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HomeMy Public PortalAbout9936 BOGUE ST_Building__ KERS' COMPENSATION DECLARATION insurhere r o certif carte of Wo'ke srlComrpensatie of on eInsurance, APPLICATION, FOR BUILDING PERMIT or a 1.ertified copyvvtth�hereof (^c. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY o Policy No. �015047Cornpany 6-TA-TE, rLdf--)i7 fd copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 4�C:rr:�f�:d copy is filed with the county building inspec- BUILDING ti!��on department. UAW � / ,, ��( ADDRESS Date/o- Applicant all 36, v5cxid P-, K l../tA Coo!. - CITYf � 64, ZIP I LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 16= CROSS ST. (This section need not be completed if the permit is for one - P LOT NO. ASSESSOR hundred dollars ($100)or less.) TRACT /&55 BLOCK MAP BOOK PAGE PARCEL TEL. US ZONE MAP �f I certify that in the performance of the work for which this OWNER 11.t.© NO. J NO. Li�7 permit is issued, I shall not employ any person in any manner 1 LL SPECIAL so as to'become subject to the Workers'Compensation Laws. ADDRESS Ll` CONDITIONS 0. Dote Applicant CITY { ZIP !Qlo 0:NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT G UP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. CONST Z U Compensation provisions of the Labor Code, you must forth- ADDRESS t L> with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICA ION APT. 7NDO. fn deemed revoked. CONTRACTOR O NO. LICENSED CONTRACTORS DECLARATION 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 and LIC SEWER MAP Professions Code, and my license is in full force and effect. CITY : CLASS BK PG VALIDATION �/ , SQ. F? NO.OF NO. OF CHECK License Number zv z '55 Lic.Class SIZE STORIES FAMILIES tf ONE 1 ✓�, / DESCRIPTION OF WORK I L M- NEW � VALUAT N ControctorlC7t4 Q�LG�'�r Date /rD�`Y $ F ADD 0 I am exempt under Sec. ALTER a B.BP.C. for this reason � $ REPAIR _ Date: USE OF DEMO" EXISTING BLDG. .�1 �p� 11 Signature APP PR NIT) QLD 1 �r Gni+. t NO.2 FINAL 2 8 1 1' O n �MNER-BUILD_rR DECLARAT DATE J I hereby affirm that I am exempt from th ontractor's License # • 0 0 0 0,1 Low for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT Y - 24675 BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 1- 246756 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ' "I a 1 4,t 8 7 I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM txIbI. 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 Nome LDMA Ref. N Lender's Address P.C. Fee$ Permit Fee I certify that I have read this application and state that thee Fee A®1J O kLDA P/C# pop above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. q and hereby authorize representatives of this County to enter upon th ove-m tipped property for inspection purposes. a / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Ag ! ' [sate r APPLICATION FbA BUILDING PERMIT COUNTY OF LOS�ANGELES B ILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDING ADDRESS FOR APPLICANT TO FILL•1N I hereby affirm that I have a certificate of consent to self insure, q 4 (0 MWE i or a certificate of Workers' Compensation Insurance,or a certified J copy thereof(Sec. 3800p�J I,Lab.C.) CITY M pue T ZIPcl I��� LOCALITY /Policy No.���9«0OCompany CaL ��� SIZE OF LOT NO.OF BLOGS,NOW ON LOT ✓ ❑ Certified copy is hereby furnished. NEAREST CROSS ❑ Certified copy is filed wiRthe ou y bui Ing i esti n TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date ��� Applica ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS o / CERTIFICATE OF EMP ION FROM WORKERS' OWNECR ` TEL NO.COMPENTIO INSURANCE �vvVVFJ l� �+1�—^' WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be cfete if the permit is for one hundred ADDRESS (� ECrQLA� ST' DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) I certify that in the performance of the work for which this permit CI ��� �; ZIP 780f0� _3 is issued, I shall not employ any person in any manner so as to c�S become subject t0 the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLAySSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. c;Z / DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become Subject to the Workers' CONTRACTOR TEL NO. 2f ' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith a r-- -270- 136 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION Z l ``� ooJ 705 °3 D SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 ��C' 8 A G-319 1 SEWER MAP (commencing with Section 7000)Of Division 3 of the Business and SO.FT.SIZE0.OF STORIES NO.OF FAMILIES Professions Code,,and my license is in full force and effect. -2 NEW BK PG /License Number /nG4_5n Lic.Class C 3� DESCRIPTIO OF WORK -- ADD VALUATION O te IFT7'EXIST-,� ©Contractor SI�465a ALTER 1:1 a El I am exempt under Sec. !