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HomeMy Public PortalAbout9420 DAINES DR_Building__ ' WORKERS'COMPENSATION DECLARATION hereof I irm that I have a certificate of coent to.selfMDO M insurebor afcertif certificate of Worke s' Compensat on insurance,' /r v1� LnY� 1J V O O M dD [ C p Q O . or a Certified copy.thereof (Sec. 3800, Lab. C.) COUNTY OF LOS,ANGELES: . BUILDING AND SAFETY Policy No "Company a Certified copy is hereby furnished. FOR APPLICANT MFILL IN, BUILDING ADDRESS !� ❑ Certified copy'is filed with the county building inspec- BUILDING tion,department. ADDRESS '' LOCALITY Date Applicant - GTl{. . ' NEAREST ZIP CROSS ST. CERTIFICATE,OF,EXEMPTION FROM WORKERS' NO:OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT;. J ti NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed Jf the permit is for one P')I6✓rQQrJ �� USE ZONE' MAP hundred dollars ($100)or less:) TRACT GCS BLOCK LOT NO. NO: r "LC/�'•. TEL. U SPECIAL' T performance the-work w which this OWNER �,�+ v'/ p}JO d Z - CONDITIONS f I certify that in the p o ante of a ork for wh pE FIRE permit is issued, I shall not employ any person in any manner �' , :'� CONST.r % J .ZONE U DISTRICT GROUP ►V/ PROC SSED'BY a so as to eco a subject to the Workers'Compensation Lo s., ADDRES �`/tQ� ///� f. CITY—^ �1 ZIP (JGI- Ap l� . . Dat pl 1 STATISTICAL CLASSIFICATION APT. JCOVJO. t- . 7 TO APPLICANT: If, after maL g this Certificate of ARCHITECT O TEL - ,Z ENGINEER 4_-(A) L_ NO I'-7 CLASS NO._�DWELL. UNITS LU Exemption, you should become subject to the Workersr : ` Compensation provisions of the Labor Code, you must"forth- ADDRESS:J.q® I �.�1 Lj{ SEWER MAP z with:comply with such provisions or this permit shall be TEL deemed revoked. CONTRACTOR ��? NO.. BK. PG, s' VALIDATION LICENSED CONTRACTOR&DECLARATION �p� LIC. I hereby affirm that I am licensed under provisions of Chapter ADDRESS Pte' NO. 7VALIATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in fulLforce and effect. CITY CLASS U DP SQ, FT. NO; OF / NO. OF CHECK License Number Lic.Class SIZE' STORIES ! FAMILIES ONE DESCRIPTION OF WORK $ Contractor 'Date NEW 2 2 68.8 A am.'exempt under Sec: y V M f ATI Q OV # o o o o'2`� 'ADD Q ALTER O _.' FINAL_ B.&P.C. for this reason` c� �� REPAIR ' DATE I o o37.50 USE OF Date FINAEXISTING BLDG. 1v DEMOL L ra Signature APPLICANT C.�t TEL. / By i o,o 0 3.7.5 P OWNER-BUILDER DECLARATION (PRINT)-MAP-1 N f v.l NOq[ ,3 I.hereby affirm that I am exempt from the Contractors License 8'� $5 Law for the following'reason (Section'7031.5, Business and'.' ADDRESS 1 -4 ' Professions Code): - PRESENT BUILDING 2.6 a,9 A I; as owner of the property, or.my employees.with ADDRESS' wages as Their sole compensation,will do the work'and the structure is not intended or offered for,sale(Section LOCALITY `. _ #,o 0 0.o,•o 7044,'Business and Professions Code) MOVING, TEL. I,,as owner;of'the property, am exclusively contracting CONTRACTOR NO. I p ® 49.88 with licensed contractors to consteuct'the project (Sec- ADDRESS x' 'tion 7044,-Business and Professions Code).. „ , o 0 0.4 Q 8 8.0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.'LINE WIDTH hereby affirm that there is a construction