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HomeMy Public PortalAbout5912 BURTON AVE_Building__ COUNTY OF LOS.ANGELESBUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING`ADDRESS hereby affirm that BUILDING ADDRESS have.a certificate of consent to self insure, A�L or a certificate of Workers' Compensation Insurance,or a.certifietl CITY '_ ZIP A 7 copy thereof.Sec.3800,800,Lab.C.) LOCALMY _,. POIICy No. Company - SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished A p Q NEAREST CROSS ST. Or- 0 Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department USE ZONE MAP NO. ASSESSOR MAI?BOOK PAGE PARCEL 1- ?Date Applicant i�0 f/o S SPECT ONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER - - TEL No: COMPENSATION INSURANCE w.</ Ily IN WITH1000 FT OF SCHOOL? _ YE No (This section need not be completed if theermit is for one hundred ADDRESS / - - p dollars($100)or less.) OTC/ (�C DISTRICT GROUP TYPE CONST.. FIRE ZONE PROCESSED BY CITY ZIP I certify that h the performance of the work for which this permit s f J �„ �D� _ 5 - is issued, I shall not employ any person in any manner so as to ARCHITECT OR EN NEER - TEL NO. become subject to.the Workers'Compensation Laws. -STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS - - CLASS NO.c DWELL UNITS NOTICE TO APPLICANT,. If, after making this CertificateOf REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH• Compensation previsions of the Labor Code, you must forthwith- FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS -LIC.NO._ - PIF LICENSED CONTRACTORS DECLARATION - SIDE CITY LIC.CLASS ELL I hereby affirm that I am licensed underprovisions,of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES N0.OF FAMILIES - Professions Code,and my license is in full force and effect.. NEW IDBK PG d ADD VALUATION OF W WORK - License Number Lic.Class DESCRIPTIONc 0 Contractor - Date Q!I' ,. ALTER. ❑ $ wa 19O ❑ 1 am exempt under Sec. REPAIR ❑ $ BBP.C.for this reason DEMOL ❑ LOMA P/C♦ W Date. USE OF EXISTING BLDG. URM ❑ - Signature23, _ Z APPLICANT(PRINT). TEL N0, LDMA Perm 0 ✓a- — as Owner of the property, or h A•employees with wages as Z t t1 i.-� their Sole Compensation, will d0 the work and the structure•is ADDRESS '�' O 'T+ not intended or Offered for SAID, (Section 7044, Business and FINAL DATE- Q 5 1�/ 4v.7J Plpf25510n5 Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL N /' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J '❑ I, en owner of the property, am the project contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY � 1 licensed contractors to Code.) the project (Sdctiom 7044, '- - i Business and Professions Code.) YES El NO[1 _ L t,�•AC41 .r WILL THE INTENDED USE MI THE BUOUNGCONSTRUCTOR! BY THE APPLICANT MOMTROA OR FROM T BUILDING A I }} p OCCUPANT REQUIRE A PERMIT FOR C TRICT(SCAO OR EE PERMITTING FROM THE SOUTH. , v.I�:'IJ l NJ9.I'9 CONSTRUCTION LENDING AGENCY CONST AIR QUALITY MANAGEMENT DISTRICT ISGAOM01-sEE PERMITTNG CHECKLIST FOR GUIDELINES. i TTrMaj thereby affirm that there is a construction lending agency for YES C) No El the performance of the work for which this permit is issued(Sea '{ {e{7•. w 3097,Civ.C.) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING TOTAL �I AL 1587 - 64 CHECKLIST.I UNDERSTAND MY AEOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. LEC/'/ ( w 1 TTLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS [.nC`.r\ 1J'J.04 C" Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT PFAM THE SCAOMO. 