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HomeMy Public PortalAbout9821 DAINES DR_Building__ WORKERS' COMPENSATION DECLARATION `I hereby pf+lrm that I have a certificate of consent,to self A P P L I CAT 0- —IN FOR BUILDING PERMIT �., insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, L.O. C.) COUNTY OF LOS ANGELES . BUILDING AND SAFETY Policy No. ` Compare BUILDING ❑ Certified copy is hereby furnished. LID I NG F OR APPLICANT TO FILL IN¢ ADDRESS ❑ Certified copy is filed with the county buildin inspec- BU BUILDING ah 2 tion department. ©� / ^IP�7 LOCALITY f? VIDate pplicant �� NO. OF BLDGS. NEAREST , CERTIFICATE OF EXEMPT ON=FROM W / © NOw ON LO7 �J CROSS ST.COMPE N INSURANCE ASSESSORA(This section need b�eted if the permit is for one BLOCK LOT NO. MAP BOOK 6 PAGEe,v� PARCE�hundred dollars ($100) or less.) Go�%W!► TEL. s,� USE ZONE MAP NO. (a NOI:certify that in the performance of the work for which thisKSPECIALermit is issued, I shall not em to an erson in an 'manner .�1� a P employ Y P Y / CONDITIONS so as to become subject to the Workers' Compensation Laws. O yu d CITY l�i_T' .�/7" ZIP -/17 U Date Applicant ORAE -9=mwh,0�fC TEL49,6 DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER )G) C•7p��� NO. �I/B 5-77 � 9 CONST. / ZONE U Exemption, you should become subject to the Workers' ADDRESS Jr� L1N!DiJ /�� G'v `.3 l� U Compensation provisions of the Labor Code, you must forth- a with comply with such .provisions or this permit shall be te• 1' �/� STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTO NO. - LICENSED CONTRACTORS DECLARATION ] IC C::2-/CLASS NO. '� DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ��3 c�1 C. O. SEWER MAP (commencing with Section 7000)of Division 3 of the Business �°G LIC. r� and Professions Code,and my license is in full force and effect. CITY r CLASS BK .6' PG / VALIDATION SQ. FT: NO. OF y� NO. OF CHECK License Number �0.� �w Lic. Class 5tZE STORIES FAMILIES ONE.' i ✓�% 7 DESCRIPTION OF WORK �77� 70 EyrS7� NEW ? :VALUATIO]N _ Contractor Mate �/ • tCT C�iJC/ ❑ '7!O�j 7 S7 rte. ADD E ..� ► ACCT a 8 I am exempt under Sec. ALTER B.&P.C. for this reason y p J52? ! $ L•_'=107 D :L� 1 �-L B �'L REPAIR.0 EXISTING BLDG. �- 7'— -. DEMOL ❑ Al ITEMS X Si nature �^"�y�' - APPLICANT p g d L TEL. FINAL T�ITt � 328 �+v 9 (PRINT) /�/ /.7/ia%I�� NO. °�7 7 JL17A_3 a_v�n.1+® v�a1+ �©VOIVE DER DECLAR DATE 1Z n C I hereby affirm that I am exempt from the Contractor's License GJ�iiO CHECK v2'_ ADDRESS '� �• /v s• GAF 5�� FINAL f Law for the followingreason Section 7031.5, Business and t / •' ai_(i Professions Code): ( PRESENT BY. /��//�� �ANGE i ❑ I, as owner of theproperty, or m em to employees th BUILDING r' ACCT.T Y P Y Y� ADDRESS •i1 ! wages as their sole compensation,will do the work and LOCALITY t.I1 8/22 it the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. ' Y CONTRACTOR NO. 1 1 ► i1'tfL i F� 1 uE�.7 ❑ I, as owner of the property, am exclusively contracting j' y with licensed contractors to construct the project (Sec- AC•l•Ta5 DRESS _ tion 7044, Business and Professions Code.) j.-; REQUIRED TOTAL SETBACK FROM r. EXIST. ' ,:=3 7 1049.2U CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH h; I hereby affirm that there is a construction lending agency for FRONT r. ' .