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Home My Public Portal About9160 EMPEROR AVE_Building__ J ' WORKERS' DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR- BUILDING PERMIT insure, or a certificate of Workers'Compenstton Insurance, or , a certified copy thereof (Sec 3800, lab C ) r- _ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company - Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN ADDRESS ❑ -Certified copy is filed with the county building inspec- BUILDING !`__�+� / tion department ADDRESS &0 vI- LOCALITY NEAREST // Date J Applicant CITY 7 ZIP• CROSS ST O/1 CERTIFICATE'OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE ' r SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP p hundred dollars ($100)or less ) TRACT 557 BLOCK LOT NO NO D • TEL c P ( SPECIAL I certify that in the performance of the work for which this OWNER tnd N V�V NOS CONDITIONS O permit is issued, I shall not employ any person in any manner r 4„4,3-y i&0 DISTRICT GROUP TYPE FIRE PROCESSED BY V ADDRESS L > �$ V� so as to be m I t to the Workers'Cornpen atic n a ^ CONST ZONE - A �Datet Applicant 'TY N-e� ZIP STATISTICAL CLASSIF CATION _ APT CONDO V y ARCHITECT OR TEL NOTIC O PPLICANT If, after makm this Certificate of �tY ENGINEER NO CLASS NO DWELL UNITS Exemption, you should become subject-to the-Workers' H Compensation provisions of the Labor Code; you must forth ADDRESS SEWER MAP Z with comply with such provisions or this permit shall'be deemed revoked j TEL� CONTRACTOR NO BK �G VALIDATION LICENSED CONTRACTORS DECLARATION 1 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 f Professions Code, and my license is in full force and effect CITY CLASS $ �\ SQ FT 1N0 OF, NO OF CHECK License Number Lic Class / y SIZE STORIES FAMILIES ONE roe Contractor Date 1 DESCRIPTION OF WORK NEW / " ADD I am exempt from the licensing requirements as I am a „L— licensed architect or a registered professional engineer I ALTER FINAL �r C� acting in my professional capacity (Section 7051, Tr 2 A REPAIR•-[] DATE 6 Business and Professions Code) t USE OF -0 2 0 A DE FINAL , - r EXISTING BLDG � j3y r U-'-�-✓ � e 0 0 0 2 3 Lic or Reg No Date APPLICANT TEL - OWNER-BUILDER DECLARATION PRINT) NO p ^ I hereby affirm that I am exempt from the Contractor's License, �� / 2 ° 1 71 .00 1 Law for the following reason (Section 7031 5, Business and ADDRESS Professions Code) PRESENT 1 71.0 0 v BUILDING t _ 1, as owner of"the,property, or my employees with ADDRESS �J (/�j (� 0,74 08-8, 1 wages as their sole compensation,will do the work and the structure isnot intended or offered for sale(Section LOCALITY - 7044, Business and Professions Code) MOVING TEL 1, as owner of the property, am exclusively contracting CONTRACTOR NO 'S with licensed contractors to construct the project (Sec- ADDRESS $0 2 u 1 A tion 7044, Business and Professions Code) - REQUIRED - TOTAL SETBACK FROM EXIST S CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH 0 0 0 0 0 1 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P L )o 2 0'8 2 2,2 5 (Sec 3097 Civ C ) SIDE -- Lender s Name P L ° ° 8 2 2 25Ici P C Fee Permit Fee / r�� - � 07,08-81 Lender's Address w I certify that I have re4this application and state that the y� 11°�� ~�@ T � y PP r � - w Issuance Fee a above information is correct I agree to comply_with all County '' ap _ � ordinances and State laws relating to building construction, � � te' Total Fee and hereby authorize representatives of this County to enter i IQ u on thg obove-m ti d ��ion purpas s r a /� SEE REVERSE FOR EXPLANATORY LANGUAGE ` o , Sig ture of Applicant or Agent D e , @s ' � L WORKER -ON DECLARATION - hereby affirm that I have a certificate of consent to self APPLICATION, F O B U I L D I,N G PERMIT insure, or a certificate of Workers'Compenstwn Insurance, 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 O ADDRESS Certified copy is filed with the county building inspec BUILDING �^ tion department ADDRESS 0 d i Z LOCALITY v NEAREST Date Applicant CITY ( '{, lJ ZIP CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' I NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP,BOOK PAGE