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HomeMy Public PortalAbout9075 EMPEROR AVE_Building__ WORKERS'COMPENSATION DECLARATION •f`n,ure,or affcertit catte of Worke s' Compensatioa certificate of n eInsuran e, APPLICATION FOR BUILDING PERMIT ' or.a cert'ified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N . Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ra-li Certified copy is filed with the county building inspec- BUILDING 1 tion department. ADDRESS (�P �,.i >,r e LOCALITY C 4 �J� rr Ly✓i NEAREST Date //'Z `Crl Applican CITY `�..vl +��T ZIP l 7 Q CROSS ST. r.. 4 CERTIFICATE OF EXEMP I FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATIO INSURANCE SIZE OF LOT .l-4c7( �� NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP 2UU TRACT BLOCK LOT NO. NO. hundred dollars ($100)or less.) i� TEL. SPECIAL } I certify that in the performance of the work for which this OWNER,/ej 5 C-01 e, �e�O NO.�$ ��� / CONDITIONS a permit is issued, I"shall not employ an person in an manner DISTRICT .GROUP TYPE FIRE PROCESSED BY O so as to become subject to the WorkersCompensation Laws. ADDRESS ri rM' oYx./ 99 '�,/? ///� CONST./ ZONE Date Applicant CITY �z �� ZIP ; (� v 'U� /1 3 Y - ARCHITECT OR TEL. STATISTICAL CLASSIFICATION APT. ICOND29 U NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. Exemption, you should become subject to the Workers' CLASS NO. DWELL. UNITSA. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. ".� TEL' �a BK. PG, VALIDATION CONTRACTOR oGt 4. NO.�-'ca S� �) LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS O(o-7 Lc,' ,a,. N �JVALUATION (commencing with Section 7000)of Division 3 of the Business and ;� LIC. Professions Code, and my license is in full force and effect. CITY T'Gwt I C f CLASS/ , - LfS7 SQ. FT: NO. OF NO. OF / CHECK License Number �� ' SIZE STORIES FAMILIES L ONE �.� � L' .Class ^��,rfV� 4Ag DESCRIPTION OF WORK >ri� O '•e 2rci TI�^ NEW $ Contractor A --/`f-Ss- --7,A 13 pate ZY%' O � 1 11 3.3A ADD I am exempt under Sec. fl ALTER ,® FINAL # 0,0 0 0 0 B.BP.C. for this reason IREPAIR DATE a 87,38 USE OF E] FIN I � D EXISTING BLDG. DEMOL Signatur APPLICANT TEL. BY o 0 07, WNER-BUILDER DECLARATION I PRINT NO. I 1.2 —�4 I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT 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. 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 EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. 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 . FD P:L. o Lender's Name' ' P.C:Fe Permit Fee Lender's Address 1 certify that I have read this application and state that the Issuance Fee Ot above information is correct. I agree to comply with.all County Investigation Fee ¢ Q� g ordinances and State laws relating to building construction, Total Fee d and hereb authorize representativ s of this County to enter upon the ove-mentioned roper for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of Applicant or Agent Date. x WORKERS' COMPENSATION DECLARAI ION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT L� insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES _ BUILDING AND SAFETY Policy No. Company BUILDING 7 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN I S C/ G Certified copy is filed with the county building inspec- BUILDING 7 tion department. ADDRESS Q !� �rn C�iZC:1 TY ��yy yyT i-- Date Applicant CITY j 1 ZIP O CJ 6ST. /` u�a��,f 7 CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. OR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT ��/ ryOK PAGE PARCEL (This section need not be completed if the permit is for one — MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. > / TEL. - SPECIAL 0. I certify that in the performance of the work for which this OWNER (� lir 1-5 NO. +��7CONDITIONS O Perm is issued, I shall not employ any person in any anner" �l ICT GROUP TYPE FIRE ED V sopLa�s toLgbtecome subject to the Workers' mpe�ti La ADDRESS Zr CONST�� Date ✓I � AI Lica l CITY acito 14 ZIP /Qv STATISTICAL CLASSIFICATION APT. CONDO. V' NOTICE TO APPLICANT: If, aft makin this Certificate of ARCHITECT OR `/ TEL.' ////��-' �j1 F g ENGINEER �� +��f N NO., TJ�277 CLASS NO. �i DWELL. UNITS! / Q- - Exemption, you should become subject to the Workers' LA Compensation provisions.of the Labor Code, you must forth- ADDRESS SEWER M Z with comply with such of or this permit shall be .deemed revoked. C TEL BK PG G, VALIDATION CONTRACTOR C� NO. _J LICENSED CONTRACTORS DECLARATION LIC. 