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Home My Public Portal About6321 ENCINITA AVE_Building__ 1Yy!'- 3- /- 9i- WORKERS' COMPENSATION-DECLARATION II1��^I^1��p /tea p I� I hereby affirm that I'have a certificate of consent to self �u u 1' �',r /p��ILON FOR' B n��NG PIER OT insure, or a certificate of Workers' Compensation Insurance, + ll L C(06\ 0 u� Il v uV' L_rC u�u u -or'a certified copy thereof-(Sec 3800,-Lob. C.) -'COUNTY OF-LOS ANGELES ' -' :BUILDING AND SAFETY' Po�licy�15-^`-h"t�COmpany � �T �/ ,p :L Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS '(� SRI /V e' , , I �/4' 66 ^.❑ .Certified copy is filed with the unty bu' mspec- BUBDING tion department. ADDRESS /d Date 3 :7-9•� Appudam atv C na `/ l3 ocAury NEAREST .CERTIFICATE OF EXEMPTION FRO RKERS' SiZEOF_LOT NOW ON LOT CROSS ST. COMPENSATION INSURA CE ASSESSOR[BL(This section need not be completed ibth'e•permit is for one TRACT CK LOT NO. MAP'HOOK PAGE PARCEL ' hundred dollars!($100) or less .) TEI . - r+, - OWNER'.. 7 NO. . USE ZONE NO /S'3 -2-�S I certify that-in,the performance of.the work for which this ' SPECIAL - Y permit is issued,,.)shall not,employ,any person any manner ADDRESS N CONDITIONS d so as to become subject to the,Workers.Compensation Laws. '. •� O + CITY 'G . ZIP '� / - V Date Applicant - ARCHITECT OR TEL K NOTICE TO APPLICANT..If, after,makin this ,Certificate of ENGINEER ._ NO: - DISTRICT 'GROUP TYPE FIRE OCESSED BY 9 - CONST. _ ZONE .Exemption, you,should become subject to the,Workers' - /` 'b . V mpensation provisions of the Labor Code, you must forth- Co _ _ ADDRESS. - So� _ a with Rom with such provisions or-.this 67 STATISTICAL CLASSIFICATIONr -APT. CONDO. - en comp p permit. shall 6e TEL ate' deemed revoked CONTRACTOR �� NO.' Z LICENSED-CONTRACTORS DECLARATIONLIC. CLASS NO.al DWELL. i NITS I hereby affirm that I am'licensed under provisions'of Chapter 9 _ ADDRESS / NO' SEWER MAP (commencing with Section 7000),of,Division 3 of the Business LIC. and Professions Code,and my,license is it full force and effect. CITY 0 /� (� - CLASS _J BK. 76.' r/ VALIDATION SO FT., NO. OF NO. OF CHECKu License Numbers s 7�. Lic. Class SIZE STORIES FAMILIES ONE x�cc �7 DESCRIPTION OF WORK /l _ NEW ❑ VALU TION Contractor��%�1Tgr�/��pte lei `30.`y..•� OO K� d S 3 .� [T 2.. a+ /t G. ADD E] ❑ l/7 D am exempt under Sec: _ ' - ALTER ❑ - ' B.BP,C_ for this reason - - Y1 O K-• —,51J4 0 REPAIR. 3 . . ate: USE OF ,. ,[ / /rr•� EXISTING BLDG. - - DEMOL ❑ I _ 1 A ULLl7l Ol A-�1�1� /- APPLICANT TEL. _ 5 ndture FINAL OWNER-i�JJfLDERDECLARATION '(PRINT) ' NC4s7 7 -C66 DATE -!� .t t- 1,tu•-'1= I hereby affirm that I o&fexempt from the Contractor's License ,- - !! '7P0$�R+6A0 *:. Law for the following reason:(Section 7031.5 Business and ADDRESS' - ��C L� FINAL- TTS; Professions Code): - PRESENT , - B - — - - 'i. y 1227 •. 50 ❑ I, as owner of the property, ormy employees'with', BUILDINGADDRESS _ ' - wages as their sole compensation,will do the work and ,(, —D� ( ljF ;}! y v �t11 ' the structure is not intended or offered for sale (Section LOCALITY .❑ .7044, Business and Professions Code.) MOVING -- TEL' I, as owner of CONTRACTOR NO.the property, am exclusively contracting , with licensed contractors to construct the project (Sec ADDRESS _ tion 7044, Business and Professions Code.) - .. .REQUIRED - - -TOTAL SETBACKFROM EXISTr - CONSTRUCTION LENDING AGENCY y SET BACK 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:'L. - - (Sec. 3097, Civ. C.). SIDE' P.L. . .. _ Lender's Name. LDMA Ref. N Permit Lender's Address . P.C. Fee$� Pit Fee J ,J ' ' _- certify that-I Hbve read this application and.state that the Issuance Fee /3 U)" P/C R ' 8 above information is correct. I agree tocomply with all County Investigation Fee ,7 ' R ordinan and State relating to building construction, Total Fee oG i LDMA Perm. R a and h reb authori rept sentatives of this County'to enter vpo the bove-m tion proper