HomeMy Public PortalAbout4909 CAMELLIA AVE_Building__ r •' WORKERS'COMPENSATION DECLARATION_ - -
I hereby affirm that I have a certificate of consent to self. //p�� D O f/(� //p�� �FI���� gyp} �h�y O O
insure, or a certificate of,Workers'Compenstion Insurance, or aPPLOC�QIr00N •U OUT OLDD �fi G PEGMOT
a certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELE BUILDING AND SAFETY
PolicyNo. Company'
Certified copy is hereby furnished. • FOR APPLICANT TO FILL IN - - ADDRESS 0 C ✓
L
Certified copy is filed with the county building irispec- BUILDING
lion department. ADDRESS T M ✓ LOCALITY
NEAREST
Date Applicant CITY 'ZIP D CROSS ST. &)ll e
CERTIFICATE OF EXEMPTION FROM WORKERS' I NO. OF BLDGS. ASSESSOR
COMPENSATION INSURANCE - SIZE OF LOT NOW ON LOT MAP BOOK RS PAGE Q 15-' PARCEL O
(This section need not be completed if the permit is for one //,, � USE ZONE MAP Q
TRACT �T BLOCK LOT NO. NO.
hundred dollars ($100) or less.)�
- I TEL - SPECIAL
I•certify that in the performance of the work for which this OWNER (.. q NO 1
— CONDITIONS- O
permit is issued, I shall not employ any person in any manner QQ DISTRICT I GROUP ITYPE FIRE P OC SED BY V
so as to become subject to the Workers'Compensation Laws. ADDRESS , A J/✓ CONST .ZO E pc
c - CITY e ZtP [S
'Date Applicant - r( STATISTICAL CLASSIFICATION APT. COND V
NOTICE TO,'APPLICANT: If, after making this Certificate of ARCHITECTO -TEL. W.
Exemption, you should become subject to `the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS_ N
Compensationprovisions of the Labor Code, you must forth-
ADDRESS $EWER MAP Z
with comply with such provisions or this permit shall be
r deemed revoked. - OW TEL 8K. PG, VALIDATION
CONTRACTOR `� NO
LICENSED CONTRACTORS DECLARATION
LIC. j
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION d'P
,(commencing with Section 7000)of Division 3 oEthe Business and I LIC.
Professions Code, and my license is in full force and effect. CITY ' CLASS S (:?We-q
SQ.,Fi. p NO.OF .t NO.OF CHECK -
-LicenseNumber Lic.Class SIZE STORIES / FAMILIES ONE
' NEW ❑ $ . �-
Contractor - Date DESCRIPTION OF WORK '
am exempt from the licensing requirements as I am a Up L-CA '�/ ADD' ❑
licensed architect or a registered professional engineer ALTER FINAL Z
acting in my professional capacity (Section 7051, REPAIR ❑ DATE
Business and Professions Code). USE OF DEMOI FINAL �_��J
_ - EXISTING BLDG. ❑ By
Lic.or Reg. No. _Date APPLICANT TEL.
OWNER-BUILDER DECLARATION (PRINT) - NO.
Law for the following reason (Section 7031.5, Business and ADDRESS
I hereby affirm that I am exempt from the Contractor's License .
Professions Code): _ PRESENT - 1
- - BUILDING
I, as owner of the property, or-my employeesrwith ADDRESS ;?'4'.6 9.9 A
wages as their sole compensation,will do the work.and
the structure is not intended br offered for sole(Section LOCALITY
7044, Business and Professions Code). MOVING - TEL. 'es'e e
I, as owner of the property, am exclusively co nfiocting CONTRACTOR- NO. - - ,2 e -.2.200
with licensed contractors to construct the project (Sec- ADDRESS .
-tion 7044,Business and Professions Code). - ' ' 1 _
REQUIRED TOTAL SETBACK FROM EXIST, e a e 2.2 0 O_U,
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 PL. -
.(Sec.'3097, Civ. C.). - - SIDE -P.L.
Lender's Name -
P.C. Fee S Permit Fee - r
Lender's Address '
w 1 certify that I have read this application and state that the Issuance Fee
aabove information is correct: I agree to comply with all County _ Investigation Fee r
113 ordinances and State laws relating to building construction,
and hereby authorize representatives of this County to enter Total Fee
V
a upon t eabove-mentioned property for inspection purposes. _
�d a/ SEE REVERSE FOR EXPLANATORY LANGUAGE
^ I' ant Signature of Ap or Agent - Date I . - - - _ _ "• - r ®s
COUFIT° `1� LOS ANGELES TEMPLE CITY # 0508. PERMIT _
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ADD/ALT/REP
BUILDING AND SAFETY ( LAtiD'DEV'ElOPP1Eti? TEMPLE CITY CA 91780 !At 11508 ':408180017
PHCNE: (6260 285-0488 EXT:
LEGAL 1D: _ N0. Or -CONST NEW T BUILDINGA SS: — - -
1 TR: -!4467 LT: 41 SQ. FT STO.RIES TYPE OCCUP GROU'P1 4909 CAMELLIA Ai
STRUCTURE: 1 VN R3
(ASSESSOR IHF RMATICN NUMBER: __ TEMP CA 9191781%-L"1 GARAGE: - NEAREST CROSS.STP.EET: TEMNPLE.CITY ..
