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Home My Public Portal About5813 GOLDEN WEST AVE_Building__ WORKERS'COMPENSATION DECLARATION �t'�� C� C-1_ILA-A ?,AAA M I' hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) �y_f01, COUNTY OF LOS ANGELES BUILDING AND SAFETY r l 0 r-�,��y r—ft_f=AA0 Certified copy is hereby furnished. 1 FOR APPLICANT TO FILL IN ADDRESS c)E'Zt! .W C-s V tc Certified copy is filed with the county building inspec- BUILDING A, tion department.. ADDRESS- �0 G r� W LOCALITY :7��xNEAREST Date r Applica 1 CITY amu, C _ ZIP CROSS S7. CERTIFICATE OF EXEMPTIO ROM 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 O. hundred dollars ($100)or less.) TRACT BLOCK LOT NO. /n/ I NPE 404 2 �'� SPECIAL � I certify that in the performance of the work for which this OWNER -+ CONDITIONS permit is issued, I shall not employ an person in an manner DISTRICT GROUP TYPE FIRE OCESSED BY O p P Y y p y ADDRESS 1w� CONST. ZONE V so as to become subject to the Workers'Compensation Laws. Date Applicant CITY ZIP STATISTICAL CLASSIFI ATION I AP . CONDO7—]. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL.ENGINEER r` NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be a TEL. deemed revoked. O yx�('l NO. Y BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADD A-tu J NO. VALUATION 1�(commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY CLASS $ , 6 f SQ. FT. /�, NO. OF NO. OF CHECK License Numb o �� Lic.Class SIZE � STORIES FAMILIES ( ONE ^� y t Contra Tor Date (—tt— �— DESCRIPTION OF WORK (� to (l ( < G NEW $ •. ADD .11 I am exempt under Sec. 1� i( 1 CU Ch t Jy p ALTER FINAL / B.BP.C. for this reason w� u 0 t1 LL� Z REPAI DATE — � # g Date: USE OF EXISTING BLDG. T DEMOL E] FF NAL o 041.00 L Signature APPLICANT r TEL. Y '0 0 0 4 ,�Q Q� `� L S C IA�04 NO. Q OWNER-BUILDER DECLARATION PRINT D IL I hereby affirm that I am exempt from the Contractor's LicenseADDRESS 1-1S l� 12011'17 W 0 7. 1 1 -86 Law for the following reason (Section 7031.5, Business and VM Professions Code): PRESENT S BUILDING ( p) I, as owner of The property, or my employees with ADDRESS wages as their sole compensation,will do the work and 7 x' / ,06 the structure is not intended or offered for sale(Section LOCALITY G G/ -" 7044, Business and Professions Code). MOVING 1, as owner of the property, am exclusively contracting CONTRACT NO. with licensed contractors-to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. 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. 3097, Civ. C.). SIDE n P.L. . Q Lender's Name. /"� Lender's Address P.C. Fee$ Permit Fee SCJ w I certify that I have read this application and state that the � y PP Issuance Fee a above information is correct. I agree to comply with all County Investigation Fee S ordinances and State laws relating to building construction, g Total Fee u and hereby authorize re ntatives of this County to enter ' upo ove-me ned pr perry for inspection purposes. 3 SEE REVERSE FOR EXPLANATORY LANGUAGE gna ure of Ap ant or Agent Date ®3 SATION DECLARATION /h�ave a certificate ttconsentInsurance, self APPLICATION FOR BUILDING PERMIT ye f WorkersCompensato certrtiopthereof (Sec. 3800, Lab. C.) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.2.17/12 Company 6j/4i - FOa0 BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 5843 600,0/-_' Wl�-61 (� Certified copy is filed with the county build' inspec- BUILDING S�V ,•^,. ,,��y �-; LjU tion department. ADDRESS Date //G Applicant CITY meV- CC77CW.i'.