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HomeMy Public PortalAbout5932 BURTON AVE_Building__ .. •F ;WORKERS'COMPENSATION DECLARATION �L • I FierAby�Jflrm that I have a certificate of consent to self O O n �n LI IS insure;or a certificate of Workers' Compensation Insurance, //�g�n\PPUCL/1"UrOON FOR OURONG PERNT ± -or aoertified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Na. Company s - BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 3 vl• JV: Q)!L. Vile— LOCALITY /+ I / NEAREST Date Applicant CITY G Ll, 'e { ZIP / -7 7.5 CRO55 . CERTIFICATE OF EXEMPTION FROM WORKERS' <t. r . NO. OF BLDGS. c� ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 576 X I NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less.) _ TRACT BLOCK LOT NO. 1 01J3 NO. !(� TEL. . SPECIAL T I certify that in the performance of the work for which this OWNER rA 1^ a /' c`Q,. NO. CONDITIONS Q. permitis issued, 1 shall not employ any person in any manner �ry r DISTRICT GROUP TYPE FIRE PROCESSED BY 0 so as to become subject to the Workers'Compensa ion Laws. ADDRESS L v h V � CONST. ZONE 1 O a' Date �� �� Applicant t7 CITY N (� ` ZIP _ 7gT15TICAC SIFICATION __ PT. CONDO. 0 Jx NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR ®•fie TEL. V Exemption, you should become subject to the Workers' ENGINEER •vV �Qf NO. CLASS NO. DWELL. UNITS_ a Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be TEL. Z deemed revoked. CONTRACTOR © w 'Q r NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALLI TION (commencing with Section 7000)of Division 3 of the Business and LIC. fJ Professions Code, and my license is in full force and effect. CITY CLASS $ D SO FT. NO.OSTORIES NO.-OF CHECK License Number Lic.Class SIZE 0� STORIES FAMILIES ONE b - Contractor Date DESCRIPTION OF WORK NEW I am exempt under Sec. L ADD ALTER ❑ FINAL B.BP.C. for this reason ❑ DATE REPAIR s USE OF DFMOL Data: EXISTING BLDG, 9 N Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT H C y� 2Q�,/e NO.eL S$ I hereby affirm that I am exempt from the Contractor's License ADDRESS a- /V ✓�M 1'-G/'L Law for the following reason (Section 7031.5, Business and 3 7 2.b A 'Professions Code): PRESENT . I, as owner of the property, or my employees with BUILDINGADDRESS II11\l 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. Q $2 3-$4 with licensed contractors to construct the project (Sec- ADDRESS ' 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, Ci, C.). SIDE P.L. Lender's Name _ f '4- N $ Lender's Address P.C. Fee$ Permit Fee - - I certify that I have read This application and state that the Issuance•Fee above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee G and hereby authorize representatives of this County to enter 9 upo he above-meq+gned property for inspection purposes. 9 •/ SEE REVERSE FOR EXPLANATORY LANGUAGE ` x Signature of Applicant or Agent pole ..05 '• fOUNTY OF LOS ANGELES TEMPLE CITY V # 0508 BUILDING PERMIT d EPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS RESIDENTIAL PDD/ALT/REP 'BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9806190006 PHONE: (818) 285-0488 EXT: y- LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 5903 LT: 101 UN: .002 SQ. FT STORIES TYPE OCCUP GROUP 5932 BURTON AV N STRUCTURE: 297 1 VN R3 SGAB CA 917752630 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: HERMOSA 5386-014-058 OTHER: THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ONE: ISSUED ON: PROCESSED BY: EXPIRES ON:,-- EXIST N:%EXIST OCC GRP: 06/19/98 UT 06/19/9 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: ODE: STEELE THOMAS A;JEANNE S (626) 287-2344- 1 22,000 �N 5932 BURTON AV - SGAB 917752630 FEES PAID D SLRfPTION ARK FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: EXTENTION OF 2 NEW BEDROOMS AND 1 VBATHROOM APPLICANT: PEL. N0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION.REBID 22000.00 VAL2.20 SPECIAL CONDITIONS: _ AX BUILDING REVIEW FEE, 54.70 B2 PERM I T:W/ENERGY ?