185891-015-018 - OTHER: 573 1 VN U? THOMAS PAGE: 5?7 GR:D: A5 LOCALITY: 'TEMPLE CITY, C
i EMANT: __!F`/.SST'BLDG
USE: USE ZONE: ISSUED ON: PRGCESSED BY: EXPIRES CNi
!EXIST OCC GRP: 108/18/04 JK 08/13/0:
OWtJFR- _i IEL. N0: BI.G(:S. NNOw ON LOT: VALUATION: IFINAL DATE � Ft6'Gi•eY: LODE:
1CHID, ERIC/JULIE W - 11;710
4909 CAMELLIA AV _
'TEVP 917804243 FEES PAID C�ESCK I PT ION Of WORK -
REMOVE EXISTING PATIO & STORAGE PUT NEW PATIO 257 SOF''.
`EE DESCRIPTION: QUAIJTITY: UOM: AMOUNT: NEW STORAGE 317 2 N°F' FiitIDOWS
A?PLICANT: TEL. N0:
1S.AME AS OWNER - - 144 BLDG PERMIT ISSUAKCE - 27.75
I IAC STRONG MOTION RESID .11SP_710.00 VAL "i.17 ' ECIAL CO DITIO4r.
AX BUILDING REVIEW FEE 5•;,70
82 PERMIT 'W/ENERGY 11710.00 VAL
_ TOTAL FEES 33.34 _
'CONTRACTOR: . TEL. N0: - ?P OS'ALS'�- PATE INSPECT^. Si GNFTt4"E
ISAME AS OWNER
IS
LIC. NO - LOCAT ION PNU SE BACKS
- IILS E3GiNEER A^PRO'JAL
i;
..... '.c�T C2 ENGINEER: TEL. NC: ----- rouoV TION/TRE=:-C:: -- - - '--
LIC.
i j�.•:Ia_Ji' FLOOR FRAC:P.:C u I
MAP N0: SEWER, CHAP BGGK: PAG'c: -'---FIRE ZGN'c: �j�:' - IiNDr.R FLOOR fN5(ILA?ff�ti v�- �
1 - z ' 03
"S LE'JF.L fLGOR ,7t,r i
INO. OF FAMILIES: DWELLING UNITS: APT/CONDI STACLASS:
"`
NO 21FLOOR SIiEATH
----'- ' " ---- ------i
12ND BEVEL i--_-1
SCHGI- WITHIN HAZARDOUS 60CF SHE-ATHING.
(AIR QUALITY: 1000 FEET MATERIALS - - I
NO NO NO IFI kE DEPT, FRAME iriPEGTI --�
REQUIRED _TOTh.i. ETBACK FP.OM EXIS"—I BLDG DEPT, FRAME )ER 5?EC1_I
�--
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- - I§HEAR PANELS
SIDE-0L -- ,1 1NSULAPION/WEATHER -;RTP!
I I 1iNT ERiGR ASH%ORYWA L —�
IFXT ER IOR. -
LOT DRAINAGE
(SMOKE DETECTION DEVICES i --
FIRE DEPARTMENT APPROVAL —'
REPORT ID: DPR261 ROUTE T0: BS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0107270034
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDINGADDRESS:
TR: 14467 LT: 41 SO. FT STORIES TYPE OCCUP GROUP 4909 CAMELLIA AV
STRUCTURE: 450 1 VN R3 TEMP CA 917804243 4';W429-A2'5. �
ASSESSOR N ORMATION NUMBER: GARAGE: NEAREST CROSS STREET: TEMPLE CITY BLVD.
8589-015-018 OTHER: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: USE ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 08/08/01 UT 02/04/02
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
CHIU, ERIC WING (626) 291-5534- 38,250
4909 CAMELLIA AV /d•Z3A
T�
TEMP 917804243 FEES PAIDDESC I TION OF WO K
NEW ADDITION: MASTERBEDROOM, 1BEDROOM, AND 1BATHRM = 450S.Q.
FEE DESCRIPTION: QUANTITY: LOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - 61 PLANCHECK W/ENERGY 38250.00 VAL 611.62
AA BLDG PERMIT ISSUANCE27.75 SPECIAL CONDITIONS:
,_
AC STRONG MOLION"RESID- - - _38250.00 VAL 3.83
82 PERMITiW/ENERGY^c L E S -38250".00 VAL 719.57
-TOTAL FI'71EES 1,362.77
CONTRACTOR: TEL. N0: �J J APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER LIC.-NO LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL 1 A�
ARCHITECT OR ENGINEER: TEL. NO: ,/! l�, \ FOUNDATION/TRENCHFORMS
1 I�I -
LIC.-NOi�� SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:' �` ,` i /� �. �" UNDERFLOOR INSULATION
3 01. 1
U - IST LEVEL FLOOR SHEATH
NO. OF FAMILIES: DWELLING UNITS: APT/CO D: STA C _--- _ -
NO 21 ��� /' ��' - ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARD
OUS ��� ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS �\
NO NO NO �� ` V �`/ FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBACK FROM I � � �� -� � J BLDG DEPT. FRAME INSPECT
SET BACK YARD: HWY: PROP LINE: NI DT N: - /ip- --' _ _' -�� ;'� LO G
kc
FRONT PL- `'�.����i VIG E' l��S� SHEAR PANELS
SIDE PL- _ - -
- - INSULAT 0 W R STRIP
INTERIOR LATH/DRYWALL O ¢
ERTMUF-LATH
/v g
LOT DRAINAGE
SMOKE DETECTION DEVICESD/
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508