HomeMy Public PortalAbout10628 HALLWOOD DR_Miscellaneous__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1012290001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
ITR: 19189 LT: 65 SQ. FT STORIES TYPE OCCUP GROUPI 10628 HALLWOOD DR
I (STRUCTURE: 1 V-B R-3 I TEMP CA 917804124
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: PAL MAL
18585-028-018 IEXIST BLDG USE: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl
I IEXIST OCC GRP:. R-3 USE ZONE: 1
TENANT: I (ISSUED ON: PROCESSED BY:
IBLDGS. NOW ON LOT: VALUATION: 112/29/10 VG
I 1 0 1
(OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE:
ILI CHENG (626) 757-3516- ILIST ITEMS: 1 I
110628 HALLWOOD DR I
ITEMP 917804124 1 IDESCRIPTION OF WORK 1
IREMOVE UNPERMITTED STORAGE ROOM INSIDE GARAGE I
I IOCCUP LOAD EXIST: I I
(APPLICANT: TEL. NO: 1OCCUP LOAD NEW: I I
ISAME AS OWNER - I I I
I IPARKING SPACES REQUIRED: (SPECIAL CONDITIONS: I
I IPARKING SPACES PROVIDED: I
I I I I
1 1EXIT HARDWARE: _ 1
ICONTRACTOR: TEL. NO: I I LIMITED TIME USE I
ISAME AS OWNER - INBR OF EXITS: I FROM .TO I
1 LIC. NO I I 1
1 1 FEES PAID I- I
I 1APPROVALS DATE INSPECTOR SIGNATURE
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 1'
(ARCHITECT OR ENGINEER: TEL. NO: I 1TRAILER USE I
I - 10A PERMIT ISSUANCE 27.80 1_. I
I LIC. NO: 101 R/M OCC/USE INSPECT 146.00 ISAFETY PERMIT I 1 I
1 1 TOTAL FEES 173.80 1 I 1 I
I ITEMP. STRUCT. APPROVED I
I I 1__ I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 ITEMP. STRUCT.'REMOVED I
1 I I I I
1 I I I I
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I i
NO
I I I I I I
1 SCHOOL WITHIN HAZARDOUS
1AIR QUALITY: 1000 FEET MATERIALS
1 NO NO NO 1 I I I I
EXPIN"ED
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
IREPORT ID: DPR267 ROUTE TO: BS0508 I I
W RICERS'COMPENSATIONDECLARATION CE 875 MISCELLANEO SAPPLICATION
CE 875(11-84) 'ytl Icy I�
I-hereby affirm that I have a certificate of consent tself COUNTY OF.LOS ANGELES BUILDING AND SAFETY DIVISION
insure, or a certificate of Workers'Compensation Insurance,
e,or
a certified copy thereof(Sec. 3800,Lab.C.).
Policy No. Company -'
FOR APPLICANT TO FILL IN ;, BUILDING /1
ADDRESS C—X/
Certified copy is hereby furnished. BUILDING -
ADDRESS 'LOCALITY
Certified copy is filed with the county building inspection LOCALITY
NEAREST
department. CROSS ST.
Date Applicant NEAREST DISTRICT NO G UP TYPE PROCESSED BY
CROSS ST. Cwa
O
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL V
COMPENSATION INSURANCE DESCRIPTION LOT NO.. BLOCK HIGHWAY
- (CIH CLE) STATE MAJOR SECOND LOCAL
NO: OF BLDGS. -
(This section need not be completed if the work involved TRACT NOWO N LOT US ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) sE OF (//)
I certify that in the performance of the work for which this SIZE of Lor OF
BLDG. �[ o
permit is issued, I shall not employ any person in any manner OWNER ���JJJ
so as to become subject to the Workers' Compensation Laws. MAIL A�CC ANCY GROUP a
ADDRESS
Date ApplicantTEL
uC3,
NOTICE TO APPLICANT: I£, after making this Certificate of CITYNO. W OCCUPANT LOAD
Exemption, you should become subject to the Workers' AP LIGATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this permit shall be TRAILER USE ❑ I GEOLOGY INSPECTION ❑ No Spec. Knowl. ❑
deemed revoked.
LICENSED CONTRACTORS DECLARATION �` Panic Devices El
OCCUPANCY INSPECTION
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ i(LIsT ITEMS BELOW)
9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS
ness and Professions Code, and my license is in full force and
effect. PARKING REO'D D PROVIDED O
PACES
License Number Lic..Class
LIMITED TIME USE
Contractor Date DATE DATE
1 am exempt from the licensing requirements as I am a FROM. TO.
licensed architect or a registered professional engineer SIZE OF NO.'OF INS ECTO R'S
acting in my professional cdpacity (Section 7051, Bus- EXISTING BLDG. STORIES S GNATURE
iness and Professions Code).
LIc.or Reg.No. Date FINAL APPROVAL
PRESENT USE OF BUILDING /
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND USE
I hereby affirm that I.am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): NO.PARKING
❑ 1, as owner of the property, will do the work and the SPACES PROVIDED
structure is not intended or offered for sale (Section
7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY PROP sED usE OF BUILDING f
I hereby affirm that there is a construction lending agency z T1 A
for the performance of the work for which this permit is °�
issued(Sec. 3097,Civ.C.). f ° °'
Lender's Name
PROPOSED MAX. OCC. I `O O O 8 ciJ Q - O
Lender's Address
I certify'that I have read this application and state that the PERMIT FEE � /0 1 � �, I 6-88
above information is correct.I agree to comply with all County ISSUANCE FEE O'
ordinances and State laws relating to building construction, ✓ ;
�r[d au rize representatives of this County to enter TOTAL FEE `
upon t a ove- ntioned pr perty for ins ction purposes. / ,
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of P ittee Date