lending agency for FRONT 0.a 1 3-8 5 the performance-of the work for which this permit is issued P.L.; (Sec. 3097, Civ. C.). SIDE P.L:`. Lender's'Name Lender's Address Permit Feet 0 certify that I have read this application'and state that_ihe Issuance Fee above information is correct. I agree to comply with:all County Investigation Fee Q Q $ ordinances'and State laws relating to-building construction, Total Fee / d u and hereby authorize representatives of.this County to enter up n the above-me tinned prop rty for inspect' purpo es. . - • / ti%. /� SEE REVERSE FOR EXPLANATORY LANGUAGE -S re of Applicant or Agent Dat ' ®s WORKERS COMPENSATION DECLARATION �° T± , I hereby affirm that,I_have a,certificate,of consent,to selfO M O I^/� ' p U 1 L D M G_. ~PER insure, or a certificate of Workers'Compensation Insurance, (T� Lr\1 LI LI V U�1 U V u V u or'o certified copy thelteof (Sec.'3800; LaF% C ) _ :,•. COUNTY OF LOS ANGELES BUILDING ANDVSAFEYY Policy No. Company ❑ Certrf+ed.,copy is hereby furnished. FOR APPLI ANT TO FILL IN BUILDING ': ADDRESS ❑ Certified copy is filed''wilh,tlie' unf nspec- BUILDING ,, tion de' 'I " T ADDRESS �© - Date ! �r, yq CITY �- ZIP / ! LOCALITY CERTIFICATE OF EXEM . FRO WORKERS' - O OF-BCDGS. NEAREST. 'GOMPENSATION`'INSURANCE+.= SIZE OF LOT NOW ON LOT GQ CROSS ST. (This'sechon need not'be.'complete'd'if the permitzis'-for - ASSESSOR hundred dollars ($100)or•,less.) y TRACT LOTLN T BLOCK MAP BOOK P PARCEL _.� OWNER.�_ � N OP �.' I certify that in the performance of the work for which'ihis �� ON ' ; — SPECIAL-' 3 permit is tssuecJ, I SIK611'not employ any person many manner :ADDRESS �� "'" ZONE USE so as to become subject to th'e Workers;Compensation Laws. I CONDITIONS ` CITY ZIP _ Date A'ppltcant ARCHITECT OR ,/ TEL. ' , ._PROCESSED BY, NOTICE TO r' ,APPLICANT: 'If afte 'making DISTRICT. GROUP,; TYPE FIRE.this Certificate of ��7/U ST ENGINEER NO. � Exemption•'Yyou•should become•subjects to>','the, Workers' � - CON ZONE Compensation'provisionsofthe Labor,Code, you'must forth- ADDRESS - - with comply; with':-such•provisions or„this,permit, shall, be EL _ _ �/J(x T O J STATISTICAL C SSIFICATION' PT CONDO. deemed revoked:,-. >> ., T �ZWWU - LICENSED CONTRACTORS DECLARATION - l NITS ZZrS ��69 A- N CLASS NO. DWELL. U I hereby affirm that,I am licensed,under_provisions of Chapter 9 ADDRES a NO. <-LIC. SEWER MAP (commencing with Section 7000)of Division.3 of the Business and .-. i Professions Code, and'my license is in full force and effect. CIT �✓ l/ J CLASS - BK. PG. VALIDATION f - - N -7-7 SQ. FT. NO. OF. NO:,OF. / CHECK Ljcens Ltc`Class SIZE STORIES / FAMILIES ( ONE L_1$1 ALUATION , �_ �U/044, DESCRIPTION OF WORK � W` ❑te, —` ADD cJ© tJ G l✓ ❑ I am•exempt under Sec 7' i• ALTER ❑ D s B.