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HomeMy Public PortalAbout4815 HALLOWELL AVE_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I haver certificate .of tion Insurance, self ° APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or-a certified cpay thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 44 J+ALL. OL t- ❑ Certified copy is filed with.The county building inspec- BUILDING ij ! tion department. ADDRESS P2 ll Date Applicant CITY ZIP LOCALITY. 1 fj / ! LOT NO. OF BLDGS. NEAREST CERTIFICATE-OF EXEMPTION FROM WORKERS' SIZE OF 76 NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT ASO �! BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. q OWNER p NO. f �/ USE ZONE MAP I certify that in the performance of the work for which this NO >_a permit is issued, I shall not employ any person in any manner ADDRESS G CONDITIONS O SPECIAL so as to become subject to the Workers'Compensation Laws. CITY G�f 7x-4- S U Ib� - ZIP 9- 'mak• Date Applicant ARCHITECT OR qy� TEL. �� DISTRICT G TMONSir^ FIRE E JN�VROCESSSDBY O NOTICE TO APPLICANT: If, after makingthis.Certificate of ENGINEER t7 C1 NO. (Y/ f/ Exemption, you should become subject to the Workers' / w Compensation provisions of the Labor Code, you must forth- ADDRESS�v N with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT DO. Z deemed revoked. CONTRACTORtL Q NO. — LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that l am licensed under provisions of Chapter 9 ADDRESS • NOA lZ9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. /� ��-� iJ and Professions Code,and my license is in full force and effect. CITY L- 1- CLASS �!J BK � VALIDATION SQ. FT. // NO. O NO. OF CHECK License Number Lic. Class SIZE G Q STORIES FAMILIES ONE y .CT 3 aff VALUATION DESCRIPTION OF WORK D��t {� NEW El ,1+`07 r'}r•7°'rt Contractor Dare •' DD ❑ •S ❑1 am exempt under Sec. .t ILS ` , 1 1 I ES i:7 Z L3f� � I V 11U LPAI ❑ $B.&P.C. for this reason TOTAL '`=499 ® 84 USE' REPAIR ❑ c Dater EXISTING BLDG. DEMOL CHECK❑ `'-i� � Signature APPLICANT TEL. FINALG CHANGE °rlLl OWNER-BUILDER DECLARATION. (PRINT). NO. DATE I hereby affirm that I am exempt from the Contractor's License Law for the followingreason Section 7031.5, Business and ADDRESS FINAL �Q/ ' "V -�(�t ' 2/210.' 1;z. ( !/ 130Q LS I, :fj Professions Code): PRESENT By FYJ� BUILDING 9Ew`5 I, as owner of the property, or my employees with ADDRESS y i`o00, wages as their sole compensation,will do the work and _ LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code.) MOVING TEL. , r•r•T s °g ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. A,,%A -• with licensed contractors to construct the project (Sec- ADDRESS 48;7.; _ E i tion 7044, Business and Professions Code.) r ••- REQUIRED TOTAL SETBACK FROM EXIST. L 1 I C' CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT c 1 TI:I AL 4 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE "HECK 487 .L P.L. Lender's Name °_{ ANGE °I m Q LDMA Ref. # P.C. Fee$ fJ Permit Fee 3 Lender's Address /p•�/ (/�/ Poo Issuance Fee V l/ LDMA P/C q f= t o I certify that I have read this application and state that the 100--�lil0 _/3,CD W above informati n is correct. I agree to comply with all County Investigation Fee _ _ 49A 71 i A�e! a 9 0 ordinances a Store laws relating to building construction, Total Fee LDMA Perm. N i0��• �, AtE1l.l�ar:; a and hereb r authoriz presentotives of this County to enter upon h bove- ned property for inspection rpose a G? SEE REVERSE FOR EXPLANATORY LANGUAGE gn`o 0 ppli ant or Agent Date WORKERS' COMPENSATION DECLARATION 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 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS % C ' / /! ! - LOCALITY T / NEAREST Date Applicant CITY / Y j r ZIP CROSS ST. >_CERTIFICATE OF EXEMPTION FROM WORKERS' / NO. OF BLDGS. ASSESSOR SIZE OF LOT �j ,J( I NOW ON LOT MAP BOOK PAGE PARCEL a COMPENSATION INSURANCE O (This section need not be completed if the permit is for one USE ZONE MAP U hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. ;i W TEL. 1 SPECIAL I certify that in the performance of the work for which this OWNER NO. CONDITIONS Li permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY >_so as to become subject to the Workers'Compensation Laws. ADDRESS YYI�` CONST. ZONE Cie DateApplicant ° CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. 