HomeMy Public PortalAbout5013 GOLDEN WEST AVE_Building__ " wORJCER.S'• C:OMPENSAnoN DECAwiotj yy'
r I haKet .�af#�m that I have a certificate of consent to self.. e� f �)�O'insure, or a certificate of Workeri Covlpensatlon Jnsuranoe, � � Vii/ GE �T,
fOF
bf a Certified COpy thereof (Sbc 3 ,JA 6C.) fAPPLICA
��- 'K'��� 1✓�+�1�'iAMGELESr ~/ R1.+1.41+IHY r+r,YF - _
Policy No. ��COmpdny!�G� �- - -1 ---__
- ❑ .Certified q�-I. beroby furrllihed. ._. �' FOR APPLICANT TO FILL IN r -
BUILDING - —'`
Cerrtfied copy 4.filed%�Ij+*f a couhty Wlld1N.4rupec-
do dent.
epartm
4 , CITY' ZIP LOCALTY
Date Applic¢ � _ N6I5ZST
CERTIFICATE OF DSYRT10N FROM S OF NOW�LOf
CROSS ST.
OOMPE�:S 1`I0('4 INSURANCE F,_.,. ASSESSOR (y
rBLis section nb4d riot com ietdd tf tAe perinlf Is for oneTgAa
O NO. MAP PAGE d P
hndred dollar* (;lOQ)or less.
1J0 � 115E TOPE MAP � /7' b• --
'I cwtLfy.that in the-er ormgn6&.o'F the work for whlah this .k`� 5 .,
permit Isjwued,•i•Ball not employ any-
any-p�r�soqn to ary mgnner
wastobecomewj)ectto tha �prkers Comperuatori 1gwactry ADDRESS
. OUIP
I
Dat4 !. .,. ;,y •.. ARCH ITFCI-. TEL'
NOTICE TO APPI,JCANT:, If; after-makings fhW CerttNcate .of - ENGINEER Np... STRICT GROUP TYPE 1 RE PROCESSED BY Q
ExerOptlon, you should'beggme subjj4ct�-to the•Workers' CONST, SONE
Cornpertsatlon provisions of,the Labor Code;{you-must: -ih- ADDRESS - �� �3
with comply-,with such provisions ,or this p¢rmlT.abdll -be. J TEL STATISTLCAL CLASSIFICATION APT. GAO.
deemed.revoked. + NO. —
UCENSED COMT2ACTORS DECLARATION' LIG CLASS NO: �!� "__DA�L. UNITS
I hereby pffirrn that I am licensed uodAr'pr'ovlslons of Chapter AlSDRlSS NO'
(cgmmeocing with Sedlon 7000)of Dl.yWon 3 aff
of thrBuslrmair. UG MAP 1 "
Pr,Prcfesalpry Cgde,,4nd my I lcease is in full force' nd oeCE. C1T1'' • •'6 C1 AM
_ FT NO. OE NO. OF CI KX h C�•
_Igpiise Number fa CXaar SJg STORIES FAMJUES
------
--- _` r VALUATION 369 t C
Coritrdcto � E� �DrrM DESCRIPTION OF NEW
1 r ..
I am exempt under Sec. -
+� ; _ � ► TTrriALTER. Z3 0 7 t
;.55 r
REPAIR-UB.dP G forthis Fdan W9.56
Ikrti► EXIST1�tJG DEIAOL ❑ 2 . I
Slgnaturp. r:^ APPLJCANT.r••. TEL FINAL
OWNER-;UIWXR DECLARATION 9-
I
I hereby affirm thdt.(am'exempt from the ntiattoes 1Jcbnse
Law for th'e'following r64&grL`(Sdctlon X(X1.51 J3ualneas'.and ADDRESS PINAL
Profpssloru Code): _ By- _ -
❑ I, .as qW,w'of thq prop",_9f my-bniptgyees with pp '' ;';• L 7 i
wog" sole will do•ttm work and =
•w ` o+.s
the-irydbrejssnot Inteh8bd gr'pftered for sale(Sectlon LOCALITY ,, 111 TAC [ i�b>,82
7001, Basln" grid Proess
flgns Code.) TEL'
' .I, as ownet oferty
.the prop , am exclusively contracting NO. c h;/�{ j�/i��, 1,326 � 2
_ __ S l r - I W R77LG •UV
with Ilse contractors to danatr1ict the ProIK`1.(c*&c_ ,qD6R�SS
tlorl 7041 Ines and Frbfesslons'Code.)
