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Home My Public Portal About6109 HART AVE_Building__ APIPUCATMO H FOR Q U&MR0 PERMF i1 • ', COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO.FILL IN BUILDING ADDR E BUILDING ADDRESS e hereby affirm that I have a certificate of consent to self insure, 0 a 2 or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) LOCALITY Policy No. Company SIZ OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. 60k /6L) NEAREST CROSS ST. ❑ Certified copy is filed with the count b ildin 'inspection TRA T BLOCK LOT NO. Y 9 P P / USE ZONE MAP NO. departmen. !�`7 G��' T/3��0 22 ASSESSOR MAP BOOK PAGE PARCEL r/ Dat@ j `f Applicant Fv �' �5 f� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWU�D -. 7-/ �� 7�`L.NO. �� Z /C� YES NO COMPENSATION INSURANCE• y `�� WITHIN 1000 FT.OF SCHOOL? ADDRESS p�� ,�1 _ - (This section need not be completed if the permit is for one hundred 6+/ O j W/f T i/L, DISTRICT ".GROUP TYPE CONST.' -FIRE ZONE PROCESSED BY dollars($100)or less.) Cl ZIP1/ I certify that in the performance of the work for which this permit f L,(_74 0/Z1A- %T C i3 issued,f shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. r� become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.-1-1\-2-5 DWELL UNITS NOTICE. TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST - Exemption, you ShOUId b@QDmQ subject t0 the Workers' CONTRACTOR TEL.NO.�j�� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /7"/ FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL SIDE }' a LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL 1 hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP SQ.FT SIZE �f� NO.OF STORES NO.OF FAMILIES C (commencing with Section 7000)of Division 3 of the Business and 10 + t NEW ❑ BK PG Professions Code,and my license is in full force and effect. D v DESCRIPTION OF WORK VALUATION W License Number Iyy 3 3 .f Lia Class s� r� ADD ❑ y Contractor /Z S f Date // 0 ALTER ❑ Z 11ZI)- 4• J3,IL REPAIR •❑ — ❑ 1 am exempt under Sec. B.BP.C.for this reason DEMOL LDMA P/C a Date: USE OF EXI NG BLDG. UR.M ❑ 11 1 Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# t ❑ I, as owner of the property, or my employees with wages as O/3/�� 5 S� N� yy'�SvZ. p '�•`�•i= their sole compensation,will do the work and the structure is ADDRESS �,/ -ji: «1 not intended or offered for sale (Section 7044, Business and Z 4 / Niru:r INAL DATE Professions Code. `�'�� 1 rE MS 0-1-as � ) WILL J 1 "F 1J I, as owner of theproperty, am exclusive) contracting WIt11 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOUAL.TO OR GREATER THAN Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY -J 0 licensed contractors to construct the project.(Section 7044, YES❑ No❑ '/`?G I.i I _. ,....r a Business and Professions Code.). y;6 ;=:,= =I((1 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING :, -y OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST IR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST 5 3 S�tij� of I%1 I hereby affirm that there is a construction lending agency for YES 11NO❑ the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD _ 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES i'f_ �i[S tE i 11 T7';-`I': �. COUNTY XTITLE CHAPT R2.20 SECTI NS 2.20.100 THROUGH 2.20.140 CONCERNING I=.: ---s i l.,i i"1 i Lender's Name HAZARDS TING AN OBTAINING A PERMIT FROM THE SCAQMD. A( P e aLender's Address AGtNT/ o' I certify that I have read this application and state that the above RC.FEE PERMIT FEE information is correct. I agree .to comply with all county ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE /3 the above-mentioned property for inspection purposes. INVESTIGATION FEE TOTAL FEE SiWv m of Apglum w Agem Dm SEE REVERSE FOR EXPLANATORY LANGUAGE, .',�„�:..p�• ..�,� y apG0 [��C�Q`�DOO J'Al4:: . : COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDREsS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, 0 or a certificate of Workers'Compensation Insurance,or a certified Copy thereof.