�64 ZIP ZIP QLOCALITY 7F-Mae F-Ma C.. Yil CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGSIZE OF LO7 ,000 . NOW ON LOTS CROSSS NEARET COMPENSATION INSURANCE 40ST. �46 �UVv�S (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL.fir% I certify that in the performance of the work for which this OWNER 0gVtV (Je j�Ctj R �.Z USE ZONE MAP —. SPECIAL f permit is issued, I shall not employ any person in any manner - 80 6cX&;%U V057� CONDITIONS ! (J so as to become subject to the Workers'Compensation Laws. _ ADDRESS /�!� n /j CITY 75;#7,V4_-- / CA ZIP /71J�—" Date Applicant ARCHITECT OR TEL..__ - NOTICE TO APPLICANT: If, after making this Certificate of . DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER DI(�� NO.', �. CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS ��O 3 with comply with such provisions or this permit shall be TEL. r STATISTICAL CLASSIFI ATION APT. CO DO. deemed revoked. CONTRACTOR 66/1 6Z �� } NO. JZQ LICENSED CONTRACTORS DECLARATIONLIC.O. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 0 0 "nta va N �� SEWER MAP.. (commencing with Section 7000)of Division 3 of the Business and �,�( LIC. p Professions Code, and my license is in full force and effect. CITY c,4006 CLASS BK I. PG. 2i" VALIDATION SQ. FT. LL NO. OF NO. OF CHECK License Numb ~� Lic.Class SIZE J 0 STORIES FAMILIES ONE �y _ _ VALUATION Contractor Date Z�. CJ DESCRIPTION OF WORK u..6 , C'C)�EJ / NEW ® $�1r7 �P1P1 O ADD ❑ Cy�iim+- ❑ I am exempt un er Sec. �t�' ALTER ❑ 13 9,6 A B.BP.C. for this reason REPAIR CJ U' Date: USE OF „ )1 F ❑ # o - 23 (k EXISTING BLDG. r /7v` — DE Signature APPLICANT TEL ! FINAL I ° 21 6 7 5 OWNER-BUILDER DECLARATION (PRINT) DAT I hereby affirm that I am exempt from the Contractor's License ( ° ° 2 1 6 7 5 0 Law for the following reason (Section 7031.5, Business and ADDRESS-30YO TWr. FI L Professions Code): PRE EN 1222'88_ ❑ BUILDINGL y°;II j I, as owner of the property, or my employees with ADDRESS ti�Ljr` wages as their sole compensation,will do the work and ` the structure is not intended or offered for sale(Section LOCALITY ' EMS 7044, Business and Professions Code). MOVING TEL. _ ,....;E �' =00 ❑ I, as owner of the property, am exclusively contracting n i R °” CONTRACTOR NO. 1,„,j A with licensed contractors to construct the project (Sec- -•.fir „.€ .? '??°;( ; tion 7044, Business and Professions Code). ADDRESS REQUIREDTOTAL SETBACK FROM EXIST. °C!j CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH L•itf`s I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE --^.�• -�.-3 P.L. .-tit: `”1 t r[,1 s.:' Lender's Name ;� 3° / LDMA Ref. # i�II•EG4 ° I r m P.C. Fee$ Permit Fee ?/ 1 , Lender's Address 3 I certify that I have read this application and state that the /�c��p o y pp� • V 6.� Issuance Fee ® i SZ kDA P/C# s!-.+•.. Z above information is correct. I agree to comply with all County Investigation Fe `'�'€°� o ordinances and State laws relating to building construction, Total Fee �� LDMA Perm. # -77 „=fj a and h reby outhori representatives of this County to enter -- up a above- tioned property for inspection purposes. ) -• Q 1 1[rEF Z P� SEE REVERSE FOR EXPLANATORY LANGUAGE t 0 .A 1„ � „ 01 -3 Signature f Applicant or Agent Dote _ _ 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 0603170031 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST - BUILDING ADDRESS: TR: 6561 LT: 468 SQ. FT STORIES TYPE 5813 