QOt35TRUCTIC)N lJ3JbING,4C,�tJCY. Imo` TOTAL
YARD `Hy✓Y _
I hereby afflrrd that theca Is d-cor4tructlon lending dgency for FRONT. i
the perfpmtance-,gf tbi work fpr whlch,this permit Is Itived P.L ` } 11! UK'c. 30W, Ov. c�.. 5,D . . � WS 57
Lender* Ndmb r
P.G fee Permk Fee LDMA'Ref.#
Lenders Adds" r� O• - _
r certify that I have fead this cppficatlon gnxd state that tT q ' IsK,anu �f LDlrV P/C/
above Informafion Is correct. I-agree to corppplX with all County InvetliQatlo I Fee _
ocdlnancm acid State Jaws'relatirtg to building cdnsfruction, Total fee / S/�• 'r .Lbw Perm.
and hereby authorize mpresentativps-of 4hls County to enter _
Opo mp ed operty-for Irispecilbn�
>�lowPOR Ean ANATo[V uo#GuAa4
karrt.or Date
WORKERS'CPOMPEtySATION DECLARATION
hereby affirm that I have&a rs'C mer consent r ce, APPLICATION FOR" �B UI L D N O PERMIT. ' ....,E RM I T
insure, a a certNicate of Workmri Compensation Insurance, -
or q cmritfted copy thereof (Seca$800, Cab. C.)
PoIlcyNo O f Allo Fairmont Ins .Co . COUNTY OF LOS ANGELES _ BUILDING AND SAFETY
� company_.
Leh Certified copy is hereby furnished. FOR APPLICANT TO FILL JN ADILDIN0ORESS
f1 Cerifled copy Is filed with,.th•coubty bulldlpp rnsper- Buie
{J tion department. ADDRESS LOG�iJTY.
Date .2/21 /83 Applicant -- an Te1>$ le Cit zip 91780 CR ST.
G$2TIFICATE Of ID(ENAPTION rRtOM WORhEFS' SIZE of Lor 5�+ ]t 170 �BLDG& 1 MAP Bootc PAGE PARCEL
COMPENMT)ON INSURANCE .
(This section need not be cam leted if the. b
p"It -foron• 115E Zoe
hundred dollars ($100)or.,less. . . - TRACT - 9L k 3 LOT No. 21 NO,
I certify that:Jn the p,rformonce of the work for.which.thh �' r &"i�r 8 Ci. Purdy ,tr 286-� 71 �'/ �,pM d
pmr{nti Is Issued,.I shall not employ any In any marinerTSTRiCT GROUP TYPE " FIRE- FROGS®BY O
so as to become subject to the Workmrs�npmnsdtlon Laws ADDRESS X013 OOldeIl What AAve . CONST. r z U
CITY Tem e Cit zip -- G
Date Ilont WGN ECi OR Ta-
Exemption,
TpN AFT.
NOTICE To APPLICANT'. rf, triter inaklrtg thl� C«tffieate of . No. CLA55 r?.NDO.
NO. u ITS
Exemption, you, should become subLed to" the Workers' d
Compensation provlslQns.of the Labor Code, you.must forth- ADDRESS SEWER MAP N
with comply.with such provWons ar this permit-shall be, Z
dem m ed revo ked. CONtRACTOR B r li c® "B.e n a o n 'a. 2 8.6-1 2 Bac PG, VA MATION
LhCET18E�CONTRACTORS-DECLARATI qN 9 �+4 Kenn 6 r 1 S 388627
1 h.rgby affirm that I am Ilcmnsmd under.provlslonk of ChdpW 9 ADDRESS y } . VALUAT}OM
(commertdng with Sbctbn 7000)of DN-h$ort 3 6f the Boslriess and �C
Professions Code, andmy Ikerne is in full force-and-effect. . CITY Temple City CLASS : 'J
388627 B �pr. 8 7 7 � 1 -NO.
LES 1: Ot4E �-
,.
