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Home My Public Portal About6102 ENCINITA AVE_Building__ WORKERS' COMPENSA710N.DECLARA710N I Fi`f b affirm that 6-trove .'certificate of consent Eto self //(�� D 11p1th� ��//([��////pp�� I�I��I��Ipp1�� FOR O MM�(/� O I��} O �///L�� ` insure ora certificate of Workers' Compensation Insurance, !/'11��Lva5 `V(/'l1��0V U O0V �� DD�U.0`/ PIS�I/T7U�� or a certified copy thereof (Sec. 3800, Lab. C.) t. =, . . _,.•: COUNTY-01F.•LOS ANGELES ' BUILDING AND SAFETY i Policy No. Company - Certified copy is hereby furnished. t Ka[; FOR•APPLICANT TO FILL IN- S'� + BUDDING ADDRESS ❑ Certified copy is filed with the,county building inspec- BUILDINGr I - an tion department. ADDRESS / r�' -T ]7 ff+"::'- ° LOCALITY - nn NEAREST Data Applicant' CITV. G I ZIP ��y��' - CROSS ST. D 4" -,CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE MAP (This section need not be completed if the permit is for one R /fj�mm 7 TRACT BLOCK LOT NO hundred dollars ($100)or.less.) ' . - . NO. - TEL. / SPECIAL I certify that in the performance of the work for which this OWNERL r. Jnnw1p10. 'r7sgS 1 CONDITIONS IL permit is issued, I'sha not employ any person in any manner DISTRICT .GROUP TYPE FIRE PROCESSED BY 0 so as ton6ec mesubject to the Worker ompen5ationLawS. ADDRESS O C N ,�� CONST. ZONE ill Date / Applicant /// CITY (✓I ZIP STATISTICAL CLASSIFICATION APT, CONDO. - V ARCHITECT OR ENGINEER NO. CLASS NO. DWELL UNITS_ NOTICE O APPLICANT If, after'making this Certificate of TEL. ' W Exemption, you should become subject to the 'Workers'' _ d Compensation provisions of the Labor Code, you must forth-. gDDRE55 SEWER MAP _ Z with comply, with such provisions orr this permit shall be TELp?, deemed revoked. CONTRACTOR. QW N Z BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION sP _ (commencing with Section 7000)of Division 3 of the Business and LIC. /�QO Professions Code, and my license is in full force and effect. CITY CLASS SQ. FT. NO.OF / NO.OF CHECK _ D License Number Lic.Clais - SIZE STORIES i FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ ❑ I am exempt under Sec. 1770,V %4- COV ADD ALTER FINAL Xv B.&P.C. for this reason yU✓�+yQ{- 6417 - ❑ DATE / =lC`,t,,, REPAIR ---Date. F FINAL. - - EXISTING BLDG. DEMOL '❑ FI . By Signature • APPLICANT TEL. �-- OWNER-BUILDER DECLARATION PRINT NO. _WSJ 1 hereby affirm that I am exempt from the Contractor's License blD�, Er 1 N IT}? /tut D 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 3 3 6 2 A' 'tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. e • e s CONSTRUCTION LENDING AGENCY SETBACK YARD HWV 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.1. 1,2 e,1 0,611 ,3 (Sea 3097, Civ. C). SIDE P.L.. 1 0 61 36 m Lender's.Name y $ P.C. Fee$ Permit Fee 0701:S 3 Lender's Address S I certify that I have read this application and*state that the Issuance Fee O a above information is correct. I agree to comply with.all County Investigation Fee ordinances and State laws relating to building construction, ToolFee >5 and hereby authorize representatives of this County to enter upo above-mentioned property for inspection purposes. -� - n P SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of kpplicont or Agent Owe .. ®s WO^KERS' COMPENSATION DECLARATION /fes /� " 1�1�� L}� �rr��s 11E� 1�E�� 1'r��j(�p/L�� I hereby a coir l iliac gr'aWo a certificate of consent to self /U\ Pp L�IL Q7000 V FOR ✓UILD� U VO PEU�lEld LI T insure, or a c€�tificale ci Workers"Com penstion Insurance, or (/'11 V- a certified copy thereof (Sec..3800, Lobb.. C. j p COUNTY OF LOS ANGELES BUILDING AND SAFETY, Policy NoL�1Ss$� Company I BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS G/tr2 Tf 2r / - ' Certified copy is filed with the county building inspec- BUILDING /;O j� �7l tion department. DRESS [t //• LOCALITY p/ ag /SIO (J NEAREST w Date��1Ipplicom /•• CITY ZIP 7 4 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKS S' 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 USE ZONE MAP hundred dollars ($100) or less.) TRACT BLOCK LOT NO. 1 NO. TEL., p SPECIAL d I certify that in the performance of the work for which this OWNER NOA S^�+O�J �� CONDITIONS O ,permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY V so as to become subject to the Workers Compensation Lows. • ADDRESS CONST . ZONE a, CITY ZIP /Q - O Date Applicant STATISTICAL CLAS KATION _ APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR A /- - TEL. f 2,^ . . A. Exemption, you should become subject to the Workers' ENGINEER L�l � NO. VW CtA55 NO. DWELL UNITS_ A. Compensation provisions of the Labor Code, you must forth- .ADDRESS SEWER MAP ? with comply with such provisions or this permit shall be TEL�+7�p,r� deemed revoked. CONTRACTO BK. PG, VALIDATION ` LICENSED CONTRACTORS DECLARATION xx ,. `�� _ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS -L /J NO3SZ . 