for inspection purposes. '' - �aSEE REVERSE FOR EXPLANATORY LANGUAGE SignaN of ApplicaN or Agent Date COUNTY OF LOSANGELESTEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1211270060 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST I BUILDING ADDRESS: ITR: 12115 LT: 41 SQ. FT STORIES TYPE 6321 ENCINITA AV I (STRUCTURE: 352 V-B TEMP CA 917801317 (ASSESSOR INFORMATION NUMBER: 1 NEAREST CROSS STREET: LONGDEN 1 15382-023-033 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl (TENANT: IE%IST BLDG USE: HACK USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: (11/27/12 SR TOWNER: TEL. DiC IBLDGS. NOW ON LOT: VALUATION: FINAI. DATE FINAL BY: CODE: CONTRERAS• PAUL (626) 445-0404- 500 16321 ENCINITA AV _ ITEMP 917801317 •I FEES PAID IDESCRIPTION OF WORK 1 IREROOF EXISTING HACK PORCH, NEED TO REPLACE 2 PIECES OF IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 141X 8' PLYWOOD + ROOF MATERIAL AREA IS 16' X 22' (APPLICANT: TEL N0: (SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 IAB STATE GREEN BLDG FEE 500.00 VAL 1.00 ISPECTAL CONDITIONS: IAC STRONG MOTION RESID 500.00 VAL 0.50 f ID2 PERMIT W/O EN-HC 500.00 VAL 43.70 IFR INV WORK W/O PERMIT 169.70 DOL 169.70 CONTRACTOR: TEL. NO: TOTAL FEES 242.70 APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO III LOCATION AND SETBACKS ISOILS ENGINEER APPROVAL III ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I I I LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( �/�V� DY7 l j��12(/a K7 UNDERFLOOR INSULATION 1153 H2653 001 Q C \1JR`�e 1D\V' l I IIFLOOR SHEATHING INO. OF FP.MILIES: DWELLING UNITS: APT/COND: STAT CLASS: 11/� I 1 1 1 0 NO 21 1 IROOF SHEATHING I I I SCHOOL WITHIN HAZARDOUS (SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS /L ! �_ NO NO NO EXPIRED a,5 1_ IFRAME INSPECTION IFIRE SPRINKLER HANGERS I I I 1 1 II INSULATION/WEATHER STRIP( 1 1 I NTERIOR LATH/DRYWALL I IEXTERIOR LATH I II (RATED FLOORf CEIL ASSEM. I I I ' (RATED WALL ASSEMBLIES I I (RATED SHAFTS/OPENINGS I I I T-BAR CEILINGS LOT DRAINAGE IRE PORT ID: DPR261 ROUTE TO: 850508 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 0802210003 PHONE: (626) 285-0488 EXT: LEGAL ID: O. OF CONST BUILDING ADDRESS: ITS: 12115 LT: 41 SQ. FT STORIES TYPE 6321 ENCINITA AV (STRUCTURE: 144 V-B TEMP CA 917801317 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 15382-023-033 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 JISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 102/21/02 SR 06/19/08 OWNER: TEL. NO: 1 1BLDGS. NOW ON LOT: VALUATION: (FINAL DAT WIRED CODE: CONTRERAS, PAUL (626) 445-0404- 2,880 16321 ENCINITA AV TEMP 917801317 FEES PAID (DESCRIPTION OF WORK IFRONT WOOD TRELLIS 144 S.F. IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( (APPLICANT: TEL NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 1 IAC STRONG MOTION RESID 2880.00 VAI, 0.50 (SPECIAL CONDITIONS: IAX BUILDING REVIEW FEE 54.70 1 ID2 PERMIT W/O EN-HC 2880.00 VAL 99.00 1 TOTAL FEES 181.95 (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE (SAME AS OWNER - I I I I LIC. NO I (LOCATION AND SETBACKS I I I I I I I I (SOILS ENGINEER APPROVAL _I I (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS I I I LIC. NO: I (SLAB/UNDER FLOOR I J I I I I- 11 I RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 IUNDERFLOOR INSULATION I I I 1153H265 3 oil I I I (FLOOR SHEATHING I I I NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I NO 21 IROOF SHEATHING I 111 SCHOOL WITHIN HAZARDOUS (SHEAR PANELS )AIR QUALITY: 1000 FEET MATERIALS I NO NO NO (FRAATE INSPECTION I _I --1-1 IREQUIRED TOTAL SETBACK FROM EXIST IFIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: 1— IFRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- I I1 I (INTERIOR LATH/DRYWALL I (EXTERIOR LATH I I I I RATED FLOOR/CEIL ASSEM. (RATED WALL ASSEMBLIES I IRATED sxAFms/oeexlNas I I I T-BAR CEILINGS (LOT DRAINAGE I (REPORT ID: DPR262 ROUTE TO: HSO508 I