HomeMy Public PortalAbout5730 CLOVERLY AVE_Building__ WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent,to self
insure,'or.a certificate of Workers' Compensation Insu-rcince, APPLICATION• F"O R B U I LD I ISI G` P E RMI T
or a certified copy.thereof (Sec. 3800, Lab. C.)
Folic No V8 5 COUNTY'OF LOS ANGELES i BUILDING AND.SAFETY
Policy 1?7 l mpany Fremont Tnr�e=4 ty BUILDING r
Certified_'copy is hereby furnished. g FOR APPLICANT TO:FILL IN ADDRESS
i
® Cdrtified'copy is filed with the county building.jnspec- BUILDING
tion department..
ADDRESS 5790 'MbVir:l
Date �4/� Applicant Vtrg n RiSn a E'n' CITY ZIP- " LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS NO. OF BLDGS. NEAREST 77
COMPENSATION INSURANCE SIZE.OF LOT . NOW ON. CROSS ST.
(This section need.not be completed if the permit is for and
ASSESSOR
hundred dollars.{$100)or less.) TRACT BLOCK LOT..NO. - MAP-BOOK' PAGE',: . PARCEL
TEL. USE ZONE % MAP
OWNER' 'CO11 ' e -.StantonNO.
,1 certify That in-the performance of the work for which thisSOCIAL i ;
`permitAis issuCL
ed ;I shall not employ any person in any manner ':
so as to-become
"Subject to the Workers'Com ensation'Laws. ADDRESS. 'CONDITIONS
O
�,- I P .k U
k. CITY ArCStclS ZIP '`
Date Applicant''"•
- ARCHITECT OR TEL. DISTRICT -" 'GROUP' TYPE ,FIRE PROCESSED-BY LU
NOTICEC,TO'APPLICANT: If, after making this Certificate of
-. ENGINEER ." NO. � ZONE 1�
Exemption, you' should, become subject to the Workers' ..a'
CONST.
Compensation'provisions of the Labor"Code, you must.forth- ADDRESS `J y
with, comply with such provisions or this permit shall be, TEL. ST TISfiICAL;C SSIFIL�ATION PT: C NDO.
deemed revoked. CONTRACTOR. NO'
LICENSED CONTRACTORS DECLARATION` + LIC CLASS NO: DWELL UNITS "
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS p NO:
(commencing.,with Section 7000)of Division 3 of the Business and SEWER:MAP
LIC:
Professions Code,'and my license is in full force and effect. CITY Sian Ciro't3�,'ri''l 91778 CLASS 09 - BK. PG. VALIDATION
y SQ. FT. NO:OF NO. OF - .:CHECK
License Number 160650 Lic.Class C.39 � SIZE STORIES FAMILIES ONE
VALUATION
DESCRIPTION OF WORK NEW
Contractor Virgin Roof Co Date Ea/13/84 Aozone
ADD 0 $',768.00..-,
�hom exempt.under Sec. th 220# C9.Si38 CQ' Si$io>is. ALTER ,
'B.BP.C. for this reason _ zShiri les.. 5. 1/1 Islas') REPAIR Q $
Date: USE OF DEMOL ❑
EXISTING BLDG.
' APPLICANT TEL.
Signature � FINAL
;OWNER-BUILDER DECLARATION . '
PRINT) Virgin Roof NO. 87®Q Q DATE.
I hereby affirm.that l am exempt from the Contractor's License
' Law for the following reason (Section 7031.5, Business and ADDRESS FINAL:
Professions Code): PRESENT BY':'
BUILDING
f, as owner of the property, or my emplayees with ADDRESS
wages'as,their sole compensation,will do the work and
t the structure is not intended or offered for sale,'(Section LOCALITY ' n Z
Y4',N f. Af �7r f1
7044, Business and Professions Code)° ' MOVING TEL." V f �` L
I
1 ,as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contractors to'construct the project (Sec-
tion 70441.^Business and Professions Code). ADDRESS
REQUIRED TOTAL SETBACK FROM EXIST. ;
CONSTRUCTION LENDING AGENCY SETBACK YARD HWY PROP. LINE-, WIDTH41
-1 heeeb"affirm that there is a construction lending agency for o 9''m''
Y 9 9 Y FRONT
the erformance of.the work for which.this permit is issued
P P Q
(Sec. 3097, Civ. C.). SIDE
P.L.
