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HomeMy Public PortalAbout6032 ENCINITA AVE_Building__ PWORKERS' COMPENSATION DECLARATION I her�oy afv'imn that I have a certificate of consent to self 0 O frrf� �(/� //U�� I1I�gIp� �r�} �rr�p�r r Insure or a certificate of Workers' Compensation Insurance, 0 C�O�L .®Y 11 U ®0�1 TiM NIG, (�L�f�G� 7 - or acertrfied copy thereof (Sec 7800, Lab. C.) '� COUNTY OF LOS'ANGELES - .BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. i` FOR APPLICANT'TO FILL-IN _ ADDRESS - ❑ Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS ,L�Gd�CI<_y ..Date Applicant' CITU ZIP ��-; Q LOCALITY N F MIDGE. NEAREST _ CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT r 'N ON LOT CROSS ST." COMPENSATION INSURANCE ASSESSOR c�j (This section need not be completed if tBe'permit is for one TRACT BLOCK LOT'NO. K ' MAP BOOK ^9eg� PAGE O�� PARCEL ��� hundred dollars ($100) or less.) C K' ✓ T4 USE'ZONE MAP �j • OWNER - -� .1.certify:,that in the performance.of the work for which this - i /1ce" SPECIAL. ' } .permit is issued, I shall not employ any person in any,monner ADDRESS -Z - /'� h, CONDITIONS d so as to become subject to the Workers' Compensation Laws.. / - O CITY ZIP / 7 0'- U Date - Applicant ARCHITECTS TEL, NOTICE TO APPLICANT: If,.after makingthis Certificate of ENGINEER. ..NO. ". DISTRICT. GROUP TYPE . _ FIRE PROCESSED BY _ CONST ZONE Exemption, you should become subject to the.,Workers' Compensation provisions of the Lobar.Code, you must forth- ADDRESS ._ withcomply with such provisions or.,this permit shall be TEL. STATISTICAL CLASSIFICATION COAPT. CONDO. NTRACTOR NO. z deemed revoked. _ - LICENSED CONTRACTORS DECLARATION LIC. CLA55 NO. DWELL.UNITS_ _ I hereby affirm that I am licensed under provisions of Chapter ADDRESS NO. (commencing with Section 7000)of Division 3 of ihe'Business LIC. SEWER MAP and Professions,Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. 2 NO. OF NO. OF CHECK License Number Lic Class SIZE „/ STORIES FAMILIESONE - -" - - - - - VALUATION Contractor - Date DESCRIPTION OF W RK NEW ❑ S /.y nDO• �Q - _ .. . . ADD', / El am exempt,under Sec. �L•i ' ALTER ❑ -- ., - B.BP.C. for this reason _ REPAIR ❑ $ " Date: USE OF. _ _ .. EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL - -, FINAL ' OWNER-BUILDER DECLARATION (PRINT) - NO. DATE - - I hereby affirm that I am exempt from the Contractor's License _ - - - _ __- " Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 1 Prof scions Cade): - PRESENT - _. .. _ By I, as owner of the property, or my employees wBUILDINGith ADDRESS - - ' wages as their sole compensation,will do the:work and - - - - - - - 330; 336,41 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) - MOVING TEL. D r{' .❑ ; '1 .23- CONTRACTOR NO.I, as owner of the property, am exclusively contracting _ t N ACCT.a with licensed contractors-to construerthe,project (Sec- ADDRESS tion 7044,.Business and Professions Code.) - L�y .j �� i303 ' 50.50. REQUIRED. ' TOTAL SETBACKFROME%IST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH f .2 ITERS I hereby affirm that there is a construction lending agency for FRONT T J-i c : • J tiL f - the performance of the work for which this permit is issued - P.I. --' - i - f TOTAL 336— C?+ I (Sec. 3097, Civ. C.). SIDE PL. CHECK 385,91 Lenders Name /] rr,,rn� $ - PC. Fee$ ��L'x� Permit Fee LDMA Ref. # CHANGE .Vl` Lender's Address I certify that I have read this application and state that the Issuance Fee 27 A9 LDMA PTC# - 8 above information is correct. I agree to comply with all County Investigation Fee 9 - 0000-0001 6/25/96 ordinances and State laws relating to b ilding construction, Total Fe Y `� h T- f LDMA Perm. # 7113 1 �•� :,1v mand hereby authorize representatives this County to enter $ n the v entioned prop rt ins -ction pur ses. Q// 5 E�/K ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of pplicant or AnT Date , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0108230025 PHONE: (626) 285-0488 EXT: DUPLICATE L 0. OF CONSTBUILDING TR: 6561 LT: 364 SO. FT STORIES TYPE OCCUP GROUP 6032 ENCINITA AV. STRUCTURE: 0 1 VN R3 TEMP CA 917801934 ASSESSOR INFORMATION R: GARAGE: NEAREST CROSS STREET: LAS TUNAS DRIVE 5385-004-009 OTHER: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: 0 D PROCESSED . EXIST OCC GRP: 08/23/01 JK 02/19/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL ATE F11 CODE: WANG, KIANG CHUN (626) 255-3016- 3,000 (] 4 '©/ 6032 ENCINITA AV _/ 6Ti'0{A- TEMP 917801934 S 6'�T OF CONVERT DEN TO BEDROOM AND BA H FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: L. 0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID_ 3000.00 VAL 0.50 SPECIAL CONDITIONS: 62 PERMIT W/ —ENERGY - _ 3000.00 VAL 108.90 0,NGELE,§TO?AU-FEES 137.15 CONTRACTOR: TEL. NO: 0� ��/j. APPROVALS DATE INSPECTOR SIGNATUR SAME AS OWNER CIL. NO LOCATION ANDS BACK ( SOILS ENGINEER APPROV L EC OR ENGINEER: EL. 0: ( -,i �� NDA ON/TR CH FO S A � LIC- NO: Imo - �\ SLAB/UNDER FLOOR 17711 RAISED FLOOR FRTM N MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:' �.