Loading...
HomeMy Public PortalAbout8624 HERMOSA DR_Building__ WORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT i%ereby affirm that I have a certificate of consent to self ins re, or a certificate of Workers"Compensation Insurance, or{ certified copy thereof (Sec 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company �j ❑ Certified copy is hereby furnished. F/9-EJ?W-5A OR APPLICANT TO FILL IN nooeEss 9�p� �/1 wcQQd- El �I . Certified copy is.filed with the county building inspec- Sro`Z4' E •I'�RmaSR p� ,. tion department. S G Date Applicant NE TEM FLE CI ZIP 1TI E) LOCALITY t CERTIFICATE OF EXEMPTION FROM WORKERS' F LOT +0 X�5�O f NOW ONNO OF LOT ✓ CROSSSST. - Q, �tJ COMPENSATION INSURANCE •� / �7 ASSESSOR (This section need not be completed if the permit is for one J t07 3 BLOCK 53S� LOT NO.' I'� 1 MAP BOOK 5,3 9 7 PAGE 0O (0 PARCEL 02.0 hundred dollars($100) or less.) - vo& L .CVON4i 4 TEL p- may, E - SES USE ZONE OP certify that in the performance of the work for which thisG ,f �Lper,, d r��� SPECIALpermit is issued, I shall not employ any person in any manner S p b ZT L"[ F-ftV5A- 'CT4 CONDITIONSso as to becomeL�subject to the Workers'Compensation Laws. Sf�N �/�3 R/t<L ZIP 9 77rJ' OU Date - / _ • ApplicantE�ET,L•�-•'^ yECT OR/' TEL C�UU'���/�NOTICE TO APPLICANT: If, after makhng this Certificate of EER Ci 4F w�t"r-7 P.6 Np.2 0 "65 DISTRICT GROUP TYPE FIRE PRO ED BY O Exemption, you:should become subject to the Workers' �, �• aCON$T� Z�provisions of the Labor Code, you must forth- SS 91,24- Compensation f}EJ?W-5A DR $off �'/ ,80E S®$. ^ a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C O. Z deemed revoked. CONTRACTOR NO. q _ LICENSED CONTRACTORS DECLARATION - LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter'? 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 VALIDATION SO. FT NO. OF NO. OF ) 'CHECK License Number Lic. Class SIZE STORIES FAMILIES II ONE VALUATION Contractor Date DESCRIPTION OF WORK ADP Ivew NEW ❑ f V7,500 - 00 ❑I am exempt under Sec. /3�D(ZDOM 0222 S.F•7 ADD -E , _ ALTER ❑ B.BP.C. for this reason - $ USE OF REPAIR ❑ Date: _ EXISTING BLDG. FE51oaNcE DEMOL ❑ Signature APPLICANT CBJI2QE CVUA/C' TEL. nn rv� (PRINT) Vvo L 4xoN NO. '`'4 SQ�bS FINAL OWNER-BUILDER DECLARATION DATE ?J hereby affirm that I am exempt from the Contractor's License _ Law for the following reason (Section 7031.5, Business and ADDRESS FINAL / i'ACCT. - Profpssions Code): PRESENT . BY 3 30; j 50 U 50. /`CR_1F BUILDING J I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and � - 1 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code-) MOVINGCONTRACTORNO.TEL. ' r r r/I ACCLAT S lVV/� i I, as owner of the property, am exclusively contracting 3303 4.11.98 with licensed contractors to construct the project (Sec- ADDRESS ITEI IS ,/ 3 tion 7044, Business and Professions Code. 7 REQUIRED TOTAL SETBACK FROM EXIST. TOTAL 46 CONSTRUCTION LENDING AGENCY SET BACK YARD HWV PROP. LINE WIDTH `2 Te4'4' hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. - CHECK 462.48 (Sec. 3097, Civ. C.). SIDE P.L. CHANGE .00 Lender's Name �+ y I - P.C. Fee$ J © �O Permit Fee �7 � E Ref. q Lender's Address OOOO-0001 7/ 1/96 I certify that I have read this application and state that the Issuance Fee 3� LDMA P/C It 8 above information is correct. I agree to comply with all County Invest go ion Fee 7216 1 FM 5:09 ordinances and State laws relating to building construction, Toml Fee - LDMA Perm. p a and hereby authorize representatives of this County to enter m upon th above-mentioned property for inspection purposes. - a ]— f (o SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturdy of Applic or Agent Date ' WORKERS' COMPENSATION DECLARATION 850402 SB hereby affirm that I havecertificate of consent to =elf APPLICATION FOR BUILDING PERMIT insure,'or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lob, C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No V85-22515kinp.m remont Indemnity Certified co is hereby furnished. BUILDING ❑ copy Y FOR APPLICANT TO FILL IN ADDRESS �. CL Certified copy is filed with the county building,inspec- BUILDING tion department. ADDRESS '8624 E. Hermosa Dr. LOCALITY. San Gabriel NEAREST Date 8/26/85 Applicant Virgin Roof Co. CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDG5. