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HomeMy Public PortalAbout6133-6135 GOLDEN WEST AVE_Building__ WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self 'APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance, or d certifiedi copy thereof (Sec. 3800, Lab. C.) ICOUNTY OF LOS ANGELES BUILDING AND SAFETY o�y f f c �� Company Certified copy is hereby furnishe FOR APPLICANT TO FILL IN ADDRESS ?,/ rt��Ir Certified copy is filed with the county building inspec- BUILDING ` ) �-� tion dep rtment. ADDRESS l "(,?1 � , �-O G OCALITY L> iZ �-7 ©�ryy NEAREST Date 1 �' Applicant CITY ZIP' /�v CROSS ST. ERTI KATE OF EXEMPTION FROM WO KERS' "�]]NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZEAE LOT b /NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one f'tNL�� f1 USE ZONE MAP '} hundred dollars ($100) or less.) TRACT BLOCK LOT NO. 5 NO. �/�� yTEL. d�� - SPECIAL I certify that in the performance of the work for which this / OWNER II.F '� C5 / TE`o � 1 ` Z CONDITIONS permit is issued, I shall not employ any person in any manner fj f �j� y► DISTRICT GROUP TYPE FIRE PROC SSED BY y ADDRESS �� / i.�✓ ( CONST. ZONE so as to become subject to the.Workers' Compensation:Laws. � �w •�j � _, \ CITY a T ZIP �� ` /l_ I.- Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT TEL.. ! LLI �- (�{rJ F A3�B- CL Exemption, you should become subject to the Workers' ENGINEER f NO. j /6Jf/ CLASS NO. Sic ,aF= DWELL. UNITSe Compensation provisions of the Labor Code, you must forth- ADDRESS R. SEWER MAP with comply with such provisions or this permit shall be r VALIDATION deemed revoked. . CONTRACTOR �• �� GNO.� BK. � PG, LICENSED CONTRACTORS DECLARATION LIC. f I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/,Id NO. ��! -Z- VALUATION (commencing with Section 7000)of Division 3 of the Business and �- LIC. I Professions Code, and my license is in full force and effect. CITY / f CLASS !; 6 $ / SQ. FT NO. OF NO. OF CHECK License Number Z` ��� Lic.Class_ '�f SIZE 9L,7 STORIES FAMILIES 2— ONE `'� ( DESCRIPTION OF WORK (d ��� NEW $ �v Contractor! - L 7-0, Date l OADD I am exempt from the licensing requirements as I am a. Q J /�A/a � 2399,5A licensed architect or a registered professional engineer ,tt�� �,�y ALTER FINAL acting in my professional capacity (Section 7051, '-=�A � O DATE �} °� Business and Professions Code). USE OF J� REPAIR °'o o ° 2 3 ". EXISTING BLDG.�� L �; r, d EMOL � FINAL � g Lic. or Reg. No..` Date APPLICANT T t I TEL BY Im 2.o o I R O O (PRINTJ �'��-� '( lNeo S7 !h i OWNER-BUILDER DECLARATION ° °,O 1 8,0 O I hereby affirm that I am exempt from the Contractor's License /� �- p `' `J Law for the followingS1 -Business ADDRESS ®4J �1�J' r reason (Section 703 .5, usiness an3 05, 1 4-82 Professions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS 7 - C) wages as their sole compensation,will do the work and the structure is not intended or offered for sale(SectionJADD LITY 7044, Business and Professions Code). ING TEL. / �.-�_ •- ® z 3 9 9,6 A I, as owner of the property, am exclusively contractingTRACTOR NO. with licensed contractors to construct the project (Sec- ESS _ # o'0 0 0 ° 1 tion 7044, Business and Professions Code). UIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP. LINE WIDTH 2 ° 8.71250. I hereby affirm that there is a construction lending agency forONT he performance of the work for which this permit is issued . ° ° 8 7 2 0 .05 (Sec. 3097, Civ. C.). E .Lender'sNameLender's AddressFee$ PermitFee w 1 certify that I have read this application and state that the � Issuance Fee aabove information is correct. I agree to comply with all Countytigation Fee 1. ordinances and State laws relating to building construction, Total Fee (XJ E and her authorize representatives of this County to enter a upon e ov -menti ned property for inspection purposes a f / / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant 0r Agen Date ©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 0810200007 PHONE: (626) 285-0488 EXT: . LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 6133 6135 GOLDEN WEST AV 1STRUCTURE: 3175 V-B TEMP CA 917801754 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15385-020-027 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl TENANT: JEXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: EXIST OCC GRP: 110/20/08 SR 1 1OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: 1FIN/AL DATE FINAL BY: CODE: (BIRCHES HOME OWNERS ASSOCIATE - 6,750 1 16129 GOLDE WEST AVE. I I TEMP 917801754 FEES PAID IDES R PTION OF WORK IRE-ROOF WITH COMPOSITION SHINGLES, TERMITE REPAIRS, DRY ROT I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IREPAIRS. I (APPLICANT: TEL. NO: I I IQUEMADA (626) 806-5410- IAA BLDG PERMIT ISSUANCE 27.75 I I 15122 E. BEVERLY BL. IAC STRONG MOTION RESID 6750.00 VAL 0.68 ISPECIAL CONDITIONS: I ILOS ANGELES CA 90022 ID2 PERMIT W/O EN-HC 6750.00 VAL 166.20 I I TOTAL FEES 194.63 I (CONTRACTOR: TEL. NO: i (APPROVALS DATE INSPECTOR SIGNATURE I IJ Q CONSTRUCTION (323) 263-5411- 1 15122 E. BEVERLY BLVD. LIC. NO 1LOCATION AND SETBACKS ILOS ANGELES, CA 90022 570652 B 1 I I I I I I ISOILS ENGINEER APPROVAL I I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUNDATION/TRENCH FORMS I I LIC. NO: I (SLAB/UNDER FLOOR I I IRAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 (UNDERFLOOR INSULATION 1 I 1150H269 3 001 I I I I IFLOOR SHEATHING I I I 1NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I NO 21 I IROOF SHEATHING It SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS _-1 (AIR QUALITY: 1000 FEET MATERIALS I I I NO NO NO I 1FRAME INSPECTION I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I I I 1SET BACK YARD: HWY: PROP LINE: WIDTH: I 1FRONT PL- I 11NSULATION/WEATHER STRIPI I SIDE PL- I I I I I I 11NTERIOR LATH/DRYWALL I 1EXTERIOR LATH I I 1RATED FLOOR/CEIL ASSEM. I 1RATED WALL ASSEMBLIES I 1 IRATED SHAFTS/OPENINGS I IT-BAR CEILINGS I ILOT DRAINAGE (REPORT ID: DPR261 ROUTE TO: BSO508 I I I I I I I I I