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Home My Public Portal About9019 CALLITA ST_Building__ WORKERS' COMPENSATION DECLARATION /� n G� hereby o certificate that I have r certificate of consent to self ��'( yp` 11 �OM �O� ��0.�®�� 2�� 'insure, or o certificate of Workers' Compensation Insurance, G'llll `V- !/& 0 II V B PER or a certified copy thereof (Se 3 , Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No?'��°7.LUT Company BUILDING Certified copy is hereby furnished. —�93 FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- tion nspec- - BUILDING - - DRESS _ ttion''department. 'F,�` AD 'Datef q Applica "r` ` CITY' ZIP LOCALITY- G-GL O. OF BLDGS. NEAREST- ' CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF 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.) - - TEL. - - NO. USE ZONE MAP OWNER - I certify that in the NO performance of the work for which this +� SPE permit is issued, I shall not employ any person in any manner - - ADDRESS G _ -� Lk CONDITIONS 0- so as to become subject to th orke omp nsaY n Laws. O � HITY ZIP Date)=--Applica , ARCHITECTOR TEL• 0 NOTICE TO APPLICANT: If,'a r i ihi Cert f cote of ENGINEER NO _ DISTRICT GROUP FIRE PROCESSED BY CONST. ZONE _ Exemption, you should become. ubject to the - orkers' , �D� • �. - �_ U Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with .such provisions or this-permit shall be STATISTICAL CLASSIFICATION - APT. CONDO. Z deemed revoked. _ CONTRACTOR 1 s'\ CLASS NO. DWELL�UNITS_ 'LICENSED CONTRACTORS DECLARATION • -- - ' .I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES TI- Or - tIC SEWER MAP =(commencing with Section 7000)of Division 3 of the Business •/ ' and Professions Code,cm my license is in full force and effect. CITU CLASS I ` BK./Y PG. /DO VALIDATION ,�} 4 SO. FT. NO. OF NO. OF CHECK ' License Number 17,0 Lic Class C•r SIZE STORIES FAMILIES ONE Q n` ZL`s(y I'` VALUATION 'Controcto ate 1��_ �% DESCRIPTION OF WO RK C.�-'r..Ou1 L,�L� NEW ❑ $ ADD ❑� D- ❑I am exem n'under Sec. _ J wilkfUl ALTER B.BP.C. for this reason I l REPAIR $ ' USE OF yn., - Dote: - EXISTING BLDG. {�. REPAIR ❑ - Signature _. APPLICANT TEL FINAL ' OWNER-BUILDER DECLARATION (PRINT) ' NO. — 'IL - �L ,�,� /� DATE hereby affirm that I exempt from the Contractor's License ADDRESS Law for the followingg r reason (Section 7031.5, Business and FIN 1 - Professions Code): - PRESENT Sr By I, as owner of the property,'or my employees with AUILDING DDRESS J Y r r1t••`T'� r wages as their sole compensation,.will do the work and - - //n +7 70' the structure is not intended or offeredforsale(Section LOCALITY D r�I f. /�,//y/ 33707 i Ch1` -333.71 7044,•Business and Professions Code. MOVING TEL. u t ;`y 1 ITGtIr CONTRACTOR NO. ❑ I, as owner of the property, am exclusively contracting TOT 383- 71 with licensed contractors to construct the project (Sec, ADDRESS tion 7044, Business and Professions Code.) TOTAL REQUIRED TOTAL SETBACK FROM EXIST.IST., - i.HEI•Tt 381.71 CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LINE WIDTH I �I I hereby affirm that there is.o.construction lending agency for FRONT .. .� the performance of the work fon CHANGE.which this permit is issued - P. ` (Sec. 3097, Civ.C.). • SIDE Lender's Name p0000'0001 9/ L/92 • - LDIVA Ref. # .. c �t� P.C. Fee$ Permit Fee 1 A 110:L( Lender's Address 5310ry' / � , I certify that I have read this application and state that the - - Issuance Fee C; '7 /7d✓ LDMA P/C# D 8 above information is correct. I agree to comply with all County Investigation Fee yJ� ry /, ' d ordinances and.State laws relating to building construction, Total Fee t) • / LDMA Perm. If a and ereby out orize representatives of this County to enter L m p the bov enti ed property for inspec'on por oses. �v SEE REVERSE FOR EXPLANATORY LANGUAGE r ig ure f RIFT nI or Agent - Date WORKERS' COMPENSATION DECLARATION I hereby affirm that I havecertificate of consent to self - QPP.LOCATIOU M V FOR. 13VOLDD,I.0 VO PERMIT '. I insure, or a certificate of Workers' Compensation Insurance, _ or a certified.copy thereof, (Sec. 3800, Lob. C.) -. .COUNTY OF LOS ANGELES - BUILDING AND SAFETY Policy No. Company �q PY Y .- BUILDING ADDRESS Q/9 ..e `K IG tQ ❑ . 'Certified co is hereb furnished: FOR APPLICANT TO FILL IN �❑ _Certified copy is filed with the county building inspec- - - BUILDING 0 y 11 t .__ - / /j /' tion department ADDRESS `/f -Q+ r ' Q[ (,')�1fr/e /7• Date Applicant CITY :S` /' . ZIP (� 7�L i NO. 7 LOCALITY OF 5LDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZEOF LOT - NOW ON'LOT CROSS Si. 