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Home My Public Portal About6117 ENCINITA AVE_Building__ WORKERS' COMPENSATION DECLARATION � /� p II I hereby affirm that I have a certificate of consent to self //& PPLIC//""Y ON FOR BUILMNG PIERMH LS insure,or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lob, C.) COUNTY Of LOS ANGELES BUILDING AND SAFETY Policy No. Company I ❑ _ BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 7 ❑ Certified copy is filed with the county building inspec- BUILDING tion.department. - ADDRESS G LOCALITY • /• �l/1 NEAREST Date Applicant CITY (� ZIP CJG/ CROSS Si. CERTIFICATE OF EXEMPTION FROM WORKERS' /,jy Lz. NO. OF BL S. 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 /� n`n ZONE MAP J� iRACT� !/ BLOCK LOT NO.�C �Gr NO. (/ r -hundred dollars ($100)or less.) / E /� •,.q SPECIAL d certify that in the performance rkfor which this QWNE /�L,� .�/'C. F-- CONDITIONS O t DI TRICT UP TYPE FIRE PRO ESSED BV V p ,cls to issued, shall not em any on in an JJJayyyn ner t ADDRESS/ VyIG' �� / �s, CONST. r;ONE O so,cls to become subject to orke pgnn w `"/1i L Appl `� CITY ZIP BO STATISTICAL C ASSIFICATION APT. CONDO. __3 V NOTICE TO APRIL AN g this Certificate of ARCHITECT OR /)�� EL. ' ' W ENGINEER L/ NO. CLASS NO. OWELL UNITS_ d Exemption, you should,becom s lect to the Worker, z I` Compensation provisions of the -bar Code, you must forth- ADDRESS SEWER MAP Z with comply with such or ions or this permit shall be /r . deemed revoked. � CONTRACTOR �/V C. NO.TELBK. PG, �> VALIDATION LICENSED CONTRACTORS DECLARATION , LIC. I hereby affirm thoi I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and . LIC —7 Professions Code, and my license is in full force and effecl. CITYCLASS $ p� 0 6 b SQ. Fy. NO.OF NO. OF / CHECK License Number Lic.Class $QZ • S ORIES FAMILIES / ONE Contractor Date DESCRIPTION Of WORK NEW ❑ S /� r / F' d (/ am exempt from the licensing requirements as I am a ,,�' U J" + ADD ! 3 3 2.9 A licensed architect or a registered professional engineer �/ �^s ALTER ❑ FINAL acting in my professional capacity (Section 7051, v G�f—[/ REPAIR ❑ DATE # o o e o 23 Business and Professions Code), USE OF FINAL / _ I EXISTING BLDG. DEMOL ❑ By G_/ t e e 4200 Lic.or Reg. No. _Date APPUCANT j]�L // y q OWNER-BUILDER DECLARATION PRINT) �✓J(_� 'J� ,7 a e e (G.2,C O v I hereby affirm that I am exempt from the Contractor's License ADDRESS 3 6L1 , �3��1 ) Law for the following reason (Section 7031.5, Business and / 2 Q 8'8 Professions Code): PRESENT .— I, as owner of the property, or my employees with BUILDING ADDRESS - wages as their sale compensation,will do the work and the structure is not intended or offered for sale (Section I LOCALITY / 3 3 3.0 A 7044, Business and Professions Code). MOVING ) TEL. v ' I, as owner of the property, am exclusively contracting CONTRACTOR NO. # o e e e e with licensed contractors to construct the project (Sec- ADDRESS /� tion 7044, Business and Professions Code). % _3 U V 2 - 4 2 1.00 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - x I hereby affirm that there is a construction lending agency for FRONT - ° 4 2 �'Q Q the performance of the work for which this permit is issued P.L. �. ( 2.O _8 O (Sec 3097, Civ. C.): SIDE ' P.L. I Lender's Name $ Lender's Address P.C. Fee 8 Permit Fee W I certify that I have read this application and state that the ,,�.00 Issuance Fee aob n is correct. I agree to comply with all County I Investigation fee $ di <e d State lows relating to building construction, her authorize re resentoIVes of this County to enter Total Fee m po o rye ed property for inspe tion urposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE Wre of Applicant or Agent Dote i ®t t . Ir WORKERS' COMPENSATION DECLARATION .^ /� /� .. E"� Z I� L� F�p (LLq F� ,rpp�I�/T/T II .ii hereby affirm that hove a 's'Coicare scion insurance, to self - -- yp\ 'J'J��.",p 'M N FOR I�(.0��N CI I�r l}I,�('F�/ 7 �S =insure, or a certificate of Workers'Compenstian Insurance, or !/-'Q II 11 !/"�l 11�1 U 0 V 11 L7 u�lll T/11 o certified copy thereof (Sec 3800, Lob. C.) ._ . . . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company - ❑ Certified copy is hereby furnished. •• — - FORAPPLICANT TO FILL IN ADDRESS l . _ _ BUILDINGN/ ElCertified copy is filed with the county building inspec- `'• BUILDING / c - q _ tion department. \ ADDRESS LOCALITY LE t,;./ ' /D NEAREST . Date - Applicant - CITY - E- .