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Home My Public Portal About9044 HERMOSA DR_Building__ 1-7— I _JWORKERS'COMPENSATION DECLARATION Ihe.46.iSffic tifica I have r certificate of consent to self APPLICATION FOR BUILDING PERMIT insu✓.;.or,F,certificate of Workers' Compensation Insurance, 'or+d certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES_ BUILDING AND SAFETY Policy No. Compan ❑ pr r FOR APPLICANT TO FILL IN ADDRESS rl7�.S Certified co is hereb furnished. Certified copy is filed with the county building inspec- BUILDING LZ']I tion department. _ ADDRESS LOCALITY 0.1 rV ,�• NEAREST Date � Applicant CITv / ZIP CROSS ST. L /� CECE TIS R FICA TE OF EXEMPTIO FROM WORKERS' - NO.OF BLDGS. ASSESSOR ` COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK7� PAGE PARCEL (This section need not be completed if the Permitis for one USE 77Z��ONE MAP - 'Y7 - hundred dollars ($100)or less.) TRACT BLOCK LOi /7 NO. !J TEL. - � K SPECIAL y �^ I certify that in the performance of the work for which this OWNER NO. CONDITIONS C .. DISTRICT GRQQQUUUP TYPE FIRE P OCESSED BY O permit is issued, I shall not employ any person in any manner ADDRESS 09 r ,s, /+7�CONST. ZONE U so as to become subject to the Workers'Compensation Laws. .G.04 (JY R Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APi. ONDO. V NOTICE TO APPLICANT: If,.after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS.NO.Z DWELL. UNITS_ CL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Z with comply with such provisions or, this permit, shall be Rv'a�s�¢r T L - deemed revoked. CONTRACTOR p, BK.e PG,,- VALIDATION - LICENSED CONTRACTORS DECLARATION / uC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS// y ,{ 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.' CITU / CLASS $ ,S t'O , �1 .te__K // SQ.FT. NO.OF NO.OF CHECK License Number .Class 10'/ SIZE / STORIES FAMILIES ONE��`�. DESCRIPTION OF WORK EW ❑ $ Contractor �1'— `T� S ❑ ADD I am exempt under Sec. Q A p 8 4.6 A ALTER ❑ FINAL B.BP.C. for this reason DATE REPAIR ❑ 4 . � � • � Date: USE OF DEMO ❑ FINAL By (' Signature EXISTING BLDG. •' . 6&6 3 APPLICANT TEL. ![, S OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License , 0 9.0 4�8 5 Law for the following reason (Section.7031.5, Business and ADDRESS Professions Code): p N - ❑ I, as owner of the property, or my employees with BUILDING 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. ❑ 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). REQUIRED TOTAL SETBACK FROM EXIST. _ CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for - FROM the performance of the work for which this permit it issued P.I. r - jSec. 3097, Civ. C.). SIDE Lender's Name Lender's Address P.C. Fee$ Permit Fee L•/ p f I J \ _ L I certify that I have read this application and state that the Issuance Fee /0, SO - above information is correct. I agree to comply with all County Investigation Fee Q _ gordinances and State laws relating to building construction, Total Fee J d and hereby authorize representatives of this County to anter upo above-me tioned property for inspection urposes. a r '., _ /'/�S�/`�� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of OApplicant or Agent D to • ®s Y 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 0205160044 PHONE: (626) 285-0488 EXT: LEGAL O. OF CONST BUILDING ADDRESS: TR: 5905 LT: 110 SQ. FT STORIES TYPE 9044 HERMOSA DR _ STRUCTURE: VN TEMP CA 917801841 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: SULTANA 5387-014-007 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: EXIST DG : RESID USE : R-1 ISSUED 0 PROCESSED R . EXIST OCC GRP: 05/16/02 JK 11/12/02 OWNER: TEL. N • BLDGS. NOW ON LOT: VAL ON: L DAIE HAL BY: CODE: WALKER WILLIAM R;MARTHA J (626) 286-2016- 4,000 _ l � 9044 HERMOSA DR a // i TEMP 917801841 FEES PAID ULbLRIPILUNOFRK REROOF HOUSE 8 HAL/GARAGE W/SHEATING 8 25YR COMP FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: L. - SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 4000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC -4000.00 VAL 115.80 TOTAL FEES 144.05 CONTRACTOR: TEL. O: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT ENGINEER: TEL. N0: T699UA-T-ION7TRENCH FORMS LIC. NO: SLANDER FLOOR RAISED FLOOR FRAMING AP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR NSUL T ON X 3 01 FLOOR SHEATHING . OFFAMILIES: DWELLING /CO - 5 CLASS: NO 21 ROOF SHEATHING �- SCHOOL WITHIN HAZARDOUSS AIR QUALITY: 1000 FEET MATERIALS ., NO NO NO FRAME INSPECTION REQUIRED OTAL=BAER FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR L EX ERIOR LATH RATED FL00 L ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508