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Home My Public Portal About5341 ENCINITA AVE_Building__ - ` .0 CIRKERSRCOMPENSATION DECLARATION 4 hereby affirm tha' I have a certificate of consent to self 'A P P L I CAT I O�N F O R' B U I L D I N G PERMIT , insure, or a r�eriQica,IF►or Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING;AND.SAFETY Policy No. ompany �L� �-��i �` Y BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 55y y Certified'copy is filed with the county building inspec- BUILDING 1 Y" i �' tio�FTE ' ADDRESS 1 !��— /l_/ Date Jpplicant 1 .iVt Y-� CITY ZIP LOCALITY CXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST - 71 COMPENSATION INSURANCE SIZE 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..) TRACT 1,LOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP l certify that in the performance of the work for which this OWNER NO. - NO. } permit is issued, I shall not employ any person in any manner i SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS t. CONDITIONS 00 CITY �Y . t ZIP Date Applicant 0 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GRRR��UP TYPE FIRE PRO SED BY ENGINEER NO. CONST. / ZONE Exemption, you-should become subject to the Workers' �j,� � (// � Compensation provisions of the Labor Code, you must forth- ADDRESS f `�'�� CA with comply with such provisions or this permit shall be L, q, ISTICAL CLASSIFICATION APT. fNDO. z deemed revoked. CONTRACTOR O. L LICENSED CONTRACTORS DECLARATIONLIC. CLASS NO.u; 1 DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �/ NO.� `r (commencing with Section 7000)of Division.3 of the Business and SEWER MAP - LIC. Professions Code, and my license is in full force on effect. CITY �� CLASS �� BK ' VALIDATION SQ. F NO.OF NO. OF _ CHECK SIZE STORIES FAMILIES ONE License Number Lic.Class VALUATION '4`� 1. 1..A l� �'' NEW- i ContractorI DES RIPTIONOF WORK ` VkJ ❑ — # 0 0 0 0 1 IPS J 1 .- ADD' $ 1. ❑ I am exempt under Sec. ALTER ❑ , B.BP.C. for this reason ,` f TI REPAIR ❑ s 1.2 9= USE F ❑ ° o o v Date: DEMOL EXISTING BLDG. - - APPLICANT 0,327-8 ' 27-8 6Signature 1' LxJ PRNTACA4 ,dipOWNER-BUILDER DECLARATION — - I hereby affirm that I am exempt from the Contractor's.LicenserL 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 he work and 4'3 1 2"A the structure is not intended or offered for'sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. # o 0.0. °.° 1 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- 01061-3 tion 7044, Business and Professions Code). ADDRESS z REQUIREDYARD" HWY TOTAL SETBACK FROM I ° ° 1 0 6 130-- CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT O 327—8 6 the performance of the work for which this permit-is-issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name L LDMA Ref. # X/, Lender's Address P.C. Fee$ /,.2 Permit Fee /n► certify that I have read this application and state that the Issuance Fee V kLD P/C#• a above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total-Fee u -and hereby I thor'ze r resentatives of this County to enter D t ^� LDMA Perm. # upon t ve- entio ec) propert for inspectiq�i purp `s , _ - 411 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant or Agent D e - Te WORKERS'COMPENSATION DECLARATIDN I hereby affirm that I have•a terfificdte ofconsent to self,, - insure, or a certificate of Workers' Compensation Ipsurbr?' , A P P L i CATION FOR BUILDING 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 rtified copy is filed with the county building inspec- BUILDING a[/ y� n / �=+ tion department. ADDRESS �J 7 /It ��Gi/f��7 LOCALITY NEAREST Date Applic / CITY / C_/ ZIP �� CROSS ST. CERTIFICATE OF EXEMPTION F W K '/,a� NO. OF BLDGS. ASSESSOR COMPENSATION IN RANO SIZE OF LOT Z7�/ NOW ON LOT MAP BOOK PAGE PARCEL (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. 5 17 0 �� ` TEL. �.O a CONDITIONS F� I certify that in the performance of the work for which this SPECIAL OWNER GE57�Q G/ NO.