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HomeMy Public PortalAbout6129-6131 GOLDEN WEST AVE_Building__ WORKERS'COMPENSATION DECLARATION c� hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT . insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company El Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ADDRESS ��—3� Certified copy is filed with the county building inspec- BUILDING J tion department. ADDRESS 1 Zq , Gs LOCALITY -7 pA NEAREST ' Date 7- Applicant—2 CITY v� C T ZIP 1 6 p y CROSS ST. + -� CERTIFI ATE OF EXEMPTION FROMRKERS' ,,JJ NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT D 7 NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one -->A9TA I-IMMA oojC�6� I- 7 �t<}f�i USE ZONE MAP /� /� hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. 0 `� Gam' JTEL. °/ j�j ,SPECIAL I certify that in the performance of the work for which this OWNER PJ� t otzp.>� J/TjNO. (a/ CONDITIONS permit is issued, I shall not employ any person in any manner //�� QQ� DISTRICT, GROUP TYPE FIRE PRO ESSED BY (� ADDRESS U k V9 ltU�� ar/ CONST. ZONE �, so as to become subject to the Workers'Compensation Laws. (� �f(O S " D ®` Dote Applicant CITY C-L ZIP {CJ� STATISTICAL CLASSIFICATION PT. CONDO. NOTICE' TO APPLICANT: If, after making this Certificate of ARCHITECT _ ���p,�TEL. (jLU g ENGINEER r-. 4 - �RI TEL.. I L� CLASS NO. DWELL. UNITS @ Exemption, you should become subject to the Workers' //�] � D/ IMS provisions of the Labor Code, you must forth- ADDRESS67 C 8 ,PA �4, � SEWER MAP with comply with such provisions or this permit shall be deemed revoked. T r-Z/ Nr TEL. � BK / PG 7,) VALIDATION CONTRACTOR I Z'�' (�„1� 1rC NO. s-� LICENSED CONTRACTORS DECLARATION LIC. / I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS u0 �J �� NO. -Z2Ly I. VALUATION (commencing with Section 7000)of Division 3 of the Business and r LIC. Professions Code, and rimy license is in full force and effect. CITY 4�,ITY CLASS U $ SQ. FT. i L16 NO. OF NO. OF CHECK. License Number LS (a Lic.Class ` d� SIZE STORIES FAMILIES ONE ///� ///� M q 1p� V DESCRIPTION OF WORK U I�fi NEW $ f�r` D O� Contractor � _M ��Z /1y to a ADD ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer ALTER FINAL J m acting in my professional capacity (Section 7051, _ REPAIR DATE Business and Professions Code). USE OF !� EXISTING BLDG. U L. FINAL I �j)N(�I p� ¢} fi �U DEMOL BY c z 3 9 9,7 A Lic.-or Reg. No. Date APPLICANT TEL. cc I77/ '�' OWNER-BUILDER DECLARATION (PRINT) L L �.NO.J `//�� t 'a a a a 23 I hereby affirm that I am exempt from the Contractor's License ADDRESS �� /� /V/v✓�� �i Law for the following reason.(Section 7031.5, Business and 2 0 0 97,20 Professions Code): PRESENT FI, as owner of the property, or my employees with, ADDRESS `1:� 0 0 0 9 72 0 cz� wages as their sole compensation,will do the work and � �p the structure is not intended or offered for sale (Section LOCALITY 0 5 1 4 82 Y 7044, Business and Professions Code). MOVING TEL. � 1- I, as owner of the property, am exclusively contracting CONTRACTOR NO. d with licensed contractors to construct the project (Sec- JADDRESS f 399.8 A tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. o a.0 0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1 I hereby affirm that there is a construction lending agency forFRONT the performance of the work for which t 's permit is issuedr P.L.- 2 1. 1 8 7 5 0 (Sec. 3097, Civ. ). ( SIDE _ ' 131,OOL Lender's Name 051 4—8 2 Q / �- $ - L( �/ C. fee$ [) Com/ Permit Fee Lender's Address w I certify that I have read this application.and state that the �© Issuance Fee above information is correct. I agree to comply with all Countyvestigation Fee 0 ordinances and State laws relating to building construction, Total Fee m and hereb authorize representatives of this County to enter U upon th ab ve-menti d propert for inspection purposes. I a r� Q Z 1 7 C/� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Or- Pplicant or Agent Date - _ r Os II WORKERS' COMPENSATION DECLARATION insure,ora-clertificatehat lhave a ofWorkes'Colcate mpensstfonolnurance,o'r APPLICATION FOR BUILDING PERMIT a cert' 'copy thereo (Sec. 3800, La COUNTY OF LOS ANGELES BUILDING BUILDING AND SAFETY P icy No. � Comp y � I� Certi ed copy is her 4 furnis d. FOR APPLICANT TO FILL IN ADDRESS 1 3 �--�C��o�e Ce r ified copy is fi with th co my ildin i pec- BUILDING r� do department. ADDRESS 6431 9L. G.