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HomeMy Public PortalAbout9932 BROADWAY_Building__ WORKERS' COMPENSATION DECLARATION € .hereby affirm that I havea certificate of consent to self . insure, oro certificate of Workers' Compensation,Insurance, APPLICATION FORBUILDING .PERMIT pr.a certified copy thereof (Sec 3800, Lob.�C./)+ .. - COUNTY OF LOS ANGELES -.` - BUILDING'AND SAFETY 'Policy Nal 22-yN/7 company SlAke OYYIj t " BUILDING ��Q - - - • , ❑-, Certified copy is hereby furnished. „ FOR APPLICANT TO FILL IN ADDRESS 2,0n.- BUILDING '- ❑ = Certified copy is filed with the county building inspec-. # /� (/) /'� tion department. p,•yrry'.�,-ISn•t - ADDRESS JL 'r©r'RJW I li"z� �� `/ - Dates —q�-• Applicant J•k).`-�"' r"�''t'n cITY' ) e I�' .ZIP L� .• LOCALITY . .NO.OF BLDG - NEAREST CERTIFICATE OF.EXEMPTION FROM WORKERS< - SIZE-09-LOT NOW ON LOT - CROSS ST. COMPENSATION INSURANCE - _ .". ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. !" MAP BOOK -. PAGE PARCEL hundred,dollars ($100)or less ) OWNER- - - 'NO. - - US&ZONE ' MAP /v /"� -, / ��G' NO. •-, / Icertify that in the performance of the work for which this - -__ SPECIAL' - } - permit'is issued, Ishall,not employ.anyperson in any manner ADDRESS ^JN '{J(� - CONDITIONS - so as to.become subject to the Workers' Compensation,Lows. 'T i �j'� - - _ . O n n n CITY I lY— ZIP _ �'0 - V •Date•�- L•• ao ��tnA tP f1Cl ARCHITECTO TEL. - - d' Applic'. DISTRICT GROUP TYPE FIRE PROCESSED BY r- O ",NOTICE TO APPLICANT;Af, after makin this Certificae 'of ENGINEER - - - -• - NO. t V 9 _ CONST. ' Z NE -Exemption; you should become subject to the. Workers' ��� -3 . ' / - w Compensation provisions of the Labor Code,.you.must forth- ADDRESS - n. with comply wim.such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION - - . APT. CONDO. N deemed•,evoked. - - CONTRACTOR NO. mo:i5 LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.g�DWELI. UNITS_ I herebyoffirm that l am licensed under provisionsof.Chapter9 - /+DDRESS�(� �. Sri./'I NO. ©$ a' /� /� LIC. ? SEWER MAP .(commencing s Code,and 7000)of Division 3 of the Business CITY ` lifT CLASS C-J .� VALIDATION and Professions Code,and my license is in full force and effect. .• BK..- PG.�� . . , ' SQ. FT. - - NO. OF NO. Of CHECK License Number 3$a�rn(�o� Lia CdssC,3 I SIZE STORIES FAMILIES ONE Contrdcto1�.W, (�.'aS ..411 -lf G 1-. __ICl ` N Z� - VALUATIO T€ Date S y 7 /DESCRIPTION OF WORK NEW •$ ❑ am exempt under Sec. ._ ►- _ . .ALTER. ❑ B,BP.C. for this reason f• REPAIR ❑ $.. r D te: USE OF DEMO- EXISTING BLDG. Signature— APPLICANT TEL. (PRINT) ❑ FINAL OWNER-BUILDER DECLARATIO - -' -- - - �''.„ DATE ffi I hereby arm that I am exempt from the Contractor's License- ADDRESS')OOH' S ,�(� Q 1l-W I ) „yurt r FINAL ' f - Law for the followingtreoson (Section 7031.5,Business and - Professions Code): PRESENT -- - - BY-' 1 - - '• _ �t BUILDING n '� ❑ I, as owner of the property,. or my employees with ADDRESS f - wages as their sole compensation,Will do the work and ��IY -r '(ir t the structure is not intended or offered for sole Section LOCALITY ' -a+ 7044, Business and Professions Code.) - - MOVING - TEL ❑ 'I,as owner of the property,am exclusively contracting CONTRACTOR NO. ti' a• ' with licensed contra o construct the project,($ec- - ADDRESS - -- tion 7044, Business anndd 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 . FRONTthe performance-of the work'for which this permit is issued - P.L. (Sec. 3097, Civ. C.). - 'SIDE _ $ Lender's Name. .� p - Ref. R 7 Y`i - I P.C. Fee$ Permit LIMA R Fe0 '-' -I Lender's Address - - a I certify that I have read this application and state-that°the . Issuance Fee ��73�' LDMA P/C'N 0 8 above information is correct. I agree to comply with all County Investigation fee _ J ,; _ _ - .... •- R ordinances and State'laws relating to building Eonsfruction, Tool Fee /� �' 3 LDMA Perm. N a and hereby authorize representatives of this County to enter 0 - upon t above-mentioAed pro erty for inspection purposes. .