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Home My Public Portal About4819 CAMELLIA AVE_Building__ `IV - WORKERS' COMPENSATION DECLARATION ■ hereby affirm that I have a certificate of consent to self n PPn Ch% 1` M O R FBn n G PERK j'_ insure, or a certificate of Workers'Compenstion Insurance,or (� ILi u UD V��C��VVV///��u��J��JJJ u a certified copy thereof (Sec. 3800, Lab, C. COUNTY OF LOS ANGELES - BUILDING AND SAFETY . Policy No. Company - Certified co is hereby furnished. BUILDING copy y FOR'APPLICANT TO FILL IN ADDRESS YJZ(�CG�G ❑ Certified copy is filed with the county.building inspec- tion department. ADDRESS TD C�i"YVt'� LOCALITY / ( ``'' NEAREST Date' Applicant CITY 6Q,. �, ZIP LL DC CROSS ST, _ CERTIFICATE OF EXEMPTION FROM WORKERS' 7 NO.OF BLDG5. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 01— MAP BOOK PAGE aPARCEL (This section need 'not be completed if the permit is for one U5 ZONE MAP TRACT BLOCK LOT NO. NO. 'hundred dollars ($100)or less.). - Q - Y Ma"� -TO"0,J TEL. SPECIAL I certify that in the performance of the work for which this OWNER �] L1n/S NO. 1 CONDITIONS - 1 O - permit is,issued,,Lsholt not employ any person in any manner n/� 9 c -(r1 _q /^� DISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become subject to'the Workers'Compensation Laws. ADDRESS 48(03 y(-d-O(L YrZ N CONST. '/ ZO 09 Date Applicant CITY LY4 �6RAs1 Q.. ZIP i7S� �� I O Pp STATISTICAL CLASgggIFI ATION APT. CONDO. U `NOTICE TO APPLICANT: If, after*making this Certificate of ARCHITECT OR' 1 ` j TEL. Exemption, you should become subject to the Workers' ENGINEER M'1q'Vv� O' NO. CLASS NO./DWELL UNITS_ y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER P z with comply with. such provisions or this permit shall be deemed revoked. TEL BK. P�t� CONTRACTOR NO. VALIDATION II ' LICENSED CONTRACTORS DECLARATION LIC - I hereby affirm that I am licensed under provisionsof Chapter 9 ADDRESS LIC. - VALUATION �� ,(commencing with Section 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY I LIC. LIC. S t - SQ. FT. NO.OF NO.OF CHECK .License.Number Lic.Class SIZE L. STORIES FAMILIES ONE ' Date' DESCRIPTION OF WORK iAl�4 - ' Contractor � NEW a exempt from the licensing requirements as am o �L�� p ADD` ❑ licensed architect or a registered professional engineer FINAL , acting in my professional capacity (Section 7051, EPAIR Business and Professions Code). USE OF- 11 FINAL EXISTING BLDG Lic.or Reg. No. Date APPLICANT TEL. By 1 OWNER-BUILDER DECLARATION - IPRwTI No. �I l I hereby affirm that I am exempt from the Contractor's License I Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): . PRESENT --2). d ) 2 2 1L 1.2 A ❑ I, as owner of the,property, or,my employees with ADDRESS wages as their sole compensation,will do the work and ! 7� y #,° 's ° • s the structurenis not intended or offered for sale Section LOCALITY 77�� 7044, Businessland Professions Code). MOVING TEL i 2 ° 10600 „as owner of the'property,:am exclusively contracting CONTRACTOR NO. ` with licensed contractors to'"construct the project (Sec- O f3 O O v t tion 7044, Business'and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. 1 2. 