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Home My Public Portal About9071 EMPEROR AVE_Building__ WgRKERS'COMPENSATION DECLARATION e'eba rtself Insurance, APPLICATION FORBUILDING PERMIT certificate of'War l� ora 1,01fied 2opy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY P014 No Company - BUILDICertified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS 1 ADDRESS Certified copy is filed with the county building inspec- BUILDING ,p tion department ADDRESS n ,�\( Date Applicant CITY L`E Cil ��v LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' ! i ' r' NO OF.BLDGS " NEAREST_ COMPENSATION INSURANCE SIZE OF L T` NOW ON LOT CROSS S7 (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less ) TRACT BLOCK LOT NO' /i MAp BOOK PAGE PARCEL TEL USE ZONE MAP I certify that in the performance of the work for which this OWNER NO fH0 } permit is issued, I shall not employ any person in any manner _ SPECIAL Ll.f so as to become subject to the Workers'Compensation Law ADDRESS CONDITIONS CITY ZIP Ddie Applicant � �� .a NOTIC TO APPLICANT pIff,, after making f is Certificate of ARCHITECT OR )_� TEL 012 � � DISTRICT GROUP TYPE FIRE PRO SED BY O ENGINEER t �` �E0D NO !!/C CONST ZONE 0 Exemption, you should become subject to the Workers' U Compensation provisions of the Labor Code, you must,forth- ADDRESS+ "' '� K-� IL.I with comply with such provisions or this permit shall be deemed revoked TEL STATISTICAL CLAS5I�,IC�TION APT NDO N CONTRACTOR NO '� � z LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS _ ''. rb NO h,.. i SEWER MAP (commencing with Section 7000)of Division 3 of the Business and =a t -' ' t' " a ° '' `Y 1s ; " -��, "LIC'` Professions Code, and my license is in full force and effect CITY ( ,� ` t i'* CLASS .• BK VALIDATION SO FT NO OF'1,. xi NO OF,,, " '~ CHECK License Number Lc Class SIZE TORIES` t FAMILIES _ ONE A VALIJ/�T ON \ 7 DESCRIPTION OF W R NEW ❑ ((A (i/1 (/J] ® 3 Contractor Date V ANADD $ ❑ j am exempt under Sec ALTER [E:])b B 8P C for this reason m C - REPAIR' ❑ $ USE ❑ Date EXISTING BL � l DEMOL Signature APPLICANTTEL t�Q/v FINAL ^� OWNER-BUILDER DECLARATION , PINT NO DATE I hereby affirm that I am exempt from the Contractor's License A E55 If FINAL' Law for the following reason (Section 7031 5, Business and , k 9 5 Ll 0 A Professions Code) 1 • PR _ By BUILDING 7 # 0 0 0 0 0 I, as owner of the property, or my employees with ADDRESS r• p r wages as their sole compensation,will do the work and } ' the structure is not intended or offered for sale(Section LOCALITY rI - 75S25 7044, Business and Professions Code) MOVING ' - TELL""' ®=' 1, as owner of the property, am exclusively contracting CONTRACTOR NO e - 75S255 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) 65, 05-88 CONSTRUCTION LENDING AGENCY SETBUIREDACKYARD HWY TOTAPREOTP LINE WIDTH 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 (Sec 3097, Civ C ) SIDE PL Lender's Name LDMA Ref # m P C•Fee$ Permit Fee Lender's Address a I certify that I Nave read this application and state that the Issuance Fee tJ� LDMA P/C# above information is correct I agree to comply with all County Investigation Fee 5 o ordinances and State laws relating to building construction, Total Fee J •�� LDMA Perm # 0 and hereby author zerepresentatives of this County to enter m upon the above-mentioned prop y or inspection purposes (� SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of pplcant or gent Date DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES f WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY _ DISTRICT NO PLANCK NO PERMIT NO BUILDING - - - �- "1 / /9 D ADDRE89 ,�► 1 LOCALITY w,... RECEI ED BY /DATE OF APPL yyDA�.TfE ISSUED NEAREST e �+ / 3` 09 I�"<p- T T' CROSS ST. / + _ BUILDING I � C 2 OWNER `` � ADDRESS 0/(�( (J � ADDRESSMAIL J+ �/ .�rrl ,,.� r LOCALITY _ (�A'rh U G 1 NEAREST TEL. CROSS ST CITY NO ^ M L FIRE P�,� TYPE GROUP�� ARCHITECTORZONE ENGINEER l-tea /P c BLDGNO ADDRESS SETBACK LINE 1 `„� _y_9 O D I sd' APPROVED TEL CONTRACTORS 6 / �iDW1rs�"� NO BY DATE {q USE _ APPROVED ADD REBS/-i �� ZONE BY DATE LEGAL �,,,-(�a Z„ CORRECTIONS ' DESCRIPTION LOT NO. BLOCK TRACT u- NO 93F SIZE OF LOT � 0, Q I NOW ON L ®Dy..41;. •r Y USE OFI NO OF D I NO OF �- EXISTING BLDG I FAMILIES ROOMS DESSCRIPTION OF WORK NEW Y ALTERATION ADDITION O REPAIR MOVING DEMOLISH � SqFT NO OF tg Z SIZE a3 ROOMS J STORIES D r WALL ROOF # COVERINGw4'�,rtl. COVERING --) USE NEW BUILDING �q� s�rlGy o I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVAL/SI APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION' LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS EGULATING BUILDING CONSTRUCTION L✓ '�V FRAME: FIRE STOPS, r / SIGNATURE OF - BRACING,BOLTS ,� 2 Zyv PERMITTEE LATH,INT.: AUTHORIZED AGT r LATH,EXT : � DBS-3 SOM SETS 7-47 $ t70 P C m GG PLASTER,INT FEE /'^� 1 pLA9TER,EXT. VALUATION FEE ��(j FINAL �1 "y WORKERS'COMPENSATION DECLARATION hereby affirm that 1 have certificate of consent to self APPLICATION FOR A U I L D I N G PERMIT insure, or a certificate of Workers' Compensation or a certtf d copy thereof (Sec 3800, L C ) c[� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N Insurance Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING / ADDRESS Certified copy is filed with th my building inspec- BUILDING D tion dep rtment ADD Date ApplicantL—�--i CITY ZIP LOCALITY C RTI KATE OF EXEMPTION FROM WORK NO OF BLDGS NEAREST COMPENSATION INSURANCESIZE OF LOT NOW ON LOT CROSS ST (This section need not be completed if the permit is for one . ASSESSOR hundred dollars ($100)or less ) TRACr BLOCK LOT NO MAP BOOK PAGE T PARCEL TEL USE ZqPE MAP I certify that iri the performance of the work for which this OWNER NO NO permit is issued, I shall not employ any person in any manner SPECIAL 8f so as to become subject to the Workers''Compensation Laws ADDRESS CONDITIONS U CITY ZIP Date ' Applicant r ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO'APPLICANT If, after making this Certificate of �., ENGINEER NO k3l CONST ZONE V f Exemption, you' sho Id become subject to the Workers' - �A 93 `` / Compensation provisi of the Labor Code, you must forth- ADDRESS U V Lt1 with comply with such p ions or this permit shall be deemed revoked CONTRA L STATISTICAL CLASSIFICATION APT CONDO Z LICENSED CONTRACTORS DECLARATION ^'LI CLASS NO DWELL UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code, and my license is in full force and effect CITY'-'' CLAS BK PG VALIDATION n Q SQ FT NO 04 NO OF CHECK License Nu er 'Lic Class / SIZE STORIE FAMILIES ONE VALU ION 7�' DE PTION OF WOK N Date ❑ ' ' Contract D $ Mb , I am exempt under Sec A B&P C for this reason w $ Date USE OF EXISTING BLDG V= DEMOL 8 5 4,3 A Signature APPLICANT NT �_ ! T FINAL Q # 0 0 0 0 0 OWNER-BUILDER DECLARATION DATE `f o t� O 1 3 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS FI e 0J 0 60 3 Professions Code) RE ❑ BUILDING I, as owner of the property, or my employees with ADDRESS / 2 Q 8'°8 7 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 l,'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) CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY IRED TOTAL SETBACK WIDTH 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 (Sec 3097, Civ C ) SIDE PL LendI er's Name P C Fee E- Permit Fee 75-, 3 LDMA Ref # Lender's Address ' I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm # and hereby authqfJze representatives of this County to enter upon the bove arty for inspJectio pur a • SEE REVERSE FOR EXPLANATORY LANGUAGE m Signature of Applicant or A& Date w COUNTY OF LOS ANGLLES 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 1205210031 PHONE (626) 285-0488 EXT (LEGAL ID I NO OF CONST I BUILDING ADDRESS I ON FILE I SQ FT STORIES TYPE 1 9071 EMPEROR AV I ISTRUCTURE V-B I SGAB CA 917752016 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET ROSEMEAD 15382-011-018 I THOMAS PAGE 596 GRID H1 LOCALITY TEMPLE CITY, Cl I I I I ITENANT (EXIST BLDG USE RESID USE ZONE R-1 (ISSUED ON PROCESSED BY I IEXIST OCC GRP 105/21/12 SR (OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL DP/,TE FIN/A�L 13Y CODE I IGHABOUR WAGDY R,ANAAM S (626) 482-2433- 1 300 1 19071 EMPEROR AV 1 1 / , ISGAB 917752016 FEES PAID IDE CR TION OF WOR I (BATHROOM REMODEL I i _(FEE DESCRIPTION QUANTITY UOM AMOUNT (APPLICANT TEL NO I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 80 I I IAB STATE GREEN BLDG FEE 300 00 VAL 1 00 ISPECTAL CONDITIONS IAC STRONG MOTION RESID 300 00 VAL 0 50 I I IB2 PERMIT W/ENERGY 300 00 VAL 48 10 I I I IFR INV WORK W/0 PERMIT 166 40 DOL 166 40 ICONTRACTOR TEL NO I TOTAL FEES 243 80 1APP-0'ALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I I I I LIC NO ILOCATION AND SETBACKS I I I I I I 1 1SOI-�S ENGINEER APPROVAL (ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I I I LIC NO I (SLAB/UNDER FLOOR I I 1 1 � JRAI:,cD FLOOR FRAMING IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I IUNDERFLOOR INSULATION I I I 1153H265 3 001 1_- 11 1 I I IFLOOR SHEATHING I I INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 11 0 NO 21 IROOF S,12ATHING I I I I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I 1AIR QUALITY 1000 FEET MATERIALS I I NO NO NO I (FRAME INSPECTION 11 IFIRT SPRINKLER HANGERS I I I I I I I I I (INSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL I I I I (EXTERIOR LATH I I I I I I IRATED FLOOR/CEIL ASSEM 1 (RATED WALL ASSEMBLIES I IRATFD SHAFTS/OPENINGS I I I IT-BAR CEILINGS 1 I 1 ILOT DRAINAGE IREPORT ID DPR261 ROUTE TO BS0508 I I I 1