14 Lender's Address [.HAVE .. _—,OU k; ONNER OR AGENT oI certify that I have readabove info application and state under penalty o of perjury that the above information is correct. agree to comply P.C.FEE ,/�n PERMIT FEE q Z/- " $ with all county ordinances and State laws relating to building /J' / 4;1 000[I'0001 i'r 14'�9a GO construction, and. a authorize representatives of this County ISSUANCE FEE /{ to enter upo we-mentioned property for inspec' n urpos S. pT •PFJ _ 8M _ 1 AM 10�44 a r'— f� INVESTIGATION FEE TOTAL FEE m GpWwaaa. Ao+w4 0... A fT SEE REVERSE FOR EXPLANATORY LANGUAGE APPUCAMON FOR �Uu�®uNG PEr�NT � COUNTY. OF LOS ANGELES— BUILDING AND SAFETY ' WORK ER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN - BUILDING ADDRESS ✓C� ' I.hereby affirm that I have a certificateof consent to self insure, BUILDING ADDRESS or a certificate Of Workers' Compensation Insurance, or a certified _ - - copy thereof (Sec.3800;Lab.CJ CITU ZIP 'LOCALITY °� •r Policy N0. Company SIZE OF LOT NO.OF BLDGS NOWONLOT ZZ ❑ Certified copy is hereby furnished. 'i;, 0 NEAREST CROSS ST., ❑ Certified copy is filed with ttie county building inspection TRACT BLOCK LOT NO, 'OVI-111;114/ Coy department. _ USE ZONE MAPNO. ASSESSOR MAP.BOOK PAGE 'i PARCEL + SPECIAL CONDITIONS Date. Applicant CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL No - COMPENSATION INSURANCE % wITHIN 1000,FT.of SCHOOL? Yes .No (This section need not be completed if the ermit is for•one hundred ADDRESS - P P O pISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSEp BY ' dollars($100) or loss.) ' CITY ZIP' 1 rn ` I certify that h the performance of the work for which thso as to 9. d'` O Iv-.Q /1 i5 issued, Shall not employ any person i0 any RlanOef so as t0. ARCHITECT 0 ENGINEER TEL NOT (�O /L. J Gam' -become subject t0 the Workers'Compensation Laws.- STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS - CLASS NO. �a/ DWELL UNITS NOTICE TO APPLICANTIf, after making this Certificate Of .REQUIRED TOTAL SETBACK FROM EXIST _ Exemption, you should become subject. to the Workers' 'CONTRACTOR' - TEL NO: SETBACK YARD .HWY PROP LINE WIDTH .Compensation provisions of the Labor Code, you must forthwith - FRONT - comply,with such provisions or this.permit shalt be deemed revoked.- ADDRESS LIC.NO. '- P L _ LICENSED CONTRACTORS DECLARATION .- SIDE - ) CITY - LIC.CLASS P L I hereby affirm that I am licensed underprovislons of'Chapter.9 SEWER MAP ' (commencing with Section 7000)Of Division'3 of the Business and SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,andmy license is in full force and effect NEW ❑ BK PG D Il License Number Lia Class DESCRIPTION OF WORKADD ' VAO Q / VALUATION dD U Contractor Date ALTER ❑ ❑ I am exempt under Sec. REPAIR ❑ $ - Q B:SP.C. for this reason - p6 - DEMOL ❑ TDMA P/c s W Date' - USE OF EXISTING BLDG. ° URM ❑ CO ;- -- Signature APPLICANT(PRINT) TEL NO LDMA Perm# - y "' - Z ,Xj I, as owner of the property.-or my employees with Wages-as their sole compensation, will do the workand the.structure is ADDRESSI not intended or offered for sale (Section 7044, Business and FINAL DATE ^• G SLI�' L - , PfOfCSBIOnS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 4 S`- ' OF MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GWOE? FINAL licensed,contractors to construct-the project (Section 7044, YES❑ No❑ Business and Professions.Code.) -- .. WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING DO UPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH •• - CONSTRUCTION LENDING AGENCY. Coesr AIR OUAUTY MANAGEMENT DISTRICT CCAQMD)SEE PERMITTING CHECKLIST FOR _ n TT^{s- GUIOEUNES' hereby affirm that there work o construction lending agency for ves❑ NO - - - - ifl{-1L L�7,'* 30the 7, Civ. C.) Of the Work for Wf11Ch this permit IS ISSUed(.Sec. I HAVE READ THE HAZAROOUB MATERIALSINFORMATION GUIDE AND THE SCAQMD PERMITTING 3D9], CIV.