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �•A4E NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and. LIC. 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 �{c+S STORIES' FAMILIES ONE r ' Contractor Date DESCRIPTION OF WORK Co• S I UC NEW $ 0 I am exempt from the licensing requirements as I am a O / (r W ADD _ �41 8,9 A licensed architect or a registered professional engineer _ p„ ALTER FINAL � �� z acting in my professional capacity (Section 7051, t 6E n ,1- DATE REPAIR � �f 0 0 0 0 23 Business and Professions Code). USE OF FINAL �J EXISTING BLDG. DE MOL By Y— 2 0 -43,20 Lic. or Reg. No. _Date APPLICANT j JEL. �7 /" OWNER-BUILDER DECLARATION (j,3,2 0_ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 2,2 5-81 Professions Code); PRESENT / �'`�'' BUILDING I, as owner of the property, or my employees with ADDRESS �+ �/`�'V wages as their sole compensation, will do the work and d� ��� the structure is not intended or offered for sale(Section LOCALITY 0 7044, Business and Professions Code). MOVING TEL. >. ��' � a 4 1 9 0 A aI, as owner of the property, am exclusively contracting CONTRACTOR NO. / 1 with licensed'contractors to construct the project (Sec- ADDRESS 0 0 0 0 0 tion 7044, Business and Professions Code). - 2 0 6 3 8.5 0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YA D HWY PROP. LINE WIDTH - I hereby affirm that there is a construction lending agency for FRONT o a 6 38.50 the performance of the work for which this permit is issued P.L. (.Sec. 3097, Civ. C.). SIDE 0 2,2 5_2,2581 • P.L Lender's Name z / Lender's Address P.C. Fee$ pJ�Oo Permit Fee JIB SG -20 I certify that I have read this application and state that the �i Issuance Fee aabove information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, �l S�(1 and hereby authorize representat' es of this County to enterA Total Fee V n /�� e a��ment" ed pro y for-'nspection purposes. 0 a Z�—.1 S��'� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant`or—'Agent Date ©s ' 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 1201310001 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: ON FILE I SQ. FT STORIES TYPE 9075 EMPEROR AV I 1 ISTRUCTURE: V-B SGAB CA 917752016 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 15382-012-037 I THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 101/31/12 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL ATE FINAL BY: CODE: I ICHENG, PAUL (626) 372-9180- 1 10,000 1 19075 EMPEROR AV I I � ISGAB 917752016 I FEES PAID _ (DESCRIPTION OF WORK I IKITCHEN REMODEL, REPLACE 2 WINDOWS AND REMOVE POPCORN 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ICEILING AND SMOOTH CEILING 1 (APPLICANT: TEL. NO: 1 1 I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 IAB STATE GREEN BLDG FEE 10000.00 VAL 1.00 ISPECIAL CONDITIONS: IAC STRONG MOTION RESID 10000.00 VAL 1.00 IB2 PERMIT W/ENERGY 10000.00 VAL 238.90 I - IFR INV WORK W/O PERMIT 257.00 DOL 257.00 __ I ICONTRACTOR: TEL. NO: I TOTAL FEES 525.70 (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I I I I LIC. NO I ILOCATION AND SETBACKS I I I ISCILS ENGINEER APPROVAL I 1 I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLLB/UNDER FLOOR I I I I I--- 11 IRAT_SED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I I 1153H265 3 001 1 11 I 1 --I IFLOOR SHEATHING I I I NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLdSSS: I -1-1 I 0 NO 21 1 (ROOF SHEATHING 1 1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I I I I I NO NO NO I (FRAME INSPECTION 1 ( IFIRE SPRINKLER HANGERS I I I I (INSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL I I I (EXTERIOR LATH I I I IRATED FLOOR/CEIL ASSEM. I I RA'Z'ED WALL ASSEMBLIES I I I I I I I I I 1 I IRATED SHAFTS/OPENINGS I I I 1 I IT-BAR CEILINGS I I I I I I I I I I (LOT DRAINAGE I I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 Z I I