HomeMy Public PortalAbout6048 CAMELLIA AVE_Building__ RI(eip"COMPENSATION DECLAkATION
i sure affirm that I•haver certificate of tabs Int to �� A P P L I CA l.0 'FOR I D I�V G P E RM I T
Incurs,or'a certificate of Worker' Compenwtlon Insurance, O B•
orb certffied copy thereof (Sec- 3800, Lab. C') `
1POUNT1l.OF LOS ANGELES' BUILDING AND SAFM
Policy No. _. Company-
Cqrrtlfled copy Is hereby furnhhed. FOR 74PPL1 TO FIP.k•.IN. �;, ,,,Dpi
0 Yr
Certified copy U filed with the county'bulldlnp Inspec- BUILDING
' tion department. ADDRESS
Date Aopllcont CITY ZIP Lp(l{LITY
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF
COMPENSATION INSURANCE SIZE OF LAT X } ST.
(This,section need not be coni leted if-the permit is for one. TRACT - 1 NO. 1 ASS SOR PA(ie PARCH
hundred dollars (=100)or lewd .
NO USE ZC*& Z f
I certify that In e performance of the work for which this 211 Nath
permit Is Issued, 1-shall not employanyTrson In any manner 2� Efv7AL
w to become subject to the Worker Com nation Laws. COPD1T10N5 Q
Gly ZIP
h Applicant DISTRICT TYPE BY
I. NOTICE TO APPLI • lf, after fnakl 7it
cafe of ARCHITH"i
Exemption, you should becortte wbrect tWorkers' - COMET. z0►E- ,
Compensation provisions of the Labor Code, st forth- ADDRESSM f2
[ �8 3
with comply with such provisions or thishall•be -Ta
deemed revoked, STATISTICAL CL•SEII4CAT10N APT.
' 1
LICENSED CONTRACTORS DECLARATION CLASS Na DWEL UNITE,T ) -+
I.hereby-affirm that I am licensed under,provisions of Chapter 9 ADDRM NO.
(c6rn ' Inp with Section-7000)of plvWw 3 of the Business and LEG ErWER MAP
Professions Code, and my license is in full force and effect. CITY CLAMPC3• 3 VALDATF M
License Number• Llc.Cldu
SIZE
FT b " EOR No.of ofd"
VALUA
i OF WORK NEW _
Contractor pate NE 1 '1 $.5A
I am exempt under Sec ,
UnnALTER �i1D # ° a•a•e ?,3
B.3P.C. for this reason REPAIR _ )
000.
Dbfe: Use OF lot. DEMa 1 0 524,03
EXISTING BLDG.
--T.� � a 52403 '
s nater. —� -- - - - - - MNAL
OWNER-8UILDER DECLARATION _ DAM. ^ IJ 1,2 2°*`8 8
1 hereby affirm that I am exempt from the Contractors License ADDRESS G `
Law-far the following region {Section 7031.5, •Bwlneas and
frofesslam Code): PRESB14T `
�. BUILDING I,-as owner of the property, or my employees with ADDRESS'
W09e9 a;thelr sole compensatlon,w(II do the worts and ` > `
the structure Is not Intended or offered for ogle(Section LOCALITY ,
7044, Buslrem and Professlons Code}. MOVING T8 CQNTRACTOR t r li .i
I, as owner of the property, am exclusively coniroctlnq ' y } \ `�` � •� '
with licensed contractors to coratruct the project (Sec-
esADDRES5 'h,. { �t�c
tion 7044, BusInon and Profsions Code). I� J I C•L sS
'TMAL SETBACK FROM
CONSTRUCTION LENDING AGENCY YARD H11V1 PROP. LINETAT 709 - 00
