HomeMy Public PortalAbout9014 HERMOSA DR_Building__ WOKE4y QMBENSATIO?! D.C4R7+11ON, + �i
?reby affirm the f have a certificate of co?fsenf Ifo self ,J APPLICATION .FOR BUILDING PERMIT
ick -e, oro certificau;,rf Workers' Compensation Insurance,
or• certified copy thereof (Sec. 3800, Lob. C.) -
COUNTY OF LOS ANGELES 'BUILDING AND SAFETY
Policy No. Company BUILDING /r'1
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING
.tion(( ��
department. ADDRESS /1�di`i �, �.
Date��� 7 sL Applicant CIN ZIP LOCALITY TEIMLLQ li /
O. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM W RKERS' 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 PAGE PARCEL
hundred dollars ($100) or less.) TEL,
OWNER e- NO. USE ZONE MAP
I certify that in the performance of the work for which this n ,,r NO.
P employ any y •IL-n QJ/'1 �, SPECIAL }
ermit Is Issued, I shall not em to an person in an manner ADDRESS a
CONDITIONS Q
so as to become subject to the Workers' Compensation s. � - U
/ CIN ZIP
Date 21Uy l/Applicant - ARCHITECT OR r TEL.1DISTRICT/ ROUP TVPE FIRE PROCES D By Q
NOTICE TO APPLICANT: If, after making this i irate of ENGINEER Ar1)J1 O. CONS . ZONE �
Exemption, you should become subject to a Workers' /nJif'' CJ.
Compensation provisions of the Labor Code, u must forth- ADDRESS p 5+ V L/ •3 l 1 d
with comply with such provisions or this permit shall be r TEL STATISTICAL CLASSIFICATION APT CON N
deemed revoked. CONTRACTOR' (jjYI.TI NO. ,.} z
LICENSED CONTRACTORS DECLARATION // uc r 9 CLASS NO. DWFLL. uwrs
I hereby affirm that I am licensed under provisions of Chopter9 ADDRESS - U o5F,?& NO -U J -SEWER MAP 7 A
(commencing with Section 7000)of Division 3 of the Business CTT, e � CLA55 B AC\/A;IDATION
LIC
and Professions Code,and my license is in full force and effect. CIT F7.p 2 NO. OF !� NO. OF CHECK. BK' �'
License Number 7 Lic. Class' �� _
SIZE 3 � STORIES 4 FAMILIES ONE
Z.L . ` DESCRIPTION OF WORK Z-STOICY ADDITIN) NEW ❑/ VALU Ti N j ITEMS
Contractor Date c ADD - IJ _$ , TC!TR� 350 . 00
❑I am exempt un er Sec. JTo EXIST/i✓6, J'5?V log
1 'ALTER ❑ 11//��``�� �,.yr/���� NEC 1}
B.BP.C. for this reason ¢ zN� 'F � Sl.r'r� �� +'P' REPAIR ❑ $ c✓�Moto p O(D LO �X 3e0r!�V
USE OF / 7 ti CHANGE .Ui!
Date: EXISTING BLDG. ��1�G^rG� DEMOL ❑ - '
Signature - APPLICANT - TEL. q:
g OWNER-BUILDER DECLARATION (PRINT) No. FINAL 1_$ f
I hereby affirm that I am exempt from the Contractors license -- v
DATE 1'V !�IJCL�-IJO41 1!�/�0�-39/
Low for the following reason (Section 7031.5, Business and ADDRESS FINAL1 - A_� 6448 1 AM 111:!
Professions Code): PRESENT - By -(i'�(1/W�✓
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS 4
wages as their sole compensation,will do the work'and - ' to + L
the structure is not intended or offered for sale(Section LOCALITY _
7044, Business and Professions Code.) MOVING TEL. - ,, .r _T A
CONTRACTOR NO. e -
yi_,,t v
I, as owner of the property,am exclusively contracting - _ '
with licensed contractors to construct the project (Sec- ADDRESS "!�� %-•^I=
tion 7044, Business and Professions Code.)
REQUIRED TOTAL SETBACK FROM EXIST: '
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH. S IT II.
I hereby affirm that there is a construction lending agency for FRONT - - - T(LTaI +� _ -70
the performance of the work for which this permit is issued P.L. t
(Sec. 3097, Civ. C.). - SIDE
Lender's Name ' �j �) •'LDAl RbYN
� v-+\ J s\{1{ HANtGE
I it
m P.C. Fee$ /ar Permit Fee =v Fy .A -,=
Lender's Address �''JT'/�/f\\� //l� Poo
�N
certify' that have read this application and state that the 3 / V Issuance Fee "'LJ LDML{{LP IY
8 above information is correct.,)agree to comply with all County Investigation Fee t+'i
R ordinances and State laws relating to building construction, Tatal Fee r LD Perm. p 9i ,i i AM�i;ijY
a and here aut ri re sent ives of this County to enter tr
upon t be - nti or
_inspection purposes. r.t ® t )
SEE REVERSE FOR EXPLANATORY LANGUA®E
Sig tore of Applic i or Agent Dote
COUNTY OF LOS ANGELES TEMPLE CITY k 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0507130059
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 5905 LT: 126 SQ. FT STORIES TYPE 9014 HERMOSA DR
STRUCTURE: VN TEMP CA 917801837
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5387-014-023 5 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 07/13/05 JK 07/08/06
OWNER: TEL, NO: BLDGS. NOW ON LOT: VALUATION: FIN --CODEDATE NAL BY:
REYNA RAYMOND S (626) 286-7466- 10,000
9014 HERMOSA DR
TEMP 917801837 FEES PAID DESCRIPTION OF WORK
KITCHEN REMODELING
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL, NO:
ROYAL BUILDERS (323) 464-4625- AA BLDG PERMIT ISSUANCE 27.75
5419 SUNSET BLVD 227 AC STRONG MOTION REBID 10000.00 VAL 1.00 SPECIAL CONDITIONS:
LOS ANGELES 90027 B2 PERMIT W/ENERGY 10000.00 VAL 238.26
TOTAL FEES 267.01
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ROYAL BUILDERS (323) 464-4625-
5419 SUNSET BLVD, #227 LIC. NO LOCATION AND SETBACKS
LOS ANGELES, CA 90027 803030B
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: £OCCSDATION/TRENCH FORMS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
XX 3 01
_ FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH: -
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: ES0508