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Home My Public Portal About5446 BALDWIN AVE_Building__ •t. ``WORKERS' COMPENSATION DECLARATION WAPPLICATION FOR BUILDING PERMIT � y. cy affirr� that I have a ,rtificate of consent to self ` ,•insure, or certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab: C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pollcy No. .. Company Ce,tified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING y ESS ❑ ADDRct,— ElCertified copy is filed with'the county''building inspec- BUILDING tion department. ADDRESS � `� , / //`7 Date Applicant CITY c--� ZIP LOCALITY y CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST.- COMPENSATION INSURANCE SIZE OF LOT Q NOW ON LOT CROSS ST. (This section need not.be completed if the permit is for one ASSESSOR. hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK' PAGE [PARCEL TEL. /✓/�•�/� USE-ZONE MAP /) I certify that in the performance of the work for which this OWNER G 5 G� L/-I/5�� NO�QG✓(�'� NO. �t/ f �— r� �O CL permit is issued, I shall not employ any person in any manner AZ �f// /�� G; SPECIAL so as To become s bject to the Workers'Compensation Laws. ADDRESS 7� / `// c� CONDITIONS u 7 CITY_ l / ZIP ��OG 09 Date •" Applica' ARCHITECT OR TEL. O NOTICE TO APPLICANT: If, after ing is rti i Te of DISTRICT GROUP TYPE FIRE PRO SED BY f. ENGINEER NO. CONST. ZONE U Exemption, you should become sub_je to a orkers' L,;Uc( W Compensation provisions of the Labor,Code, you must forth- ADDRESS Jv OO- �� -. ✓ y with comply with. such provisions or this,permit shall be TEL. STATISTICAL CLASSIFI TION APT. NDO. Z deemed revoked.. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC- CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter.9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and •LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK �- VALIDATION SQ. FT. -J—NO—OF NO. OF / CHECK License Number Lic.Class / SIZE ZGL� STORIES FAMILIES / ONE VALUATION DESCRIPTION OF WORK NEW Contractor' Date ��'> . ADD ❑ E ❑ 1 am exempt under Sec. ❑ , ALTER ❑ ` 4 p 4 3 A. B.&P.C. for this reason REPAIR $ Date: USE OF DEMOL ❑ # o o o o2.3 EXISTING BLDG. -TEL. - Signature APPLICANTPRINT1Cr- aee,- /r►'�C NO. ��6 Iry DAT FINAL OWNER-BUILDER DECLARATION 1 - 569.93 �-� - I hereby affirm that-I am exempt from the-Contractor's License �� o 0 5 6 9,9 30 = Law for the following reason (Section 7031.5, Business and ADDRESS FIN / Professions Code): PRESENT B c� 0 2, 1 -8 6 ' ❑ BUILDING I, as owner of the property, or my employees with ADDRESS \ � wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ' 7044, Business and Professions Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. ;2 4 9 6 7 A with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS # o o o o 2 3 , REQUIRED TOTAL SETBACK FROM EXIST.. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ° °.8 O,3 2 I hereby affirm that there is a construction lending agency for FRONT . the performance of the work for which this permit is issued P.L. ;I = (Sec. 3097, Civ. C.). SIDE '0 0 o83 2 5 P.L. _ Lender's Name 0#Ref. 6, m LD Lender's Address P.C. Fee$ � Permit Fee S,O� o#1 0 0 0 X7°75.510 I certify that I have read this application and state that the Issuance Fee ®��® LDMA P/C#- a above information is correct. I agree to comply with all County Investigation Fee j ° - 7 7 5 5 0 c=i ordinances and State laws relating to building construction, Total Fee LDMA Perm. # U and hereby authorize representatives of this County to enter 0 1.0 7`�8 6 m upon the above-mentioned pr'perty for inspection purp es. a � s/ 7 SEE REVERSE FOR EXPLANATORY LANGUAGE � - 5 ature App ca r Agent• 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 0306020059 PHONE (626) 285-0488 EXT --LEGAL ID NO OF CONST NEW BUILDING ADDRESS BK 187 PG 50 PC 1 SQ FT STORIES TYPE OCCUP GROUP 5446 BALDWIN AV STRUCTURE 195 1 VN U1 TEMP CA 917802624 ASSESSOR 0 GARAGE NEAREST CROSS STREET DAINES 8586 023 028 OTHER THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY TENANT EXIST SE USE ZONEU 0w- PROCESSE Y EXPIRES ON EXIST OCC GRP 06/03/03 JK 05/28/04 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE BY COD PETZHOLT RAYMOND P & ANNIE A (626) 575 4950 2,000 5446 BALDWIN AV TEMP 917802624 FEES PAID DESCRIPTION OF WORK PATIO COVER FEE DESCRIPTION QUANTITY UOM AMOUNT PLTEL NO SAME AS OWNER AA BLDG PERMIT ISSUANCE 27 75 AC STRONG MOTION RESID 2000 00 VAL 0 50 SPECIAL CONDITIONS D1 PLANCHECK W/O EN HC 2000 00 VAL 82 11 D2 PERMIT W/O EN HC 2000 00 VAL 82 20 TOTAL FEES 192 56 CO RACT R TEL 0 APPROVALS ATE INSPECTO SIGN URE SAME AS OWNER ' LIC NO LOCATION 1 SOILS ENGINEER PP OVAL ti ARCHITECT ENGINEER EL NO - FOUNDATION/TRENCH FORMS LIC NO _ ` I , _ _ _ SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 3 01 ST LEVEL FLOOR SHEATH NO OF FAMILIES U=10-UNITS D STATCLTW- NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY 1000 FEET MATERIALS NO NO NO 51RE DEPT FRAME INSPECT REQJIRED TOTAL SETBACKFROM EXIST BLDGDEPT FRAME INSPECT, SET BACK YARD HWY PROP LINE WIDTH FRONT PL SHEAR PANELS SIDE PL INSULATIONIWEATHER STM INTERIOR LATH/DRYWALL EXTERIOR LOT DRAINAGE SMOKE DETECTION EVIC SFIR DEPARTMENT APPROVAL REPORT ID DPR261 ROUTE TO BS0508