I hereby affirm that there Is a construction lending agency forrFRONT TH ` = i, µ
the performance of the work fowhlch this permit Is issued P :'�.4 ti'^ = x`-! � `,~ -
OR
7M.80
(Sec. 3097, Civ. C.). SIDE
Lender's Name k• C� \',.: r
Lender's Address P,C. Fee it f-ee --:1
\ ,
PooOX0 --001 3/M/89
I c.,dy that I have read this application and state that the wewwnce Fee 10• Lw AA,-P/C f
a above Information is correct. I agree to comply wtth all County Fee 2024
Qy 5.8
ordl_ngnces and Stats laws relating to building construction, 1 AM 8:
l� and hereby au*Rxlze represdntativee of this County to enter Taal fee LVU• v� LDAAA Perm f
Upon the above-mentioned property for Inspection purpose
• • f�WiMM POR EUTANATOCY LAPOGUAG4
-SWdrvrer kcnt or Agent - Date
COUNTY OF LOS ANGELES TEII4PLH CITY 4 0508 BU110ING PERMIT
DEPARTMMiT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/RrPA132
BUI TNG AND SAFE'T'Y / LAND DHVELOPf4NT TE2�LE CITY CA 91780 BL 0508 1202280033
PRONE: (626) 285-0488 HET:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
BK: 215 PG: 84 PC: 1 3 SQ. FT STORIES TYPE 6048 CAMZLL?A AV
STRUCTURE: 25 V-B TEMV CA 917802007
ASSESSOR DNFORMA=ON NI1MBER: NEAREST CROSS S1St.SET: T 34PLE CITY
5385-018-030
THOMAS PAGE: 597 GRID: A2 I4)(?.LITY:. TEMPLE CITY, C
TENANT: HAST BLDG USE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY:
S7CIST OCC GRP: 02/28/12 SR
OWNERi TEL. NO: BLDGS. NOW ON IAT: VAIZATION: F TS BY: CODE:
Cfffa'UM, JANE (626) 665-9693- 6,000
6048 CA+nLLIA AV 3
TEMP 917602007 FEES PAID Dksciftpriou OF WORK
TZAR OFF EXISTING ROOFING bUT£RTAL ON HOUSE 4 ATTA(aM GARAG
FEE DESCRIPTION: QUANITTY: DOM: AMOUNT: H 30 YEARS STEENG E NZATHER-ED WOOD
APPLICANT: TEL. NO:
SQN9HI2TFi ROOFING - AA BLDG PER}ffT ISSTIANCE 27.86
AB STATE GREEN BLDG FEE 6000.00 VAI, 1.00 SPECFAL CONDITIONS:
AC STRONG MOTION REBID 6000.00 VAL 0.60
D2 PERMIT W/O EN-HC 6000.00 VAI, 149.40
TOTAL FEES 178.80
CONTRACTOR: TEL. NO: APPROVALS DANE INSPECTOR SIGNATURE
SUNSHINE ROOFING (909) 598-8988-
516 N DIAMOND BAR BLVD #183 LIC. NO - LOCATION AND SETBACKS
DIAMOND BAR CA 91765 755126 C39
SOII3 HNGncmk APpRbvAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS
LIC. NO: STAB UNDER FLOOR
FLOOR FRAM@PG
MAP NO: SEWER MAP BOOL: PAGE: FIRE ZONE: CMD: - UNDERFLOOR INSULATION
150H269 3 00
SFIHA7.lI18G
No. OF FAMIL IES: DWELLING UN-I i'S: APT COND: STAT CLASS:
0 NO 21 ROOF SHEATHING 7 -
SCHOOL WI'PHIN HAZARDOUS SHEAR eAr.a
AIR QUALITY: 1000 FEET )UTF.QTALS
NO NO PO
FRAFI 2209 FECT'ION
FIRESPRINKLM BANGERS
INSUj�ATION WEATHER STRIP
INTW TOR LA= DRYIo r,r,
EXTERIOR LATH
. - RATED FIAOR CSIL ASSFM.
RATED NALL ASSEMR Tia
RATHP SHAFTS OPHNINGS
T-BAR CEIIJIVGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508
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