__ _� 22000.00,VAL 463.32 --TOTAL-FEES- 547.97 CONTRACTOR: TEL. N0: "�'�' �" " SAME AS OWNER APPROVALS DATE INSPECTOR SIGNATURE LIC. NO �` f 1� !'' \ LOCATION AND SETBACKS 7y SOILS ENGINEER APPROVAL q ARCHITECT OR ENGINEER: TEL. NO: '. � I "' i `, FOUNTATIONPRENCH FORMS L I LIC. NO:M �- —�' � SLAB/UNDER FLOOR _ RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: _, UNDERFLOOR INSULATION 3 101 . ST LEVEL FLOOR SHEATH NO. OF FAMILIES: ING UNITS: APT/COAD: 5 AT CL SS:. NO 21 / - NDLEVEL FLOOR SHEATH SCHOOL WITHINROOF SHEATHING M AIR QUALITY: 1000 FEET MATERIALS NO NO NO ` �j � �'� FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBAC ROM EXIST �U�. �C i"� BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SIDE PL- SHEAR PANELS - t( -" INSULATION/WEATHER STRIP INTERIOR LATH/ BY LL EX RIOR LAT LOT DRAINAGE SMOKE DETECTION DEVIC S FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 WORKERS' COMPENSATION DECLARATION >�' L�r�LL /�� /� �FL��Ip� R M�(/�.�� gyp} �//�T� -�1 hereYy 5f cert that have a certificate of consent to self /O\ I0 PO �'.1( /O\��ON FOOD RURD�U VG PLSRM67 --rinsure, ai o certificate of Workers'Compenslion Insurance,or (/"UD Il LLSS "VV/N 0 a certified co y thereof (Sec. 3800, Lob. C.) ( . COUNTY OF LOS AN GELES'• BUILDING AND SAFETY Pol' N�Company /L/LL.� ' r K. • BUILDING - - Ceru Ted copy is hereby furnished. -FOR APPLICANTTO-FILL IN` ADDRESS 2— DD Certified copy is filed with the county buildin inspec- BUILDING - tion diCATE'eO , . ADDRESS -5932':Burton Avenue LOCALITY - rule City CA 91.7r7C`. NEAREST Date.-y� pplicant CITY I `LFP'' CROSS ST. Q/ - CERTXEMPTION IrFVCTATWORKERSI SIZE OF LOT 50'X190'+ NO, OF BIDGS. 2 ASSESSOR COMPENSATION INSURANCE — NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one _ USE ZONE MAP hundred dollars ($100)or less.) TRACT 5903_ BLOCK LOT NO. lQ1* NO. r TEL I certify that in the performance of the work for which this - DISTRICT GROUP permit is issued, TYPE FIRE PRO ESSED BY V shall not employ any person in any manner ADDRESS5932 n -AVenlle- . CONSTZONE so as to become subject to the Workers'Compensolion Laws. �L . O CITY Teng)le City, CA. ZIP 91775 VGf 1- -Date— _Date Applicant STATISTICAL CLASSIFICATI C61NIX5. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR - TEL. W Exemption, you should•become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS_ W Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be deemed revoked. CONTRACTOPAI1M'S.HOME LMP. No.-276-2503 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC' 400095 . I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1607. Garth Avenue NO. VAL TION (commencing with Section 7000)of Division 3 of the Business and LIC. r - Professions Code, and my license 'n full force and ffect. CITY �S AnC3eleS/ CA. CC. B $ QOO.00 ` SQ.R. NO.OF NO,OF CHECK License Num r Lic.Class SIZE STORIES 1 IFAMIUES 0 ONE Contractor ! Date DESCRIPTION OF WORK •Gard -,iiIorkSh NEW ® $ ADD ❑ am exempt from the licensing requirements s am e licensed architect or o registered professional engineer - ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code), USE OF DEMOL FIN _ EXISTING BLDG.BL1Tellln &- Gara ❑ By - Lic, or Reg. No. Date APPLICANT PR NT) Owner.-above NO. - OWNER-BUILDER.DECLARATION � I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS ' Professions Cade): PRESENT BUILDING 1, 5932' Burton Avenue . I, as owner of the property, or my employees with ADDRESS z2 8 8 5 4 A wages as their sole compensation,will do the work and le Cl the structure is not intended or offered for sole(Section - - LOCALITY # e e • e le ,� 7044, Business and Professions Code). MOVING TEL. ElI, as owner of the property, am exclusively contracting CONTRACTOR - NO. ) z 56.1 3 with licensed contractors to construct the project (Sec- ADDRESS e e 2 5(Z,� 3 tion 7044, Business and Professions Code). - CONSTRUCTION LENDING AGENCYREQUIRED TOTAL SETBACK FROM EXIST. RE BACK YARD HWY PROP. LINE WIDTH ` j . ti •t hereby affirm that there is o construction lending agency for - FRONT - ''� �- '�; '- •' �' ZQ 6— BB the performance of the work for which this permit is issued P,L. ,L (Sec. 3097, Civ. C.). - SIDE - P.L. Lender's Name P.C. Fee 8 Perrri Fee - _ Lender's Address _ n -�.•,r-.rte ���• �' •_\ ,\. R. �S i :�, yt 1 certify that I have read this application and state that the w Y PP Issuance Fee p above information is correct. I agree to comply with all County Investigation Fee -ordinances and late laws r luting to building construction, 1`.+ and hereby ou ari,,e repr entatives of this County to enter imol Fee G t m upon,t b e- property for inspectionurpos Jo s. a / G SEE REVERSE FOR EXPLANATORY LANGUAGE ®s 51 nature of Applicant or Agem Do