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Home My Public Portal About10632 FAIRHALL ST_Building__ I, WORKERS' COMPENSATION DECLARATION I hereby II insure, ora affirm certif cane of Worke s' Compensation oof n eInsuran elf APPLICATION FOR BUILDING PERM I or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date Applicant CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST 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 BLOCK LOT NO MAP BOOK PAGE PARCEL TEL. USE ZONE MAP O I 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 SPECIAL W so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS - L Li CITY ZIP �,,, Date Applicant ARCHITECT OR TEL. > NOTICE TO APPLICANT: If, after making this Certificate,of DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER NO. CONST. ZONE Q Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR NO. ' W LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS- I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. ° r SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT, NO. OF NO. OF CHECK License Number Lic.Class--r SIZE S)'ORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTlow6l'WOK NEW ❑ ADD $ , ❑ I am exempt under Sec. ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL g PRINT a NO FINAL OWNER-BUILDER DECLARATION 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 Professions Code): PR EN By s • I A ElBUILDING 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. ❑ CONTRACTOR NO. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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. M Lender's Address P C Fee$ Permit Fee 1 certify that I have read this application and state that the Issuance Fee LDMA P/C k oabove information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. N R and hereby authorize representatives of this County to enter m uporr the above-mentioned property for inspection purposes. !r ' SEE REVERSE FOR EXPLANATORY LANGUAGE -n- Signature of Applicant or Agent /•'j ` D ,76AS38ACE*803-7Se APPLICATION FOR BUILDING PERMIT 4 1 BUILDING AND SAFETY DIVISION ABUILDING DDRESS Department of County Engineer County of Los Angeles LOCALITY r t JOHN A LAMBIE COUNTY ENGINEER NEAREST CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST ` DISTRICT NO GROUP I TYPEI SEWER MAP FOR APPLICANT TO FILL IN B K PG CONST" BUILDING I-- � / j STATISTICAL CLASSIFICATION I ADDRESS �/ST/ '71 / /r 4 L s� CLASS NO DWELL UNITS LOT NO BLOCK MAP STATE Q' NUMBER -��/� HWY YES O TRACT � /j USE ZONE SPECIAL NO OF BLDGS CONDITIONS SIZE OF LOT I NOW ON LOT LL USE OF EXISTING BLDG BUILDING EXIST SETBACK YARD HWY STREET NAME WIDTH OWNER , FRONT f / MAIL ��jj.� P I- i ADDRESS �D 6,7� A lRH.4/J SIDE TEL P L CITY / k4 No .-y INSPECTION RECORD ARCHITECT OR TEL 7 ENGINEER NO - _ Gl 100r2le✓ ADDRESS CONTRACTOR` ) �Q � NO �� ADDRESSz(9/1.�/ R.�INC/.SU•Ulf/O - DESCRIPTION OV WORK NEW 7ADD "ER REPAIR DEMOLISH- SCI EMOLISHSCI FT X10 OF NO OF SIZE STORIES FAMILIES USE OF STRUCTUR I APPROVALS SIGNATURE OF APPLICANT - DATE INSPECTOR S SIGNATURE FOUNDATION LOCATION ADDRESS /f Off _ FORMS MATERIALS n ��,/ P C S FRAME FIRE STOPS v �JJ FEE BRACING BOLTS J VALUATION $ FURNACE LOCATION FEE < --®' GAS VENT DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND _ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH EXT STATE- LAWS REGUL _ B ILDI� C STRUCTION — SIGNATURE OF /1 HOUSE NUMBER COR- - PERMITTEE RECT AND POSTED // C ADDRESS FINAL JOHN A LAMBIE COUNTY ENGINEER CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK m o CASH PERMIT VALIDATION CK m oC,;sj V �Hi;,8 7 5 9 U� JUS! 3 1 200 N DEPART14ENT OF COUNTY ENGERM DIVISIONF OF DOS ANAND SAFETY BRUILDINO 11 WILLIAM J. FOX, COUNTY ENGINEER } APPLICATION CASSATT D GRIFFIN, 8UP'T OF BUILDING - ti FOR APPLICANT IO FILL IN i FOR OFFICE,,,USE.ONLY f FDR i\/ c DISTRICT NO I PLANCK OR1REc No ®PERMIT NOS I � �2 4 B31 --3 387 1 -,)3/ 4r / L RECEIVED BY P DATE OF APPL -DAT ISSUEDN EAREST A / GY �NEAREST � BUILDING Gt ADDRESSi �� aZ MAILi,�,_ �- �i `.