� LOCALITYv „f: NEAREST � Date �3 Appli CITY Lr L ZIP CROSS ST. C MPTI W 1 NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT I( L NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the r i> or oneS USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. y TEL. �j /�- SPECIAL �y ati% s• I certify that in the performance of the wor for which this OWNER L NO. ` �\ CONDITIONS permit is issued, I shall not employ an person in an manner DISTRICT GROUP fN PE FIRE PRO ESSED Y Uo as to become subject to the Worke s'Compensat on Laws. ADDRESS / �✓� d �� ST. ZONE �^ Date Applicant CITY ZIP J STATISTICAL CLASSIFICATION 90 3 APT. CONDO. l� NOTICE TO APPLICANT: If; after making this Certificate of ARCHITECT OR TEL. Ey ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' Vf Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP, with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR E � DY BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC, I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7 VALUATION (commencing with Ser n 7 )of Division 3 of.the B 'Hess and IC. Professions Co nd my lic nse is for and a fect. CITY (�j L' $ SG�0 SQ. FT. N0. OF NO. OF r CHECK - License N mbe J Class SIZE �� STORIES FAMILIES / ONE DESCRIPTION OF WORK Q �Y NEW $ Contract r L]I a exe t rom the lic sing requirements as I am a / C�: �S ADD licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, 1REPAIR DATE C® ! (J Business and Professions Code). USE OF DEMOL FINAL EXISTING BLDG. — ® By ��✓�"��� Lic.or Reg. No. _Date APPLICANT F TEL. c OWNER-BUILDER DECLARATION (PRINT) %w ,% NO�J 7 1 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and the structure is not intended or offered for sole(Section LOCALITY NIA 7044, Business and Professions Code). MOVING TEL. z 3 9 9 4 A I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- _a o 0 0 0 tion 7044, Business and Professions Code). ADDRESS t REQUIRED TOTAL SETBACK FROM EXIST. 2 ° ° 3 8 50 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - • I hereby affirm that there is a construction lending agency for FRONT010 3 5 0 cz� 0 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 05, 14.-82 P.L. Lender's Name 1 Lender's Address P.C. Fee S Permit Fee .3v w I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee f/ ordinances and State laws relating to building construction, Total Fee and h eby authoriz epresentatives of this County to enter aupo th above-menti ed pr rty for inspection purp ses. a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Y pplicant or Agent D to ©s' r , WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of coa;o self Insurance, - APPLICATION FOR BUILDING PERMIT nsure, or a certificate of Workers'Compenstion Insurance, or t certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY 'olicy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING or— ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS �Q [I LOCALITY NEAREST )ate Applicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL This sectionneed not be completed if the permit is for one USE ZONE MAP iundred dollars ($100)or less.) TRACT BLOCK, LOT NO. NO. TEL. SPECIAL certify that in the performance of the work for which this OWNER N '��� CONDITIONS >ermit is issued, I shall not employ any person in any manner / DISTRICT GROUP TYPE FIRE PRO ESSED BY (� o as to become subject to the Workers'Compensation Laws. ADDRESS 7 L CONST. ZO E /�� G� ZIP n )ate Applicant CITY Pi' C� TATISTICAL CL SSIFICATI APT. CONDO. U pt, APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. xemENGINEER NO. xemption, you should become subject to the Workers' CLASS NO. DWELL_UNITS @y :ompensation provisions of the Labor Code, you must forth- vith comply with such provisions or this permit shall be ADDRESS SEWER MAP TEL. G! /(� VALIDATION teemed revoked. � CONTRACTOR � NO. /� �/d BK. PG, LICENSED CONTRACTORS DECLARATION - Llc ,.,f hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS N VALUATION `• commencing with Section 7000)of Division 3 of the Business and J / LIC. 