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Home My Public Portal About5003 GOLDEN WEST AVE_Building__ WORKERS' COMPENSATION DECLARAT10N t. raffirm that I have a certificate oi�consent to �, fhsure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING P E RM I T or a certtffed copy thereof'(Sec 39K Lab. C) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY , . Pdfkyr�q, Company BUILDING ElCertified copy is hereby fumished. y FQR APPLICANT TO FILL IN ApDD WEST '❑ Certifled copy is filed with the bounty building Inspec- BUILDING tion department. 'S QIY ZIP_ LOCALTTY Datil Appl lcahT �• � i ., NEAREST - CERTIFlCATE OF EXFlJIP110N FROM WORKERS' Sig OF LOT Z NOW oN LO C205S Si. COMPENSATION INSURANCE (This section need not be completed H the permit Is for one TRACT BLCK7C LOTNc;" ASS SOR hundred dollars (;100) or Igss.) AP BOOK PAGE PARCa Ew LbtJE S NO ,' —/_'Y25 USE ZONE M I certtfy that In the pecfoFinance of The work for which this com permit Is Issued, I shall not employ-any person In coy manner ADDRESS 500-Sv 77 SPECDUR S so.as to become subject to the,Workeri mpe n O cm '1 E111 e•6 zip '1750 u Date �AppllSan ARCH OR TELCY SCANT` DI GROUP TYPE FIRE BY O tJOTI TO 'APPLI If,,after making this fflmto- of ENGINEE32 NO. - {.LST ZONE Exemption, you should become subLect to a Worker' Compensation provisions of the Labor Cc-do, you.must forth- ADDRESS •a9 o3 with comply with such provisions,dr This permit shall be TE STATISTICAL.CLASSI TION AFT. COrJpQ deemed revoked. CONTRACTOR NO. Z L1C!LASED CONTRACTORS DECLARATION UC CLASS Tao. UNfTS I hereby affirm that I am Ilcarlsed Under provisions of Ow"9 ADDRESS NO. (commencing with Section 7000)of Division 3'of the Bu}Iness LIC SEWER MAP olid Professions Code,and my�llcen se is In full force and effect. CLAM BK. K1 VA MATFON SQ. FL NO QF NO. OF CHEOC License Number' Llc. Clan Sig ST�RIES FAM LI ES ONE V ALUATFON Confractor Date D[SMPT10N OF WORK NEW ❑I am exempt under Sec. U t ADD ❑ J ALTER ❑ ► B.BP.C. for this reason REPAIR 4 ; Date: USE OF Exts-nNG BLDG. DE ^� MOL ❑ Signature• APPUCANT / NO. FILL OWNER-BUILDER DECLARATION (PRINT)A" St_ElDATEI herebypfflrm that I am exempt from the Contractor's-Llodnae C[ t _ Law for The following reoion (S.e '� ction 7031.5, Business and � '( 3 ( O L_DE T k RHAL Professions Code): Qw� By 1 I, as owner of the property, or m em I ees with BADDRESS- ACCT UILDING - wages ti as their sole compensation,will do he work and �-y-� the structure Is not intended or offered forsole(Section LOCAUTY 7 ,j,j W 70.44, Business and Professions Cade.) MOPING TEL TTS � ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with Ilbensed contractor to construct the project($&c- F D ' Tlon 7044, Business and Professloas Code.) �� QONSTRUCTION LENDING AGENCY YARD HW1 sL FROM 3j.0l 1 hereby affirm-that there Is a construction lending agency for FRONT M the performance. of the work for--which