�L•. LOCALITY/ / NEAREST' -1'� v� �v e 'NO 7(./4(p CR039 ST T OR TEL FIRE 1 NO OF TYPE GROUPi NO ZONE i PLArrNS,,��..�� } ` ADDRESSQ y BLDG ETBAC/KsLINE i eC�C/ /+. t4 - CONTRACTOR / — L C �A NEL ( ZONE �+'� gyPROV ED ATE / f ADDRESS -Z72'L" 54AI a-4.441-le-1 ( !� HOUSE NUM ERING j LEGAL / MAP NUMBER d 0 } NO ASSIGNED BY j DESCRIPTION I LOT N I BLOCK CORRECTIONS"` TRACT10 � i �Q U/1 O OF BLDGS SIZE OF LOT UVJ ll NOW ON LOT USE OF I NO OF EXISTING BLDG FAMILIES •~ DESCRIPTION OF WORK r o — NEW =ALTERATION = ADDITION Q -Z _ REPAIR r DEMOLITION Y r SQ FT J� / NO OFEXT WAI:L / SIZE I/ �b7 ROOMS b STOO'+RIES 6 h ROOF COVERING Lkc_c_p I COVERING Cc kyt Pi USE OF STRUCTURE n � APPROVfilS INSPE R'S AIGNATURE DATE FOUNDATION LOCATION - FORMS, MATERIALS �j •Ha 5 ,, Pd+ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS S PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS CORRECT ,, r I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION -AND STATE LAWS REGULATING BUILDING CONSTRUCTION GAS VENT, DUCTS SIGNATURE .J� LATH, INT .,I _ ! '�'ws !7 OF PERMITTEE 2r, LATH EXT ADDRESS z ;72 AUTHORIZED AGT' {�J LASTER, INT s� PLASTER, EXT �y�J FEE 8 _SO COR- RECTE NUMBER AND POSTED VALUATION !/✓ S G \ �/ FEE Z Z FINAL 76ASSBA%DDS B 8-5II , 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 0612150029 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS TR 19189 LT 13 SQ FT STORIES TYPE 10632 FAIRHALL ST STRUCTURE VN TEMP CA 917804120 ASSESSOR INFORMATION NUMBER NEAREST'CROSS STREET 8585-027-008 THOMAS PAGE 597 GRID C4 LOCALITY TEMPLE CITY C TENANT EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY EXPIRES ON EXIST OCC GRP 12/15/06 JK 12/10/07 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE F L BY CODE QUICK DELLIEMER G,JUDITH M (626) 444-7050— 1,900 7 10632 FAIRHALL ST — �'� C TEMP 917804120 FEES PAID DESCRIPTION OF WORK C/0 (3) WINDOWS SAME SIZE FEE DESCRIPTION QUANTITY UOM AMOUNT ,) APPLICANT TEL NO SEARS HOME IMP (800) 807-9889— AA BLDG PERMIT ISSUANCE 27 75 ' 10395 SLUHER DR AC STRONG MOTION RESID 1900 00 VAL 0 50 SPECIAL CONDITIONS S F F CA 90670 D2 PERMIT W/O EN—HC 1900 00 VAL 82 20 TOTAL FEES 110 45 i CONTRACTOR TEL NO - APPROVALS DATE INSPECTOR SIGNATURE SEARS HOME IMP (80 0) 807-9889- 10395 SLUSHER DR LIC NO LOCATION AND SETBACKS SANTA FE SPRINGS CA 90670 721379 B ""` N t SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS ` LIC NO SLAB/UNDER FLOOR RAISED FLOOR FRAMING r MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 144H273 3 01 FLOOR SHEATHING NO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEFR PANELS — AIR QUALITY 1000 FEET MATERIALS _ NO NO NO FRAME INSPECTION _ REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD HWY PROP LINE WIDTH FRONT PL— INSULATION/WEATHER STRIP SIDE PL— INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES r RATED SHAFTS/OPENINGS T—BAR CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO BS0508 t e y7=17 WOR�yR', COMPENSATIONrDECLARATION,' `Y y ' _I hereby affirm that-,nave a certificate of consent to self ® r ` ^`,nsure;or a (tr rttficate of Workers Compensation Insurance A e P L I C AT I �,` ®k BUILDING ?i M 1 or'a cert11 ified