&P.C. for this,reason / L y� - -�j, REPAIR ❑ . $ Date: EXISTING BLDG-=d/lfCi'/J� C^ /`.es DEMOL ❑ i APPLICANT TEL. >3 Signature PRINT /// NO FINAL �`1(jy��yjp//� OWNER-BUILDER DECLARATION _ DATE Y` I•hereb affirm that am:exem t'from.the Contractor s:License / �7 �j� ( yy zl p ADDRESyL/Z� ���W �C///rC `r j��I'�rir✓�j + Law for the following-reason (Section 7031.5, Business and IMA rofessions Code) . . . . PRESENT By BUILDING L N t a.210 4.''1+A I, as owner of the property, or my employees:with _ ADDRESS wages as their sole compensation,will do'Jhe work and LOCALITY H. ` #'o+o 0 the structure is not intended or offered for sale(Section, /- 7044; Business and Professions Code). ' ' „ ' MOVING ” TEL. D _2 c �5 1 S 0 O I, as owner,of the property, am exclusively contracting CONTRACTOR NO. r. with'licensed contractors to'construct the project`(Sec- 'o o j 1 ,O O _' Tion.7044, Business and Professions Code). ADDRESS ~ REQUIRED. SETBACK FROM _ 5 . �-� CONSTRUCTION LENDING AGENCY " SET BACK YARD ' HWY. PROP.LINE WIDTH '~ "Q 1.5—"8 4 ; I hereby affirm that there is a construction lending agency for FRONT " the performance of the for which this permit is issued - PA: - - ---- _ (Sec,.3097;Civ. C. SIDE _ .... � P.L. - - - - Lender's Name m _ LDMA Ref. # Lender's Address P:C. Fee$ - Permit Fee [S` .I certify that I have.read.-this,application and state that the Issuance Fee LDMA•P/C-# above information is corre agree to comply with all County Investigation Fee 9 ordinances and State ._ws elating to building.construction, _. Total Fa / J . �- LDMA Perm. # { u and her uthori�resentatives of this County to entermu perty for inspection purposes. d / -4S,- SEE REVERSE FOR EXPLANATORY LANGUAGE 1 ature or-Agent-- -•- - Date -` - - - `- s _ COUNTY 0(LOS ANGELES TEMPLE CITO # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0108240038 y PHONE: (626) 285-0488 EXT: 1 LEGAL ID: NO. OF CONST BUILDING DDR SS: ON FILE SQ. FT STORIES TYPE •9420 DAINES DR STRUCTURE: 2300 VN TEMP CA 917803112 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 8588-028-001 THOMAS,PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY TENAN EXIST BLDG SE: RESID USE ZONE: XX ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/24/01 UT 02/20/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D TE F A Y: CODE: MC NEVIN THEODORE J;MARY N — 5,700 Qr 9420 DAINES DR TEMP 917803112 FEES PAID DESC I TIONOF W TEAR—OFF, RESHEET W/ 1/2 OSB EROOF W/30YR. CLASS A DIMEN. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: J N DAVIS ROOFING (626) 821-4665— AA BLDG PERMIT ISSUANCE 27.75 2 E. LA PORTE ST #A AC STRONG MOTION RESID=__ 5700.00 VAL 0.57 SPECIAL CONDITIONS: ARCADIA CA D2 PERMIT W/O-EN=HC--X5700.00 VAL 149.40 7 T SAL\\ES 177.72 CONTRACTORS ROOFING EL. N821-4665— APPROVALS DATE INSPECTOR SIGNATURE 2 EAST LA PORTE, LIC. NO LOCATION AND SETBACKS SUITE A 572125C39 ARCADIA, CA 91006-2825 // 5�' ? ��� SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: �, "'(.� i ��� \ FOUNDATION/TRENCH FORMS LIC. NO: L S AB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP i I I `'J ` .�,� _ l I UNDERFLOOR INSULATION XX 3p FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS:"' _ _—_— ——"—- — _ —_ — 7! NO 21 ` ! �i /fir ROOF SHEATHING SCHOOL WITHIN HAZARDOUS % �, # ase ��� SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS FRAME. INSPECTION NO NO NO REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL— INSULATION/WEATHER STRIP SIDE PL— --- �' INTERIOR L T /DR WALL I EXTERIOR LATH i RATED'FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T—BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508