this permit It Issued 4WHE .00 (Sec. 3097, Cly. C). �-y-yam�WyLender's Name LDMA U) -"l 6f 16/89 Lender's Address Permit Fee v `J 4018 1 ,W 9309 I urtlfy that I have rood this appllcatlon and mote that th• Lawanm [ LDMA P/C/ 17 r 7above Information Is correct. I agree to comply with all County ie ordinances and.State laws relating to building construction, Total F« LDMA Perm. and hereby authorize representatives of.this County to enter u t abov Ion party fbr lrupect., purposes ; R ' SM"V�FOR DIPL.AlLATMY LANGUAG& Signarun OCKIkom or Apant Date . c OTIoNCZARA_TI(�?tN, . { •�� 1.SAS ofy gnsen}•fq yelf 1• 1 t wo eis'�Caompenwtlonlrourgnc'e,, s }F''APTUI ON FOR BUKDING PERMIT « fflid.copylh*reo# (sec. , Lab. C.) ,�•t :: t �' C INF'If" F COS ANGELS-, 4UIW�NG AND SAFFTY P +4ggmpd nY gid4opy *V b{ fi,rnfsh4d. �- . _; . �_ tQR.ADPL( `NT TO,fiIE{. C.ertlfled Eopy 1 „ led with the county building Inspec= f3UIlDINC3 .e tion drpariftsent. _��Ir' ADDRESS .,&0 //� O ' / ' } Applicant cOY G'r!f f{ IrF ZIP Q LOGAl17Y CERTIFICATE OF EXEMPTION SROM WORKERS -- OF BLDG& N6�T t. COMPENSATION INSURANCE 6121 OF LOT .� vi 10 NOW ST U=section r1s�not-bi'corn leted_if the'permit Is for one TRACT :. �. r BLCIbC ' h LOT 140. /y+IP 4001( PAGE PARCH dollar(;1d0)or.leu-) TEL �Z I tint In tbe'pakformanu'of the work for which this COMER NO. �• Itis issC od, I shall not employ bnyn In arty manner * i- } { {' SPEN so aj to become subject to the WorkLst�mponsatl \ ; rye t �t P ti � . Pati' Appllcdnf -J ARCHfTECT _ .• �.... NOTICE TO ICANf: ff, after maklis;thls Celt of t i 4R GROUP TYPE ARP Y Exemption; you should betome subject to the Workers' C:ompenkatlon provJslons of the Labor Code;you must forth, ADDRESS ` /� ' + •�� {JO 2T� 2 r with-tortiply'wlth such provisions or this. permft shall be 'TEL revoked. STA Cu FOCAT0N APT. J 9. LICENSED C DNTI ACTORS DECI. I ATION `LIC, Z ` CUSS DWBU,.-UNfrS- Itonsby affirm that I am Ilcenked under provisl of Chaplet 9 ADDRESS NO. oins bEW81 (commendng with Sed1 7000)of Division,3 of the Byslneu and ~�. LIC_ `- J � r Profeuia Code, and Ilcenee is In full forceand effect. crr1 D., b PC3 1 _ FT NO: Llc.ns." ,6eT L1c.CIasaT_ Srg sroRlEs VAILUArr 7 9 S2.A Confrvctor Date DESCRIPTION OF woRtc ► ;, � j� �1 d0 # o'e . 0 2 s A✓i (/ll U ,- I ant exempt under Sec o.6$ 5 4 AITEk B.BP.0 fot this reason ��71 �1 �� REPAIR _ Doff: USE-OFEXISo soja ,3' T' c.0 6 8 6 5 9,.6 sigriatur. APPllc�rr o9, 1 $-8T f OWNER-BUILDER DKIAR,AT10f} INT IVO. j I hereby}fflrm that I am exempt from the ContractoQ's Llcerum I Law for the following reason (Settlors 7031.3, Business,and L y7PU1�' Profissigns Code): !y I, as owner of.Nie property,,or my employees with BUIIDI t s " 7 �`; as thelrsole com notion,will do the work anti 4 • the str¢lige Is not Intended or offered for sole{Sectlon ►�.. 