� ZIP - / -O CROSS ST. JJ CERTIFICATE OF EXEMPTION FROM WORKERS' N . OF BLDGS. ASSESSOR • COMPENSATION INSURANCE - SIZE O&LOTAl 3 NOW ON LOT MAP HOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP TRACT - (J BLOCK LOT NO. NO. hundred dollars ($100) or less.) TEL r SPECIAL d OWNER / NQ '3/ r CONDITIONS O certify that in the performance of the work for which this _ DISTRICT GROUP TYPE FIRE PRO SSED BY (j permit is issued, I shall not employ any person in any manner \ CONST. ZONE so os to become subject to the Worker Compe tion Laws. 'ADDRESS �Q ��-%L/E r�� / ad O X Date pp 'cant CITY 71P U STATISTICAL CLASSIFICATION APT. CONDO. V /`NOTICE TO APPLICANT' If, aft making this Certificate of ARCHITECT OR - EL. y� Exemption„ you should become subject to the Workers' ENGINEER fi�. NO. QA$$NO. DWELL. UNI75 N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER M� Z with comply with such provisions or this permit shall be L // deemed revoked. \ I - TEL BK. ` PG/(/ `VALIDATION CONTRACTOR r��'(/� NO. LICENSED CONTRACTORS DECLARATION \ LC. I hereby offlrm that I am licensed under provisions of Chapter 9'. ADDRESS A6e4.1E NO. . - VALUATION , (commencing with Section 7000)of Division 3 of the Business and - t LIC. ; Professions Code, and my license is in full force and effect. 'CITY CLASS 9 SO. F NO, OFNO.AF - CHECK License Number Lic.Class SIZE ' Q ST RIES FAMILIES .ONE - - Contractor Date- DESCRIPTION OF WORK C Chi - NEW $ am exempt from the licensing requirements as I am o �J ..F �� ADD" _ 'licensed architect or a registered professional engineer _ ,./ _ _ ALTER FINAL - acting in my professional capacity (Section 7051, t 61;_*415- /S7/A) �CA.e `7AR. REPAIR DATE / d Business and Professions Code). USE.OF _ FINAL r_ EXISTING BLDG. - DEMOL El B Lic'. or Reg. No, Date APPLICANT TEL, ➢ OWNER-BUILDER DECLARATION (PRINT) /c /L�� NO. I hereby.affirm that I am exempt from the Contractor's License gDDREss'�C%O 6 Low for the following.reason (Section 7031.5, Business and - Professions Code): - PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole ccmpensohon,will do the work and LOCALITY the structure is not intended or offered for sale'(Section - pz'O 0 2 1 A 7044, Business and Professions Code). " MOVING TEL I, as owner of the property, am exclusively contracting CONTRACTOR t. NO. - # with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). - - 2, 9 7,0 0 REQUIREDTOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY' I SET BACK YARD HWV PROP, LINE WIDTH - I hereby affirm that there is a construction lending agency for - - FROM _ - ' / - °,°,° 9,7.0 O the performance of the work for which this permit is issued P.L, LA if' le. , (Sec. 3097, Civ. C.), - - SIDE_. — .._ . . _ fl r7,.L'�.2 8 2 P.I. ' Lender's Nome _ (_ - f P.C. Fee 5 -• - Permit Fee J d r, Lender's.Address w 1 certify that I have read this application and state that the Issuance Fee a �S aabove information is correct. I agree to comply with all County dmestigation.Fee. S ordinances and State laws relating to buildingconstruction, Total Fee 49 �. and hereby authorize representatives of this County to ¢ upon bove-men 'o ned property for inspection purposes. _ -SEE REVERSE FOR EXPLANATORY LANGUAGE 1^ r Signmure of Applicant or Agent Dote �s y 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 0308130011 PHONE: (626) 285-0488 EXT: LEGALCONST BUILDING ADDRESS: TR: 5904 LT: 292 SQ. FT STORIES TYPE 6117 ENCINITA AV STRUCTURE: 2400 VN TEMP CA 917801637 ASSESSOR IO NUMBER: NEAREST CROSS STREET: LAS TUNAS 5384-012-026 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: - ISSUED ON: PROL SED BY: EXPIRES ON: EXIST OCC GRP: 08/13/03 VG 08/07/04 OWNER: TEL. NO: SLOGS. NOW ON-LOT: VALUATION: FINAL DATE FINAL BY: C E: FIEDLER ROBERT;GERALDINE TRS (626) 2874602- 4,000 I•:� I J 9 6117 ENCINITA AV _U J TEMP 917801637 F ES PAID i-7€$CR-1-P ')ON OF WORK 1/0 EXIST ROOF ON HOUSE ONLY AND INSTALL 30-YR CLASS A FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: COMPOSITION SHINGLES EL. N0: SALAS (626) 287-0669- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 4000.00 VAL ,0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 4000.00 VAL 115.80 TOTAL FEES 144.05 CONTRACTOR: TEL NO: APPROVALS DATE INSPECTOR SIGNATURE WEATHER GUARD ROOFING (626) 287-0669- - 4251 BALDWIN AVE. LIC. NO LOCATION AND SETBACKS EL MONTE, CA 91731 808888 C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: _ FOUNDATION/TRENCH FORMS LIC. NO: I SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION XX 3 01 FLOOR SHEATHING NO. Of FAMILIES: DWELLING UN /COND: STAT CLASS: NO 21 ROOF SHEATHING J k- To 1- (j7� SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST R SPRINKLER HANG SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIORLATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508