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Home My Public Portal About4941 CAMELLIA AVE_Building__ COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 4941 CAMELLIA AV 780 or a certificate of Workers'Compensation Insurance,or a certified 4941 CAMELLIA AVENUE .. copy thereof (Sec.3800,Lab.C.) CITY - ZIP TEMPLE CITY CA 91780 LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ' ❑ Certified copy is hereby furnished. 9180 ONE NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO, department. #,14467 36 USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL -,f./ 296 29-30 1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL No. COMPENSATION INSURANCE IREEggNE T.' MAC 1 (818)448-2509 WITHIN 1000 FT,OF SCHOOL? YES NO (This Section need not be completed if the permit is for one hundred "❑g41 CAMELLIA AVENUE' DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars IS 100)or less.) cIEMPLE CITY, CA ZIP 91780 � I certifythat in the performance of the work for which this permit yy is issued, I shall not employ any person in any manner s0 as t0 ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'COmpenaati0n Laws, STATISTICAL CLASSIFfCATION APT CONDO Date Applicant ADDRESS - CLASS NO. DWELL UNITS NOTICE TO APPLIC4N7.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CONTRACTOR ,yam TEL NO. SET BACK YARD MY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �G FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION - SIDE CITY I LIC.CLASS P L I hereby affirm that 'I am licensed undermovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.7jr I NO.OF STORIES NO.OF FAMILIES } Professions Code,and my license is in'full farce and effect NEW ❑ BK PG a License Number Lic.Class DES ON OF VORK ADD ❑ VALUATION D Q ContractorDate ❑ $ vALTER P4 I ❑ 1 am exempt under Sec. "— REPAIR ❑ 1.$ 0 B.&PC. for this reason DEMOL ❑ LDMA P/C . W Date: USE OF EXISTING BOG. URM ❑ ignature APPLICANT(PRINT) TEL NO. LDMA Perm H A�CT.4 Z 1, as owner of the property, or my employees with wages as' IRENE T. MAC H1H 448-2509 Z their sole compensation, will do the work and the structure is ADDRESS O . . not intended or offered for sale (Section 7044, Business and 4941 CAMELLIA AVENUE, TEMPLE CI.'Y, CA FINAL DOIE C3303 50.50 PfOfCS510G5 Code.) 1 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL Q `S 9 ❑ I, as owner Of the property, am exclusively contracting with A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE JwithAMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL V'. > a I, y licensed contractors to construct the protect (Section 7044, YES 1:1 No❑ /� ACCT., Business and Professions Code.) OWILLCC THE INTENDED USE MI THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING _ 3303. 125•" OCCUPANT REQUIRE P PERMIT FOR CONSTRUCTION(STION OR EE PERMITTING FROM THE SOUTH CONSTRUCTION LENDING AGENCY GUIDEUREapUAUTV MANAGEMENT DISTRICT($CAOMp)SEE PERMITTING CHEGKUST FOR ,-, 2 ITEMS - I hereby affirm that there is a construction lending agency for YES El No the performance of the work for which this permit is issued(Sec. _ TOTAL 1.76 m I I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING D (�M 3097, Civ.C:) CHECKLIST.I UNDERSTAND MY REOUAEMENTS UNDER THE LOS ANGELES COUNTY WOE, Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SOAOMD 'CHECK 160.05 TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 210.140 CONCERNING HAZARDOUS . ECK � (((75 Lender's Address lb.,l�,y o - aN++eR aR rr>ExT l.tiF11417t 'JlJ o I certify that I have read this application and.state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE r�D PERMIT FEE AV with all county ordi�ra S and State laws relating to building m - construct on Steby a thorize representatives Of this County ISSUANCE FEE 0000-0001 tf1MT e toe r upon thea a-me toned property for inspection pu owls. // �/• ✓ yyyy-QQQ 1 7/26/95 INVESTIGATION FEE TOTAL FEE • R e G PP. 1574 1 PM 5.0� SEE REVERSE FOR EXPLANATORY LANGUAGE ' 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 81- 0508 