Licertsm Number dlc,Cldi.' �_
;
ra
Contdor' Bruce B e n s Q4, D 2/1.8/8 3 DucTzl pnoN aF woRtc NEW k
QluM1hexempt tlnderSec: &--LauT1dPy Rm. Addition-; p
�� Kitchen $ Dinjn remodel ALM �
h3.d,P.C. for this reason RFPAIR Q
USE OF
Date:^ OUSTING BLDG. Re 8 j d QTICADFAhOI FFVtAL
Slgnatun - ' APNKAPfT. TEL IT
OWNER-BUIPDER DE0AkATFON. I NO. 9,9 2 8 A
I#hereby affirm tttot I am exempt from tht CQnftxiMr's klcens. 9 y /+ .gerinerl�• St, Temple Ci :� �
Law for the follawJng reason (Section 7037.5, Byslness and y
ir
e o 0 o L„
Professions Code):
Q _ .. - 1 - . . o �1 C`h• ..
I, as owner of the prop", or thyPrrrPloyees with ADDRESS BUILDING i` •
wcQ"as their sole tompeneation,will do the work and
the structure Is not Intended or offered for sale(S&-(on L
70",Business and Professions Code). MOVING TEL - 3
_ I, as awnmr of the property, am exclusively contractinb �'
with Ircmnsmd conft-co to coastruo the project (Sec- . ADt ss ° 9 2,9 A
tion 7044, Business and Profession Code
CONSTRUCTION LENOING.AG4NCY al1OC YARD HWY IREID' f�� YMTM �:� ' +S � 0 0 0 • •
I_bmrmby affirm that there is'q conpmY dlgn Iepolnq agency for F
'O �� 4 P 0.0
��+,e° pmrformahce of ti5e.work for which_this permit is wed
l� 3097, Clv.-C-). - o a 3 4 ' 0 0
Lranders Name, Nflne. 0 2 2 2 g
L ndtar s Address- r P.0 Fes Perm 7.
I certify th;Qt I Baum regd this aWlico lon and Irtais that the Iswarxa FM O
above Infomrcitlon is . I agree to comply with-all County In�sWigaHon Fee .
ordinances and$late {awe relpting to'bolldlnq cortsfrucHon, dQ
and hermlvy UUthoHxe reprgentatives of thls County to enter IT Fe. a
upon thth�e.abovd-mentioned property,for Inspection rposms. - r^
VE wWw Pol oRLAKATorY u►re0uA01111
SJgnatan of App Ikartt or Agent 7. Datta tDs
COUNTY OF LDS ANGELES TrE34 r< CITY # 0508 BUIIDING PERMIT
DEPARTIENP OF PUBLIC WORKS 9701 LAS TUDA.S ALTERAT=ON/REPAIR
BUILDING AND SAFETY / LAND DEVEZPl-= TEMPLE CITY CA 91780 BL 0508 0904280036
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 14832 LT: 21 SQ. FT STORIES TYPE 5013 GOLDEN WEST AV
STRUCTURE: 3000 V-B TEMP CA 917803939
ASSESSOR INFORMATION NUMBER: NEAREST CROSS SANEST: LA ROSA
8589-018-017 THOlA.S PAGE: 597 GRID: A4 LO-CAL=: Tla4 r.r?
