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Home My Public Portal About9041 EMPEROR AVE_Building__ WORKbW COMPJNSATION DECLARATION a r era certificate of Workers' Compensation Insurance, APPLICATION- FOR BUILDING PERMIT or 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 BUILDING Fn�41 E. 6^06rox— ,4Ve ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING Qf tion department.-: ADDRESS /D I c. "pCKOK AcVE. 0,41391 EL- Date Applicant CITY SAn! �f�BR IC—L— i C—L ZIPJ/775 LOCALITY jCERTIFICATE OF EXEMPTION FROM•WORKERS' Q j NO.OF BLDGS. 3 NEAREST LI vOf) S' sly ill COMPENSATION'INSURANCE SIZE OF LOT CJ x ��1� NOW ON LOT CROSS ST. (This section need not be completed if the permit is for oneMAP BOOK PAGE ASSESSOR j hundred dollars ($100)or less.) TRACT BLOCK LOT NO. 5-' 8 OSI PARCE L k�✓k J. NE✓!�'RfG J1�• TEL. f(e8 USE ZONE MAP- I certify that in the performance of the work for which this OWNER �qJ 4. N>✓✓R'jJ__ NO.ZSS-� NO. A permit is issued, I shall not employ any person in any manner ADDRESS 74 4/ E. C—,-4rC—_V/z- AVe SPECIAL f$, so as to become subject to the Workers'Compensation Laws. L�L q CONDITIONS c0 �j CITY SRAJ 6A•OX IC-L- ZIP !1775 09 Date '� V� Applican NOTICE TO APPLICANT: If ter making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE P O ESSED BY ENGINEER NO. CONST ZONE U Exemption, you should 6 subject to the Workers' /�� LU Compensation provisions of the Labor Code, you must forth- 1 V R ADDRESS with comply with such provisions or this permit shall be TEL. / STATISTICAL CLASSIFI ATION APT. JUONDO. to deemed revoked. CONTRACTOR QWa�'� /3t11LaE� NO. SA'/0E LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS SSE NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. - Professions Code, and my license is in full force and effect. CITY 5�� CLASS VALIDATION SQ. FT. [� O NO. OF / _ _ NO. OF CHECK BK. /� pG. License Number Lic.Class SIZE ISTORIES FAMILIES ONE Avv r�QA /' VALUAT ON Contractor Date DESCRIPTION OF'WORK NEW Ct7 - ❑ , ❑ I am exempt under Sec. ADD $�� i[E/•�lOa�C.r � E�js1/t/<7 - - ALTER B.&P.C. for this reason �dSE AvD 9l'y 7V /0056 REPAIR ❑ $USE OF n Date: EXISTING BLDG. ^ 5i��f�A� DEMOL ❑ z 6 3 1.6 n Signature APPLICANTkA41k 77 K/6•VARIL J TEL. FINAL # a a o a 2 3 ' OWNER-BUILDER DECLARATION PRINT)/ tIQ Z DATE'-),)) -•. I hereby affirm that I am exempt from the Contractor's License Law for the following reason'-(Section 7031.5, Business and ADDRESS �O l �. E/�1°Er�O� R✓� 5-6- FINA ! 1 a 3 5 Q 0 0 Professions Code): PRESENT ,��n d By ' R71BUILDING O4f/ �i. Fil �vr�c�l�- /t VC- , �,. _ I, as owner of the property, or my employees with ADDRESS o (} wages as their sole compensation,will do the work and LOCALITY CJ�� r'7R�ie(�L✓ O the structure is not intended or offered for sale(Section ' 7044, Business and Professions Code). MOVING TEL. - I, as owner of the property, am exclusively contracting CONTRACTOR NO. ❑ with licensed contractors to construct the project(Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM T. CONSTRUCTION LENDING AGENCY" SET BACK YARD HWY PROP. LINE WIDTH Z b$O 8 1 hereby affirm that there is a construction lending agency for FRONT # 0 0 0 0 0 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE I a 4 2 2 2,5 P.L. Lender's Name m /� j� LDMA Ref. # a a 4 2 2 2 5 c=i Lender's Address - P.C. Fee$ - )1 Permit Fee /J' iv I certify That I have read..this application and state that the Issuance Fee t V LDMA.P/C#- - I O U O 6 i 8 7 a above information is correct. I agree to comply with all County Investigation Fee m ordinances and State laws relating to building construction, - Total Fee 5 LDMA Perm. # u and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. a !lLG2i hG' //Gj4/ SEE REVERSE FOR EXPLANATORY LANGUAGE f SignatWe of Aeplicant or AgAt Date i WORKERS' COMPENSATION DECLARATION insure, oraafcertif cafirm tharte of Worke s' Compensation Insuran nt to e, APPLICATION FOR B U I L PI N G PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) } COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS D Certified copy is filed with the county building inspec- BUILDING(/-04/ �� ') LOCALITY tion department. ADDRESS / �lC V�.