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE Z NE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. I NO. Mrs. Brown TEL, SPECIAL I certify that in the performance of the work for which this OWNER NO. CONDITIONS ,d permit is issued, I shall not employ an DISTRICT .GROUP TYPE FIRE PROC ED BY 0 p p y y person in any manner ADDRESS 8624 E. Hermosa Dr. � - f CONST. ZONE 09 so as to become subject to the Workers'Compensation Laws. � 3 CITY San Gabriel ZIP 0 Dote Applicant STATISTICAL CLASSIFICATION APT. CO O. h NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL, V Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. iL DWELL. UNITS_ d Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Vf with comply with such provisions or this permit shall be o Z deemed revoked. - CONTRACTORV L rg I n Roof Co. N�87—DSD] BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION . P.O. OX J "C' 160650 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 San Gabriel CLASS C39 $ 1284.D() pop. FT. NO. OF t NO. OF CHECK License Number (1011 Lic.Class C39 SIZE STORIES FAMILIES ONE Contractor V rq in Roof Co-Date 8/26•/85 DESCRIPTION OF WORK Tear off one roof NEW ❑ ❑ I am exempt under Sec. E re-roof with Class A fiberglii`i; ❑ ALTER ❑ FINAL B.BP.C. for this reason `comp. shingles. 11 squares ❑ DATE REPAIR Date: USE OF dwe 1 1 i n EXISTING BLDG. 9 DEMOL ❑ FINA R 2 9 1.9 A _ Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT Virgin Roof Co. No. 287-0507 g e . ° e e 1 1 hereby affirm that I am exempt from the Contractor's License P.O. BOX J SGabriel 91 778 Law for the following reason (Section 7031.5, Business and ADDRESSF an o49.88 Professions Code): - PRE ENT x ❑ BUILDING ° ° . 4 9.8 8 I, as owner of the property, or my employees with ADDRESS O 9. 1 6—8 5 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 FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD Hwv PROP. UNE WIDTH - I hereby affirm that there is a construction lending agency for FRONT the performance of the work forwhichthis permit is Issued P.L. is 3097, Civ. C.). SIDE P.L. Lender's Name _ Lender's Address P.C. Fee$ Permit Fee 26,25 rc I certify that I have read this application and state that the Issuance Fee 10.50 a above information is correct. I agree to comply with all County Investigation Fee g ordina ces and State laws relating to building construction, Total Fee 36.75 d and h reby authorize representatives of this County to enter upon t e above-mentioned p arty or pection p rposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ure of Applicant or Agent Date ®s WORKERS' COMPENSATION DECLARATION 10`3 7b-5 I hereby affirm that I haver certificate of consent to self APPLICATION FO•-R�f--BUILDIGER T insure, oro certificate of Workers' Compensation Insurance, ora certified copy thereof (Sec. ry, Lab. o COUNTY OF LOS ANGELES / � BUILDING AND SAFETY If Policy No.IV 8 3—22 5 1 50 pony, Fremont Indemnity BUILDING eY, 7 Certified copy is hereby furnished. .FOR APPLICANT TO FILL IN- / ADDRESS w y �Y Certified copy is filed with the county building inspec- BUILDING v✓ '—T /_ -.4 Cy/ tion department. ADDRESS -8624 E. Hermosa Drive LOCALITY Cit le Tem Dore 12/20/83 Applicant Virgin Roof Co. clry p Y ZIP 91780 cNROSSEARESTST CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ONLOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one _ O USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK �_ O O LOT NO. l� NO. TEL R SPECIAL >.OWNER MTs. M. BTOWR TEL 287-6573 CONDITIONS d I certify that in the performance of the work for which this - DISTRICT GROUP TYPE FIRE PROCESSED BY O permit.is issued, Ishot(not employ any person manymanner ADDRESS 8624 E. Hermosa Drive CONST. ZONE V so as to become subject to the Workers'Compensation Laws. U 2 rc-Nmo "c'ITY Temple City ZIP 91780 , 93 3 V2J •6-A O Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. �J Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. y ' DWELL. UNITS_ I W W Compensation provisions of the Labor Code, you must forth- ADDRESSSEWER MAP W Z with comply with such provisions or this permit shall be TEL. deemed revoked, coNTRacroR Virgin Roof Co. No 287-0507 BKPG, VALIDATION LICENSED CONTRACTORS DECLARATION P.O. BOX J Llc. 160650 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 San Gabriel LTO' C39 VALUATION Professions Code, and my license is in full force and effect. CITY CLASS S 50. 650.00 FT. NO. OF - NO.OF - CHECK , 7 8.6 6 A License Number,-160650 Lic,Class C39 SIZE - STORIES FAMILIES ONE Contractor Virgin Roof CO. Date 12/20/83 DESCRIPTION OF WORK Re-roof house NEW E] $ # o o a o o El rear flat deck only with 231F ADD I am exempt under Sec ALTER E] FINAL _/� (fY� B.BP.C. for this reason & 72#. 4 squares REPAIR DATE r /` 2 0 0 3 3 0 0 USEDEMOL . Date: EXISTING BLDG. By FINAL 4_4 (1 o e o 3 3,0 0 6 Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. 3 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):. ^ F,ENT I, as owner of the property, or my employees with BUILDING 3,l20 ADDRESS „'y//n��y ,7,l2'0 wages as their sole compensation,will do the work and fC IY { the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. as I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project(Secy. ADDRESS 'tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWv PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. Pilo (Sec. 3097, Civ. C.). SIDE ' P.L. .. - Lender's Name Z..19ro Lender's Address P.C. fee$ Permit Fee — y+O > Oe ( O r I certify that I have read this application and state that the Issuance Fee '"'_'�org. � above information is correct. I agree to comply with all Count 9 PY Y Investigation Fee 8 ordinances and State laws relating to building construction, Total Fee 334 andlhereby authorize representatives of this County to enter upt�T the obove_mentione roper inspection purposes. •/ur, l..J/�/ SEE REVERSE FOR EXPLANATORY LANGUAGE ignoture of Appli ant or Agent Dote .®s ' WORKERS'COMPENSATION DECLARATION f•I hereby affirm that I have certificate of consent to self inAPPLICATION FOR BUILDING PERMIT yll�ll sure, or a certificate of Workers' Compensation Insurance, or a certified copy 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 Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date Applicant CITY L r ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE Z/.)NE� MAP I certify that in the performance of the work for which this OWNER Q�/✓ NO. /{/(_/ NO. permit is issued, I shall not employ any person in any manner SPECIAL •. so as to become subject to the Workers'Comp nsation Laws. ADDRESS CONDITIONS U Date - L/ �iZApplicant T /C.� CITY C ZIP NOTICE TO APPLICANT: If, after making this C ificate of ARCHITECT OR TEL, DICT GROUP TYPE FIRE CESSED BY O ENGINEER NO. K/J CONST. ZOtJ� U Exemption, you should become subject to a Wt forth • / .JTi Compensation provisions of the Labor Code, you must forth- / v W with comply with such provisions or this ADDRESS p y p permit Shall be TEL. �7/// STATISTICAL CLASSIFICATION APT. CONDO. (f) deemed revoked. CONTRACTOR - /(� Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO._11—DWELL. UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. O 3/ SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and my license is in full force and effect. CITYQ CLASS BK PG VALIDATION SO. H. NO.OF NO.OF CHECK License Number � O 3 13 Lic.Class � SIZE STORIES FAMILIES ONE / �rr� ❑ VALUATION / Contractor P. H.