aw "'tende'r's Name
o LDMA Ref. #
P C.Fee$ Permit Fee Q. s
Lender's AddressL 4 s, _
t s;s zv
certify that I have read this application and state TFiat.the I 10 LDMA P/C#
. . ssuance Fee -
a, above information is correct. I agree to"comply With all<,County Investigation Fee
0 ordinances and State laws relating to.building construction, Totat Fee y LDMAPerm. #
and hgreby authorize representatives of this County to enter
upon theabove-mentionedpropertyg4nspectionpp" Iposes.
h
f _ .. _ ,
1/ 'SEE REVERSE FOR,EXPLANATORY LANGUAGE
<
.r'Sig q�re of Apj lPcant'og`r- Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS NEW RESIDENTIAL
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 _ BL 0508 0502180030
PHONE (626) 285-0488 EXT
LEGAL ID NO OF CONST NEW BUILDING ADDRESS
TR 6561 LT 699 UN 002 SQ FT STORIES TYPE OCCUP GROUP 5730 CLOVERLY AV
STRUCTURE 2820 2 VN R3 TEMP CA 917802551
ASSESSOR INFORMATION NUMBER GARAGE 625 1 VN U1 NEAREST CROSS STREET LAS TUNAS -��
8587-011-021 OTHER 315 1 VN U1 THOMAS PAGE 596 GRID J3 LOCALITY TEMPEL CITY, C
TENANT USE ZONE R-1 ISSUED ON PROCESSED BY EXPIRES ON
04/29/05 JK 04/24/06
OWNER TEL NO BLDGS NOW ON LOT VALUATION F L TE: FINAL BY CODE
ZHANG, YONG (626) 286-3098- 309 000
5730 CLOVERLY AVE
TEMPLE CITY CA 91780 FEES PAID DESCRIPTION OF WORK
NEW 2STORY 5BR/4BA SFR W/ATTACHED 3 CAR GARAGE FRONT PORCH
FEE DESCRIPTION QUANTITY UOM AMOUNT 43 SF & STORAGE 315 SF
APPLICANT TEL NO
EVERSTRONG CONSTRUCTION INC (626) 281-9623- B1 PLANCHECK W/ENERGY 309000 00 VAL 2 494 77
1033 WESTMINISTER AV AA BLDG PERMIT ISSUANCE 27 75 SPECIAL CONDITIONS
ALHAMBRA, CA 91803 AC STRONG MOTION RESID 309000 00 VAL 30 90
B2 PERMIT W/ENERGY 309000 00 VAL 1,016 40
TOTAL FEES 3 569 82
CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE
EVERSTRONG CONSTRUCTION (626) 281-9623-
1033 WESTMINSTER AVE LIC NO LOCATION AND SETBACKS
ALHAMBRA CA 91803 721681 B 1
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS
WU HAROLD P (626) 288-0708- _
1168 N SAN GABRIEL BL #N LIC NO SLAB/UNDER FLOOR
ROSEMEAD, CA 91770 721681 B
RAISED FLOOR FRAMING
MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION
150H265 L 138 3 01 _ 1
1ST VEL FLOOR SHEATH
NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS - - - - - - - - - - _
NO 01 2ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS ROOF, SHEATHING
AIR QUALITY 1000 FEET MATERIALS
NO NO NO FIRE DEPT FRAME INSPECT
REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT FRAME INSPECT
SET BACK YARD HWY PROP LINE WIDTH
FRONT PL- SHEAR PANELS i
