HomeMy Public PortalAbout6046 CAMELLIA AVE_Building__ f 3VORKERS'•COMPENSATION DECLARATION
/� M InsureL7Yaffirm that']. have kers' C rune of consent to teff A�PL.ICATIO.N -FOR ,BUILDING PERMIT
Insure, or q certlficote of Workers' Com�ensaTlon Instlronce,
or a ceFtlfied copy fift6reof ($ec 3800, Lab G ) COUN!fY OF-LOS-ANGEi� BUILDING S BDING AND SAFETY
Policy No: Compdny
❑ Certified copy li.}t'ereby fiJmished, FOR APPLICANT.TO FILL IN �rp� �!}j ca.
r El Codified with the Is filed wthe county building Inspec- RUBBING _
. tion depart.Ment. ADI
Date lcant
C nY ti.,• n P LOCALITY +
" -Ptppl
CERTIFI('ATF OF bZWMON FROM WORKERS' SIZE OF LOT" NOW-ON LOTCROSS STS
COMPENSA`TI ON INSURANCE
(This sectlorrmeed not bg com I�ted•tf the permit la for or* TRACT '. :, kOCK ' LO1 NO.' MAP PAGE PARCH
hundred dollars (;100) 8r iess TR
Qv01ER NO. USE Z[NE MAP
14,2613
I c,.rttfy that Irt the,perf6-rinance bf the work for which this
pe Is Issued, I shall not employ grty n Jn any manner. ADDRESS 20 LOS ' SPEClAL
ta.6s.to bZrne w•a[eci to-the Workpri" Ion Laws, �� OU
C7rY LP
Applicdht ARCHITKr OR TEs- p GI20lJP TYPE B
NOTICE T&.. CANT:•ff, ,after mpk cote,of INEER NO. -
ExpTlon, yolk �hoVld•'b6come..su4{ect .4o- tny,
Y 0
Workers'Pertsatlon provisions•of the Labor Code, L.fortfi ADDRESS r V V
with, 4ompLy• wlTh �urlt provisions or,this It aFtal The Ta- STAT15T1CA1 C]�SSIFK.4TKNJ APT•0��-
7
Z
"deemed revoked. OONtRACTOR NO. ,fit —
UCENSED.CONTRACTORS-TORS-DECLp,RAT1QN - ADDRESS NO CL SS NO. - UN.-f—L
I hereby affirm that I am licensed uno*provisions of Chapter 9
. SEWER
.(commgrKIng eswith Sgatlon 799)of.D�vlslon 3 of the Buslneu LIC - AARP
and Proflans'Code,and me
y librlse" In full"force and effect. CITY CLASS
134� PG �� VALIDATION
: .: SQ. Fr., NO:Of NO. OF LNECK
License Numbdr Llc. Clc* STORIES F LIES ONE
r— VALUATION
1l
Contractor DataNDN $ 6�O ,60
. ;
DESO�IPTI(Nf OF WORK
❑I am exempt'under Sec ADO 1
ALTER 10 - Pilo,
B.BP.C. for this rpasonREPAIR 1:1
_
EX15T1 NCS BLDG. pEMOL q i
SInaturb
g APPUCANT TEL �/ 1
FINAL
OWNER-BUILDER DECLARATION NO '77M
' DATE/r T
ACCT.
I hereby off that I am exempt from the Contractors License d/s�` ,, ACC �41
Law'for•the followlr4 reason (Sectio6'7031.5, Buslnes and. &1�4t�J�
Professions Cade): - 1 ITErS
BUILDING
❑ owner of the property;-or my employees with - - -741-75
wagesus their sole com nsatlon,'wl I I do the work and + '
the ttrurrture Is not.lntended of ofjwed for sale(Sectloh LCLffY
70Mt, Buslpes and-Professions Godo.) FhOVItJG T73 - .+. ,. +c' :. ��i� t . 7�F1.
4 --�,t i,...� 4
�as ownerof the prdpert�; am exclusively contracting CONTRACTOR �' � ?