�O/✓5 Z �/6 - i y DESCRIPTION OF WORK NEW S(J/}✓� L Date ADD E] $ Sec. , I am exempt under Se ! G / N ❑ AVER B.BP.C. for this reason REPAIR $ Date: USE Of DEMO. / EXISTING BLDG. Signature ti + T /I)� APPLICANT TEL. FINAL -7 OWNER-BUILDER D RATION PRINT NO. DATE Z Z. I hereby affirm that I am exempt ram the Contractors License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By BUILDING I, as owner of the property, or my employees with ADDRESS 8 9 6 6 A wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sole(Section e is a,e a 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. e o 4 0 5 0 with licensed contractors to construct the project (Sec- ADDRESS e e e 4 0,5 0 50 tion 7044, Business and Professions Code). CONSTRUCTION (ENDING AGENCY SETOP. T BACK YARD HWY UIRED TOTAL RpLINE WIDTH I hereby off irm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. tY m P.C. Fee f Permit Fae Y110 ' Lender's Address t I certify that I have read this application and state that the Issuance Fee LDMA P/C R above information is correct. I agree to comply with all County Investigation Fee /y ` ordinances and State laws relating to building construction, Total Fee !/,J LDMA Perm. R 9 and hereby authorize representatives of this County to enter m RR upo a abov mentioned roperty for inspection purposes. mr —el—�y SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ap licant or Agent Dote . Yc9kIYERS' COMPENSATION DECLARATION Ae T J'I I H'u affirm that I have certificate of consent to self PPLIC�4 ■ ION , F®R BUILDING PERMIT �I�JII insure, or a certificate of Workers'Compensation Insurance, 41or //"" a•certified-topy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company n!� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN . ADIDRESS p( s.1177/ Certified copy is filed with the county building inspec- BUILDING ` n tion department. ADDRESS Dale Applicant CITY ZIP C, O LOCALITY r CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ^ NEAREST COMPENSATION INSURANCE SIZE OF LOT / NOW ON LOT aL CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT I BLOCK LOT L'NO. MAP BOOK PAGE PARCEL OWNER USE ONE MAP TE �1 - /� �V (L/ NO.�e ��li _ I certify that in the performance of the work for which this � NO. permit is issued, I shall not employ any person in any manner �+ Z L t i SPECIAL ADDRESS so as to become subject to the Workers'Compensati laws. CONDITIONS 0 Dote 'Z /a Applicant CITY ®LE-- Gi - ZIP C7/7 ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after maki this Certificate of DISTRICT GgpUP TYPE 'FIRE PRO ESSED BY C) Exemption, you should become subject to the Workers' ENGINEER NO. ^�;/ /)� CONSi� ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS J\r. OV lye, V UJ with comply with such provisions or this permit sholl be TEL d deemed revoked. STATISTICAL CIASSIFIGgTION A C NDO. to CONTRACTOR NO. I Z LICENSED CONTRACTORS DECLARATION - LIC CLASS N0. Z DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MHP (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 BK PG VALIDATION SO. FT 5 6 OF FA. Of CHECK License Number Lic.Class SIZE NO FAMILIES ONE Contractor Date DESCRIPTION OF WORK = 006L, NEW ❑ VALUATION �G / ADD ❑ $ , I am exempt under Sea (//L6 l✓E�� ALTER x B.BP.C. for this reason REPAIR ❑ $ Dote: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT EE''TT__ TEL O FINAL) / pyGG1� -// OWNER-BUILDER DECLARATION PRINT) /C/JtW NO.N �- - DATE` / I hereby affirm that I am exempt from the Contractor's License _ Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT By ; BUILDING 9�1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and 000, e the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. 