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Home My Public Portal About6241 GOLDEN WEST AVE_Building__ m°�5 .. .. a ?KERS'COMPENSATION DECLARATION O ereby %a certifica I haver certificate of consent to self APPLICATION , FOR BUILDING PERMIT ' +rnsure,,o+ a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800;Lab. C ) .� 70`37$0"9s " S'I'oL �u>�� COUNTY OF LOS ANGELES BUILDING ANDS FET.Y Policy-No, Company - Certified.copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ❑ Certified copy is filed with the-cou ty building inspec- BUILDING tion d par ment: ADDRESS i Date ! ��' � Applicant CITY �, ZIP LOCALITY CERTIFICATE OF EXEMPTIO FROM W } KERS' �` NO. OF BLDGS. NEAREST COMPENSATION SURANC SIZE-OF LOT X 3Q NOW ON LOT 0 CROSS ST. (This section need not be-completed if the permit is for one TRACT BLOCK LOT NO. ASSESSOR, hundred-dollars ($100)or less.) MAP BOOK" PAGE PARCEL �,JEL. USE ZONE MAP /r/+ I certify that in the performance of the work for which this OWNER fllr( vt vu oA"}10, yyb"q 13 NO !/VV permit'is issued, I shall not employ any person in any mannerSPECIAL d so as to become subject to the Workers"Compensation Laws. ADDRESS pS K (IceA-6 `�� CONDITIONS CITY A lA _ ZIP. qI�� v Dale '' Appli'can't NOTICE'70' APPLICANT:'If,`after making this Certificate of ARCHITECT O t r TEL. L u DISTRICT GROUP.. TYPE FIRE PROCESSED BY ENGINEER t/Pv�S1�fiW /QSSOC.. NO. jL137 16� Exemption"`you should become subject to the-Workers' / �,f �j �(� CONST. ZONE LU Compensation provisions of the Labor Code, you.must.forth- ADDRESS 3 �s 'DLkA I,,Ir IC"1 �` (.,f(j �� ... e4 � with comply,.with°.,such,provisions ,or this permit shall be to deemed revoked, ' TEL. STATISTICAL CLASSIFI ATION APT. CONDO. z CONTRACTOR Sa a.d LJiN�``0 NO. LICENSED CONTRACTORS DECLARATION LIC. j a CLASS ±NO. DWELL. UNITS r - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business and LIC.. SEWER MAP Professions-Code, and'my license;is in full force and effect. CITY CLASS BK VALIDATION J j 3 SQ. FT. NO. OF NO. OF _ _ CHECK License Number J z Lic.Class _ SIZE ZZ STORIES / FAMILIES / ONE / C) �t/`� t �, VALUATION Contractor I��uS N�L15��" p I) �3 `�� DESCRIPTION OF WORK' Co� : f 1'� NEW " ® $ 234 5,6 A ADD ❑ 1� ❑ am exempt under Sec. k 8 uS Sl ` w�l 2we ihl , # 0 0 m 23 - I ALTER ❑ B.BP.C. for this rens n REPAIR ❑ $ ' ( o 5 8 1.4 0 Date: USEEXIOF F G BLDG. DEMOL ❑ Signature Gj'� APPLICANT TEL. ° ° rJ 8 1,"4 O g WNE - ILD DECLA TION PRINT NO. FINAL /�� j 1, 1 3=8 5 DAT (�J I hereby of i that I am a pt from the Contractor's License Law for th following reason (Section 7031.5, Business and ADDRESS FINA Professions Code): PRESENT By ❑ 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 sale(Section LOCALITY •7044, Business and Professions Code). MOVING ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. -with licensed contractors to construct the project (Sec- O 8 tion 7044, Business and Professions Code). ADDRESS ,^-# +'; t o'o o a a 1 REQUIRED TOTAL SETBACK FROM ... E T. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ` I hereby affirm that there is a construction lending agency for FRONT A a 6 9 4( 5'0 the performance of The work for which this permit is issued P.L. (Sec. 3097, civ. C.). SIDE a 6 4 4,5 0 v m P.L. Lender's Name ,.rrT� LDMA Ref,.# 1. 1 0 P.C. Fee$ e J L� 'Permit-Fee Lender's Address ;- a .1 certify that I have read this application and state-that the Issuance Fee . (!-' -LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee ® LDMA Perm.#" and hereby ou ha ize representatives of this County to enter upon th bo -me Toned property for inspectio purGyGases. vv a � SEE REVERSE FOR EXPLANATORY LANGUAGE ' 0 Signature of 4Vnt or AgelK Date - 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 917.80 BL 0508 0812160021 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST BUILDING ADDRESS: I ON FILE SQ. FT STORIES TYPE 1 6241 GOLDEN WEST AV 1 I ISTRUCTURE: 2012 V-B I TEMP CA 917801705 . 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15385-021-012 1 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-2 TISSUED ON: PROCESSED BY: I (EXIST OCC GRP: 102/11/09 SR I I I 10WNER: TEL. NO: 1BLDG9. NOW ON LOT: VALUATION: iFINAL DATE FINAL BY: CODE: 1CHEN, CHIN (626) 235-2233- 1 100,000 16241 GOLDEN WEST AV I ITEMP 917801705 I FEES PAID I CRIPTIONF WORK 1 I i 1REPLACE --(E) LF FRAMING D TO FIRE DAMAGE ONLY, REPLACE I IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IDRYWALL, KITCHEN AND 2 BATHROOMS REMODEL 1APPLICANT: TEL. NO: I I 1LIM (213) 210-3979- 1B1 PLANCHECK W/ENERGY 100000.00 VAL 1,211.62 1 17250 BANDINI BLVD. IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: I ILOS ANGELES CA 90040 IAB STATE GREEN BLDG FEE 100000.00 VAL 4.00 1 1 I IAC STRONG MOTION RESID 100000.00 VAL 10.00 I 1B2 PERMIT W/ENERGY 100000.00 VAL 1,425.44 1 1CONTRACTOR: TEL. NO: I TOTAL FEES 2,678.81 1APPROVALS DATE INSPECTOR SIGNATURE 1SOUTHERN CALIFORNIA CONSTRUCTION (714) 220-7460- 1 I I 18611 E. ROLAND ST. LIC. NO ILOCATION AND SETBACKS I IBUENA PARK, CA 90621 862893 B I I I - I 1SOILS,ENGINEER APPROVAL I I I 1ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I IJ C ENGINEERING (213) 210-3979- I 1 1 12155 VERDUGO BLVD #124 LIC. NO: 1 (SLAB/UNDER FLOOR 1MONTROSE, CA 91020 40597 I - I 1RAISED FLOOR FRAMING I I I 1 1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:i 1UNDERFLOOR INSULATION I 1153H269 3 001 1 11 I I IFLOOR SHEATHING I I I 1NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I NO 22 1 1ROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS - 1 NO NO NO 1 1FRAME INSPECTION I I IREQUIRED TOTAL SETBACK FROM EXIST 1 1FIRE SPRINKLER HANGERS ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I I 1FRONT PL- 1 JINSULATION/WEATHER STRIP( `I �� 1 SIDE PL- 1 1 JINTERIOR LATH/DRYWALL I (EXTERIOR LATH 1 a 1 IRATED FLOOR/CEIL ASSEM. 1 I (RATED WALL ASSEMBLIES I I I I IRATED SHAFTS/OPENINGS I IT-BAR CEILINGS I I I I ILOT DRAINAGE I 1 I I I I 1 I 1REPORT ID: DPR261 ROUTE TO: BS0508