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HomeMy Public PortalAbout6023 CLOVERLY AVE_Building__ --- WORKERS' COMPENSATION'DECLARATION I-hereby offirrh that I have a certificate of consent to self ihsure, or'a certificate of Workers' Compensation Insurance, APPLICATION F R BUILDING, M or a certified copy thereof (Sbc, 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY � G/ Company /� ll oricy AllII ❑ BUILDING Certified copy is hereby furnished , FOR APPLICANT TO FILL IN ADDRESS �ps ' CLAVE L Certified copy is filed with the county building tnspec_ BUILDING 0 tion departmentl/� ADDRESS 1. a -�a nO�/J A�7r ri"'/� CITY ZIP LOCALITY Date Applicant ,. NO OF BLDG NEAREST 'CERTIFICATE OF EXEMPTION FROM WORKERS SIZE OF LOT � NOW ON LOT CROSS ST 1 -COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one' TRACT BLOCK LOT NO // MAP BOOK PAGE PARCEL hundred dollars ($100) or less ) OWNER NL �3 (O © USE ZON FP • I certify thaton the performance of the work for which''this n y /' _ CIAL n}.permit is issued I shall not employ any person in any manner ADDRESS d� 6 V �/~ - NDITIONS i Q so as to become subject to the,Workers' Compensation Laws ' �. U I I CITY C - ZIP 7 n Date Applicant "' ARCHITECT OR TEL 0 pp IST ICT G U TYPE ~�� FIRE CESSED BY Q NOTICE TO,APPLICANT If, after, making this Certificate of - ENGINEER NO r CONST t r .SIE ,Exemption, you should become subject to the. Workers $ �� /) J/ �j U ADDRESS ✓✓ Compensation provisions of the Labor Code, you must forth- - 1 � with comply with such rovisions or this permit shall be TEL STATISTICAL CLASS FICATION APT CONDO N P Y P P Z deemed revoked t CONTRALTO N a LICENSED CONTRACTORS`DECLARATION LIC�,�/ CLASS NO DWELL UNITS — LICENSED hereby affirm that I am licensed under,provisions of Chapter 9 _ ADDRESS ri ®, N�/SSA SEWE MAP (commencing with Section 7000)of Division 3 of the Business LIC and'Professions Code,and my license is in full force and effect CIN If CLA ' BK pG 15 VALIDATION SQ FT NO OF NO OF / CHECK License Number / Lic Class SIZE �© STORIES FAMILIES / ONE r VALUATION DESCRIPTION OF WORK NEW ❑ Contractor Date $ ❑ , } ADD ❑1 am exempt under Sec ' _ _ALTER D „ B&P C for this reason REPAIR ❑ $ Date USE OF EXISTING BLDG DEMO APPLICANT _ Signature (PRINT) J� /� r3oGJ FINAL ) OWNER-BUILDER,DECLARATION DATE //hin I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section'7031 5, Business and ADDRESS 4o FINA _- r a Professions Code) PRESENTS / ACC{ °T BUILDING �' ❑ 1, as-owner of the property, or'my employees with ADDRESS I +t •ciZ wages as their sole compensation;will do the work and the structure is not intended or offered for sale(Section LOCALITY 1 TEri: 7044, Business and Professions Code ) - MOVING - TEL ONTRACTOR NO TOTAL 6(3 - 50 ' C ❑ I, as owner of the property, am exclusively contracting _ with licensed contractors to construct the project (Sec- ADDRESS k {'�tN 1 til tion 7044, Business and Professions Code ) , w I: U REQUIRED, YARD HWY TOTAL SETBACK FROM ;EXIST 1K�1�U� •1f{I CONSTRUCTION'LENDING AGENCY SET BACK PROP .LINE WIDTH FTA I hereby affirm that there is a construction lending