PARCEL (This section need not be completed if the permit is for one IUSE ZONE MAP hundred dollars ($100)or less ) - TRACT BLOCK LOT NO NO TEL / // SPECIAL CLI certify that in the performance of the work for which this OWNER (/� NO (, CONDITIONS O permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROC ED BY U so as to become subject to the Workers'Compensation Laws ADDRESS Zoe, CONST ZONE c Date Applicant CITY ZIP STATISTICAL LASS FI (CATION APT CONDO U ARCHITECT OR TEL LU NOTICE TO APPLICANT If, after making this'Certificate of ENGINEER NO CLASS NO DWELL UNITS tL Exemption, you should become subject to the Workers' VW Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such-provisions or this permit sholl,be — deemed revoked - - CONTRACTOR NO BK PG VALIDATION LICENSED CONTRACTORS DECLARATION IC 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 /Q Professionseffect,Code, and my license is in full force and eect CITY CLASS> $ SQ FT NO OF NO OF CHECK License Number Lic Class SIZE Qls�ri' STORIES Z FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK 4 A NEW ❑ ADD I am exempt from the licensing requirements as I am o �U Rg/Sia FLLa licensed architect or a registered professional engineer l ALTER FINAL �] acting in my professional capacity (Section 7051, P. C io REPAIR DATE Business and Professions Code) USE OF DEMOL FINAL EXISTING BLDG FI Lic or Reg No Date APPLICANT t TEL ` By OWNER-BUILDER DECLARATION (PRINT) NO 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 - j, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY b 4 A the structure is not intended or offered for sale(Section 7044, Business and Professions Code) MOVING TEL j, as owner of the property,,am exclusively contracting CONTRACTOR NO # ° ° ° ° 2 3 with-licensed contractors to construct the project (Sec- ADDRESS 2 ° °Y]9,2 Q tion 7044 Business and Professions Code) J REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH ° ° 07`920 v j hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued ° P LO Jc_8 1 (Sec 3097, Civ C ) SIDE / PL Lender's Name PC Fee$ �� Permit Fee G� Lender's Address u > I certify that I have read,this application and state that the Issuance Fee h aabove information is correct I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee w and hereby authorize representatives of this County to enter V a up t e a entioned-property for-mspeohrmmi p rpose I a SEE REVERSE FOR•EXPLANATORY LANGUAGE a D e Signature o Applicant or,A �1 6�: 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 0310160075 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING . BK. 95 PG: 76 PC: 3 S0. FT STORIES TYPE 9160 EMPEROR AV STRUCTURE: VN SGAB CA 917752019 ASSESSOR INFORMATIONNEAREST CROSS STREET- ROSEMEAD 5382-015-034 THOMAS PAGE 596 GRID: J1 LOCALITY: TEMPLE CITY EXISTSS . EXIST OCC GRP: 10/16/03 JK 10/10/04 OWNER: TEL NO BLDGS. NOW ON LOT. VALUATION: F L FINAL BYE CODE: BERRY WESLEY R,ELIZABETH TRS 12,900 9160 EMPEROR AV SGAB 917752019 FEES PAID PTION OF WORK T 0 HAKE ON HOUSE & GARAGE;INSTALL 7.2# EAGLE TILE FEE DESCRIPTION: QUANTITY UOM: AMOUNT: APPLICANT: TOM MC GRAIL ROOFING (909) 980-3329- AA BLDG PERMIT ISSUANCE 27.75 8729 BEECHWOOD DR ool 2-m U)1 W Q AC STRONG MOTION RESID 12900.00 VAL 1.29 SPECIAL CONDITIONS: ALTA LOMA 91701 D2 PERMIT W/O,EN=HC�12900.00 VAL 267 00 GELES �0®L�FEES 296 04 TOM CONTTOR: TEL RACGRAIL ROOFING (909)N980-3329 APPROVALS DATE INSPECTOR SIGNATURE 8729 BEECHWOOD DRIVE LIC NO ND SETBACKS ALTA LOMA, CA 91701 673647/C37 SOILS ENGINEER APPRUVAL ARC41TECT OR ENGINEER: TEL. No �! T&RUATToN7TRENCH FORMS LIC. NO:/ X111111 SLA /UNDER FLOOR RAISED FLOOR FRAMING r MAP XNO SEWER BOOK: PAGE: FIRE ZONE CMP- n (1 �� [� jam,, jJO(� UNDERFLOOR HINGINSULATION 0 E DWELLING STAT I — ;wJI I LP \`,!I\1�J�/ �UUU UUU\ FLOOR TM NO 21 - — ROOF SHEATHING SCHOOLS \\\ t PTP AIR QUALITY: 10NO OFEET MATERIALS \\ O ❑ �'�''� F ME INSPECTION �� FIREHANGERS R TOTA AC FR El p�®Q FSET BCKRONTTAPL- YARD HWY: PROP LINE WIDTH: Sgt �ervoce INSOLATION/WEATHER �� NSULATIO /W R STRIP SIDE PL- INTFRIOR LA D L EXTLRIOR LATH RATED 00 I A . AT D WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508