The URL can be used to link to this page

Home My Public Portal About5003 GOLDEN WEST AVE_Miscellaneous__ woRitERs'coMPENSATIONDECLARATTON 76MM4 MISCELLANEOUS APPLICATION �--I I herCE 876 (11-84)ebyefffFm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION hisure, or a certcate bf Workers'Compensation Insurance,or a certified copy thereof(Sea 3800,Lab.Q. Policy No. Company FOR APPLIC NT TO FILL IN ■U ILDING ADDRKI■ Certified SPY L hereby furnished t u t LD I n a Q Lo CA L rr Y ADDR[1■ F-1Certifled Copy is filed With the county building hrapection LOCALITY NKAR[ST department. CRO■/ST. O`er Date Applicant N[wR[rr /^, DI Welt no. our TY Krl[D ■Y CROSS 5 �/V CERTIFIGAT'E OF EXEMPTION FROM WORKERS' LKGAL COMPENSATTON INSURANCE D[RCRIPTION LOT NO. .LOCK NA• HMHWAT No. (CmcL ) STATIC MAJOR ■[CO ND LOCA NO. OF ■LDON. (T'hir rection need not be completed if the work hnofved rRwcr NOW ON LOT LINK son[ 'BPKC1AL CONDITIONS by the permit is for one hundred dollars ($100) or less.) NO of (�/7 SIX[ of LOT R.2K.TI NG ■LD 6. T I certify that fn theormance f the wor;c for Which this yCn permit I not emplo y person in er OWNKR s� so as'to a subject to the er Compensa MAIL 1 ) OCCUPANCY CROUP Eka Co ADDRKS■ �(J �3 Date ApplicantZ!nq T^L T[L. '7f'1'•''` 3 OCCUPANT LOAD W NOTI APPLICANT: If, after+..��6 this Certifl to of crr ( No. - 5 ( � Exemption, you should become subject to the Wo n' Compensation provisions of the Labor Code, you must forth- with Comply With such provisions OI this permit shall be TRAILKR USK ❑ G[OLOGY INS►KCTION ❑ No Spec. Knowl. deemed revoked. LICENSED CONTRACTORS DECLARATION OCCUPANCY INSFKCTION ❑ Panic Devices I hereby affirm that I am licensed under rp oviajons of Chapter 9 (commencing With Section 7000) of D on 3 Of the Buss ■AF[TY [RM ❑ (LIST ITKY/ BELOW) NO. OF KXITS nem and Profossion5 Code, and my License is in fail force and effect CK■ SPA6 R[q'D FROVIDKD ■FAC[ License Number Lie. Clan LIMITED TIME USE • Contractor Date D AT K DAT K F1I am exempt from the Hamming requirements as I am a TOI Licensed architect or a registered profbeaional engineer SIX[ OF NO. OF IN/FKCTOR acting In my professional Capacity (Section 7051, But- KXI/TING BLDG. ST ORI[S ■I NATURX inemand ProfetdonsCo(1 ). l FINAL APPROVAL ., 1 FRK/[NT US[ OF BUILDING f' - Lia or Reg.No. Date HOME OWNER-BUILDER DECLARATION NO. OF [X ISTING BUILDINGS ON LOT AND USX - JL I hereby affirm that I am exempt from the Contractor's ACCT•T License Law for the following reason (Section 7031-5, Busi- 3W7 80.50 and Professions Code): NO. PA>IXING I, as owner of the property, will do the work and the /PACK/ PROVIDKD 1 I TEMS structure is not intended or offered for sale (Section TOTAL SC). -5(3 7044,Business and Professions Code). {� CONSTRUCTION LENDING AGENCY FR OPO/[D U/K OF BUILDING DECK 80/50 I hereby affirm that there Is a construction lending agency ■00 for the performance of the work for which this permit is - iasaed(Sea 3097,Civ.C.). Lender's Name " PROs O■KD MAX. OCC. Lender's Address � 1 AMIM I certify that I have read this application and state that the moo PERMIT FEZ above Information is correct.I agree to comply with all County IoavANCK FKK or ces and State laws relating to building construction, oro authorizeMpxnta,1vcs of this Cou�y to ter TOTAL F[[ the bovo-mentior inspection ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of t�a COUNTY OF LOS ANGELES TEN!Pl R CITY # 0508 HZSCEL.A*EOUS PERMIT DEPARTWENT OF PUBLIC %URLS 9701 LAS TUNAS NP 0508 1308150001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 ETT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TRS 14832 LT: 23 SQ. FT STORIBS TYPE OCCUP GROUP 5003 GOLDEN WEST AV STRUCTURE: 3883 2 V-B R-3 TEMP CA 917803939 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LEY WEST 8589-018-019 ELI9T BLDG USE: THOMAS PADS: 597 GRID: A4 LOCALITY: TEMPLE CITY CA EXIST OCC GRP: USE ZONE: TENANT: ISSUID ON: PRCKMSSED BY: BLDG9. NOW ON LOT: VALIDATION: 08/15/13 9R 0 OWNER: TEL. NO: FINAL DATE CODE: SLEIGHT GLENN R;DAS2TRNE (626) 287-1305- LIST ITIN9: 5003 GOLDEN NF-9T AV ,1 TEMP 917803939 DESCRIPTION OF WORK CONFIRM TOTAL OF 6 BEDROOMS, 4.5 BAT[ROOMS 3883 SQ.FT. WITH OCCUP LOAD E3=: 1125 9Q.FT. NON LIVING BASEMENTS WORK FINArEM IN 11-28-94. APPLICANT: TEL. NO: OCCUP LOAD NEW: SAME AS OWNER - PART19G SPACES REQU : SPECIAL CONDITIONS: PARKING SPACES PROVIDED: =T HARD0LRE: CONTRACTOR: TEL. NO: LIYL= T-063 USE SAME AS OWNER - NBR OF EXITS: FROM TO LIC. NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCHITECT OR ENGINEER: TEL. NO: TRAILER USE - OA PERMIT ISSIIANCE 27.80 LIC. NO: 01 R/M OCC/USE INSPECT 146.00 SAFETY PERMIT TOTAL FEES 173.80 TEMP. 9TRUCT. APPROVED MAP 90: SEWER MAP BOOL: PAGE: FINE ZONE: CNP: TE►S. STRUCT. REMOVED NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO REPORT ID: DPP-267 ROUTE TO: BS0508 COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC WORKS C } MICROFILM M Jn V2iSLJC Record Search Building Adds e s s 5DD LGPM"o ✓ �I,ocality Tract No. Lot No. Lot size : . -Buildin& Perm, Jq:ssUe Date - - - - Final Date e c' ' tion -- Building Permit ; Issue e Final Date Building Permit. 0 Issue Date Final Dat e Sq.' Ft. Building Permit I eVt4 aminal. Date Description of work sq. Ft. Building Permit # Issue Date' Finbl Date Description of work Note: ,The information given is taken from gu,ilg Permit Records. Unless an Oceupancy Inspection is requested and the fee for this inspection is paid y no investigation of the Department. property 'Wal be made by this ' i Sewer Permit # Issue Date Connected to sewer in street: Inspection Date C Senior er