(�'.) -. - - CHECKLIST.I UNDERSTAND MY.REQUIREMENTS UNDER.THE LOS ANGELES'COUNTY CODE„ • TITLE 2 CHAPTER 2.20 SECTIONS 2,20 100 THROUGH 220.100 CONCERNING HAZARDOUS CHECK Lender's Name - MATERIALS REPORTING AND FOR OBTAINING'A PERMIT FROM THE SCAOMD. _ o Lender's Address o. MNER OR AGENT oI certify that I have read this application and state under penalty _ AC of perjury that the above information is correct.I agree to comply PC.FEE PERMIT FEE /1 _ $ with all county ordinances and State laws relating to building n ��7• u[ 1;3:' m CONShUCtIOh, an efeby aUlhOrZe representatives of this County - ISSUANCE FEE / ' �. to enter a on Bove=mentioned property for inspection urposes. (/O_ © I��_? �. AN 7:5E - AC'O NO d INVESTIGATION FEE TOTAL FEE o/O `' 9 - sa,am,°m nowl�m o.Acem � aJ d (J 7 , SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY t 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 8L 0508 0406100015 PHONE: (026) 285-0488. EXT: LEGAL ID: — - NO.. 0 -CONST,- BUILDS�GTADDRESS: TR: 5903 LT: 99 UN: .003 SQ. -FT STORIES TYPE 5912 BURTON AV N STRUCTURE: 16001 VN SEAS C 917752630 _ ASSESSOR INiGf2MAT15!! NUMBER: " NEARESTCROSS STREET: HERMOSA 5386-014-054 - - - THOMAS PAGE: 596 GRID:, G3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZOHF-� ISSUED O;i: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 06/10/0» - VG 06/05/05 OWNER: TF.I. tiC: BLOGS. N041 ON LOT: `9'.4005'1?ON: FIN L FINAL Y: CODE: TRAN KIEN H;NGO CAROLYN (6265 451-0336- 6,000 5912 BURTON 'V SGAB 917752630 FEES­PAID E CRIPTt OF WORK T/0 ROOF OF EXIST RES, RESHEAT & It STLL EAGLITE-MALIBU APPLICANT: FEE DESCRIPTION: QUANTITY: UCH: AMOUNT: LESS THAN 6 LES) ICBO 4660; STUCCO EXIST HOUSE I 7tL. NO: T B CONSTRUCTION (626) 675-1119- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 6000.00 'JAL 0.60 SPECIAL CONDI 71UNSc j D2 PERMIT W/D EN-HC 6000.00 VAL 149.40 - I TOTAL FEES 177.75 i CONTRACTOR: TF1. NO: - APPROVALS DATE INSPECTOR SIGNATURE T B N. MOORE V (6265 675-1119- I 520 N.-MOOAR AVE.CLIC. NO IOCATIOd AND SETBACKS MONTEREY PARK, CA 91754 746963 B SOILS ENGINEER APPROVAL ARCHITECT C5 ENG!N`cE'd.--- -'EL. NO; FOU!iDP1IC41-8E!iCV!FORMS ZHANG, RU-;IAO (626) 233-6640- _ 7220 N RCSLNSAD BLVD LIC. NO: '----/L;" - __ -- - STE 202-8 "...F OC7 043.'67 _ Cii :' I SAN GABRIE' , CA 91-7G RATS`- f'.00APING -- - — ----j MAP NO: SEk'�7 MAF GOOK: PALE: FID° ZGT+F: . cmPi UNDERFLQOR XX 3 01 _ FLOOR SH EATHINf• NO- OF FAMi LTES: DWELLING UNITS: APT/CC+ND: ST;J CLASS: NO 21 R0-0; SiiEATHING _I ' SCHCOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME II.SPECTION 1 REQUIRED TOTAL SETBACK FROM EXIST FIRt:SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: — FRONT PL- INSULION/iHER STRIP1FAT SIDE PL- AT _ 1—NT—IRI-OR Lis?ii ORYWALL -- - EXTEP fOR-L TH —i RATED Fi09R(CEIL ASS EM. RATED WALL i:SSEMBLiES RATED SHAFTS/OPENINGS T-BAR CEILRdCS TOT GRAINAO' REPORT'10: DPR261 ROUT,' TO: BS050&. -i COUNTY OF LOS ANGELES TEMPLE CITY 9 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 0311030035 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 5903 LT: 99 UN: .003 SO. ,FT STORIES TYPE OCCUP GROUP 5912 BURTON AVN STRUCTURE: 412 2 VN R3 SGAB CA 917752630 ASSESSOR N ORMATION NUMBER: GARAGE: NEAREST CROSS STREET: HERMOSA 5386-014-054- OTHER: _THOMAS .PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: S ED ON: PROCESSED-BY: EXPIRES ON: EXIST OCC GRP: 03/11/04 VG 03/06/05 OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: F AL D T fJNAL BY: CODE: TRAN KIEN H;NGO CAROLYN (626) 451-0336- 60,000 C 5912 BURTON AV _ SGAB 917752630 FEES PAID DE CRI ON OF WORK ADD SECOND STORY (lBR/iBA) AND 1BATH IN EXISTING FIRST STORY APPLICANT: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TTL WHEN DONE: 4BR/3BA T N0: SAME AS OWNER - B1 PLANCHECK. W/ENERGY 33000.00 VAL 538.42 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 60000.00 VAL 6.00 B1 PLANCHECK W/ENERGY 60000.00 VAL 302.94 82 PERMIT W/ENERGY 60000.00 VAL 989.84 CONTRACTOR: TEL. NO: TOTAL FEES 1,864.95. APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: OUNDAT ION/TRENCH FORMS n ZHANG, RU-,IIAO (626) 233-6640- 7220 N ROSEMEAD BLVD LIC. NO: SLAB/UNDER FLOOR STE 202-8 C43767 SAN GABRIEL, CA 91775 RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEAT ING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SE BACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: FSOIDE PL-NT PL- SHEAR PANELS V- Z2 (, INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL X7= TERIOR LATH LOT DRAINAGE SMOKE DETECTION DE C S FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508