Loading...
HomeMy Public PortalAbout4820 HALLOWELL AVE_Building__ WORKERS'COMPENSATION DECLARATION insure, ora affirm certif certificate of Worke srlificate Compe'nsat oof n'ms Insu Insurance, APPLICATION FOR BUILDING PERMIT � 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 �✓�� Id�,� / ADDRESS Certified copy is filed with the county building inspec- BUILDING q // / tion department. ADDRESS ,C 0 11Q ([ (v Q l LOCALITY / NEAREST f� Date Applicant CITY 1 + ZIP V CROSS ST `V e,-k— CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 17 I NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one ++ ra Bi" USE ZONE MAP �j hundred dollars ($100)or less.) TRACT /-3 BLOCK OT NO. t! ( � NO. C' d & ZTEL. y [ ' SPECIAL >_ I.certify that in the performance of thE r which this OWNER e a NO. -5 .�( CONDITIONS IL permit.is issued, I shall not employ any any manner G / 6J' P' ( DISTRICT GROUP TYPE FIRE PROCESSED BY O / so as to become subject to the Workerssatior>,La ADDRESS p 1 0 / t 110 Wel/ .� . p'f CONST. ZOy{NE p U '�( CITY /e C l( ZIP l p � �� s1��6� O Date Applicant / -� STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after making this Certi icate of ARCHITECT OR TEL. 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 with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR TEL.NO. r BK 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. d Professions Code, and my license is in full force and effect. CITYCLASS $ SQ. FT O. OF NO. OF CHECK License Number Lic.Class SIZE TORIES lFAMILIES ONE Contractor Date DESCRIPTION OF WO �l�ZG NEW ❑ $ I am exempt under Sec. ADD ALTER ❑ FINAL B.&P.C. for this reason REPAIR DEMOL ❑❑ DATE r/✓�"� — . Dater � USE OF EXISTING BLDG. �, _,�,� B Signature APPLICANT TEL. �;A/z/ OWNER-BUILDER DECLARATION PRINT NO. n 7 1 hereby affirm that I am exempt from the Contractor's License , Jrl� I" Law for the following reason (Section 7031.5, Business and ADDRESS .Professions Code): PRESENT r J1 BUILDING 1 2511 511 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ". c o 0 0 0 the structure is not intended or offered for sale(Section kADDRE 7044, Business and Professions Code). TEL. p� © I, as owner of the.property, am exclusively contracting CTOR NO. 11 ,30 o - 2 9 0 C 17 with licensed contractors to construct the project (Sec- c, ` c 0,2 u H tion 7044, Business and Professions Code). ED TOTAL SETBACK FROM EXIST. n 7 CONSTRUCTION LENDING AGENCY CK YARD HWY PROP. LINE WIDTH , 'C 1 hereby affirm that there is a construction lending agency for T the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name $ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee Aq. -,5v above information is correct. I agree to comply with.all County Investigation Fee O g ordinances nd tate laws relating to building construction, Total Fee d and hereb�a horize rep sen tive of this County to enter m upon they ve-men ' ed pr p t. or inspection purposes. a �F6 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date es 117 - - t 4� - WORKERS' COMPENSATIO'_v =cARATION ,in bQr afirm that certif cot, of WWorkers' Compensat on hve a certificate of eInsuran nt Jo of APPLICATION FOR BUILDING PERMIT �fiVj ccly�'4hereof (Sec: 3800, Lob. C.) (( /�f�, � � � COUNTY OF LOS ANGELES " BUILDING AND SAFETY Polic,Ao. Conipanyz ❑ � Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDIrJG ADDRESS F1Certified copy is filed with the county building inspec- BUILDING tion department.