agency for FRONT _ the performance of the work for which this permit is issued P L "y (Sec 3097, Civ C) SIDE P L LrLl l—Q �1, Z L! "l S; Lender's Name � i ('l{H -• a LDMA,Ref # �:Lri'} 1 li V•a_ Permit Fee �� i - P C Fee$ w , Lender's Address 0 1 certify that I have read this application and-state that the Y Issuance Fee a LDMA PiC# 8 above info ation is correct I agree to comply with all County Investigation Fee + R ordinance 'and t ' jaws relating to building construction, Total Fee ( LDMA Perm # a and here y u o ze r resentatives of this County to enter m po th a e enti ned property for inspects puuf se a /o H SEE,REVERSE FOR EXPLANATORY LANGUAGEI Ile 54natur of Applicant or Agent Date t _ e WORKERS' COMPENSATION DECLARATION Irhereby,affirm that I have a certificate of consent to self 'sure, or a certificate of Workers' Compensation Insurance, APPLICATION. FOR BUILDING PERMIT �r a certified copy thereof (Sec..3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. /� FOR APPLICANT TO FILL IN ADDRESS BUILDING ❑ Certified copy is filed with the county building inspec- BUDRENG/' CN tion department: Q CITY � ZIP 90 LOCALITY 1 Date Applicant O. OF BLD S, T. CERTIFICATE OF EXEMPTION FROM'WORKERS' SIZE OF NOW ON LOT ROSS EAREST. rCOMPENSATION INSURANCE ASSESSOR. (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. pis / { OWNER/JR. 6 NO.vd7C� 7 USE ZONE NO ! J '0 I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS so as to become subject,to the Workers'Compensation Laws. NDITIONS r / O CIT Date Applicant_ ARCHITECT OR // TEL. 7 DISTRICT GROUP TYPE' FIRE PROCESS BY O NOTICE TO APPLICANT: If, after making this Certificate�of ENGINEER Lt(.� oO_ / O CONST. ZONE Exemption, you should become subject to The Workers' U. Compensation provisions of the labor Code, you must forth- ADDRESS ` �� -`�j 0- with comply with such, provisions-or this permit shall be TEL. STATISTICAL C IFICATION t APT. CONDO. N deemed revoked. CONTRACTO l NO. / z LICENSED CONTRACTORS DECLARATION ((�� L ✓ CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS KOc/QdLs (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY 5/4Yyt)6 kq"" LASS2�,,?3 3 eC BK PG VALIDATION SQ. F NO. OF NO. OF CHECK 23 License.Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION ACCT.T Contractor Date DESCRIPTION OF WORK NEW /J /' .�� 839.60�839�y. 0�� C (n $ .3307 E] ADD I am exempt under Sec. ` V V � - ALTER • B.&P:C. for this reason REPAIR ❑ 1 ITE9fS USE.OF a TOTAL 839®60 Date: EXISTING BLDG. Y�fJ�' DEMOL CHECK Q p70.FfF Signature APPLICANT TEL.. FINAL CHECK 83 9V OWNER-BUILDER DECLARATION (PRINT). NO. 51,)3--5/,F;7. DATE. GNAW .00 I hereby affirm that.I am exempt from the Contractor's License �J� � ,en /+ Law for the following reason (Section 7031.5, Business and ADDRESS & it FINAL Professions Code): PRESENT , G By 00 - 101 .. S/1g ° ► BUILDIN `) ' j a ,' Vi►tJLt—UtJtJ 7 tt ❑ I, as owner of the property; or my employees with ADDRESS wages as their sole compensation,will do the work and : ,'' 14 . . IQo32 The structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) - MOVING TEL. t .;`• � �* I ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. �' with licensed contractors to construct ADDRESS the project (Sec- X307 .176.91 tion 7044, Business and Professions.Code.) 1 ITEMSREQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT �5i // i 7 ' •JOTAL . 