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.) TEL' OWNER NO. t USE ZONE' MAB `- - - .I certify that in the performance,of the work for which this NO. n /� / r SPECIAL-- ? permit is issued,'I shall not employ any person in any manner ADDRESS ��7 `<((//• GI -J� CONDITIONS O so as to become subject to the Workers' Compensation Laws. - /' / ,. CITY �' 'c, Gsbr/_ ZIP U ... - ac RDate - Applicant ARCHITECT OR - TEL. /,�/ n p DISTRIq GROUP TYPE FIRE. P CESSED BY O .NOTICE TO APPLICANT: If, after making. this Certificate of ENGINEER e (/l�/sT/V NO.d'�a - Z/'JS' rp CONST. _ ZONE _ - U Exemption, you should become subject to the Workers' ..".Compensatioprovisions of the Labor Code, you must forth-` ADDRESS' _ U 1�- - with comply with such provisions or this permit shall be TEL, STATISTICAL CLASSIFICATION AP7. CONDO. w Z deemed revoked. - CONTRACTOR, NO. LICENSED CONTRACTORSDECLARATION - - - - _ LIC. - --" - -CLASS-NO. �- � - DWELL UNITS_ I hereby affirm that I'am'licensed under provisions of Chapter 9 ADDRESS NO. LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY CLASS '+. VALIDATION and Professions Code,and my license is in full force and effect -- SQ. FT.r f/ SNC TO OF FA OF CHECK License Number - tic Class SIZE O J STORI S / FAMILIES ONE . VALUATION Ca _ Contractor Dote DESCRIPTION OF ORK i NEW ❑ $ `/ 2.��, _ Li tr,l! Elam exempt under Sec. ADD N'/ D + - ALTER ❑ - B.BP.C. for this reason Wit You L>"xb REPAIR ❑ $ I)-1j �t8 a =J Date: USE OF .. - DEMOI ❑ L_IitL.ti c0' . i_ EXISTING BLDG. l - Signature _ APPLICANT a / i / /' N0.L.8 _ �� FINAL - '.a lFihit3y ,I_it OWNER-BUILDER DECLARATION- PRINT L— DATE I hereby affirm that I am exempt from the Contractor's License - ADDRESS , -r.: ` c� - Law for the following reason (Section 7031.5, Business and FINAL Professions Code): PRESENT S4/-.`. By LI!I[lil I tf6 y /rc BUILDING tq ❑ I, as owner of the property, or my employees with.' wages as their sole compensation,viill do the work and the structure is not intended or offered for sale(Section LOCALITY D �� 7044, Business and Professions Code.) MOVING _ „ TEL. _ _ D -❑ I,as owner of theproperty,am exclusively contracting - CONTRACTOR NO. / with licensed contractors to construct the project.(Sec- "' ADDRESS tion 7044, Business.ond Professions Code.) REQUIRED- TOTAL SETBACK FROM EXIST. I 1 - CONSTRUCTION LENDING AGENCY' SET BACK -YARD HWY PROP. LINE WIDTH t 0 - • hereby affirm that there is a construction lending agency for FRONT ' the performance of the work for which this permit is'issuedP.L. (Sec 3097, Civ. C.). SIDE r P.L: ' Lender's Name $ _ • _ (j � _. • LDMA I. # P.C. Fee$ O / �O�} Permit Fee D- •- Lender's Address a I certify that I have read this application and state that.the Issuance Fee _DMA PiC R - above information is correct. I agree to comply with all County, Investigation Fee ordinances and State laws relating to building construction, Total Fee LD" Perm. R. a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. - - SEE REVERSE FOR EXPLANATORY LANGUAGE - Signature of Applicant or Agent Date .,, COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 SL 0508 0206140008 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONSTNG ADDRESS: TR: 12522 LT: 3 SO. FT STORIES TYPE OCCUP GROUP 9019 CALLITA ST ASSESSOR STRUCTURE: •%4�j9q' 1 VN R3 SGAB CA 917752005 v u ON NUB GARAGE: NEAREST NEAREST CROSS STREET: ROSEMEAD 5382-011-021 OTHER: THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY TENANT: BLDG USE: USE ZONE: ISS PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 07/16/02 JK 01/12/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI NA4 D FIlJ�L BY: CODE: GAO; XIO 90119 CALLITANST (626) 336-8592- 33,675 / ///2 /n -,.. SGAB 917752005 F ES PAID D�/C//R'31 31ON OF WO ADD MASTER BD & BATH FEE DESCRIPTION: QUANTITY: COM: AMOUNT: APPLICANT: EL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 33675.00 VAL 3.37 S ECIAL CONDI ONS: 81 PLANCHECK W/ENERGY .33675.00 VAL 550.61 B2 PERMIT W/ENERGY- ; 33675.00 VAL 647.79 ' TOTAL-.FEES, 1,229.52 CONTRACTOR: EL. NO: ,:� - ' C - �, APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO - - LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: / -+` -�� , C DAT ON/TRENCH FORMS;-�7 i J LIC. NOi L _ _ - SLAB/UNDER FLOOR RAISED FLOOR FRAMING � oL MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMPOi., - UNDERFLOOR INSULATION 6 9L C j ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH L WITHIN ARS SHEATHING M AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL ROM EXIST BLDG D-E-P777-RA-W-rUFM SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- - SHEAR PANELS SIDE PL- - - NSUL N ST INTERIOR LATH/DRYWALLEXTERI OR LATH LOT DRAINAGE ! SMOKE DETECTION DEVICES IRE DEPARTMENT AP RO L REPORT ID: DPR261 ROUTE TO: BS0508