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Home My Public Portal About4924 FIESTA AVE_Building__ WORKERS'COMPENSATION DECLARATION hereby affirm that I hive a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a ces)ificate of Wortkers' Compensation Insurance, or a certified copy theref.(Sec. 3800, Tab. C.) COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDBUILREING SS 9,_2 Certified copy is filed with the county building inspec- BUILDING ❑ tion department. ADDRESS -4q 2-4 �1GS 1>9 ��t,U LOCALITY ank NEAREDate Applicant CITY `�i J Q ZIP t cTV CROSS SL CERTIFICATE OF EXEMPTION FROM WORKERS' 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 TRACT BLOCK USE ZONE MAP ,L/'_ hundred dollars ($100)or less.) 7� LOT NO. NO. —� TEL. SPECIAL ik— � I certify.that in the performance of the work.for which this OWNER µ106A0 L NO. lllCONDITIONS f3 permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE OCE ED BY O ADDRESS A "S CONST. / ZONE so as to become subject to the Workers'pompe sation Laws. `DU _ , / 19 Date /2 Applica -' CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICA T: If, after making this Cer icate'o ARCHITECT OR TEL. Exemption, you should become subject to th Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. q L VALIDATION deemed revoked. CONTRACTOR C�,t}-N NO. BK. PG, LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION ams (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 $ SQ. FT. NO.OF 1 NO. OF CHECK ► License Number Lic.Class SIZE STORIES 6 FAMILIES a ONE $ Contractor Date DESCRIPTION OF WORK n NEW ADD El r_11 am exempt under Sec. Z ALTER ❑ FINAL B.BP.C. for this reason yw. DATE � REPAIR ❑ Date: USE OFDEMOL �± EXISTING BLDG. -�4 �� ❑ B FINA y Signature APPLICANT n TEL. �1 OWNER-BUILDER DECLARATION PRgQINTNQ. I hereby affirm that I am exempt from the Contractor's License AD-REISS14 T�- Cwt , Law 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 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 tion 7044, Business and Professions Code). 3 %5 9-3.5 R REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH , 0 0 0 0 q;1_ 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. 1 0 26550 (Sec. 3097, Civ. C.). SIDE Q Lender's Name F rP L a ° 2 6 5 5 0 Lender's Address P.C. Fee$ Permit Fee �c b 1, 1 4=8 6 I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with,all County Investigation Fee �l g ordinances and State laws relating to building construction, Total Fee u and hereby authorize representatives of this County to enter ///^/` upo the ove-mentioned operty for inspection purposes. I T I ` / a 1.9�fJ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of pplicant or Agent Date ®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 0601260005 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 14647 LT: 11 SQ. FT STORIES TYPE 4924 FIESTA AV STRUCTURE: 22 VN TEMP CA 917803816 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8590-018-002 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/26/06 JK 01/21/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: HFI NN DA V. INAL BY: CODE: HUANG MICHAEL T;CINDY H (626) 286-1793- 4,800 4924 FIESTA AV TEMP 917803816 FEES PAID DES RIP ON OF WORK T/O OLD ROOF REPAIR RO WOOD. NSTALL CLASS A 30 YR COMP FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SHINGLES HOUSE ONLY APPLICANT: TEL. NO: ALFRED LAU (626) 285-9016- AA BLDG PERMIT ISSUANCE 27.75 4533 SHIRLEY AVE AC STRONG MOTION RESID 4800.00 VAL 0.50 SPECIAL CONDITIONS: EL MONTE, CA 91731 D2 PERMIT W/O EN-HC 4800.00 VAL 132.60 TOTAL FEES 160.85 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE GOLDEN KEY INC. (626) 285-9016- DBA NEVADA GOLDEN KEY LIC. NO LOCATION AND SETBACKS 4533 SHIRLEY AVENUE 775115 C39 _ EL MONTE, CA 91731 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUIIDATION/TRENCH FORMS LIC. NO: I SLAB/UNDER FLOOR I RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I UNDERFLOOR INSULATION 144H269 3 Oli FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 I ROOF SHEATHING SCHOOL WITHIN HAZARDOUS I SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS - i NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST i FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- I INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL . EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508