� �� permit is issued, I shall not employ any person in any manner _ DISTRICT GROUP TYPE FIRE 2L:�� O so as to become subject to the Workers'Compensation Laws. ADDRESS �y� �Li9iY/G r/ �� CONST. _ ZONESl* 0 ce Date Applicant CITY �� ZIP % oQ6 STATISTICAL CLASSIFICATION APT. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be deemed revoked. /� TEL / BK. PG, / VALIDATION CONTRAtk�� G��/�/�,� N��E��6 �'` , LICENSED CONTRACTORS DECLARATION t� LI �'.��Lr I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS N / VALUATION (commencing with Section 7000)of Division 3 of'the Business and LIC. $ Qp_pq Professions Code, and my license is in full force and effect. CITY CLASS 7 SQ. FT_ NO.OF NO. OF CHECK License Number Lic:Class SIZ 040 ISTORIES FAMILIES ONE �` L!5 2 A Contractor Date DESCRIPTION OF WORK NEW o a 0 0 2 3 r �r�❑ I am exempt under Sec. f a ADD El 2 - 633. C5 ALTER ❑ FINAL' _ B.BP.C. for this reason REPAIR ❑ DATE o c, E. 3 J C5 v Date: USEOIFEXIBLDG. DEMOL E] BNA G 7 C 3 —8 4 Signature APPLICA L. Y y- OWNER-BUILDER DECLARATION PR �O O 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 - -529,5A 7044, Business and Professions Code). MOVING TEL. ❑ .I, as owner of the property, am exclusively contracting CONTRACTOR NO {t,o 0 0 0 0 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). Z o ] 5 J 2 5 REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH o �7 rr 2 �T I hereby affirm that there is a construction lending agency for FRONT " c the performance of the work for which this permit is issued P.L. , O 7_ 54 (Sec. 3097,.Civ. C.). SIDE FD P.L. Q Lender's Name Lender's Address P.C. Fee$ Li :3�i d Permit fee > ffi I 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 $ ordinances and State laws relating to building construction, Total Fee u and hereby authorize representatives of this County to enter upon the bove-mentioned propert #or inspection purposes. a � 0' 7 % SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Sig g► re of Aq, ica o ent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1304150050 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I ITR: 7796 LT: 30 I SQ. FT STORIES TYPE OCCUP GROUPI 5341 ENCINITA AV 1 (STRUCTURE: 263 1 V-B R-3 I TEMP CA 917803115 1 (ASSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET: I 15388-008-033 OTHER: I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI (TENANT: IEXIST BLDG USE: PHOTO 11SSUED ON: PROCESSED BY: 1 1 IEXIST OCC GRP: R-3 104/15/13 SR I 10WNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: 1F /AyLI/' FIAL CODE: 1 ICHIDAN, CAO (626) 684-0060- 1 12,030 IC %/.T 1 15341 ENCINITA AV 1 I ITEMP 917803115 1 FEES PAID ID S RIPTION OF WORK 1 I ISOLAR SYSTEM ROOF MOUNTED 15 PV 4.9 KW 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 - I (APPLICANT: TEL. NO: I I I (CAMPBELL, SCOTT (951) 300-0768- IAA BLDG PERMIT ISSUANCE 27.80 1 I 13080 12TH STREET IAB STATE GREEN BLDG FEE 12030.00 VAL 1.00 ISPECIAL CONDITIONS: 1 IRIVERSIDE CA 92507 IP1 RES PV PC<10KW 153.90 I' 1 I IP2 INSPCT RES PV <10KW 138.00 I I TOTAL FEES 320.70. I ICONTRACTOR: _ TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I ISOLARMAX RENEWABLE ENERGY PROVIDER, (626) 965-4286- 1 1 I 13080 12TH ST. LIC. NO ILOCATION AND SETBACKS I 1 I (RIVERSIDE, CA 92507 972048 1 1-_ I I ISOILS ENGINEER APPROVAL I 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I . I I LIC. NO: ISLAB/UNDER-FLOOR I I I IRAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I 1UNDERFLOOR INSULATION I I 1 3 001 1 1 I IFLOCR SHEATHING I 1 I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I 1 NO 20 I IROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEA.R PANELS 1 1 I 1AIR QUALITY: 1000 FEET MATERIALS i I I I I 1 NO NO NO 1 (FRAME INSPECTION I I I . I (FIRE SPRINKLER HANGERS I I I I I IINSULATION/WEATHER STRIPI I I 1 IINTERIOR LATH/DRYWALL I I I 1EXTERIOR LATH IRATED FLOOR/CEIL ASSEM. I I I 1 I IRATED WALL ASSEMBLIES I I I 1 IRATED SHAFTS/OPENINGS I I IT-BAR CEILINGS 1 I I I I ILOT DRAINAGE 1 I 1 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I 1 1 I I I I I I