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Home My Public Portal About9056 HERMOSA DR_Building__ 1 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUI ING ADDRESS I hereby affirm that I have a certificate of consent to self insure, pensation Insurance,or a certified BWL ING ADDRESS d or a certificate of Workers'Com 'S copy thereof(Sec.3800,Lab.C.) 11 ✓ r CITY ' ZIP - Policy NOS&EOd00J4�.Company S/a.Tr-' ?✓^l^ SIZ/E?O'F P LOCALITY OT - NO.OFBLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. a-Certified copy is filed with the county building inspection TRACT - BLOCK LOT NO. - - department, •s' / USE ZONE MAP NO. Date III Applicant /��ACHA ASSESSOR MAP BOOK PAGE PARCEL ' SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS'. OWNER COMPENSATION INSURANCE —��f� WITHIN 1000 FT of SCHOOL? YES NO (This section need not be completed if the permit is for one hundred AD RE / P f� DISTRICT GROUP TY CONST. FIRE ZONE PROCESSED BY dollars 1$100)or less.) (O I certify that CITY ZIP the performance of the work for which this permit is issued. I Shall not employ any person aany manner 50 a5 f0 ARCHITECT OR ENG ER TEL NO.- U become Subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION I APT CONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR ..�c/� ` EL NO. /'9SET BACK YARD MY PROP LINE WIDTH Compensation proV151005 Of the Labor Code, you must forthwith (J/C.(I ��B/ —///� FRONT comply with such provisions or this permit shall Be Leemed revoked. ADDRESS LIC.NO P L LICENSED CONTRACTORS DECLARATION /6/S- �' A aCJP, J�1J� SIDE CRY F UC.CLASSC P L « I hereby affirm that I am licensed underprovisions of Chapter 9 �/`� 3 SEWER MAP (commencing with Section 7000)of Division'3 of the Business and SO.FT.SIA, NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect �C' / NEW ❑ BK PG a License Number (Y��B,Z r^ Date Lia Class DESCRIPTION OF/W`ORK I ADD VALUATION polo. O Contractor T -/'.7 9-.�O-9G -roar W/f r ^ ♦�, $ /TDA B� U + ALTER El // Cr P Par.r� IrAN Pf ❑ I am exempt under Sec. REPAIR ❑ $ 0_ B&PC. for this reason DEMOL ❑ COMA P/C w - UJ Date: USE OF EXISTING BLDG. �r^ URM ❑ �(�jj C G Signature. APPLICANT(PRINT) T L NO CDMA Perm x. `�^^�•AV 125.55 Z ❑ I, as owner of the property, or my employees with wages as (I OrCN .Q BF G- JmY�i•P.� Z their sole compensation, will do the Work and the structure is ADDRESS 0 1. ITEMS not intended Or Offered for sale (Section 7044, Business and lG�� SI. / 0�+✓'�i� �PyL�//1FINAL DA Q Professions Code.) C WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _ 1. OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J C ElaS owner Of the property, am exclusively contracting Wllh AMOUNTS SPECIFIED ON THE HAZARD(US MATERNLs INFORMAL ICN GUIDED FINAL B j TOTAL 1�5 55 licensed contractors to construct the project (Section 7044, Business and Professions Code.) ESO NO / CHECK 125.`5 WILL THE INTENDED USE OF THE BUIOLINR BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIA QUALITY MANAGEMENT DISTRICT ISCAOMDI SEE PERMITTING CHECKLIST FOR I , GUIDELINES - CHANGE .00 hereby affirm that there is a construction lending agency.for YES El NOIR the performance of the work for which this permit is issued(Sec. -r'� 3097, I)IV.�). IHAVEREADTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 0000-LJOoi 9/21/9.5 I CHECKLIST. UNDERSTgp1e MV REO IREMENT$UNDER THE LOS ANGELES COUNTY CODE TIRE 2,CHAPTER 2 $ECTIpN$ .20.ID0 i CUG 0.1x0 CONCERNING HAZARDOUS Lender's Name MATF3NI/ EPO �G AND F BTA1 00 R PLWI FROM THE SCAQMD. 0 Lender's Address 2412 1 AM11:02 O MINOR OR AGENT o I certify.that I have read this application and state under penalty 0 of perjury that the above information is correct.1 agree to comply P.C.FEE PERMIT FEE with all county ordinances and State laws relating to building d AT COnSarUCtiOn�, ands ereb authorize representatives of this County ISSUANCE FEE n Q to enter Upon t bo men'oged operty for inspe ion purposes. p( Ag AD INVESTIGATION FEE TOTAL FEE /f �� d w. OS SEE REVERSE FOR EXPLANATORY LANGUAGE - COUNTYOF LOS ANGELES TEMPLE CITY $ 0508 ALTERING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 40 BL 0508 0510210036 PHONE: (626) 285-05-0488 EXT. LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 5905 LT: 98 SQ. FT STORIES TYPE 9056 HERMOSA DR STRUCTURE: 1400 V TEMP CA 919801916 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA 5387-015-014 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE`. REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/21/05 VG 10/16/06 OWNER: TEL. NO: HLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: WANG, SHIM (626) 287-7097- 1 5,860 9056 HERMOSA DR (Y r- TEMP 917801916 FEES PAID DESCRIPTION OF WORK T/O EXIST ROOF, RESHEAT AND INSTALL GAP SHINGLES FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: FUN ON (323) 842-8306- AA BLDG PERMIT ISSUANCE 27.75 1948 LANSDOWNE AVE. AC STRONG MOTION REBID 5860.00 VAL 0.59 SPECIAL CONDITIONS: LOS ANGELES 90032 D2 PERMIT W/O EN-HC 5860.00 VAL 149.40 TOTAL FEES 177.74 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE FON ON (323) 342-9388- 1948 LANSDOWNE AVE LIC. NO LOCATION AND SETBACKS LOS ANGELES CA 90032 685987 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: FOUNDATION/TRENCH FORMS LIC: NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H265 3 01 N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: FLOOR SHEATHING NO 21 ROOF'SHEATHING f SCHOOL WITHIN HAZARDOUS SHEAF 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 RATEDSHAFTS/OPENINGS - T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508