'rofessions Code, and my license is in full force and effect. CITY /ielr 4CJ CLASS .� �� $ `S� SQ. FT. NO. OF NO. OF J CHECK ' icense Number ' Z.?=7� Lic.Class J SIZE STORIES IFAMILIES / ONE :oniractor Date DESCRIPTION OF WORK NEW $ ] I am exempt from the licensing requirements as I am a a ADD licensed architect or a.registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, DATE REPAIR Business and Professions Code). USE OF FINAL EXISTING BLDG. DEMOL BY ic. or Reg. No. Date APPLICANT y� TEL. z"5 9 0,5 A OWNER-BUILDER DECLARATION (PRLNT)�jc� O.N hereby affirm that I am exempt from the Contractor's License '#'o 0 o io 2 1 aw for the following reason (Section 7031.5, Business and ADDRESS 'rofessions Code): T MLLijim PRESENT BU2 0 0 2 9,4 O ILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and e. ot0�o 2 9,4 0= the structure is not intended or offered for sale(Section LOCALITY U 7044, Business and Professions Code). MOVING TEL. 0 8 2:7—8 2 I, as owner of the property, am exclusively contracting CONTRACTOR NO. project ( z590,6A with licensed contractors to construct the ro ect Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. 0 0 0 0 0 CONSTRUCTION LENDING AGENCY SETBACK . YARD HWY PROP. LINE WIDTH # 1 hereby affirm that there is a construction lending agency for FRONT 2 0 0,6 1.O O he performance of the work for which this permit is issued P.I. Sec. 3097, Civ. C.). SIDE t' PL o a 0'61.00 ender's Name la 08,2i7r-82 P.C. Fee$ Permit Fee ender's Address certify that I have read this application and state that the Issuance Fee bove information is c ;t.O�Uilcling gr mply with all County Investigation Fee rdinances and e laws lacing construction, Total Feend hereb thor"e reprsef thi ounty to enter Pon th ve-mentio perry for i� ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of�icant or�,gentor��gent• – `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 0810200006 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 6129 6131 GOLDEN WEST AV i STRUCTURE: 3175 V-B TEMP CA 917801754 ASSESSOR INFORMATION NUMBER: - NEAREST CROSS STREET: 15385-020-025 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl TENANT: IEXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: EXIST OCC GRP: 110/20/08 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: BIRCHES HOME OWNERS ASSOCIATE - 6,750 I 16129 GOLDEN WEST AV I I _ 0 Y (TEMP 917801754 FEES PAID IDNJCRiPTION OF WORK IRE-ROOF WITH COMPOSITION SHINGLES, TERMITE REPAIRS AND DRY IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: IROT REPAIRS. APPLICANT: TEL. NO: I I IQUEMADA (626) 806-5410- IAA BLDG PERMIT ISSUANCE 27.75 1 15122 E. BEVERLY BL. IAC STRONG MOTION RESID 6750.00 VAL 0.68 ISPECIAL CONDITIONS: ILOS ANGELES CA 90022 ID2 PERMIT W/O EN-HC 6750.00 VAL 166.20 1 TOTAL FEES 194.63 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IJ Q CONSTRUCTION (323) 263-5411- 1 15122 E. BEVERLY BLVD. LIC. NO ILOCATION AND SETBACKS ILOS ANGELES, CA 90022 570652 B ISOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I LIC. NO: I (SLAB/UNDER FLOOR I I I IRAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1150H2G9 3 001 I 1-1 I I IFLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I NO 21 I IROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS 1 1-- 1-1 1 NO NO NO IFRAME INSPECTION I I IREQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS I I ISET BACK YARD: HWY: PROP LINE: WIDTH: I -1-1 IFRONT PL- IINSULATION/WEATHER STRIPI I I SIDE PL- I 11 1 1 (INTERIOR LATH/DRYWALL I 1 I I I I 1 1 (EXTERIOR LATH 1 1 IRATED FLOOR/CEIL ASSEM. I 1 I I I I I I IRATED WALL ASSEMBLIES 1 1 IRATED SHAFTS/OPENINGS I 1 IT-BAR CEILINGS ILOT DRAINAGE IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I