7 2 v I VALUATION (commencing with Section 7000)of Division 3 of the Business and -n LIC. Professions Code, and my license is in full force and effect. CITY CLASS CE S3 $ D SZ9as-0 _3 SO. R NO.,OF NO. OF CHECK ,License Numbe Lic.Class Q 5 `' SIZE STORIES FAMILIES ONE - �(n/��, NEW ❑ 5 , Contract,o'r'W�` Pn-- Date DESCRIPTION OF WORK ! ❑ 1 am exempt from the licensing requirements as I am a /W /A/ A00 ADD ❑ licensed architect or a registered professional engineer ALTER' ❑ FINAL DATE /O —_s-- U J , acting in my professional capacity (Section 7051, REPAIR ❑ Business and Professions Code). USE OF DEMOL - ' 2 8 9.6 A L / EXISTING BLDG. ❑ FINA By �<1 �••^-•—+`� a a • s Lic.or Reg. Na. Date- APPLICANT `TEL. 21 OWNER-BUILDER DECLARATION (PRINT) NO. 2 • • 6.2.4 8 1 hereby affirm that I am exempt from the Contractor's License ADDRESS //� 'J 6 2 4 F sE Law for the following reason.(Section 7031.5, Business and / e e ' Professions Code): _ PRESENT ❑ BUILDING 6. 1 b_8 3 1, as owner of the property, or my employees with ADDRESS 0 wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section LOCALITY - 22 8 Q`] A 7044, Business and Professions Code). MOVING TEL ' I, as owner of the property, am exclusively contracting CONTRACTOR NO. # e e e e . 1 with licensed contractors to construct the project (Sec- ADDRESS .2 ^ 1 1 5 5 0 tion 7044, Business and Professions-,Code). REQUIRED ' REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH .a o 1 1 5 5 0 5 I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued 1 6 1 6—83 (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name $ lender's Address P.C. Fee$ l(/ 7 Permit Fee - > I certify that I have read this application and state that the Issuance Fee a above information is correct. I agree to comply with all County - Investigation Fee u a ordinances and State laws correct., to building construction, 9 9 Tot61 Fee anuthonze representatives os this County to enter ' a upon e a ave-mens' n pe inspection purposes. - a` ^ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature djT`AlfpIiccr1 or Age t Dote I �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 0501270008 PHONE: (626) 285-0488 .EXT: LEGAL ID: NO. OF CONST BUILDINGADDRESS: ON FILE SQ. FT STORIES TYPE 6102 ENCINITA AV STRUCTURE: 2200 -- VN TEMP 'CA 917801636 ASSESSOR INFORMATION NLR48ER: NEAREST CROSS STREET: 5385-003-025 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: SID S 0 : - ISSI ON: PROCESSED BY: EXPIRES ON: EXIST GCC GRP: 01/27/05 JK 01/22/06 OWNER: TEL. N0: - BLDGS. NOW ON LOT; VALVA ION: FINAL DATE FI L BA Y: CODE: 0ARDS, KATHELEEN (626) 309-5024- 5,500 61 -7� 6102 ENCINITA AV O"n TEMP 917801636 FEES PAID DENTITMON OF WORK REMOVE EXIST. ROOFS, INSTALL 1/21, 30LB FELT + 30 YEAR ELK FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: WITH MOFIFIED BITUMEN FLAT ROOF HOUSE AND GARAGE. APPLICA0: SIERRA PACIFIC ROOFING (909) 949-7663- AA BLDG PERMIT ISSUANCE 27.75 1042 N. MOUNTAIN AVE AC STRONG MOTION RESID 5500.00 VAL 0.55 SPECIAL CONDITIONS: UPLAND CA 91786 DZ PERMIT W/O EN-HC 5500.00 VAL 149.40 TOTAL FEES 177.70 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SIERRA PACIFIC ROOFING (909) 949-7663- 1042 N MOUNTAIN AV B 383 LIC. NO L7iCATION AND SETBACKS UPLAND, CA. 91786 627233 C39 � f SOILS ENGINEER APPROVAL ARCHITECTNG NEER: TEL. NO: / fOUNDAT 0 C FORMS LIC. NO- / SLAB/UNDER FLOOR RTISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSU ATI N XX 3 01 SHEATHING NG NO. OF FAMILIES: DWELLING : P /COND: STA SS: NO 21 ROOF SHEATHING SCHOOL WITHIN R OUS WE-AR PAR€ AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIREDTOTALK FROM -XIS IR S ER A G RS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL i EXTERIOR LATH TED FLOOR/CEIL ASSE97FLOOR/C - RATED WALL ASSEMBLIES- RATED SSEMBLI SRA ED SHAFTS/OP I GS -BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE T0: BS0508