y! -'" DEPARTIIFVT Or, BUILDING AND S VETA APPLICATION FOR PERMIT COUVTI Or IOS ANGELES BUILDING WM J FOX CHIS E4Gfi rLANa -40NE rIR[ DISTR��VO PLA FEE PERMIT NQ� FILED .a CTS I 20hE 12C\E /J"^ TY?E n QLO( I II III IV i X CROUP = �. - r ,a--- DATE~r�A/PlJ RECEIVED DAT //IU/EAG Ei�bt, SEru.�Cn �rtv i. JJ �( l ,�.r- ORD NO ��'� � d!3 1I'I'I ICANT PILL IN HEAVII I OUTI INI D PORTION O1L1 lri / Q13U -5 ! I O u1 F.AMF ADD2C3S 4 I rE �� -� ra 01 W Z_, AI'DRESS _ -OCALI-Y ~ UI NEAREST n, U u CITY C9035 S KSTATE i < I LICCNr'E NO TCL No YAM I - 1 A-.' W M A I 0 f rI NAME A..RESi 0 1 ~ 7 CY < I ADDRESS 0 CITY _�/. / FL NO , 1 h I _ O I CITY ry�J/_�_,/Cr.+�l.i'/�t It Jd LO�/ SrZE OF U I STATE T ' I �_., _ oU LICENS_ N `� TI, Nn ^:fes[=]+[L119� <¢ NO OF QLDGS ` , I�$A -LOCK NOW ON LOT JO USE OF 13LDG CLASS OF WOR 1 TR AC[,_J / c,/ y- NO IV 0%LOT iia�..��:11MOAI OI Ivo;-?K ADDITION nFl I ALT IA i I REPAIR I I I.OVING U `, _w0 OF [[[[ IZE BLOC 7�' G _ITOOM3,40O QLOG OF I STORIES IFAw SE Or ES � t 1 I ORhI;U \� SI'ECIA(CATIONS FOUNDATION MATEPIAL LxrL Ok I P,l I 1 , cif H IN CRo J D d �� —orf ?1 I SIZC SPACING SPAN R W PLATES (SILL( CIPCCR9 �- ! I JOISTS_F-OORl — f0 V/- 4T — I r JOISTS_CEILINC $( BEARING %V ILLS PA-TITIOI S R Af)F "AFTERS rl Y I 611E 1IOLT9 l�zi - -I IrIltiAL AI'I'I'OVkf , COV RNC DATE II' /' rrler[ctow• NArt � � I` I ROC I- - 2 r r WALL IT>r/�/rYt,G! /`� .r.�rv�a I��.a-�♦ naR£u ..C: .. �CD^.0 �•.•,.� ••�..D f •� APPLICATION AND STATE THAT THE ABOVE�18 CORRECT (�` ANO AGREE TO COMPLY WITH ALL COUNTY CADINANCES P C FEE c_��- ND STATFvLAW§ EGU TING BUILDING CONSTRUCTION } VALUATION SFEE owr:ro Aar UR 3 3 3% N N ar k f � p1 LTC