�//^{y 9,1 /75 CROSS NEAREST. Date Applicant CI7Y� /6✓/�/ ZIP CERTIFICATE OF EXEMPTION FROM WORKERS' X l5D NOW ON LOT t� MAP BOOK PAGE PARCEL COMPENSATION INSURANCE SIZE OF LOT (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less.) ' TRACT BLOCK LOT NO. NO. SPECIAL S I certify that in The performance of the work for which this OWNER✓ a�I-/-� Neva-,L NO. - CONDITIONS G- ^ DISTRICT GROUP TYPE FIRE PROCESSED BY O permit is issued, I shall not employ any person in any manner \ J CONST. ZONE o as to become subject to the Workers'Compensation Laws. ADDRESS 64 i Z• �Y�PC Q-02 f-1 V` . CITY n Gale- I ZIP ��7 � �� Dat - Applica STATISTI L CLASSI ICATIONAPT. CONDO. NOTICE TO APPLICANT: If ter aking this Certificate of ARCHITECT OR TEL. Exemption, you shout ecom ENGINEER NO. CLASS NO. DWELL. UNITS subject to,the Workers' � Compensation provisions abor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. TEL' CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. 00 Professions Code, and my license is in full force and effect. CITY CLASS , SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class SIZE Q STORIES FAMILIES ONE � $ n Contractor Date DESCRIPTION OF WORK NEW ✓f � • oexu ADD D 1 am exem t under Sec. FINAL p ALTER DATE B.&P.C. for this reason REPAIR DATE A Date: USE OF FINAL 0 0 0 0 2 3 EXISTING BLDG. O� DEMOL By a.d Signature APPLICANT j T�E�L. g PRINT ney�2 LP10. /ice , 2 a - 97,22 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License /.,�� t5 0 o o ° Law for the following reason (Section 7031.5, Business and ADDRESS v1 7 2 ? Pro essions Code): PRESENT 02,0 2-84 ,BUILDING 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 7044, Business and Professions Code). MOVING TEL. --. v 9 A I, as owner of the property, am exclusively contracting - NTRACTOR NO. f` 0-0 0 0 2 3 with licensed contractors to construct the project (Sec- ; tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. �° ° / 1.?3 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for hInvestigation , ° 7 1.7 j L the performance of the work for which this permit is issued f' (Sec. 3097, Civ. C.). J.0 2-'8 m Q Lender's Name Permit Fee - Lender's Address cn °' ro > LU C o t, o I certify that I have read this application and state that the 3 Issuance Fee f o above information is correct. I agree to comply with.all County Fee c ON O o `O g ordinances and State laws relating to building construction, Total Fee v CA u and hereby authorize representatives of this County to enter a _>� o C-n upon the above-mentioned property.for inspec 00n purposes. N N o� CD =a 0 01 ^ SEE REVERSE FOR EXPLANATORY LANGUAGE CH Signature of Applicant or Agent Date ®_ 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 0402170002 PHONE: (626) 285-0488 EXT: / LEGAL D: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 9041 EMPEROR AV STRUCTURE: 3200 VN SGAB CA 917752016 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5382-011-011 THOMAS PAGE: 596 GRID: H1 LOCALITY: SAN GABRIEL, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 02/17/04 VG 02/11/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY CODE: NEVARIL FRANK J JR;JAN L (626) 285-9168- 7,500 Z/AY/��/ 9041 EMPEROR AV / '( fz SGAB 917752016 FEES PAID DESCRIPTION OF WORK T/O EXIST TILE ROOF AND INSTALL 50-YR COMP SHINGLES FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: DOWD ROOFING CO. (626) 857-1070- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 7500.00 VAL 0.75 SPECIAL CONDITIONS: D2 PERMIT W/0 EN-HC 7500.00 VAL 183.00 TOTAL FEES 211.50 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE DOWD ROOFING CO. (626) 857-1070- 540 S. GLENWOOD AVE. LIC. NO LOCATION AND SETBACKS GLENDORA CA 91741 380611 C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 153-265 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- NTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAG REPORT ID: DPR261 ROUTE TO: BS0508