$EE REVERSE FOR EXPLANATORY LANGUAGE - Signature o Ap icant 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 9906150050 PHONE: (626) 285-0488 EXT; LEGAL 10: NO. OF CONST BUILDING ADDRESS: TR: 13805 LT: 40 SQ. FT STORIES TYPE 9932 BROADWAY STRUCTURE: 0 VN TEMP CA 917802618 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY BLVD. 8588-016-015 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R- ISSUED ON: PROCESSED EXPIRES ON: EXIST OCC GRP: 06/1 UT 12/12/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: INAL B : STONE BEATRICE C TR (818) 286-4789- 1 1,500 9932 BROADWAY to 2. TEMP 917802618 FE 5 PAID D IPTI N OF WUu OR 3 NEW ACEMENTS FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: APPLICANT: TEL. NO: AMERICAN HOME IMPROVEMENT (800) 807-9889- AA BLDG PERMIT ISSUANCE 27.75 10415 SLUSHER #2 AC STRONG MOTION RESID 1500.00 VAL 0.50 SPECIAL CONDITIONS: SANTA FE SPRINGS,CA D2 PERMIT W/O EVHC.-1500.00 VAL 82.20 P`NGELEJO AL-\FEES 110.45 CONTRACTOR: TEL. NO: SOS APPROVALS DATE INSPECTOR SIGNATURE AMERICAN HOME IMPROVEMENT PRODUCTS (800) 807-9889- 10415 SLUSHER DRIVE LIC. NO LOCATION AND SETBACKS SANTA FE SPRINGS, CA 721379/C61 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. O: FOUNDATION/TRENCH FORMS LIC. NO y 11[1111 SLAB/UNDER FLOOR i RAISED FLOOR FRAMING - MAP NO: SEWER MAP. BOOK: PAGE: FIRE ZONE: LMP: p p p p p// UNDERFLOOR INSULATION 147X269 3 I I II 1 II � A711111/O IKC ' LTJ L� �7 V V II�JJ LLLLII LI O��JJ FLOOR SHEATHING - 0. OF FAMILIES: DWEL [NG-UNITS: APT/GOND: ST CLASS:-„ NO 21 C' -ef d - --` ROOF SHEATHING SCHOOL WITHIN HAZARDOUS ` ;il' rf�t� E PANELS AIR QUALITY: 1000 FEET MATERIALS 0 J _ NO NO NO A - 13 FRAME INSPECTION REQUIRED TOTAL SETBACK FOM EXISTG6 '- � FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: 7%�. - FRONT PL- `Service That SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/ RYWALL EXTERIOR LATH RATED FLOOR/CER ASSEM. RATED WALL ASSEMBLIES TED SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAff REPORT ID: DPR261 ROUTE TO: BS0508 r COUNTY OF LOS ANGELES TEMPLE CITY i-# 05Qe BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9807140062 PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 13805 LT: 40 SQ. FT STORIES TYPE 9932 BROADWAY STRUCTURE: 0 VN TEMP CA 917802618 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-016-015 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 07/14/98 UT 07/14/99 OWNER: TEL. NO: BLOGS. NOW ON LOT: VALUATION: FINAL DATEFINAL BY: . STONE BEATRICE C TR (818) 286-4789- 1 3,000 9932 BROADWAY y1_ q/ ;e4 TEMP 917802618 FEES PAID DESCRI � OFWORK / VOLUNTARY RETROFIT-PER CITY OF LO ANGELES PLAN #1 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: MEGA BUILDERS (818) 787-8914- AA BLDG PERMIT ISSUANCE 27.75 16136 SHERMAN WAY AC STRONG MOTION.RESID _-- ..3000.00 VAL 0.50 SPECIAL CONDITIONS: VAN NUYS, CA D2 PERMIT W/O-EN-AC- - _ -3000,00 VAL 99.00 �> „:___iOTAL FEES, 127.25 CONTRACTOR: TEL. N0: ;'�� �'� ✓ - ``- APPROVALS DATE INSPECTOR SIGNATURE MEGA BUILDERS (818) 787-8914- 16136 SHERMAN WAY LIC NO LOCATION AND SETBACKS y VAN NUYS, CA. 91406 623980/C55 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: FOUNDATION/TRENCH FORMS u LIC NO:•1 C— - - i rLIi i "1 SLAB/UNDER—FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: -� ! " �� '� UNDERFLOOR INSULATION 147H269 3 OYA,.!: 1 .. FLOOR�SH ATHING NO. OFFAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:- - NO 21 ! / V ROUF SHEATHING SCHOOL WI HIN HAZARDOUS /� .t:`, j�.j' SHEAR PA ELS AIR QUALITY: 1000 FEET MATERIALSNO NO NO � � _� , :� FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST SET BACK YARD: HWY: PROP LINE: WIDTH: - '/VC __ __ _• ��% FIRE SPRINKLER HANGERS FRONT PL- a �}'•� ��° INSULATION/WEATHER STRIP SIDE PL- - - - INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508