7044, Qvslr»u and Profeulons Code) MOV)t�(3 TE3 n1, cis"'nor of the property, am exclusively conhactlnd WWRAL70R NO. witr licensed contractors to conrtructibe prole-0 (Silt-• tldn 7044, Btfslnees and Professlom k ADDRESS YARD I nNY 1 '1 -! �� '.r: i s. j -9.3.0.1 A ODNSTRUC�hOfV LENDING AGf3JCY BACx U WI 4 I hereby affirm that there ba conatrudlbn lending ogency for t, ' -� o e.• hsanco e the Perfore of thb work for'which this perb mit Issued : P I 1.I,_ # • 1 y.... (sec. 3097,'Civ. C.). SroE 1 .I. 81 a 2 5' P.L t ° -.8 t a2 5�- Lenders Name— v j ertde�s Address` P.0 Fee Permit lee 04, 04 8 8 I'tertlfy that I have read this appllccrtlon and sta&. that the I.uance F.. LDMA P/cf above Information Is correct. I agree to comply.wtth all County ordlnQ".atld Sfate laws relating to bu3cllftq construdlort, Tool Fee LDMA Perm. • ; and hereby auffxxlze representatives of thls.County to enter g upon th above ment for Irupedlon purpokes iii REN POR EXPLANATORY LANGUAG4 -44xrftxe of Apps korttjW Agw" Dat, - - . ~ WUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DFPARTN= OF PUBLIC WORKS 9701 LAS TUNAS ALTERA=ON/REPAIR BUILDING AND SAFETY / LAND DEVELOTEMP.R CITY CA 91780 BL 0508 1201300075 PRONE: (626) 285-0488 ETP: LEGAL ID: NO. OF CONST B ING ADDRILSS: TR: 14832 LT: 23 SQ. FT STOR=S TYPE 5003 GOLDEN WEST AV STRUCTURE: 38 V-B T49e CA 917803939 ASSESSOR 121MRIATION NUMBER: NEARRST CROSS STREET: 8589-018-019 THOKAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C I TElUWT: EZIST BLDG USE: RRSID USE PANE: R-1 ISSUED ON: PROCESS BY-. EK79T OCC GRP: 01/30/12 SR OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATI FINAL DATE FINAL BY: CODE: SLEIGHT GLENN R;DARLE2M (626) 287-1305- 21,000 5003 GOLDEN W&ST AV TEh@ 917803939 FEES PAID DESCRfPTION OF WORK . TRAP OFF ALL LAYERS INSTALL 30 LB FELT PAPER AND NEW CLASS FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: •A"30 YR SKINGLE,9 (EXCEPT PATIO) APPLICANT: TEL. NO: LJVIN, CAROLYN (818) 847-0470- AA BLDG PERMIT ISSUANCE 27,80 AB STATE GREEN BLDG FEE 21000.00 VAL 1.00 SPECIAL CONDITIONS: AC STRONG MOTION RESID 21000.00 VAL 2.10 D2 PERMIT W/0 EN-HC 21000.00 VAL 402.60 TOTAL Flag 433.50 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SHEA ROOFING (818) 847-0470- 1951-T ONTARIO ST - LIC. NO LCk3�TION AMID SETBACKS BURBANK CA 91505 730563 • _ SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUKPATION/TRENCH FORMS LIC. NO: SLAB UNDER FLOOR RAISED FLOOR FRANZNG MAP NO: SEWER !AP BOOL: PAGE: FIRE ZONE: CMP: LR®E7FIOOR INSULATION 144HL269 30(� ' FLOOR'SHF_KTHING NO. OF FAMILIES: DWEJ ING UNITS: APT GOND: STAT CLASS: 0 NO 21 ROOF SHEATHING SC400L WIT= HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 F'P:n MATERIALS NO NO NO i FRAM4E INSPECT-ION FIRE SPRINI= HANGERS INSULATION/WFATHr,R STRIP lb�OSZ LAM DRYNALL ETTTi'#.IOR LATH RAT'EP FLOOR CEI, ASSEM. RATED WALT, A9SEF®LIB79 li RATFT) SHAFTS OPENINGS T-BAN CEILINGS • ADDSTZONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508