1, 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). - CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit.is,issued P.L. (Sec. 3097, Civ. C.). SIDE P.I. Lender's Name $ _ LDMA Ref. R Lender's Address P.C. Fee E Permu Fee a ' I certify that 1 have read this application and state that the Issuance Fee LDMA P/C R c above information is correct. I agree to comply with all County Investigation Fee q ordinances and State laws relating to building construction, Total Fee c V LDMA Perm. R R and hereby authorize representatives of this County to enter upon the above-me I dproperty for inspection 13urposgs. •/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signal a of Applicant or Agent Dote COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0204050056 PHONE: (626) 285-0488 EXT: LEGAL ID: . OF CONST BUILDINGADDRESS: TR: 3623 LT: 117 SQ. FT STORIES TYPE 8624 HERMOSA DR -E STRUCTURE: 400 SGAB CA_917753007 ASSESSOR0 N E --_ ._..__ _. ... __ _ _ __ .. _ ._. _. .:.______._.- -- NEAREST CROSS STREET: BURTON - - - - 5387-006-020 THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: R SI S PROCESSED ES 0 - EXIST OCC GRP: 04/05/02 JK 10/02/02 NER: -_ TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: GLORIA HONG. . (626) 583-8968- _<300 2982 SHAKESPEARE DR _ SAN MARINO 91108 _ - EES P D-S R DEMO GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: 0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN 163.50 SPECIAL CONDITIONS: TOTAL;FEES 191.25 GES CO CONTRACTOR: TEL- N0: yOS �/�/�,y APPROVALS DAT INSPECTOR SIGNATURE NAO LIC- NO PEDESTRIAN PROTECTION SEWN- DISCONNECTION ARCHITECT OR ENGINE R: A DONRIVA SPOSAL CHANG, NELSON CHI-MIN G (213) 485-7725- 9157 CAMINO RAL AVE LIC. NO: 1111111 UNDERGRND STRUCT REMOVAL SAN GABRIEL, CA 91775 NONE AND SOIL RECOMPACTI ON MAP NO: SEWER MAP BOOK: PAGE: FIRE ON CN01+ nn (� pO L�C �nnO��J NO. OF FAMILIES: DWELLING CO D: STAT I-- NO vU NO 23 SCHOOL HAZARDOD US7, AIR QUALITY: 1000 FEET MATERIALS O NO NO NO Gb��c ServiOce REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL RDD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0203070060 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDINGADDRESS: TR: 3623 LT: 117 SQ. FT STORIES TYPE OCCUP GROUP 8624 HERMOSA DR E STRUCTURE: 1196 1 VN R3 SGAB CA 917753007 ASSESSOR INFORMATIOW NUM ER: GARAGE: 441 1 VN U1 NEAREST CROSS STREET: BURTON 5387-006-020 OTHER: THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY TEXIST BLDG USE: USE ZONE: ISSUEDN: PROCESSED BY: EXP . EXIST OCC GRP: 04/23/02 VG 10/20/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: D ^� FINAL BY: CODE: GLORIA HONG (626) 583-8968- 107,379 /C/// 2982 SHAKESPEARE DR SAN MARINO 91108 FEES PAID DESCWIPTIONRK ADD 2BD/28A, FAMILY RM & LAUNDRY, REPLACE DETACHED FEE DESCRIPTION: QUANTITY: LION: AMOUNT: 2-CAR GARAGE APPLICANT: TEL. NO: SAME AS OWNER - B1 PLANCHECK W/ENERGY 107379.00 VAL 1,254.40 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 107379.00 VAL 10.74 B2 PERMIT W/ENERGY 107379.00 VAL 1,475.76 TOTAL FEES 2,768.65 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: -TEL­_W-_ ION/TRENCH CHANG, NELSON CHI-MIN G (213) 485-7725- 9157 CAMINO RAL AVE LIC. NO: SLAB_/UNDER FLOOR SAN GABRIEL, CA 91775 NONE RAISEDFLOOR FRAMING (•jFoz MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION- 3 01 0. OF FAMILIES: DWELLING UNITS: A S C S L EL FLOOR SHE H NO 21 2ND LEVEL FLOOR SHEATH SC 00 IT IN RAZARDOUS _ SHEATH ING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL 0M EXIST BLDG DEPT. FRA NSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: FSL- INSULATION/WEATHER IDDE PPL_ SHEAR PANELS I A O WEATHER STRIP C� INTERIOR LATH/DRYWALL j•��,.Z _ EXTERIOR LATH LOT DRAINAGE SMOKE-DETECTION DE C FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508