22-81 •'CONSTRUCTION-LENDING AGENCY SET BACK YARD HWY PROP. CKE . WIDT . FIhe'reby affirm that-there is a construction lending agency for FRONT the performance of the work for which this permit is issued P,I, (Sec. 3097, Civ. C.). - - SIDE P.I. Lender's.Name _ Lender's Address P.C. Fee 5 �(/ Permit Fee - ? I.certify that I have read this application and state that theIssuance Fee �— above information is correct. Ipgree to comply with all County _ Invevigotion Fee ordinances and State laws relating to building construction, J and hereby authorizer presentatives of this County to enter inial Fee v+ I upon t ov me - ned property for inspection purposes. ' pr7 s SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur f Applicant or Agent / Ale Os 1. WORKERS'COMPENSATION DECLARATION F" I.hereby affirm tbot have a certificate of consent to self ,�PPUCja 1�� n n � - �� insure or a certificate of Workers'Compenstion Insurance, or u Illlll I�� J /��I�II/�� _ a certified copy thereof (Sec. 3800, Lab. C.) t COUNTY OF LOS ANGELES_ - BUILDING AND SAFETY Policyn No. Compact ❑ BUILDING n Certified'copy is hereby furnished: FOR APPLICANT TO FILL IN ADDRESS D � "�'L'�e /A •� Certified copy is filed with the county building inspec- BUILDING //��.. � -- k ' tion department. ADDRESS v--Ort-,;r ov -- LOCALITY Pi4L�J �� `. NEAREST Date Applicant CITY ZIP cl !7 �•p CROSS ST." �2 - -2-" 4_ + CERTIFICATE OF,EXEMPTION FROM WORKERS' /_ I� /60 7 Nb. O . '� ASSESSOR ' COMPENSATION.INSURANCE � SIZE OF LOT Y! o NOW ONN LOT 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. NO. }, 'OWNER- KZ Q GLN TEL �T � "y _ SPECIAL _-_ - 1 1 ��5� L cert lfy that in the performance of the work-for which this SOS 'NO:'oC.r� ('�E_S� - CONDITIONS O" permit Is issued, I shall not employ any person to any manner" ) p� DISTRICT GROUP TYPE FIRE PROCESSED BV- U so as to become subject to the Workers Compensation Laws. ADDRESS 4 86-3 E 1 N2. CONST �. ' J .� ✓ o Date t - Applicant ' v CITY l �ZjvN-Pi ZIP �J" STATISTICAL CLASSIFICATION - APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate o4 ARCHITECT OR TEL - / W ENGINEER U NO. 'CLASS NO.�DWELL. UNITS (� 1 Exemption, 'you should become subject to the, Workers' - 1 .W Compensation provisions of the Labor Code, you must forth- - - Z with comply with such provisions or this permit shall be ADDRESS SEW�ER�fQ P " , _ - TEL' B / PG VALIDATION deemed`revoked: 'CONTRACTOR NO. r LICENSED CONTRACTORS DECLARATION _ LIC. hereby affirm thaPl am licensed under provisions of.Chapter 9 ADDRESS -- NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY - CLASS S' j/' s-vo .z ' SQ. FT.f� NO. OF NO. OF , CHECK License Number Lic.Class SIZE /.S� STORIES FAMILIES .ONE Contractor - Date DESCRIPTIOEN�OF.WORK NEW ❑ $' -. I'am exempt.from the licensing requirements os I am a `gyp SfSY' ADD ❑ licensed architect or a registered professional engineer1 r p 'ALTER FINAL / acting in my professional capacity (Section 7051, + 5 LA.C` Or REPAIR ❑ DATE Business and Professions Code). USE OF FINAL _ 1--, EXISTING BLDG. ( L'E'N p DEMOL ❑ Lic or Reg: No: _Date` " APPLICANT _ TEL. OWNER-BUILDER DECLARATION PRINT)' NO. -- I hereby affirm that I am exempt from the Contractors License - ._Law for the following reason (Section 7031.5, Business and ADDRESS �2 2 44 1 3 F Professions.Cade): _ PRESENT - - BUILDING • ; I, as owner of the property, or my employees with ADDRESS e o s e 1 wages as their sole compensation,will do the work and the structure is not intendedor offered for sale Section LOCALITY - ' 2'e 1 3, 7044, 0 7044, Business and Professproperty, ns am oclu MOVING TEL. + ' CONTRACTOR NO. //7/� s. I, as owner of the property, am exclusively contracting� - �J e � 1 3 3 0 0-0 with licensed contractors to construct the project (Sec- ,ADDRESS t 'tion 7044, BusinessandProfessions Code). 