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Home My Public Portal About9011 HERMOSA DR_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOC ANGELES _ BUILDING AND SAFETY _ WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR s I hereby affirm that I have a certificate of consent to self insure, BUILDING or a certificate of Workers' Compensation Insurance,or a certified copy thereof ( ec.3800 L.C.) P�IZE ZIP ' _ _�� LOCALITY • Policy NO.� Company�� T "I NO.OF BLOCS NOW ON LOT ❑ Certified copy is hereby furnished 1 NEAREST CROSS ST. ACertified copy is filed with the county building inspection BLOCK LOT No. department. �� • USE 20NE MAP NO Date Applicant � FJ�LS?/� ASSESSOR MAP BOOK�� PAGE O/6 PgRGELO/� _ 2 SPECIAL CONDITIONS ell) m�— a/ CERTIFICATE OF EXEMPTION FROM WORKERS' o NEH TEL No. r/, G COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS, er 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 � is issued, I shall not employ any person i any manner SO a5 t0 ARCHITECT OR ENGINEER TEL NO. J• D become subject t0 the Workers'Compensation ion Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS - CLASS NO s2 DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIREDTOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR - TEL NO SET BACK YARD HWV PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith wtosl FRONT comply with such provisions or this permit Shall be Seemed revoked. AD�DIRPSS LIC. 4- NO. / P L I I I 'J M I��.i7'1�N� -5 '1 SIDE LICENSED CONTRACTORS DECLARATION CIuG.GLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 1,vXo t SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES I NO.OF FAMILIES / l Professions Code,a�ntl�myy�ice�nse is in full force and effect. - j NEW ❑ BK PG ry,� , s a License Nu�m��bb1er��J-��rdt1 Lic. Class DESCRIPTION OF WORK ADD VALUATION �R7(� Q Contracto�L�Lz]Miiibte �r -�jl-�J4 ALTER ❑ $ cc ❑ 1 am exempt under Sec. REPAIR ❑ $ It— B&P,C.for this reason DEMOL ❑ U LDMA P/G# _ III Date: us OF E STING BILD13. ` �..�^ URM ❑ _ EL Signature APPLICANT(PRINT) Y~•1 T CDMA Perm C. El 1, as owner of the property, or my employees with wages as �" ,"L - _l Q � 'H-_�•1 .'e' their sole compensation, will do the work and the structure is ADDRESS �-t - --I -- not intended or Offered for Sale (Section 7044, Business a0d I . FINAL DATE N tiQ Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ,J 1 Ela5 Owner Of the property, am exclusively contracting with OR SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Ar 7 - licensed contractors to construct the project (Section 7044, I YES❑ NOa Business and Professions Cade.) IN OU-1.75 _10cv c: WILL THE INTENDED USE OF THE DUIDUNG BY THE APPLICANT OR FUTURE BUILDING ,j`�1{_ 7:• OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COUIOE IAIR UAUTY MANAGEMENT DISTRICT GCAOMD)SEE PERMITTING CHECKLIST FOR y ?i 1.1 I hereby affirm that there is a corutruction lending agency for YES El NO� Fi e -7� the performance of the work for which this permit is issued(Sea I=1 j AL 6 6 ® -` q Y IHAVEREAD THE HAZARDOUS MATERIALS MFORMATION GUIDE AN SCAOMDPERMo TING _ _ •; 3097,Civ.C..) � ♦ CHECKLIST I UNDERST D MY REOUIREMENTS R THE O GELES COUNTY CODE. � f' - .)`9 �•r�� TITLE 2,CHAPTE SECTIONS O.10D T GH 2 4 ONCERNING HAZARDOUS t-H'- I`. --'O1' Lender S Name ra l MATERIALS R ING AN AINI A PERMIT No _ o Lenders Address t'hril"•`' J_ 0 o I certify that I have read this application and state under penalty oP.C.FEE PERMIT FEE of perjury that the above information iS orrect.I agree to comply �•— with all county ordinances and Sta laws relating to building ' m constr tion, antl herehy author r eaentative5 of this County ISSUANCE FEE �/ ,/ - (�•;•�: _ h,h'I •� tc e r e above- ntio y for inspection purposes. (o }ice r"'` •' T .�?.L�4 INVESTIGATION FEE TOTAL FEE / ') (O ( / u�J / SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY,OF LOS ANGELES TEMPLE CITY k 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1305160035 PHONE: (626( 285-0468 EXT: (LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITA: 5904 LT: 169 SQ. FT STORIES TYPE 9011 HERMOSA DR (STRUCTURE: V-B TEMP CA 917801836 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 15384-016-019 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl I _ (TENANT: IEXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 105/1.6/13 SR 1 TOWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION JFINAL DATE FI AL BY: CODE: SAMARTIN, ROSEMARIE (626) 309-9292- 1 1,600 19011 HERMOSA DR T:7A;h[// TEMP 917801836 FEES PAID T-DfESSCCRIPTION OF WORK IREPLACE COUNTER TOPS AND REPLACE EXISTING GARDEN WINDOW IN IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT': IKITCHEN