0 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. d Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP H with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO, BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 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 CLASS SO. FT. NO. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE © S DESCRIPTION OF WORKv NEW Contractor Date ❑ ADD ElI am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer ALTER ❑ FINAL / acting in my professional capacity (Section 7051, ❑ DATF//_< REPAIR Business and Professions Code). USE OF FIN EXISTING BLDG. DEMOL ❑ Lic. or Reg. No. Date APPLICANT ) TEL. By � / OWNER-BUILDER DECLARATION (PRINT) i NO. 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 4 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 TEL :5. f 7 ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. Lj with licensed contractors to construct the project (Sec- " • • • • • tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST. ? • ?p {! SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT k the performance of the work for which this permit is issued P L • • 1 2,,4 Q o (Sec. 3097, Civ. C.). SIDE / h Y!2 Lender's Name m P.C. Fee S Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee f above information is correct. I agree to comply with all County Investigation Fee 1 0 ordinances and State laws relating to building construction, J r, m Total Fee and hereby authorize representatives of this County to enter U upon the obovb-mentloned.propCr7 ;for inspection purposes. a �,,,f; y - l• ./ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant 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 1204170006 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST I BUILDING-ADDRESS: ITR: 15098 LT: 6 1 SQ. FT STORIESTYPE 1 4815 HALLOWELL AV - 1 I (STRUCTURE: 25 t7-B TEMP CA 917803457 1 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 18585-016-014 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY, Cl (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: 1 IEXIST OCC GRP: 104/17/12 SR (OWNER: TEL NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FI AL BY: CODE: IYOU ESTHER S - 8,000 1 �.. 14817 HALLOWELL AV TEMP 917803457 FEES PAID IDESCRIPTION OF WORK I IPICK UP AND RELAY EXISTING ROOF TILES, REMOVE FELT AND NAILSI IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IINSTALL NEW MODIFIED FELT ONE LAYER 1 (APPLICANT: TEL. NO: I I I ICOOL ROOFING INC. (323) 695-5634- IAA BLDG PERMIT ISSUANCE 27.80 1 IAB STATE GREEN BLDG FEE 8000.00 VAL 1.00 ISPF.CIAL CONDITIONS: I IAC STRONG MOTION RESID 8000.00 VAL 0.80 I ID2 PERMIT W/O EN-HC 8000.00 VAL 183.00 1 I TOTAL FEES 212.60 ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE ICOOL ROOFING INC. (323) 695-5634- 1 I_ I 1424 E. I ST. LIC. NO 1 ILOCATION AND SETBACKS I I 1 (ONTARIO, CA 91764 548382 C39 I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLP.3/UNDER FLOOR 1 1 I I I I IRAISED FLOOR FRAMING 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I 1144H273 3 001 I I I I IFLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I 0 NO 21 I IROOr SHEATHING 1 1 I-_ �I 1 SCHOOL WITHIN HAZARDOUS 1 (SHEAR PANELS I 1AIR QUALITY: 1000 FEET MATERIALS I I I 1 NO NO NO I IFRAME INSPECTION I I I IFIRE SPRINKLER HANGERS I I (INSULATION/WEATHER STRIPI I I II- I I I _i 11NTERIOR LATH/DRYWALL I I 1EXTERIOR LATH I I I (RATED FLOOR/CEIL ASSEM. I I 1 IRATED WALL ASSEMBLIES I I I I I I IRATED SHAFTS/OPENINGS 1 1 1 IT-BAR CEILINGS 1 1 I I I LOT DRAINAGE 1 I IREPORT ID: DPR261 ROUTE TO: BS0508