`` ADDRESS Date /99 wpplicant CTh /t' / ZIP l LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS.SIZE OF LOT NOW ON LOT CROS NEAREST Q COMPENSATION INSURANCE (This section need not be completed if the permit is for one TRACT ,36 i jS � )�h ASSESSOR hundred dollars ($100)or less.) BLOCK LO O. r/ P BOOK PAGE PARCEL TEL. US�EO N E MAP I certify that in the performance of the wor for which this OWNER M <-, F`! NO. / - NO. �" a ✓ �J /a� / SPECIAL ] permit is issued, I shall not employ any Pers n any m er ADDRESS '_!s 1 �1�r f7:,� 1 ' CONDITIONS so as to become bject to the Workers'C pens ws. t Date Applicant CITY-7 y_0'7-11 ZIP V/ 1j•) V' NOTICE TO A PLICANT: If, after makingthis C rtificate of ARCHITECT OR / TEL. > DISTRICT G UP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER (/�rF� NO. ✓� ✓l � CONSAT./ ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS V W `7`���L' r�✓l with comply with such provisions or this permit shall be D_t TEL. STATISTICAL CLAS TION APT. fpNDO. N deemed revoked. CONTRACTOR �'�r- NO. ���� z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. ®DWELL. UNITS 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 Ti PG. VALIDATION SQ. FT. NO. OF n NO. OF CHECK License Number Lic.Class SIZE !J STORIES pL• FAMILIES ONE 1 .l VALUATION ,f Contractor Date DESCRIPTION OF WORK • 24�,ar $ /)J� V� ❑ I am exempt under Sec. ( �Ae>fJ //t ! � � 'T . ❑ ITER B.BP.C. for this reason K AAJ A 1 REPAIR ❑ $ Date: USE OF OF ❑ EXISTING BLDG. a DEMOL Signature APP PRIA TTAd , t NO. FINAL / OWNER-BUILDER DECLARATION DATE o I hereby2 affirm that I am exempt from the Contractor's License '0 4 0' Law for the following reason (Section 7031.5, Business and ADDRESS FINAL o,9 fessions Code): PRESENT BY oBUILDNG ro I 1, as owner of the property, or my employees with ADDRESS VV. S { 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. - ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project,(Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FR CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 0 7 2 9 A hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. # o'0 0 0 0 (Sec. 3097, Civ. C.). SIDE P.L. o62ZOO Lender's Name P.C. Fee$` L IJ•J Permit Fee G/"I' LDMA Ref. # 0 0 6 2.7,,0 0 6 Lender's Address g I certify that I have read this application and state that the Issuance Fee LDMA P/C# 09,2 X88 g above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and 7State laws relating to building construction, Total Fee � f LDMA Perm. # and hereby Vvy,orize representatives of this County to enter upon the a o e-menty'o4A pr9perty for inspection purposes. ��" .A SEE REVERSE FOR EXPLANATORY LANGUAGE de- Signature of Appji,conf or Agent Date a",�WORKERS' COMPENSAdION DECLARATION hereIhave a certificate of consent to s insure,-br a certifil atte•of Workers' Compensation Insurancef - APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab, C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ,20 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING s ?� O 4Well `~ tion department. o Date 2-/J-&- /Applicant CIT ` ZIPd LOCALITY NO. OF BLD S. NEAREST CERTIFICATE OF EXEMPTION.FROM.WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if,the permit is for one TRACT BLOCK LOT NO. MAP BOOK I PAGE PARCEL hundred dollars ($100) or less.) TEL. USE ZONE MAP OWNER O NO: I certify that in the performance of the work for which this p SPECIAL >- permit is issued, I shall not employ-any person in any manner ADDRESS '�- �p� CONDITIONS :r te� ?�? /0`a- so as to become subject'to the Workers'Compensation Laws. J� - O CITY ZIP U Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making.This Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE Exemption, you should .becorne. subject .to the Workers' �iyrJ V �l �V Compensation provisions.of-the,Labor Code, you must forth- ADDRESS ' G✓✓[O1 GSC- UJ with comply with such provisions or this permit shall beTEL. STATISTICAL CLASSIFICATION APT. CONDO. U)deemed revoked. CONTRACTOR ��JLf"�L _ NO. Z " / LICENSED CONTRACTORS,DECLARATION LIC. CLASS NO.