��~. .� ITEMS the performance of the.work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE TIITirt P.L. r Lender's Name. -CHECK 1�18i p(, LDMA ReLJ _Lender's Address P:C. Fee$ aGf O. 0d Permit Fee ia�LJ (,'� ,0 i1 certif that I have read this a licatjon and state that the / '5�• d Issuance Fee r� - 7� LDMA P/above nformation is correct. I agrree to comply with all County Investigation Feeal_000 II�/� �y,yd ordinances and State laws relating to building construction, Total Fee 7 LDMA Pe W and hereby authorize representatives of this County to enter Uf9 1 PM 12:42 o upon the above-mentioned property for inspection purposes. a n SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date APPLICATION FOR BUILDING PERMIT : COUNTY OF LOS`ANGEL"ES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION 'FOR APPLICANT TO FILL IN BUILDING ADDRES I hereby.affirm that 1•have a certificate of consent to self,insure,` BUILDING ADDRESS' or a.certificate of Workers' Compensation Insurance,or.a certified copy thereof (Sec.3800;Lab.,C.)" CITY ZIP �T(1!-r i�E�. 7 PLT ` { O •LOCALITY e�-� ,,.,Policy No. Company .SIZE OF LOT NO.OF BLDGS.NOW ON LOT; L c`1 ❑ Certified copy is'hereby-furnished. NEAREST.CROSS ST. QCertified copy is-filed with the county building inSpe ion TRACT BLOCK LOT NO. dep meet. USE ZONE MAP NO: •'/ _ _ , J ASSESSOR. AP BOQK;- PAGE ' PARCEL Date Applicanf. `.lf� �/ - - SPECIAL CONDITIONS CERTIFICATE OF EXEMP 'FROM WORKERS' OWNER TEL NO. COMPENS INSURANCE 1 " © �� b WITHIN 1000 FT.OF SCHOOL? YES NO 'r AD ES - _ .. . . . (This section need not be completed if the permit,is for orie hundred DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED,BY dollars ($100j or less.) ; - _ CITT ZIP I certify-,that in the performance,of the work for which this permit `"/ , �l v �(// /�(//.J_ is issued, I shall not employ any:person in;any manner,so as t0 ARCHITECT OR ENGINEER ' " I TEL NO. •D" '• -• ' become subject to the Workers'.Compensation Laws. STATISTICAL CL S ICATION APT CONDO Date Applicant ADDRESS' CLASS,NO, DWELL UNITS NOTICE, TO APPLICANT.' If, 'after 'making. this Certificate�Of' REQUIRED TOTAL.SETBACK`FROM EXIST'' Exemption, you 'should `become "subjecf` to the .Workers' CONTRACTOR. T O. __ SETBACK YARD HWY PROP LINE WIDTH Compensation%provisions of;,the Labor,Code, you•must-forthwith 67 _ FRONT - comply with such provisions orthis permit shall be deemed revoked.• AD K/E�SS . A ..r.- /LIC N PL '-''�' '"•' ' ' ' ' - J _' ' .G . CJ ^�c'� SIDE- LICENSED CONTRACTORS DECLARATION LI P L CITY'' C.CLASS I.hereby•affirm that I.am licensed,underprgvisions of Chapter.9 L/ It: SEWER MAP +' (commencing with,Section 7000)of Division 3 of the Business-and. SQ.FT.. 1E' NO.OF STORIES NO,OF FAMILIES - Professions Code,and my license is in full force and effect. NEW ❑ BK PG �(.�.�.�g a - DESCRIPTION OF WORK - VALUATION. -',_'317 ' License Number Lic.Class IN ADD Contractor Date ��� �' ALTER •❑ ��'� � I-am exempt,un � :.: �. .• ' ,.'t _ - _ �:g .�... .� -fir- � REPAIR �❑ i B.&P.C_for this reason,. LDM - - -, W ` � •DEMOL ❑ ....... .. j USE OF•EXISTING BLDG. . ',:F^ 7�{ 128.63 D_ A P/C'# Date: URM ❑ r T. Signature :. t_ _ �! 7, ITEMS- Z -' APPLICANT(PRINT,) TEL-NO." LDMA Perm S.'