The URL can be used to link to this page

Home My Public Portal About5540 BALDWIN AVE_Building__ L 31j lg-� ab - WORKERS'COMPENSATION DECLARATION G` a x nsreUy affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab.'C.) Policy NoJi `C''�!5?oi2pa2njCy_1 1 COUNTY OF LOS ANGELES BUILDING�)AND S FETY Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 2::- , J i Certified co is filed with the count buildin ins c- �� PY Y 9 BUILDING C tion department: ADDRESS o�� ;?v -�{ g , r t v �j �/Q/� Date Applicant �� CITY ZIP ! / Uv LOCALITY + ' CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST. COMPENSATION INSURANCE SIZE OF LOT 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. l V MAP BOOK P GE PARCEL TEL' [�[� �j USE ZONE FSPEN�_IAL ' OWNER /! NO. 7'l�`��3 Jy I certify,that in the performance of the work for which this permit is issued,'I shall not employ any person in any manner jj�� / �) (/ IL so as to become subject to the Workers'Compensation Laws. ADDRESS wS�?D l!K �� 1 DITIONS O Date Applicant CITY. ZIP.... ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after'.rnaking`this Certificate of DISTRICT G OUP` TYPE FIRE ROC SED BY 0 I ENGINEER NO. iFJ Exemption, you should become subject to the Workers' ��J� I CON`ST/./ ZONE /, Compensation provisions of the Labor Code, you must forth- ADDRESS ` �� / �J C'" I 0. O. with comply with such, provisions or this permit shall be W /p // TEL. G± STATISTICAL CLASSIFIC TION APT.deemed revoked. CONTRACTOR Li S(� NO.0)9 /17aI)JONDO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7 i U NO.q- (commencing with Section 7000)of Division 3 of the Business and p >r� LIC SEWER MAP Professions Code, and my license is'in full force and effect. CITY L 14 `l /O CLASS I " VALIDATION 7 SQ. FT., NO. OF NO.OF - __ CHECK BK� PG.� Cicense.Number �` �� ic.Class �✓ SIZE STORIES FAMILIES ONE ❑ VALUATION Contractor Date —97 DESCRIPTION OF WORK NEW f _ ADD I am exempt under Sec. / I ALTER ❑ „ B.&P.C. for This reason REPAIR- ❑ S" Date: USE OF DEMO[ EXISTING BLDG. ❑ Signature APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. FINAL DATE,6" -1-hereby affirm that I am exempt from the Contractor's.License q Law for the following reason (Section 7031.5, Business and ADDRESS FI L _ 6,0 4 A Professions Code): PRESENT ❑ BUILDING I, as owner of the property; or my employees with ADDRESS wages as their sole compensation,will do the work and ® it -1 53. 00 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. "' ® ®' 1 5 3,0 0 c=-' I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to'construct the project (Sec- " ADDRESS 03, 1 2-8 7 tion 7044, Business and Professions Code). . 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 the-performance of the work for which this permit is issued P.L. - (Sec. 3097, Civ. C.). SIDE Lender's Name o LDMA Ref. # - P.C. Fee$ Permit Fee -- Lender's Address l D std I certify that I have read this application and state that.ihe Issuance Fee + LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, a and hereby authorize repres ntatives of this County to enter Total Fee �O LDMA Perm. #- upon the above-mentiproperty. r ' pection purposes. a ( SEE REVERSE FOR EXPLANATORY LANGUAGE n i nature o Iicant or Agent Date - 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 0110240033 PHONE: (626) 285-0488 EXT: LEGAL ID: O. OF CONST BUILDING ADDRESS: TR: 16957. LT: 10 SQ. FT STORIES TYPE 5540 BALDWIN AV STRUCTURE: VN TEMP CA 917802627 ASSESSOR INFORMATION NUMBER: NEAREST"CROSS STREET: LIVE OAK 8586-022-010 THOMAS"PAGE: 597 -GRID: B4 LOCALITY: TEMPLE'CITY TENANT: EXISTBLDG RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/24/01 JK 04/22/02 OWNER: TEL. NO: BLDGS. NOWON LOT: VALUATION: FINAL DATE FINAL BY: CODE: �. MORGON TOM L (626) 575-5815- 1 4,100 _.._5540 BALDWIN AV TEMP 417=627 "" FEES PAID DESCRIPTION OF WORK T/O;RESHEET&APPLY 25YR FIBERGLASS SHINGLE ON HOUSE & GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: TEEPLE ROOFING CO INC (626) 445-4860- AA BLDG PERMIT ISSUANCE 27.75 214 S. FIRST AVE AC STRONG MOTION RESID _ 4100.00 VAL 0.50 SPECIAL CONDITIONS: ARCADIA 91007 D2 PERMIT W/0 EN HC -Y� 4100.00 VAL 132.60 LS'TOTAjL FEES 160.85 CONTRACTOR: TEL. NO: ,�, APPROVALS DATE INSPECTOR SIGNATURE TEEPLE ROOFING CO., INC. (626) 445-4860- 214 S. FIRST AVE. LIC. NO %' ' r '�`, LOCATION AND SETBACKS `�\. ARCADIA, CA 91006 760539 C39 SOILS ENGINEER APPROVAL .ARCHITECT OR ENGINEER: TEL. NO: .� I' I ^� � '• f -; �, 1 �',.' FOUNDATION/TRENCH FORMS SLAB/UNDER FLOOR LIC. NO'/{j i RAISED FLOOR FRAMING r MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP UNDERFLOOR INSULATION 147H269 3 101 L. u v FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS-:-- NO LASS:NO 21'v ___ _._ _ J ` ---- _ `,,".' ROOF SHEATHING 692 SCHOOL WITHIN HAZARDOUS �' " '-f ;i I .'I ` �r Jy SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NONO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST w.�.l v. + � ( � 1 „�,t� FIRE SPRINKLER HANGERS SET BACK "YARD: HWY: PROP LINE: WIDTH: s� = FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIT ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT- DRAT AGE REPORT ID: DPR261 ROUTE TO: BS0508 "