(SBC.3800,Lab.C.) _ CITYQL ZIP LOCALITY n G Policy No. / 1 Company� Fc1 � � 1.; SIZE OF LOT NO.OF BLDGS.NOW ON LOT �`� �r ❑ Certified copy is hereby furnished. O X /6 Z NEAREST CROSS ST. ❑ Certified Copy is filed with t County b ding i spection TRACT p BLOCK LOT NO. department. �/U (op/�iF /d Z 2_/ USE ZONE MAP N : Date; -Applicant I ASSESSOR MAP BOOK PAGE PARCEL N � � O $ 4_/ SPECIAL CONDITIONS. CERTIFICATE OF EXEMPTION FR 11A WORKERS' OWNER ' TEL.NO. /' C' YES NO COMPENSATION INSURANCE 061g2 �i�� _b Z� WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred �� S /�Ph�i 2fz S f- ale DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY � zIP I certify that in the performance of the work for'which this permit M/'T" ��7�l 0(J �✓ ��/• is issued, I Shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become Subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date- Applicant ADDRESS CLASS NO. DWELL UNITS. NOTICE TO APPLICANT: If, after making this Certificate OfREQUIRED TOTAL SETBACK FROM. EXIST CONTR TOR TEL.NO. Exemption, you.should become Subject to the Workers' _ SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 2- FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L iJ a I s r.,i ,.� 3 5 03 �-. LICENSED CONTRACTORS DECLARATION C TY D LIC.CLASS FIDE . lv:y_F C 'i f:��;, :...0 I hereby affirm that I am licensed under provisions of Chapter 9 V`� SEWER MAP ,_• j? �; ° (commencing With Section 7000)Of DIVISIQn 3 Of the Business a •FT SIZE- NO.OF.STORES NO.OF FAMILIES -``� Professions Code,and my license is in full force and effect. �-- NEW YO BK PG CG / U License Number yQ3 Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATIO ,, n U I �(l.tJ`ir2LrC i' L i Contractor Jain v, Date-Date ` ALTER ❑ - ;:- ;• N'. 7 S 17-1 1 / D—9 s/,t.1 /L l�5/p�•✓t.2 "i.`l' 123;.•°i.� ❑ 1 am exempt under Sec. REPAIR ❑ $ d, Q"O x. afi • B.BP.C.for this reason G DEMOL ❑ LDMA P/C USt OF EXISTING BLDG. Date: i�� !Z �L URM. ❑ .:HEC Signature APP CANT(PRINT) TEL.NO. LDMA Perm# VIE 133 ❑ I, as owner of the property, or my employees with wages as d / SI CHAINGEp their sole compensation,will do the work and the structure is ADDRESSS not intended or offered for sale (Section 7044, Business and ' DOS 401, /6/L ST /l l u�yA FINAL DATE Professions Code.) % COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY/ LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1011030042 PHONE: (626) 285-0488: EXT: ILEGAL ID: 1 NO. OF CONST NEW BUILDING ADDRESS: - 1 ITR: 5904 LT: 221 SQ. FT STORIES TYPE OCCUP GROUPI. 6.109 HART AV 1. I ISTRUCTURE: 0 1 V-B R-3 I TEMP CA 917801629 1 (ASSESSOR INFORMATION NUMBER: GARAGE:- I -NEAREST CROSS STREET: GARIBALDI . I' 15384-008-023 OTHER: I THOMAS PAGE: 596 GRID: H2 LOCALITY:, TEMPLE CITY, Cl (TENANT: IEXIST BLDG USE: - USE ZONE: (ISSUED ON: PROCESSED BY: 1 1EXIST OCC GRP: 111/24/10 SR 1 JOWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINBY: CODE: I IMARSRON, LARRY (626) 276-8000- 1. 36,820 t I 16109, HART AV I' I I - ITEMP 917801629 L FEES PAID JkACRIPTION OF WORK I IROOF MOUNT PV SOLAR 20 PANEL 1 INVERTER 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (, I, JAPPLICANT: TEL. NO: 1; IPERKINS, SHAWN (951) 532-2394- D7 ADDNL PLANCHECK FEE 1.00 HOU 109.40 11452 POMONA RD. IAA BLDG PERMIT ISSUANCE 27.80 1SPECIAL CONDITIONS: ' - 1 ICORONA, CA 92882 JAB STATE GREEN BLDG FEE 36820.00 VAL 2.00 I - ID2 PERMIT W/O EN-HC 36820.00 VAL 109.40 I . I I I" TOTAL FEES 248.60 I ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE I IMOHRPOWER SOLAR INC. (951) 736-2000-. I I - I 11452 POMONA ROAD LIC. NO 1 ILOCATION AND SETBACKS I ICORONA, CA 92882 661434C46 1 I - I' - ISOILS ENGINEER APPROVAL I (ARCHITECT OR ENGINEER: TEL. NO: - JFOUNDATION/TRENCH FORMS I I - 1 LIC: NO: , J JSLAB/UNDER FLOOR I I I I (RAISED FLOOR FRAMING I I- I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1� _ 1UNDERFLOOR INSULATION I I - 3 Oo 11ST LEVEL'FDOOR SHEATH I I NO. OF FAMILIES: DWELLING UNITS: APNO/COND: STAT.CLASS:1 - I. 12ND LEVEL-FLOOR SHEATH I I I I SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING I; I (AIR QUALITY: 1000 FEET MATERIALS 1 I I i• 1 NO NO NO IFIRE DEPT. FRAME INSPECTI I I 1 11 IBLDG DEPT. FRAME INSPECTI I, ISHEAR PANELS' I I I I - - , i JINSULATION/WEATHER STRIPI I I JINTERIOR LATH/DRYWALL I I I (EXTERIOR LATH I J I I I I LOT DRAI14AGE 1 I I I I I 1 [SMOKE DETECTION DEVICES IFIRE DEPARTMENT APPROVAL( I I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I