WITH NEW SLIDER (WINDOW SIZE 3'H X 51W) APPLICANT: TEL. NO: SAME AS OWNER - iAA BLDG PERMIT ISSUANCE 27.80 I AB STATE GREEN BLDG FEE 1600.00 VAL 1.00 ISPECTAL CONDITIONS: I AC STRONG MOTION REBID 1600.00 VAL 0.50 IB2 PERMIT W/ENERGY 1600.00 VAL 90.40 CONTRACTOR: - TOTAL FEES 119.70 TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO ILOCATION AND SETBACKS I I I (SOUS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL NO: (FOUNDATION/TRENCH FORMS I LIC. NO: iSLAP/UNDER FLOOR RAISED FLOOR FRAMING I I I (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 IUNDE^FLOOR INSULATION I I I XX 3 001 -I (FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: , NO 21 jROOF SHEATHING I SCHOOL WITHIN HAZARDOUS SH=A PANELS (AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION I IFIRE SPRINKLER HANGERS I_ IINSUI-ATION/WEATHER STRIPI I I I INTERIOR LATH/DRYWALL (EXTERIOR LATH I IRATED FLOOR/CEIL ASSEM. I RATED WALL ASSEMBLIES I I I I (RATED SHAFTS/OPENINGS IT-BAR CEILINGS ILOT DRAINAGE I (REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY N 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS ALTERATION/REPAIR - BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1008110061 PHONE: (626) 285-0488 EXT: j LEGAL ID: N0. OF CONST BUILDING ADDRESS: j JIB: 5904 LT: 169 j SQ. FT STORIES TYPE j _ 9011 HERMOSA DR j I ISTRUCTURE: 1580 V-B j TEMP CA 917801836 j (ASSESSOR INFORMATION NUMBER: j NEAREST CROSS STREET: ROSEMEAD 15384-016-019 �, j THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C ]TENANT: IEXZST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY: EXIST OCC GRP: 108/11/10 VG OWNER: TEL. NO: jBLDGS. NOW ON LOT: VALUATION: I ATE FIN B' : CODE: jSAMARTIN, ROSEMARIE (626) 309-9292- 8,900 9011 HERMOSA DR `� ) IIYV `)TEMP 917801836 FEES PAID D S PTION OF WORK IT/O EXIST ROOF, RESHEAT AND INSTALL COMP SHINGLES ON HOUSE ]FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( ]APPLICANT: TEL. NO: ]SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 AS STATE GREEN BLDG FEE 8900.00 VAL 1.00 ]SPECIAL CONDITIONS: j IAC STRONG MOTION REBID 8900.00.VAL 0.90 j ID2 PERMIT W/O EN-HC 8900.00 VAL 200.30 j TOTAL FEES 230.00 ) CONTRACTOR: TEL. NO: SAME AS OWNER APPROVALS DATE INSPECTOR SIGNATURE ] - LIC. NO - ]LOCATION AND SETBACKS I I I SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS LIC. NO: ]SLAB/UNDER FLOOR I I I (RAISED FLOOR FRAMING ]MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: j (UNDERFLOOR INSULATION XX 3 00 (FLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: j NO21 (ROOF SHEATHING / SCHOOL WITHIN HAZARDOUS SHEAR PANELS ]AIR QUALITY: 1000 FEET MATERIALS NO NO NO j ]FRAME INSPECTION I I � j FIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIP] I I ]INTERIOR LATH/DRYWALL (EXTERIOR LATH I I ]RATED FLOOR/CEIL ASSEM. ]RATED WALL ASSEMBLIES j IRATED SHAFTS/OPENINGS jT-BAR CEILINGS LOT,.DRAINAGE (REPORT ID: DPR261 ROUTE TO: BSO508 I I I I 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 1008110064 PHONE: (626) 285-0488 EXT: (LEGAL ID: N0. OF CONST BUILDING ADDRESS: ITR: 5904 LT: 169 SQ. FT STORIES TYPE 9011 HERMOSA DR I _ISTRUCTURE: 1580 V-B 1 TEMP CA 917801836 1 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: ROSEMEAD 15384-016-019 THOMAS PAGE:. 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 TISSUED ON: PROCESSED BY: (EXIST OCC GRP: 08/11/10 VG I I IOWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: 1 rb FINpL BY: CODE: ISAMARTIN, ROSEMARIE (626) 309-9292- ON, </7S\/ 19011 HERMOSA DR TEMP 917801836 FEES PAID I DEVORAPTION OF WORK I T/0 EXIST ROOF, RESHEAT & INSTALL COMP SHINGLES ON DET GAR I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 APPLICANT: TEL. NO: SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 1A STATE GREEN BLDG FEE 1000.00 VAI, 1.00 SPECIAL CONDITIONS: 1AC STRONG MOTION RESID 1000.00 VAL 0.50 I ID2 PERMIT W/0 EN-HC 1000.00 VAL 65.40 TOTAL FEES 94.70 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER _ LIC. NO iLOCATION AND SETBACKS (SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. N0: iSLAB/UNDER FL I OUR IRAISED FLOOR FRAMING NAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( IUNDERFLOOR INSULATION XX 3 001 1 FLOOR SHEATHING ! �� N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I 1> NO 21 ROOF-SHEATHING SCHOOL WITHIN HAZARDOUS 1AIR QUALITY: 1000 FEET MATERIALS SHEAR PANELS NO NO NO FRAME INSPECTION I I I (FIRE SPRINKLER HANGERS 1 I I I I I IINSULAT ION/WEATHER STRIP( 1 1 INTERIOR LATH/DRYWALL , IEXTERIOR LATH I I I RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES Ii 1RATED SHAFTS/OPENINGS T-BAR CEILINGS I I I ILOT DRAINAGE IREPORT ID: DPR261 ROUTE TO: BS0508