� ((J rt �� / �� ��/ UNDERFLOOR INSULATION i... A� \ ��;�: 1ST LEVEL FLMF`SH9rV- NO. OF FAMILIES: DWELLING : AP COND: STAT CLASS: - _"- _- - - - - -- --- - - - NO 21 ` / - ' � ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDO S , f �� ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO ( .�,I- E DEPT. FRAM INS-PE-CT- REQUIRED NSP CTQU RED TOTAL S TB FRO EXIST (/6 � \ w10C\t BLDG D R INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: CYC a� SHEAR PANELS FRONT PL- '@ervi a 1� SIDE PL- �^ INSULATION/WEATHER INSULATION/WEATHERSTW INTERIOR LATH/DRYWALL EXTERIOR A I LOT DRAINAGE SMOKE L FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0107050004 PHONE: (626) 285-0488 EXT: DUPLICATE MAL D: NO. OF CONSTNEW D ESS: TR: 6561 LT: 364 SQ. FT STORIES TYPE OCCUP GROUP 6032 ENCINITA AV STRUCTURE: 400 1 VN U1 TEMP CA 917801934 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: LAS TUNAS DRIVE 5385-004-009 OTHER: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST 13LDG S SS R ON: EXIST OCC GRP: 07/05/01 UT 01/01/02 OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINAy, TE/" 1 l C E: WANG, %LANG CHUN (626) 255-3016- 11,480 (I� / /V/ 6032 ENCINITA AV (O TEMP 917801934 S A D�-OF WORD` RENEW PERMIT FOR DEN (PERMIT # 7113) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: . NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID.._ 11480.00 VAL 0.11 SPECIAL CONDITIONS: B2 PERMIT W/ENERGY - 11480.00 VAL 27.52 �NG`j:;ff-STOTAL-FEES 55.38 CONTRACTOR: TEL. N0: OY7 �I1Vj, APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS OSOILS ENGINEER APPROVAL A 0 ENGINEER: N0: 7� ^ FOU ON/TR FORMS LIC. Hill SLAB UNDER FLOOR G L MAP NO: SEWER MAP BOOK: PAGE: FIRE 0 E: MP:' \� �� �� �'� {VA� ((/7�V i���'� UNDERFLOOR INSULATION 3 G01. Iv, S F EAT NO. 0 FAMILIES: DWELLING UNITS: T/CO : STAT CLASS: - - - - - -- --- -- � NO 21 � U f_ ( ' ND LEVEL FLOOR SHEATH SCHOOL WITHIN ARoous ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS \\\\ NO NO NO J / '., FIRE DEPT. FRAME INSPECT REQUIRED TOTALE (/b / ' .i ` 0 Q`�5 BLDG DEPT. FRAME INS-P-CC7 SET FRONTTAPL-CK YARD: HWY: PROP LINE: WIDTH: �7C S�rV1Ce That SHEAR PANELS SIDE PL- �e- - N W S INT IOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKEECT VIC FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0104110020 PHONE: (626) 285-0488 EXT: GA 0. OF CONST NEW BUILDING–ADDRESS: TR: 6561 LT: 364 SQ. FT STORIES TYPE OCCUP GROUP 6032 ENCINITA AV STRUCTURE: 400 1 VN U1 TEMP CA 917801934 ASSESSOR INFORMATION NUR-BEFF GARAGE: NEAREST CROSS STREET: LAS TUNAS DRIVE 5385-004-009 OTHER: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE LONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 04/12/01 UT 10/09/01 OWNER: TEL. N0: BL GS. NOW ON LOT: VALUATION: FINAL D E :i CODE: WANG, XIANG CHUN (626) 255-3016- 11,480 I / 6032 ENCINITA AV TEMP 917801934 FEES PAID SL I ON F WOR NEW DETACH 2-CAR GARAG FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. O: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 11480.00 VAL 1.15 SPECIAL CONDITIONS: AX BUILDING REVIEW--FEE-1 54.70 D2 PERMIT W/ EN-HC—- 1.1480-00 VAL 250.20 UELESTOTAL FEES 333.80 CONTRACTOR: TEL. NO: APPROVALS vu/1V APPROVALS DATE/ INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS 40 ra / SOILS ENGINEER APPROVAL k & ARCHITECT OR ENGINEER: TEL. O: r1 ` OUNF�IF/TRENCHO� LIC. NO// M i eK SLAB/UNDER FLOOR �11I 111 RAISED FSR FRAI�TA�— MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:- �l (, /� 1 UNDERFLOOR INSULATION 3 G [I �`JJ, `�_,�`;I WU1, �L1,iL C`-'J ST LEVEL FLOORSHEATH NO. 0 FAMILIES: DWELL UNITS: AP COND: S CLASS:-1 --_ .t{- VV1 NO 214 ��x-1 � `L`' ` U I '—� �' ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUSROOF SHEATHING "? AIR QUALITY: 1000 FEET MATERIALS ZZ �i NO NO NO FIRE DEPT. FRAME INSPE TOTAL SETBACK ROM EXIST !� f"� -q1 yV- RUG ULP I. FRAML 177FLUT SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- C Service 7haq SHEAR PANELS�4 SIDE PL- b 1 0 NS LAT WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR EATH b' LOT DRAINAGE SMOKE DETECTION D CES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: SS0508