-,Z DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business. LIC.' SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK. PG. VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE I STORIE5 FAMILIES ONE VALUATION Contractor Date ff�II N F WORK -- (/ — NEW ❑ $ y"y/ ww ADD' 4 ❑ // D17D G ► ❑I am exempt under Sec. ("` ALTER B.BP.C. for this reason eREPAIR ❑ E Date: USE OF EXISTING BLDGRO-r ,­ 04 4 DEMOL ❑ Signature APPLICANT TEL. (PRINT) NOFINAL OWNER-BUILDER DECLARATION . . DATE t 1 hereby affirm that I am.exempt.from The Contractor's Licenser. Law for the following reason (Section 7031.5, Business and ADDRESS FINA! ._ -� Professions Code): PRESENT JAI. property, By BUILDING I, as owner of theor mY with C' 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 , {'� _ :� ` a ° ( ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. _ t with licensed contractors to construct the project (Sec- ADDRESS t`'8'` '9'"� '" 6 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 ,:=az.jL , the performance of the.work for which this permit.is issued. P.L. (Sec. 3097, Civ. C.).. SIDE P.L: - Lender's Name )=II_IS)" ___. .4 14 \ LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address o I certif/inform read this app_ lication and state that the Issuance Fee � �� LDMA P'C# 0 8 above correct: I a ree to comply with all County Investigation.Feed ordinae laws re t' g To building construction, t Total Feel LDMA Perm. # and hze re fives of this County to enter upon ta perty for inspection pr s SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Applicant or Agent _ Date 'w " 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 0810220019 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 13645 LT: 11 BL: .001 I SQ. FT STORIES TYPE 4820 HALLOWELL AV I (STRUCTURE: V-B TEMP CA 917803456 1 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 18585-017-015 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY, C! (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: 1 IEXIST OCC GRP: 110/22/08 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE 'it Y: CODE: IKHAIR, PETER (626) 926-0866- 1 200 1 ,, 1 14820 HALLOWELL AV 1 1 �Al&=FIRED TEMP 917803456 FEES PAID (DESCRIPTION OF WORK '1 I 1 IREPLACE ROTTED DRYWALL & DOOR 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 (APPLICANT: TEL. NO: I I 1 IMR. HANDYMAN (626) 836-8601- 1AA BLDG PERMIT ISSUANCE 27.75 1 1 1150 E. MONTECITO AVE 1AC STRONG MOTION RESID 200.00 VAL 0.50 ISPECIAL CONDITIONS: 1 (SIERRA MADRE 91024 ID2 PERMIT W/O EN-HC 200.00 VAL 43.65 TOTAL FEES 71.90 1 I i I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IMR. HANDRYMAN (626) 836-8601- I I 1 1150 E. MONTECITO AVE. LIC. NO I (LOCATION AND SETBACKS 1 1 1 ISUITE B 807495 1 1 I 1 I ISIERRA MADRE, CA 91024 ISOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I 1 1 LIC. NO: I ISLAB/UNDER FLOOR I I I 1 1 IRAISED FLOOR FRAMING I I I I I I 1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 1UNDERFLOOR INSULATION I I 1144H273 3 001 1 1 I I I I (FLOOR SHEATHING I 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I 1 1 1 NO 21 1 IROOF SHEATHING I I I 1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I I 1AIR QUALITY: 1000 FEET MATERIALS I I I 1 NO NO NO IFRAME INSPECTION I I I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I (FRONT PL- I 11NSULATION/WEATHER STRIPI I I SIDE PL- I I I I 1 1 I 11NTERIOR LATH/DRYWALL I I I I 1 (EXTERIOR LATH I 1 I I I I I I I I IRATED FLOOR/CEIL ASSEM. 1 1 1 1 IRATED WALL ASSEMBLIES I I 1 IRATED SHAFTS/OPENINGS 1 I I � I 1 1 IT-BAR CEILINGS I 1 1 I I I I 1 ILOT DRAINAGE 1 1 I I i I I I I 1 1REPORT ID: DPR261 ROUTE T0: BSO508 !1� �� 51 W I