SIDE PL-
INSULATION/WEATHER STRIP b
INTERIOR LATH/DRYWALL O�
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
* ADDITIONAL (DATA ON FILE
RE ORT ID DP� 261 ROUTE TO BS0508
COUN-if Gi i a`6ELES TEMPLE CITY 4 0508 BUIL ? PE'0 41T
DEPARTMENT %s >i:?'_IC WORKS 9701 LAS TUNAS REST "`''^I ADD/ALT/REP
Blill-DING AND SAFETY / t_ND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0401220045
PHONE: (626) 285-0488 EXT:
Lcbl+ ID: - NO. OF CONST NEW _.i_ BUILDING ADDRESS:
TR. ..j61 LT: 699 JPI: .002 SQ. FT STORIES TYPE OCCUP GROUP• 5730 CLOVERLY AV
STRUCTURE: 1585 2 Vel, R3 ! TEMP CA 91780255/
ASsC ,nR !F'RMATiG NUMBF'?'{ GARAGE: 606 1 `,iN U1 NEAREST CROSS STREET OLIVE
85S 11 "1 OTHER: 670 1 %F! R3 THOMAS PAGE: 596 GRID: j3 LOCALITY: TEMPLE
CITY, C
IEXIST BLDG USE: -�� USE ZONE: T t.s"cD ON: PROC-EC:.L.• SY: EXPIRES ON�"-
jEXIST OCC GRP: +L)Q!24/04 JK 09/19/05
___ ��_
CaWN�: : TEL. N0: BUGS. NOW ON LOT: VALUATION• Frtv1,L CATSr-i!l�Ir.L uY• CODE
ZHAF YC�SG jHONG G6) 286 3098- 168,500 n
573E LOVERLf AVE. O
TEF' = I�'' :1780 t --- _. rYS PAID D:'cff PTiON OF WORK
0 FLR:ADD 1 MSTRBDRsiP iH;1BEDRM,1SAT H,1SEAT iN+�
IFEE DESCRIPTION: '=!UANTITY: L:OM: AMOUNT-1,1S FLR:ADD 26DRMS,BAT N0RY,3CAR GAR,RMDL 28DRMS z. ITr,N
AF's CAN TEL. NO:
EVEISTRONG CONSTRUCTION !323) 796-1882- IB1 PLANCHECK W/ENERGY 168 OG.00 VAL 1,6:,u `
IACBLDG PERMIT ISSUANCE 27 ; SP CIAL CONDITIONS:
ii,C STROId". PsOT i0N kESID 168500.0_0 VAL 1b.`�5
22 ._. WENE„C, L CE 5 PL 9_
ICON tC OP TEL. NO: !APPROVALS
y -�
^. ?)rT? ;I:SPEC'TO R
,E ERLTRONG CONSTRUCTION, ;: (626) 281-9623
lI033 WESTM N 'rER AVE. LIC. NO SETBACKS -W -�
IALHAMBRA, ;A 9180.3 721681
APPROVAZ_-�
SQ5 ?e:INEER ; I
I i
j 12C' iTECT 7R ENG NEER: TEL. N0: FL'uN fiG!d/TRENCH FGti:w `r2-2�-'t
DE:i'.:^s ASSOtAAT€'3 (323) 796-1:882
111 CORPORATE CENTER DR. LIC. N0: 1 (SLAB/UNDER FLOOR
SUITE 305 A NONE
`FiO:J' :. EY PARK, CP 91754I -_Z�F`RAIMITI NG
i
'NfiI' its?. `;E4EI FLAP BOOK: a?^ __FIRE ZONE:
-F RE%ONE: CMP: Ih:?EF2FLOOR INSULATION � I j
3
STAT CLASS:_. T t`L EVEL FLOOR SHEATH i -
..�;__._
NO 21 � FtD i.t-VEL fl_OOR SHEATH;
-_. _.._ SCHOOL WI€HIN — HAZARDOUS -� ROOF SHEATHING
AIR '=LIT1000 L Y: nFET MATERIALS f I�- _
3d0 NO NO ! IF?RE DEPT. FRAME IN';PFCT9
kE�1LI _...._____ TOTAi'SET9AtK FROM EXIST iRi_G -DEPT. FRAME INSPEC'
SET SACK YARD: HWY: PROP LINE: WIDTH:
FROl!f PL- i NEAR PANELS
Slnc PL- s
` NSULATION/WEATHER STRIPi'ERIOR LATH/DRYWALL"
ENTERIOR LATH
1I.Of DRAINAGE
K"OKE DETECTION DEVICE`
ln'E DEPARTMENT APPROVAL
`REPORT ID: DPR261 FUUTE TO: BS0508 _