•,. -- "t `• ❑ I,.as owner of ahe property, or„my employees.with.wages as Z Ti 3`r their sole compensation; will'do the.work-and,the structure is ADDRESS O _ ` not intended or.offered for'sale (Section.7044, Business and FINAL DATE. Q :}��{:�ti' 177.,8 Professions Code.) APP �� �. .... - "• , WILL'THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS•MATERIAL /7 , 6- CHANGE,' . 00 �'I,, as owner of the property„am exclusively contracting Wlth .OR A MIXTURE;,CONTAINING,A'HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE at', �tFIt143C .v AMOUNTS SPECIFIED'ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?' FINAL BY /// _ ^�; Y• !�?•�` ' licensed contractors to construct, the project (Section 7044, r� Business and Professions Code.) INTENDED'USE OF THE YES❑_, .NOET i WILL iH APPLICANT OR FUTURE ;OCCUPANT REQUIRE A'PERM T FOR C ONSTRUCTION'OR MODIFICATION.FROM THEUIDLING BY,THE SOUTH - U0.ICR.I.C061. '2,' +•1 93 •, .- CONSTRUCTION.LENDING AGENCY_ COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMn TNG CHECKL ST FOR, --- -. . i !t�rtt 7�/'� . GUIDEJNES. I _ 7936 1 F'M :4..3 - I hereby affirm that there is a construction lending agency for, YEs❑ . No❑ f the performance of the work for which this permit is issued(Sec. J _- -'IHAVE READ THE HAZARDOUS MATERIALS INFORMATIONGUIDE AND THE SCAQMD PERMITTING 3097, CIV.C.) - CHECKLIST.I,UNDERSTAND'MY,REQUIREMENTS UNDER THE LOS,ANGELES COUNTY•CODE,•' ' TITLE 2,CHAPTER 2.20_SECTIONS 2.20.100 THROUGH 2.20 140 CONCERNING HAZARDOUS. Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT,FROM THE SCAQMD. - o Lender's Address ' .O .•., _ _• OWNER OR,F ENT .. o I certify that.I have read this'application and state under penalty o .PC.FEE .PERMIT--FEE d of perjury that the above-information is correct.I agree to'comply 0 a with .ally county ordinances•and tate laws,relating'to .building _ C d - construction;and hereby authori ;represenfati4es of this County. '`^ ISSUANCE FEE. ato•enter-upon the,above-meptionicJproperty for inspection purposes` 3 - INVESTIGATION'.FEE TOTAL FEE 1} Co SEE REVERSE FOR.EXPLANATORY LANGUAGE ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 - BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - RESIDENTIAL ADD BUILDING AND SAFETY_ / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1203190018, PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST NEW 1 BUILDING ADDRESS: - I ITR: 13805 LT: 64 _ I SQ. FT STORIES TYPE OCCUP GROUPI 9821 DAINES DR I I ISTRUCTURE: 37 1 V-B R-3 TEMP CA- 917802637 1 (ASSESSOR INFORMATION NUMBER: I' GARAGE: - --, NEAREST CROSS STREET: BALDWIN 18588-016-039 - - - I OTHER: - 1. THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, cI ITENANT: IEXIST BLDG USE: - USE ZONE: '- (ISSUED ON: PROCESSED BY:, I I (EXIST OCC GRP:' 104/18/12 SR 1 (OWNER: TEL. NO:, IBLDGS. NOW ON LOT: VALUATION: IFINAL DATEY. CODE: - I CONWAY JOHN F;VIRGINIA D (626) 286-3913- 1 - . 5;.490 I 19821 DAINES DR 1 _ t CCC��� � �' - TEMP 9i7802637 - FEES PAID IEXPANDPW EXISTING BATHROOM , I IFEE DESCRIPTION: QUANTITY: UOM.: AMOUNT: ( ' 1 I (APPLICANT: TEL. NO: , I - I - I ITSAI,. WILLY (626) 281-5726-. IB1 PLANCHECK W/ENERGY_ '5490.00 VAL -139.70 1 - - IAA BLDG PERMIT ISSUANCE27.80 ISPECIAL CONDITIONS: '-• _ 1 IAB.STATE.G_REEN BLDG FEE - 5490.00 VAL 1.00 I 1 IAC STRONG MOTION RESID 5490.00 VAL ' 0.60 I I 1B2 PERMIT W/ENERGY 5490.00 VAL 164.30 ICONTRACTOR: . TEL. NO:' 1FR INV WORK W/O PERMIT- 342.20 DOL 342.20 (APPROVALS -- ,DATE INSPECTOR SIGNATURE 1 ' IPARTAIN CONSTRUCTION (626) 281-5'726- 1 TOTAL FEES. •675.60 1326 BELLA VISTA LIC. NO • 1 . , ILOCATION AND SETBACKS (MONROVIA, CA 91016 _ 950949 B I _ 1SOILS. ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL: NO: I IFOUNDATION/TRENCH FORMS I I ~l 1TSAI, WILLY _(626) 281-5726- I - - 1 1236 S ATLANTIC BLVD - - 'LIC: NO: I - (SLAB/UNDER FLOOR IALHAMBRA CA 91803 _ ' . 950949 B * RAISED FLOOR FRAMING 1 1 1 I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( - (UNDERFLOOR INSULATION . I I I 1 3 001 _ 7yI 1ST LEVEL FLOOR SHEATH INO. OF FAMILIES: DWELLING UNITS:APT/CONDI STAT CLASS 1 0 NO 21 1 . 12ND LEVEL FLOOR SHEATH I I . I SCHOOL WITHIN HAZARDOUS 1 ' - 1ROOF SHEATHING (AIR QUALITY: 1000 FEET - MATERIALS 1 NO NO NO I IFIRE'DEPT. FRAME INSPECTI I I IBLDG-DEPT. FRAME INSPEC I- 11'SHEAR PANELS - I I (INSULATION/WEATHER STRIP( ' I I I (INTERIOR LATH/DRYWALL 1 I I i EXTERIOR LATH �� I I I ILOT DRAINAGE I I I I I ISMOKE DETECTION DEVICES I I I I I IFIRE DEPARTMENT APPROVAL( I I I* ADDITIONAL DATA ON-FILE I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I. I i I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1206060043 PHONE: (626) 285-0488 EXT: ILEGAL ID: 1 NO. OF CONSTBUILDING ADDRESS: 1 ITR: 13805 LT: 64 I SQ. FT STORIES TYPE 1 9821 DAINES DR 1 I (STRUCTURE: V-B TEMP CA 917802637 (ASSESSOR INFORMATION NUMBER: I - I NEAREST CROSS STREET: BALDWIN 18588-016-039 1 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl I I I I (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 IISSUED ON: PROCESSED BY: I I (EXIST OCC GRP: 106/06/12 SR 1 1OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: I ICONWAY JOHN F;VIRGINIA D (626) 286-3913- 1 4,500 I CAri� 19821 DAINES DR I I 1 ITEMP 917802637 1 FEES PAID IDESCRIPTION OF WORK 1 I IREPLACE 5 WINDOWS 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( (APPLICANT: TEL. NO: I I IPARTAIN, MICHAEL (626) 945-7625- 1AA BLDG PERMIT ISSUANCE 27.80 1 JAB STATE GREEN BLDG FEE 4500.00 VAL 1.00 ISPECIAL CONDITIONS: 1 1 1AC STRONG MOTION RESID 4500.00 VAL 0.50 I ID2 PERMIT W/O EN-HC 4500.00 VAL_:- 132.60 1 1 TOTAL FEES 161.90 (CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE IPARTAIN CONSTRUCTION (626) 281-5726- I 1 I 1326 BELLA VISTA LIC. NO ILOCATION AND SETBACKS I I I (MONROVIA, CA 91016 950949 B I I I I ISOILS ENGINEER APPROVAL 1 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I 1 LIC. NO: 1 (SLAB/UNDER FLOOR I I I I 1RAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1147H269 3 001 1 1 1 1 I I IFLOOR SHEATHING 1 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I I 0 NO 21 1 IROOF SHEATHING I I I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I 1AIR QUALITY: 1000 FEET MATERIALS I I I 1 NO NO NO 1 1FRAME INSPECTION I I I I IFIRE SPRINKLER HANGERS 1 I I I I I 1 I 11NSULATION/WEATHER STRIPI I I I I 11NTERIOR LATH/DRYWALL I I I I I I 1EXTERIOR LATH I I - I I I _ I I IRATED FLOOR/CEIL ASSEM. I I I I I IRATED WALL ASSEMBLIES I I I I I I IRATED SHAFTS/OPENINGS I I I I I I I I IT-BAR CEILINGS I I I I I I I "- ILOT DRAINAGE I I I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I I I I