1 2.2 2;—S 1 , REQUIRED TOTAL SETBACK FROM EXIST. - CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LI W DTH I hereby affirm that there is a construction lending agency for ' 1' FRONT - the performance of the work for which this permit is issued P.L.(Sec.,3097, Civ,C,) .. .. - - SIDE - P.I. - - _ Lender's Name ,Lende{s Address' �. P.C. Fees ((� Permit Fee m - w I certify that I have read this application and state that the Issuance Fee _ a b.ve,mformaticm,is correct. I agree to comply with all County ,' Investigation Fee p ordinances and.State jaws relating to building construction, total Fee and hereby authorize representatives of this County to enter - a up"on rhe ov mentioned property for inspection p rpose ' a '��• SEE REVERSE FOR.EXPLANATORY LANGUAGE Signature of Applicant or Agent Date - Os 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 BE 0508 1205110029 PHONE: (626) 285-0488 EXT: DUPLICATE ILEGAL ID: NO. OF CONST T BUILDING ADDRESS: ITR: 14467 LT: 49 SQ. FT STORIES TYPE 4819 CAMELLIA AV STRUCTURE: 56 V-B TEMP CA 917804241 ASSESSOR INFORMATION NUMBER: i _ NEAREST CROSS STREET: 8589-015-026 THOMAS PAGE: 597 GRID: A5 LOCALITY:_TEMPLE CITY CAI I I TENANT: (EXIST BLDG USE: REBID USE ZONE: R2 TISSUED ON: PROCESSED BY: I (EXIST OCC GRP: 105/11/12 SR I I I I I IOWNER: TEL N0: IBLDGS. NOW ON LOT: VALUATION: IFI AL DATE ( FINNZIL�� Y: CODE: MARGARET, ARUIS ' /A- 2 s50 I S�i 1` 1128 VERA S CRUZ ST IMBLO 906402551 FEES PAID IDESCRIPTION OF WORK I IBATHROOM REMODEL REPLACE VANITY AND SHOWER I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 (APPLICANT: TEL. NO: ITONYS REFRIGERATION (562) 948-4194- IAA BLDG PERMIT ISSUANCE 27.80 I 18815 DUNLAP CROSSING )AB STATE GREEN BLDG FEE 550.00 VAL 1.00 (SPECIAL CONDITIONS: IRO PICO RIVERA. 90660 1AC STRONG MOTION RESID 550.00 VAL 0.50 ID2 PERMIT W/O EN-HC 550.00 VAL 43.70 T ITS INV WORK W/O PERMIT 342.20 DOL 342.20 CONTRACTOR: TEL. NO: I TOTAL FEES 415.20 (APPROVALS DATE INSPECTOR SIGNATURE I TONY'S REFRIGERATION (562) 948-4194- 1 1 1 18815 DOLLAR CROSSING LIC. NO I LOCATION AND SETBACKS I I I IPICO RIVERA CA 90047 610858 ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: IFOWDATION/TRENCH FORMS I I I 1 I LIC. NO: ISLABUNDER FLOOR I I I= 1 I I i I RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I (UNDERFLOOR INSULATION I I 1114H269 3 001 ' 11 1 I I IFLOOR SHEATHING I I ' I INC. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I a 11 I 1 0 NO 21 1 ROOF. SHEATHING I SCHOOL WITHIN HAZARDOUS 1SHEAR PANELS JAIR QUALITY: 1000 FEET MATERIALS I NO NO NO (FRAME INSPECTION I I I (FIRE SPRINKLER HANGERS I I I IINSULATION/WEATHER STRIP( INTERIOR LATH/DRYWALL EXTERIOR LATH I I I -RATED FLOOR/CEIL ASSEM. I RATED WALL ASSEMBLIES I I (RATED SHAFTS/OPENINGS T-BAR CEILINGS _ * ADDITIONAL DATA ON FILE 170T DRAINAGE I IRE PORT ID: DPR261 ROUTE TO: BS0508 l I I I I I