CITY, C
TEBANT: EIIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY:
EXIST OCC GRP: 04/28/09 SR
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FngALBY: CODE:
PURDY CLARK (626) 286-3271- 9,200 all�rvplFm
5013 GOLDEN WEST AV CA
TEt-fP 917803939 FEES PAID D CRIPTION OF WORK
TEAR OFF AIM REROOF CGMPOSIT=ON SHINGLES 40 YEAR
FEE DESCRIPTION: QUANT=TY: DOM: AMOUW:
APPLICANT: TEL. 190:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AB STATS GREEN BLDG FEE 9200.00 VAL 1.00 SPECIAL CONDITIONS:
AC STRUNG MOTION PF-SII) 9200.00 VAL 0.92
D2 PERMIT W/O EN-HC 9200.00 VAL 216.60
PR INV WORK W/O PERMIT 128.50 DOL 128.50
CONIRACTOR: TEL. NO: TOTAL.FEFS 374.77 APPROVALS DATE INSPEC OR SIGNATURE
SAME AS ONNER
LIC. NO LOCATIO& AND SETBACKS
SOILS ENGINEER APPROVAL
ARCH=TECT OR ENGIIZEE t: TEC,. NO: FOUNDATION TRENCH FORMS
LIC. NO: SLAB FLOOR
RAISED FLOOR FRAhJa4G
IAP NO: SEWER IAP BOOK: PAGE: FIRE ZONE: CTT: UNDERFLOOR INSIILFLTION
144H269 3 00
FLobR SHEATHING
NO. OF F JCELSBS: DWELIJ:93 UNITS: AFT/GOND: STAT CLASS:
No 21 ROOF SEE ATHING
SCHOOL WITHIN HAZARDOUS SE AR PANELS
AYR QUALITY: 1000 FEST bULTF'RTALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM =ST FIR& SPR12fl= HANGERS
SET BACK YARD: HWY: PROP LIN'S: WIDTH:
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RA= FLOOR CELL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPE[iNGs
T-BAR CEJJlNGS -
LOT DRAI20,GE
REPORT ID: DPR261 ROUTE TO: 13-S0508
fi
v
COUNTY OR LOS ANGELES TF34PIE CITY }1 0508 BUILDING PERr6T
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS
BUILDING ALID SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 B TERAS/206210048
PHONE: (626) 285-0488 EXT:
Ld3GA . ID: NO. OF CONST BUILDING ADDRESS:
TR: 14832 LT: -21 SQ. FT STORIES TYPE 5013 GOLDEN WEST AV
STRUCTURE: 352 V-B TEMP CA 917803939
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA.ROSA
8589-018-017 TROMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
TEHT.NT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY:
EXIST OCC GRP: 07/02/12 SR
ONNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: F DATE F CODE:
PURDY CLARX (626) '286-3271- 10,000
5013 GOLDEN NEST AV -
TIDQ' 917803939 FEES PAID D29CRIPTION OF NORb
ROOF MOUN'= SOLAR 5.10 LW SYSTEM 20 PANELS
FEE DE9CRSPTION: QUALTTSTY: UOM: AMOUNT:
APPLICANT: TET.. NO:
HIIARACHA, CHRIS (714) 493-1235- PI RF.S PV PC<10KW 153.90
1211 N. BA-TAVIA ST. {� BLDG PERMIT ISSUANCE 27.90 SPEgAL CONDITIONS:
ORANGE, CA 92867 AB STATE GREEN BLDG FEE 10000.00 VAL 1.00
AC STRONG MOTION RESID 10000.00 VAL 1.00
P2 INSPCT RES PV <10KW 138.00
COIPTRAC'TOR: TEL. NO: 'TOTAL FEES 321.70 APPP,OVALS DATE INSPECTOR SIGNATURE
VERENGO SOLAR (714) 471-6453-
1211 N. BATAVIA STREET LSC. NO LOCATION AND SET13ACES
ORANGE, CA 92867 935263 C10
SOILS ENGINEER APPROVAL
ARCH13'ECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LSC. NO: SLAB/UNDER FLOOR
RAL�ZD FLOOR FRAMING
MAP NO: SEWER MAP BOOR: PAGE: FIRE ZONE: CMP: . . UNDE;tFLOOR INSULATION
144H269 3 00
FLOOR SHEATHING
NO. OF FAMLLIRS: D4IEIJING UMTS: APT GOND: STAT CLASS:
0 NO 21 ROOF SHEATH7IPG
SCHOOL WfITH-IIi HA2ARDOUS SHEAR PANELS
AIR QUAI= 1000 FEET MATERIALS
ALS
NO NO NO FRAME PECTION
F SPRI3n= HANGERS
._ . INSULATION WEATHER STRIP
OR LATH/DRYWALL
EX=OR LATE
RATRD FLOOR CESTA ASS134.
RATEp WALL ASSENDT,
RATED SHAFT'S OP@IINGS
T-BAR CIDJ IN LS
LOT DRAT AGE
REPORT ID: DPR261 RO= TO: BS0506