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Home My Public Portal About5004 FIESTA AVE_Building__ b.oVt/ORKERS' COMPENSATION DECLARATION - • - - r affirm that I have certificate of consent to Self c infsure, or a'certificate of Workers' kers' Compensation Insurance, APPLICATION F O R � B U I L•D I N G' PERMIT or a certified copy thereof (Sec. 3800,tab. C. ' ��y,, COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N 2 ��Company Tw�' 'Pk� ❑ Certified;copy is hereby furnished. - FOR APPLICANT TO FILL IN ADDRESS ? CBUILDING ertified copy'is filed with the county building inspec- BUILDING tion department. ADDRESS DO t Date' 6 Applicant CITY VNJ64I5-' G! IV ZIP LOCALITY r. ERTIFICATE OF EXEMPTION FROM WO KERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE ' I SIZE OF LO7 Q5C/19'1NOW ON LOT CROSS ST. 4.-ci.t4OL A2-0) 9d+ (This'section need not be completed.if the*permit is for one n — ASSESSOR - hundred dollars ($100)or less.) TRACT �Z BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP �O OWNER .�.�s ry >_ I certify that in the performance of the work for which this '� k NO. 41 — r� NO. ' permit is issued, I shall not employ any person in any manner ,,r-�rte� p`� i SPECIAL � so as to become subject to the Workers'Compensation Laws. ADDRESS CJz✓N - /-�6 i CONDITIONS O Date Applicant CITY e- GA. ZIP. NOTICE TO APPLICANT: ARCHITECT OR TEL.If; after making this Certificate of DIO STRICT _ GROUP TYPE FIRE PROC SSED BY. I— ENGINEER NO. U Exemption,, you should become subject to the Workers � rB(/ �� CONST. / ZONE Compensation provisions.of the Labor Code, you must forth- (/D1 3 LU with comply .with such provisions or this permit shall be -.. ADDRESS IL deemed revoked. 'm TEL. J STATISTICAL CLASSIFICATION APT. DO. - in CONTRACTOR @�dRS y#606,f NO. da _ LICENSED CONTRACTORS DECLARATION LIC. CLASS.NO. DWELL. UNITS- I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �j 3 (✓• NO. V3I (commencing with Section 7000)of Division'3 of the Business and LIC. I SEWER MAP Professjons'Code, and my license is in full force and effect. CITY wel'i C' 00 IA CLASS —� BK. PG. VALIDATION !L SQ. FT. NO.OF NO. OF CHECK License Number Lic.Class t7�J SIZE STORIES FAMILIES ONE VALUATION Contractor Dare DESCRIPTION OF WORK tL ��1 NEW ❑ $ ❑ I am exempt ��tA�H flT ADD u er Sec. ALTER ❑ a� B.&P.C. for this reason* "�A M REPAIR ❑ $ )'`!' 92.8 A Date:' USE OF 0 0 0 0 0 EXISTING BLDG. K �eJ1dF�+rce- DEMO'es ❑ Sigri6ture "' APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION PRINT) /1rt/Isj�$ EZ¢ilf NO. a' s DATE I a 3.7 5 I hereby affirm that I am exempt from the.Contractor's License y Law for the following reason (Section 7031.5, Business and ADDRESS 3'f5 �' Lv �Ov/// FIN ° ° 2 7 3,7.5 5 'Professions'Code): PRESENT B �� ❑ I, as owner of the property, or my employees with - ADDR SS Q` 2 6—$'S wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. — ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct-the project (Sec- ADDRESS tion 7044, Business and Professions Code). , REQUIRED. TOTAL SETBACK FROM X T. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT ' the performance of the work for which this permit is issued P.L. _ (Sec. 3.097, Civ. C.). SIDE P.L. Lender's Name > LDMA Ref. # _.. .. - P.C. Fee$-... PermilFee — Lender's Address _1 certify that I have read this application and-state that the Issuance Fee �t/. LDMA P/C a above information is correct. I agree to comply with all County Investigation Fee j o ordinances and State laws relating to building construction, Total Fee v LDMA Perm. #:- v and hereby authorize representatives of this County to enter upon the ob a mention d property for inspection purposes. •ao �, ® SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applill or Agent Dae - - - - - - - - -. •. 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 0306120014 PHONE: (626) 285-0488 EXT: DUPLICATE LEGAL I • NO. OF CONST BUILDING ADDRESS: TR: 13329 LT: 54 BL: .001 SQ. FT STORIES TYPE 5004 FIESTA AV STRUCTURE: VN TEMP CA 917803818 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA ROSA 8590-018-013 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 06/12/03 JK 06/06/04 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE &VAL CODE: FLORES LORENZO J;SANDRA E (626) 286-9726- 4,900 5004 FIESTA AV TEMP 917803818I FEES PAID DESCRIPTION Or WUKK INSTALL NEW FIBERGLASS 30YR SHINGLES OVER EXISTING ROOF FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: HOUSE & GARAGE, EXCLUDING NEW ADDITION APPLICANT: TEL. NO: EAGLE ROOFING (626) 291-5700- AA BLDG PERMIT ISSUANCE 27.75 6327 LIVIA AVENUE AC STRONG MOTION RESID 4900.00 VAL 0.50 SPECIAL CONDITIONS: TEMPLE CITY 91780 D2 PERMIT W/O EN-HC 4900.00 VAL 132.60 TOTAL FEES 160.85 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE EAGLE ROOFING (626) 291-5700- 6327 N LIVIA AVE LIC. NO LOCATION AND SETBACKS TEMPLE CITY CA 91780 698529 C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR . RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 144H269 3 01 FLOOR SHEATHING N0. OF AMILIES: DWELLING-UNITS: APT/GOND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR 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 0/14/060 o l 4/037J rVM �� e�,�J��1 EXTERIOR LATH J RATED FLOOR/CEIL ASSEM. _ ^C RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508