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HomeMy Public PortalAbout5507 GOLDEN WEST AVE_Building__ l/ ,&WORKERS'COMPENSATION DECLARATION /I r I hereby affirm dhat I have a certificate of consent to self insure, or a certificate of Workers'Compenstion Ipsurance, or APPLICATION L I CATION FOR BUILDING PERMIT a certified copy thereof (Sec. 800, Lab. C.) , COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N �� o. t ca56any t' Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ADDRESS , U Certified copy is filed with the c n but Ing inspec- BUILDING s tion depart . :>.- ADDRESS / ( C-Aj W LOCALITY 1Vf I�C,� y//�) NEAREST Date r 0 Applicant CITY — ZIP CROSS ST. CERTIFICATE OF EXEMPTION FR0.,1 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 USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. , TTEL. >q5A SPECIAL � I certify that in the performance of the work for which this OWNER /L Uj�� NO. � CONDITIONS O DISTRICT GROUP T PE FIRE. PROCESSED BY sis issued, f shall not th to an person in an manner }-� / NST. ZONE /� U permit employ Y P Y ADDRESS U' ! Q�-L�e il3WCS � 7r' so as to become subject to the Workers'Compensation Laws. _ mC CITY t`. H P C...1 -1 ZIzas '�Y / i F� Date Applicant QST TISTICAL:CL SSIFICATION APT. CONDO. V ARCHITECT OR TEL., C, dd �p��..// NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO.�II O�"IC > ClASS.NO.�� DWELL. UNITS LU Exemption, you should become subject to the Workers' ff� ��- A N Compensation provisions of the Labor Code, you must forth- ADDRESS n �� Vet1T(� `-' '�r` SEWER MAP z with comply with such provisions or this permit shall be deemed revoked. TEL.�� BK PG, VALIDATION CONTRACTOR NO.. LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm.that I am licensed under provisions of Chapter 9 ADDRESS Q .1 05A /kL 10! •:5`Y4"(iJ. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY Uf A A CLASS C--7 $ V E V Q U— 1`3 • SQ. NO. OF OF CHECK License Number��9 `� Lic.Class ` J SS STORIES FAMILIES ONE J 1n'' \'\ + NEW $ Contractor �L.fl.lc.,l..l� e�`- Date 0 � �/ DESCRIPTION OF WORK • (�C ffn 0 _t_;50ADD I am exempt from the licensing requirements as I am a l �l licensed architect ora registered professional engineerI ALTER FINAL �O®�P � r acting in my professional capacity (Section 7051, vw' - / REPAIR DATE J��OBusiness and Professions Code). USE O DEMOL FINALEXISTING BL B Lic:or Reg. No. Date APPLICANT TEL OWNER-BUILDER DECLARATION (PRINT) NL( y cGS;�-3 /y�J I hereby affirm that I am exempt from the Contractor's License ADDRESS Law for the following reason (Section 7031.5, Business and Professions Code):. PRESENT BULDING z 0 1 1 A I, as owner of the property, or my employees with ADIDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY #.0:0)o 0 2 1 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. ,20.0 5 54,4 with licensed contractors to construct the project (Sec- ADDRESS o'o o 5 S 4 4 c=i tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY FIn .n YARD HWY PROP. LINE WIDTH 0 6,1 r1 '�$ 1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is is ed �0 1 k 2 A (Sec. 3097, Civ. C. . ` '# 0,0 0 0 0 1 - Lender's Name Lender's Address t-u �'�-�'.YY 4�� 'J"�� Permit Fee _ 2 0 1 V, w I certify that I have read this application and state that the Issuance Fee d�. 0 0 1 0 6,0 0 aabove information is correct. I agree to comply with all County 0 ordinances and State laws relatingto building construction, Total Fee 06. 1 1.-8 1 and-hereby authorize representatives of this County to enter J upon t�h.�e pb ve mentioned property for inspection purposes. M yh� y/f av r SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applican or Agent Dote ©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 0212300029 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDIN ADDRESS: TR: 13805 LT: 23 SQ. FT STORIES TYPE 5507 GOLDEN WEST AV STRUCTURE: VN TEMP CA 917802519 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BROADWAY 8588-010-005 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: P OCESSED BY: EXPIRES ON: EXIST OCC GRP: 12/30/02 JK 06/28/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: BRUHN STEVEN J 4,700 5507 GOLDEN WEST Z/`� TEMPLE CITY FEES PAID DESCRIPTION OF WORK REMOVE EXISTING BUILT UP REPLACE WITH NEW ON HOUSE & GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: PARSONS - AA BLDG PERMIT ISSUANCE 27.75 P.O.BOX 290939 AC STRONG MOTION RESID4700.00 VAL 0.50 SPECIAL CONDITIONS: PHELAN CA D2 PERMIT W/O;EN-HC " 4700.00 VAL 132.60 ,-TOTAL-FEES 160.85 CONTRACTOR: TEL. NO: APPkOVAIS DATE INSPECTOR SIGNATURE ROOF N IT (818) 599-0260- �x P.O. BOX 290939 LIC. NO LOCATION AND SETBACKS PHELAN CA 92329 429747 C39 r SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: 1� I,, r -\ �- -i FOUNDATION/TRENCH FORMS LIC. NO: ' �� I ---- SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: GMP: . . UNDERFLOOR INSULATION 147H269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: 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 SIDE PL - INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LNT DRAINAGE REPORT ID: DPR261 ROUTE TO: SS0508