GOLDEN WEST AV STRUCTURE: 2000 VN TEMP CA 917802204 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8587-024-003 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSU.4D ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 03/17/06 JK 03/12/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE INAL BY: CODE: SHAPIRO, BEN (213) 798-6294- 6,500 - 3 5813 GOLDEN WEST AV TEMP 917802204 FEES PAID DESCRIPTION OF WORK REMOVE SHEATHING 30 YR COMPOSITION FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: A-1 ALL AMERICAN ROOFING (626) 303-3737- AA BLDG PERMIT ISSUANCE 27.75 1705 S. MOUNTAIN AC STRONG MOTION RESID 6500.00 VAL 0.65 SPECIAL CONDITIONS: MONROVIA, CA 91016 D2 PERMIT W/O EN-HC 6500.00 VAL 166.20 TOTAL FEES 194.60 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE A-1 ALL AMERICAN ROOFING (626) 303-3737- 1705 S. MOUNTAIN AVE LIC. NO LOCATION AND SETBACKS MONROVIA CA 91016 699115039 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 150H269 3 01 _ FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I } NO 21 ROOF SHEATHING 1 �- G li SCHOOL WITHIN HAZARDOUS I SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION 1 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 EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE (REPORT ID: DPR261 ROUTE TO: BS0508 i - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1404030060 PHONE: (626) 285-0488 EXT: [LEGAL ID: 1 NO. OF CONST NEW I BUILDING ADDRESS: 1 ITR: 6561 LT: 468 [ SQ. FT STORIES TYPE OCCUP GROUPI 5813 GOLDEN WEST AV [ I- ISTRUCTURE: 0 1 V-B R-3 I TEMP CA 917802204 1 (ASSESSOR INFORMAT"ION NUMBER: [ GARAGE: [ NEAREST CROSS STREET: LAS TUNAS 18587-024-003 [ OTHER: I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI I _I I (TENANT: IEXIST BLDG USE: USE ZONE: [ISSUED ON: PROCESSED BY: 1 [ [EXIST OCC GRP: 104/03/14 SR [OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: 1FINAL DATE FINA BY: CODE: 1 1581 - I 5,000 15813 GOLDEN WEST AV _. [ �� ITEMP 917802204 FEES PAID -rTE-SCRlftI6N OF WORK I I ILAUNDRY ROOM CONVERTED TO BATHROOM I I _ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: [ I [APPLICANT: TEL. NO: I I I ITO, LANH V (626) 309-9623- .IAA BLDG PERMIT ISSUANCE 27.80 [ 1 14841 TEMPLE CITY BL IAB STATE GREEN BLDG FEE 5000.00 VAL 1.00 ISPECIAL CONDITIONS: I ITEMPLE CITY CA 91780 IAC STRONG MOTION RESID 5000.00 VAL 0.50 [ [ IB1 PLANCHECK W/ENERGY 5000.00 VAL 124.00 [ I 1 _IB2 PERMIT W/ENERGY 5000.00 VAL 145.90 (CONTRACTOR: TEL. NO: 1 TOTAL FEES 299.20 1APPROVALS DATE INSPECTOR SIGNATURE 1 (ALAN SERVICE CO. (626) 309-9623- 14841 TEMPLE CITY BLVD LIC. NO I (LOCATION AND SETBACKS [ ITEMPLE CITY CA 91780 648308 [ ISOILS ENGINEER APPROVAL [ I I (ARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS LIC. NO: I [SLAB/UNDER FLOOR [ I PAISEil FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I IUNDERELOOR INSULATION I I I I 3 ocl I [ 11ST LEVEL FLOOR SHEATH I [ INC. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I [ I 1 0 NO 21 1 12ND LEVEL. FLOOR SHEATH 1 I 1- SCHOOL WITHIN HAZARDOUS [ IROOF =HEATHING [ 1AIR QUALITY: 1000 FEET MATERIALS j [ [ NO NO NO 1 (FIRE DEPT. FRAME INSPECTI I I. [ [BLDG DEPT. FRAME INSPECTIWJJJ!jjjI [ ISHEAR PANELS I I 1 [INSULATION/WEATHER STRIPI [ I [ I I I IINTERSJR LATH/DRYWALL [ [EXTERIOR LATH Ilk I 1 ILOT DRAINAGE [ [ [ ! ISMOKF DETECTION DEVICES [ I I I IFIRE DEPARTMENT APPROVALI I ADDITIONAL DATA ON FILE I ! I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 I