� �A 1�CX1 REPAIR ❑ O $ B.BP.C.for this reason KE'`'U l re- ��yS'���, 2g' y��p FVMOL 11 IU LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ SignatureAPPLICANT(PRINT) TEL NO. LDMA Perm# z ❑ I, as owner of the property, or my employees with wages as ZO their sole compensation, will do the work and the structure is ADDRESS -313103 not intended or offered for saleSection 7044, Business and FINAL DATE Q s ` Professions Code.) ( 0 i TTrM WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL1� •!•f • ❑ 1, as Owner Of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL-TO OR GREATER THAN THE Q -•p of b 3 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5 T{_f(-!L 12 -' - 45 licensed contractors t0 CORStrUCt the project (Section 7044, YES❑ NO❑ c Business and Professions Code.) C'-HECK WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH �_ t,ff L CONSTRUCTION LENDING AGENCY COAST AIR QUAUTV MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR (NH )t GEE j GUIDELINES. I hereby affirm that there is a construction lending agency for VES❑ NO❑ N the performance of the work for which this permit is issued(Sec. :-! rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ F 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 0000-000 . N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR"OBTAINING A PERMIT FROM THE SCAQMD. I ' o Lender's Address /� 0 OWNER OR AGENT v 0 1 certify that I have read this application and state under penalty 0 of perjury that the abovejpfQfmation is correct.I agree to comply P.C.FEE PERMIT FEE with all cou y ordina es/and State laws relating to building construc ion nd her y a ori epresentatives of this County ISSUANCE FEE to enter p e abov -m do d operty for inspection purposes. Q z- INVESTIGATION FEE TOTAL FEE � Signat re a(A pliranl or Apen( Date SEE REVERSE FOR EXPLANATORY LANGUAGE/lJSS �� 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 0711090015 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDINGADDRESS: ITR: 16557 LT: 7 SQ. FT STORIES TYPE 9936 BOGUE ST STRUCTURE: VN TEMP CA 917802631 IASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 18588-015-020 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl (TENANT: JEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 (EXIST OCC GRP: 111/09/07 SR 05/07/08 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL DAT BY: CODE: WANG, PAT (626) 286-3664- 1 5,090 19936 BOGUE ST I I EXPIFED TEMP 917802631 FEES PAID IDESCRIPTION OF WORK I IHARDY WINDOWS WILL PROVIDE AND INSTALL 13 WINDOWS LIKE FOR I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ILIKE APPLICANT: TEL. NO: I. I (HARDY WINDOWS (714) 996-1807- IAA BLDG PERMIT ISSUANCE 27.75 I 11315-D N BLUE GUM ST - IAC STRONG MOTION RESID 5090.00 VAL 0.51 ISPECIAL CONDITIONS: (ANAHEIM, CA 92806 ID2 PERMIT W/O EN-HC - 5090.00 VAL 149.40 TOTAL FEES 177.66 ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE HARDY WINDOWS CO. (714) 996-1807- 1 1 11315-D BLUE GUM LIC. NO 1 ILOCATION AND SETBACKS ANAHEIM, CA 92806 503323 C17 (SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS I I LIC. NO: (SLAB/UNDER FLOOR I I I I I I RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I147H269 3 011 I I I I IFLCOR SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I -1-1 NO 21 I IROCF SHEATHING I SCHOOL WITHIN HAZARDOUS I (SHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS I I NO NO NO I (FRAME INSPECTION I (REQUIRED TOTAL SETBACK FROM EXIST IFIRE SPRINKLER HANGERS I I I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I- IFRONT PL- I INSULATION/WEATHER STRIPI I I SIDE PL- I I -1-1 (INTERIOR LATH/DRYWALL I (EXTERIOR LATH I I IRATED FLOOR/CEIL ASSEM. I (RATED WALL ASSEMBLIES (RATED SHAFTS/OPENINGS IT-BAR CEILINGS I I I I I ILOT DRAINAGE I I (REPORT ID: DPR261 ROUTE TO: BS0508 I I I I