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HomeMy Public PortalAbout10714 DANBURY ST_Building__ APPpp N 2 pp pp pp NG PERNT COUNTY OF LOS ANGELES BUILDING AND SAFETY u WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ADDRESS 1 �� Y vt �T I hereby affirm that I have a certificate of consent to self,insure, BUILDING �� or a certificate of WorkersCompensation Insurance,or.a certified copy thereof(Sec.3800, Lab.C.) CITU ZIP /t!t �'. / T yLR / LocnuTv Policy No. Company SIZE OF LCT NO.OF SLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. I NEAREST CROSS ST p(,p/r ❑ Certified copy is filed with the county building inspection TRACT � Z � BLOCK LOT NO. •,�� �E Rslw+NAO ISI department d USE ZONE MAP NO. Date Applicant ASSESSO AP BOOK PAGE PARCEL 957,3 a ( SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' owyEg �rr� TEL NO,o COMPENSATION INSURANCE /'h'�' ��'��""7 'Id k�v'��� g WITHIN 1000 FT.OF SCNOOL'I YES No (This section need not be completed if the permit is for one hundred ADDR dollars ($100)or less.) ' Ji -ESS y DISTRICT GROUP TYPE CONST, FIRE ZONE PROCESSED BY L% l7ie'-T/3 -,5 f CITY ce ify that in the performance of the work for which this permit v is slued, I shall not empty any.person in any manner so as to T/�//" •� ��/—), C ecame Subject to the Workers'C mpens 10 s ARCHITECT OR ENGINEER TEL NO. ` A ' j� /] /// STATISTICAL CLASSIFICATION APT CONDO Date / pplicant f(L// /'CQiG//I/�T ADDRESS CLASS NO. 2 DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate Df / REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the Workers' CONTRALTO TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PIF LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC,CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP >- (commencing with Section 7000)Of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES d Professions Code,and my license is in full force and effect. l NEW ❑ BK PG O License Number Lic, Class DESCRIPTION OF WORK App NK VALUATIOND 7 ,) V Contractor Date ALTER ❑ $ Z ©O•©�/ cc O ❑ 1 am exempt under Sec. REPAIR ❑ $ F- U BAP.C. for this reason DEMOL ❑ COMA Pic x W Date:'` USE OF EXISTING BLDG. URM ❑ '� N Signature ? _ APPLICANT(PRINT) TEL N0. LDMA.Permb .. - �i-.t:T ❑ I, as owner of the property, or my employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS F '.CI l.:Se not intended Or offered for sale (Section 7044, Business and FINAL DATE G _ Professions Code.) 7 „d = i;77FN- WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 44Y - _ OR A MI%TURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with _. '< - c AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? -FINAL By F licensed contractors to construct the project (Section 7044, T � }.LII{-'I' L�._L � '� Business and Professions Code.) YES❑ No❑ __1 _,y I,I _ r WILL THE INTENDED USE OF THE BUIOLING BY THE APPLICANT OR FUTURE BUILDING "��L'�''OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH •yf n CHANGE CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR (S�Z�}{ ;_fiANGE GUIDELINES. I hereby affirm that there is a construction lending agency for YES El No El the performance of the work for which this permit is issued(Sec. I HAVE READTHE U. ���J,y�.� (�n�f / y[�� _ff —in - m CHECKLIST I UNDERSTAN HAZARDODMY REOUIREMENMATERIALS OTS UNDER THE LOS ANGE ESRMATION GUIDE AND THE OCOUNTTY CODE, W,I,�� Ir-�— y L lT�iL�67R�i +al:I_U-fIL'IJ l .L�: j. TITLE 3097, Civ.C.) V TITLE z.CHAPTER 220 SECTONS 220.100 THROUGH 2.20140 CONCERNING HAZARDOUS Lender's Name. MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMDHill . Lender's Address 1�`1 o - orvr+en on wr.T _. . o I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE with all county ordinances and State laws relating t0 building construction, and hereby au twnze representatives Df this County ISSUANCE F mjelen Upo a e- i y for inspection purposes. nmay _ INVESTIGATION FEE TOTAL FE o 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 91]80 BL 0508 0505090046 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 13613 LT: 151 SQ. FT STORIES TYPE OCCUP GROUP 10714 DANBURY ST STRUCTURE: 1027 1 VN R3 TEMP CA 917802825 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: G�Fl�yr.�� 8573-002-014 OTHER: THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/05/05 JK 09/30/06 OWNER: TEL. NO: BUDGE. NOW ON LOT: VALUATION: FINAV D E FINAL BY: CODE: HU, SAMMI (626) 375-1944- 90,040 , / r 10714 Y ST TEMP 91]802817BO2825 FEES PAID DCRIPTION OF WORK FLOOR 1ST FLOOR ADDITION 2 BEDROOMS, 2 HATH, AND FAMILY ROOM - FEE DESCRIPTION: QUANTITY- UOM: AMOUNT: AND RECONTRUCT ROOF APPLICANT: TEL. NO: SAME AS OWNER - B1 PLANCHECK W/ENERGY 90040.00 VAL 1,128.30 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION REBID 90040.00 VAL 9.00 B2 PERMIT W/ENERGY 90040.00 VAL 1,327.43 TOTAL FEES 2,492.48 CONTRACTOR: TEL NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO /� LOCATION AND SETBACKS /\ SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS - ° CHOU, GEORGE K (909) 869-6388- 2147 BREA CANYON ROAD LIC. NO: SLAB/UNDER FLOOR DIAMOND BAR, CA 91765 36270 RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 IST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 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 6 6 SET BACK YARD: HWY: PROP LINE: WIDTH: f FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE Y SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO BS0508 �1 w COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUIL➢ING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0610160001 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 13613 LT: 151 SQ. PT STORIES TYPE 10714 DANBURY ST STRUCTURE: 120 VN TEMP CA 917802825 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8573-002-014 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/16/06 JK 10/11/07 OWNER: TEL. NO: BLpGS. NOW ON LOT: VALUATION: FINAL pP FINAL BY: CODE: HU, BAMMT (626) 375-1944- 2,400 /If9/ 10714 DANBURY ST TEMP 937802625 FEES PAID DEq RIPT N OF WORK - ADD PATIO COVER 120 S.F. PEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75, AC STRONG MOTION RESID 2400.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE 54.70 D2 PERMIT W/O EN-HC 2400.00 VAL 99.00 TOTAL FEES 181.95 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS CHOU, GEORGE K (909) 869-6388- 2147 BREA CANYON ROAD LIC. NO: SLAB/UNDER FLOOR DIAMOND BAR, CA 91765 36270 RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMI: UNDE^FLOOR INSULATION 15011273 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000FEETMATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: WHY: PROP LINE: WIDTH: FRONT PL- INSL7,ATION/WEATHER STRIP SIDE PL- INTERIOR Id+TH/DRYWALL EXTERIOR LATE RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508