copy thereof (Sec 3800 Lab C ) x - "-,' F' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company _ A❑ Certified copy is hereby furnished L v , F FOR APPLICANT TO FILL IN, s ADDRESS G f' L=„ ❑ BUILDIING Certified copy is filed with the county building inspec BUILDING - hon department' ADDRESS • Date Applicant,^i. ' CITY , ZIP LOCALITY L , Y „� t., NO OF'BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM'WORKERS ' - ,,s - i ;COMPENSATION INSURANCE �.f.' SIZE OF LOT NOW ON LOT CROSS STAZ (This section need not be completed if the,permit is for one TRACT t { BLOCK` LOT NO ASSESSOR y hundred dollars^($100)or less ) r,. MAP BOOK PAGE PARCEL ^ i� q� k� 1, F OWNER° OL TEL ,10 USE Z NE MAP I'certI4 that in the performance of tgwork,*r, ch,this "� y NOpermit is'issued, I shall not employ ananner 4 SPECIALsoasto become subject to the WorkerLaw M ADDRESS i CONDITIONS �` , fO -" , CITYT'-'ZIP-Dot Ap ica ARCHITECT OR -TELNOTIC APPLICANT f ter, maat of DISTRICT G UP- TYPE t FIRE PRO SED BY-Exemption, youshoul become o ers' ENGINEER N NO �^ CONST L' ��J �Compensafion provisions of the LaboriCode, you must forth- z , t ADDRESS ._ t L d with comply with,such provisions or, this_permrt*shall'"be _ ,, � ^� � _ � � p„r deemed revoked „ TEL STATISTICAL CLASSIFICAT ON APT CONDO (q, €r y G to , , , CONTRACTOR Q � .NO . Z LICENSED CONTRACTORS DECLARATION ,- s,: `tea r - LIC CLASS NO DWELV"UNITS _ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES O r r NO '.-,(commencing with Section 7000)of Division 3 of the Business and �+ LIC f} SEWER MAP jl a !, ' Professions Code, and my license is in full force and effect CITY u A CLASS f� 9 ry` ° ' BK I�PGC t VALIDATION },JQ SQ FT- OF i NO OF CHECK License NumbeF v Lice Class_ _ SIZE 0 DRIES FAMILIES r ONE , , >> - - VALUATION DESCRIP1 NEW-Date $ F71 � - ADD 1 I am exempt under ° Sec ® r I - i ALTER B&P C for this reason JQ' 1AJ REPAIR, ❑ $USE ' - 1 -Date f EXISTOIN(3 BLDG ` ~ DEMO, ❑ ° 7 6 7.3 A gnatu a ,r- r L- APPLICANT O FINAL/, #,0 a o 6'0,1 OWNER-BUILDER DECLARATION " PRINT , DATE I>hereby affirm that I am exempt from the'Contractor s License ;;�;'o 11 06. 1 3 ' Law for the following reason (Section 7031 5 Business and; ADDRESS = �t. FINA i q ^'t Professions Code) - ;- ', RESENT , - B y '�M o o i� � 3,c=i y " BUILDING "7 �M I; as owner of the property, 'or my employees with ADDRESS t` ¢ " wages ds their sole'compen'sation, 'will do`the work and £ , L ` 88.14--87 LOCALITY f j ti - the structure is not intended or offered for sale(Section 7044, Business and�Professions Code) a MOVING 4 ? TEL 10� I, as owner-of the property, am exclusively contracting CONTRACTOR ° " " NO 9 with licensed contractors to construct the project (Sec- � w T " ADDRESS '- hon 7044, Business and Professions Code) ` � REQUIRED_ TOTAL SETBACK CONSTRUCTION LENDING AGENCY` SET-BACK YARD HWY PROP LINE WIDTH ^'b n I hereby affirm that th'ere'is a construction lending agency fo'r' d FRONT y the performance of the,work for which this permit is issued {w P L - ' c (Sec 3097, Civ C,) _ a -SIDE' ; r r Pl. ` r Lender's Name , _ r. `� LDMA Ref M ? x P C Fee$ 4 Permit Fee ,3 L Lend'er's Address w ° I certify that I have read this application and,stat that the _ - 4 Issuance Fee 0�V (1 LDMA P/C`ff_ i o above information is correct' gr e t mply vjA all County Investigation Fee x ` 0 ordinances and State s o build g coristruction,,. " g - �� '3 Total Fee and hereby`autho a res fives of t s County to enter LDMA Perm # t' a ntione roperty for nspection purposes - m ryY SEE REVERSll,FOR EXPLANATORY LANGUAGE " >Sgnow pl nt or Agent D e