174 9 1 the performance of the work for-:which this permit is.issued P.L. tJ Jr t ati�.'. 1 - (Sec. 3097, Civ. C.). _SIDE �+� �.O �—, ^ =-� c r• CHECK '176.91 P.L. k}} t Lender's Name ' "`� CHA, GE m P.C..Fee$ Q �, Permit Fee r lD of 3 Lender's Address, —I Q ` 0000-13001 11/ %/0'- o I certify that I have read this application and state that the Issuance Fee s L'DMA P/C# . above information is correct. I agree to comply with all County Investigation.Fee .•-+� 6520 1 A*{.. R► �I 8 ordinances and State laws relating to building construction, Total Fee to CDMA Perm. # ! < and hereby authorize representatives of this County to enter M upon the above-mentioned property for,inspection purposes. }K, !✓l�^ _(—�� -�� SEE REVERSE FOR EXPLANATORY LANGUAGE C?Vn' an op ■� • • nature nt,or ent `Date t1 )tom--a► G '-r+ n n i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1307180063 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST NEW BUILDING ADDRESS ITR 6561 LT 311 UN 002 SQ FT STORIES TYPE OCCUP GROUP 6023 CLOVERLY AV STRUCTURE 437 1 V-B R-3 I TEMP CA 917802026 (ASSESSOR INFORMATION NUMBER I GARAGE NEAREST CROSS STREET 15385-006-009 I OTHER THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY CAI ITENANT IEXIST BLDG USE PHOTO IISSUPD ON PROCESSED BY 1 IEXIST OCC GRP R-3 107/18/13 SR I (OWNER TEL NO IBLDGS NOW ON LOT VALUATION IF DATE FINAL BY CODE I JZHANG, HONYU (818) 588-6826- I 60,000 16023 CLOVERLY AVE 1 ITEMPLE CITY CA 91780 J FEES PAID JD SCRIPT ON OF WORK I I INEW HOOF-MOUNTED SOLAR PHO VOLTAIC SYSTEM INSTALLATION 21 &1 I _IFEE DESCRIPTION QUANTITY UOM AMOUNT 11 INVFRTER (APPLICANT TEL NO I I IALVAREZ, JERRY (626) 239-1698- IAA BLDG PERMIT ISSUANCE 27 80 1 112921 RAMONA BLVD B JAB STATE GREEN BLDG FEE 60000 00 VAL 3 00 ISPECIAL CONDITIONS 1 IIRWINDA.LE CA 91706 IPI RES PV PC<10KW 153 90 I 1 JP2 INSPCT RES PV <10KW 138 00 1 1 J TOTAL FEES 322 70 I ICONTRACTOR TEL NO I JAPP�OVALS DATE INSPECTOR SIGNATURE 1 IPACIFIC STONEGATE, INC (626) 239-1698- I 1 112921 RAMONA BLVD SUITE B LIC NO JLOCP"ION AND SETBACKS 1 11RWINDALE CA 91706 965340 J 1 f 1 JSOILS ENGINEER APPROVAL 1 J JARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I I I 1 LIC NO JSLAB/UNDER FLOOR I I I JRAISL'D FLOOR FRAMING 1 IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I JUNDERFLOOR INSULATION 3 00 IFLOOR SHEATHING INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I 1 1 NO 20 J IROOF,SHEATHING SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I JAIR QUALITY 1000 FEET MATERIALS J I I 1 NO NO NO j J FRANCE INSPECTION J I I I I IFIRE SPRINKLER HANGERS 1 1 1 IINSULATION/WEATHER STRIPI I I I JINTERIOR LATH/DRYWALL I J I IIEXTERIOR LATH 1 1 1 (RATED FLOOR/CEIL ASSEM I 1 1 IRATED WALL ASSEMBLIES 1 1 1 I I IRATED SHAFTS/OPENINGS 1 1 1 IT-BAR CEILINGS 1 1 1 I I ILOT DRAINAGE 1 IREPORT ID DPR261 ROUTE TO BSO508 1 1 I