0301140010 PHONE: (626) 285-0488 EXT: GAL 0. OF CONST W BUILDING ADDRESS: TR: 14467 LT: 36 SQ. FT STORIES TYPE OCCUP GROUP 4941 CAMELLIA AV STRUCTURE: 536 1 VN R3 TEMP CA 917803864 ASSESSOR INFORMATION NUMBER: GARAGE: 410 1 VN U1 NEAREST CROSS STREET: LOWER AZUSA 8589-014-023 OTHER: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ON N: PROCESSED BY: EX ES . EXIST OCC GRP: 02/28/03 JK 02/23/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MAC IRENE T (626) 475-9631- 25,000 4941 CAMELLIA AV %7/ �� //1 TEMP 917803864 FEES PAIDSCR HTION OF WORK CONVERT EXISTING 3CAR GARAGE INTO 1CAR GARAGE 8 536SF GUEST APPLICANT: TET.--WO—' FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: HOUSE; ADD NEW DETACHED 2CAR 410SF GARAGE ELITE DESIGN INC (KAMEN) (626) 288-2651- AA BLDG PERMIT ISSUANCE 27.75 8748 VALLEY BLVD #K AC STRONG MOTION RESID - 25000.00 VAL 2.50 SPECIAL CONDITIONS: ROSEMEAD 91770 81 PLANCHECK W/ENERGY 25000.00 VAL 438.14 82 PERMIT W/ENERGY 25000.00 VAL 515.46 TOTAL FEES 983.85 CONTRACTOR: TEL. NO: APPROVALS DATE NSPECTOR SIGNATURE OSMOND CONSTRUCTION AND DEVELOPME (621) 451-0699- 1108 S. CALIFORNIA ST. LIC. NO Uo—cA–fT5–N--AND SETBACKS SAN GABRIEL, CA 91776 7913698 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LEE, PETER (626) 280-9000- 1 8748 VALLEY BLVD. #L LIC. NO: SLAB/UNDER–MOOR ROSEMEAD, CA 9170 3948 WK—lSn--FLMR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 IST LEVEL FLOOR A . OF S: DWELLING UNITS: T/ 0 D: SAT CLASS; NO 21 2ND LEVEL FLOOR SHEATH SCHO l WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED SETBACK YARD: HWY: TOTAL SETBAR—TWONF—TEXUff— PROP LINE: WIDTH: G M NSP cy O ti FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT—DRAINAGE 0 FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 l COUNTY OF LOS ANGELES C� TEMPLE CITY # 0508 _ BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS _ 9701 LAS TUNAS S RESIDENTIAL ADD BUILDING AND.SAFETY j LAND DEVELOPMENT TEMPLE CITY CA 91780 - BL 0508 9812040011 _ - PHONE: (626) 285-0488 EXT: - LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 14467- LT: 36 SQ. FT STORIES TYPE OCCUP GROUP 4941 CAMELLIA AV �. STRUCTURE: 995 1 VN R3 TEMP CA 917803864 .. ASSESSOR INFORMATION BER: GARAGE: 735 1 NEAREST CROSS STREET: SPARKLETT 8589-014-023 OTHER: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG SE: US ZONE: ISSUED ON: PROCESS BY: EXPIRES N: EXIST OCC GRP: - 07/23/99 VG .01/19/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: DE: MAC IRENE T _ (626) 285-6659 82,600 woo 4941 CAMELLIA AV - 10 TEMP 917803864 - - F SPA b SC IP OF ORK ADD 2 BEDROOMS, 1.5 BATHS, FAMILY R09, BUILD NEW FEE DESCRIPTION: QUANTITY: LION: AMOUNT: DETACHED 3-LAR GARAGE APPLICANT: . NO: MAC (626) 285-6659- B1 PLANCHECK W/ENERGY 80000.00 VAL 1,022.27 AA BLDG PERMIT ISSUANCE 27.75 27.75 SPECIAL CONDITIONS: AC STRONG MOTIOCRESID—X82600.00 VAL 8.26 B1 PLANCHECK,W/,ENERGY$8260000 VAL 31.98 B2 FERMI,T�W/ENERGY-�82600:OO�VAL 1,240.31 - CONTRACTOR: TEL. NO: / '9 1 TOTAL,FEES. 2,330.57 APPROVALS _ DATE INSPECTOR-SIGNATURE - MAC, IRENE (626) 448-2609- /V� y\ 4941- CAMELLIA AVE. LIC. NO OC 0 D 8A TEMPLE CITY, CA 91780 NONE - - - / AL_ ARCHITECT 0 ENGINEER: EL. 0: �� 0 N 0 /T CI FO KAO, PEN '(626) 839-9385-/ - 2321 FALLEN DR. LIC. NO L X111111 SLAB/UNDER FLOOR - ROWLAND HEIGHTS, CA 91748 NONE RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: LMP:', UNDERFLOOR INSULATION 3 IO UL`8)8 W0K ST LEVEL FLOOR SHEUR- NO. OF FAMILIES: DWELLING S: APT/CO : STAT CLASS:- NO L S :- NO 211 J g ND LEVEL FLOOR SHEATH .r(`�,11� SCHOOL H HAZARDOUS \ _i qROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS ❑ ''Y NO NO . NO FIRE DEPT. FRAME INSPECT - REQUIRED TOT SETBACK FROM EXIST `b% Old BLD DEPT. FRA INS CT SET BACK YARD: HWY: PROP LINE: WIDTH: %c �N dL 11A FRONT PL- - - - Service Tb SHEAR PANELS - SIDE PL- - - - INSULATION EAT R STRIP - INTERIOR LATH/DRYWALLy EXTERIOR LATH. . LOT DRAINAGE j . SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL - REPORT ID: DPR261 ROUTE TO: BS0508 i 1