F' Ith-licensed contradoTs to. construct the project{Sec- c=' \' ? t .00
ADDRESS
tion 7044, Bushes and Pwfanions Code.) + = }
To
CONSTRUCTkON J BNPING AGENCY YARD I-IKn FROG
I hereby afflrni that the".1s a co,at, ctlgn-lending agency for �-
the performance of.the work fey which this perrrtlt'ls levied P.L
(sec 3097, Cl'.. AM .57
G SIDE, 1
RL
Lenders Name
Lenders Address P.
For It F.e - - -
I Certtfy that I have rood 4hls application and state that the issuance LD6AA P/C 1
above Informatlon Is correct. I agree to comply with all County' Inwstlpatlon FM -
ordlnances pnd 5" laws rolatlrtg To,building conittvctlan, TotaFes '�� LDMA Perm.
1
and hereby author. representatives of this County To enter
upo - �ntlonpropert�for Inspectloloyp�urposes •' - -
R!VFM J XPLANATORY L ANGUAOi
Signature of or AQen*
- OOUNI'Y OF LOS ANGE aS TEMQpLE CITY # 0508 BUILDING PERMIT
DEPAATMSNT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/RRPAIR
BUILDING AND SAFETY / LAM DEVEIOP%&NT TEMD?LE CITY CA 91780 BL 0508 1202280031
PRONE: (626) 285-0488 FST:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
BK: 215 PG: 84 PC: 1 4 SQ. PT STORIES TYPE - 6046 CAMELLIA IA AV
STRUCTURE: 25 V-B TEMP CA 917802007
ASSESSOR INFOR?LATION NUMBER: NE11RWT CROSS STREET: TEMPLE CITY
5385-018-031 T'BOO( S PAGE: 597 GRID: A2 LOCALITY: TE4PLF CITY, C
TEUkNT: EELST BLDG USE: RES ID USE SONE: R-2 ISSUED ON: PROCF9SFLD BY:
EISST OCC GRP: 02/28/12 SR
OWNER. TEL. 90: BLDGS. NOW ON LAT: VALUATION: BY: CODE:
CHEUNG, JAN& (626) 665-9693-
6,000
TSKP 917802007 FEES PAID DIISCRAPTIGN OF WORK
TEAR OFF EZIBT'I IG ROOFING KATERrar. ON HOUSE 4 ATTACHED GARAG
FEE DFi4CRIPTION: QUANTITY: UOM: AMOUNT: E I119TAL MALARLEY 30 YEARS $HT GLM, MEAT'HER D WCCD
APPLICANT: TEL. NO: .
SUNSHINE ROOFING - AA BLDG PERMIT ISSMkNCE 27.80
AB STATE GREEN BLDG FEE 6000.00 VAL 1.00 9PECAL COM®ITION9:
AC STRONG MOTION RESID 6000.00 VAL 0.60
D2 PERMIT W/O EN-HC 6000.00 VAL 149.40
TOTAL FEES 178.80 '.
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SUNSHINE ROOFING. (909) 598-8988-
516 N DIAMOND BAR BLVD #183 LIC. NO LOCATION AND SETBACKS
DIAMOND BAR CA 91765 755126 C39
90 ENGINEER APPROVAL
ARCHITECT OR ENGIN: TEL. NO: FouN3ATION/TR ca FORD
LIC. NO: SLAB UNDER FLOOR
RA_ISkD FLOOR FRAMING
MAP NO: SRWER MAP BOOK: PAGE: FIRE ZONE: CFP: UNDERFLOOR INSULATION
150H269 3 00
FLOOR SHEATT-IING
NO. OF FAMILIES: DWIEJ-09G UNITS: APP/GOND: STAT CLASS:
0 NO 21 ROOF SHEATH1300
SCHOOL WITHIN HAZARDOUS
SHEAR PAAF:T.9
AIR gUALITY: 1000 FEET ►�LS
Mb NO NO FRAME.IBBPECTION
FIRE SPR_NTLER HANGER.9
nwmLATIOH wmkTu&R STRIP
INTERIOR LATH DRYWALL
EZTMUOR LATE
RATED FLOOR/= ASSEM.
RATED {ALL ASSE 4BT
RATED ShG= OPE.NIwS
T-BAR CEI 2995
LOT DRA.INILGE
REPORT ID: DPR-261 ROUT& TO: 1350508