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Home My Public Portal About9073 HERMOSA DR_Building__ WOpKERS' COMPENSATION DECLARATION - I � ` I her`eb'y affirm that I have a certificate of consent to self AP�ICATION FOR BUILDING PERMIT _ insure, or a certificate of Workers Compensation Insurance, - ' or a certified co thereof (Sec. 3800, Lab. C.) �rCOUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.I J, da pany 4;fZ µ ❑ Certified copy is hereby furnished. v - FOR APPLICANT TO FILL IN ADDBUIRESS „ ❑ Certified copy is filed with the county building inspec- _ BUILDING /I �.y ^�r� - m� tie de rtalent. ADDRESS L� F I664 2 L - Date_CF Applicant —_ Clryly ZIP LOCALITY NO. OF BLDG5. �F . NEAREST CER IFICATE OF EXEMP ON FROM WORKERS' SIZE OF LOT IW— NOW ON LOT T 5T. COMPENSATION INSURANCE L- r� CROSS CROSSASSESOR;/ / ' (This section need not be completed.if the permit is for one TRACT u �Q•O BLOCK LOT NO. � MAP BOOK 5� PAGE /5 PARCEL �2 •`.hundred dollars ($100)or less.) - F,�Pyr. TEL pp,, qp rr OWNER I IZ• S•MOR LE T' NOCr�t�" ^tT USE ZONE MAP .certify that in the performance of the work for which this _ NO. oZ • perm it is issued, shall not employ any person in any manner ADDRESS ;FO73 /C CONDITIONS d . so as to become subject to the Workers' Compensation Laws. -T- �sr� . - O CITY ' 1 F rP� F_-Ci 7' ZIP - U Date - Applicant ARCHITECT OR TT TEL. W NOTICETO APPLICANT: If, after makingthis Certificate of + - ENGINEER S 76 W(�Qan NO � DISTRICT GROUP TYPE - - FIRE PROCESSED BY Q CONS7. Z NE I- . Exemption„you should become subject to the Workers' T�-� is/ / U Compensation provisions of the,Labor Code, you must forth- ADDRESS 9J I T' 60 IZEI� �ZZ. .Amr-A DIA" J_Y' '!V L(e.�_�8,� a with comply with such provisions or this permit,sholl be L/, L. r r• STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR 7 �- /J /j / - _ LICENSED CONTRACTORS DECLARATION - LIC. �./ CLASS NO. DWELL. 11NITS I hereby affirm that I am licensed under provisions of Chapter ADDRESS P O• LX '`1/Lbo NO. //�'y/� SEWER MAP (commencing with Section 7000)of Division 3 of the BusinessIC. - and Professions Code,and my license is in full force and effect. - CITY 'U'v/`�'`��ErV/d L_r'y . 9/// U ss BK. 4 C PG. VALIDATION SO. FT. NO. OF NO. OF CHECK License Number `• Lic..Class SIZE Z� STORIES I FAMILIES ONE VALUATION r. Contractor�sPJe�✓'Cvrrs'r Date . DESCRIPTION OF WORK/aDs�DI�LN••sG NEW ❑ .s ,/ 1 '❑I am exempt under Sea ► h/� � CX•_}R.r�1` . 0� -ADD ❑ �J - 1-pl.+ . j�/�i ru�Dh ALTER_.❑ 8.8P.C. for this reason REPAIR ❑ $ Date: USE OF ��/+� - EXISTING BLDG. t-a.(y• DEMOL ❑ Signature ,, APPLICANT - TEL. 6 FINAL _i ;IP OWNER-BUILDER DECLARATION (PRINT) G WOf•-i NO. I hereby affirm that I am exempt from the Contractor's License _ _�y.� r'. 'r� �q•� I. DATE -•/ T f(hL i Law for the following reason (Section 7031.5, Business and ADDRESS ✓(y '1fdsTu-1Po"`Ar FINAL Professions Code)., - - PRESENT - - - - By _ - . . •.i BUILDING ❑ I, as owner of the property, or my employees with ADDRESS - - wages as their sole compensation,will do the work andLOCALITY _ ' - . �' ti•q�� V�' a\� the structure is not intended or offered for sale(Section .7044, Business and Professions Code.) MOVING- TEL. I !t-= 1, as owner of the property,.am exclusively contracting , CONTRACTOR' NO. with licensed contractors to construct the project (Sec- - - " - t-, j��` tion 7044, Business and Professions Cade.) ADDRESS r - •• - HFI REQUIRED TOTAL SETBACK FROM EXIST. r - CONSTRUCTION LENDING AGENCY � SET BACK � YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT. the performance.of the work for whichthis.permit is issued P.L. (Sec. 3097, Civ. C.). SIDE rj;:. CD . . .P.L.' "s_ T- T� 33---a- tiN Lender's Name %'t � 1` S _ /)� LDMAlRef. q P.C.'Fee $ / Permit Fee Lender's Address ll11 Pri , I certify that I have read this application and state that the Issuance Fee �7{-7 LDMA P/C 8 above information is correc A agree t omply with oll County Investigation Fee ordip n s and Sto_t 'a relating building constru tion, Total Fee J•c� LDMA Perm.rp and there Guth e r resentotiv of this Coun to ent th upon e boye-m ntio ed e r or mspectiopu oses. - SEE REVERSE FOR EXPLANATORY LANGUAGE / $j nature of App icant or Agent f D to �iJ h! -77� ••`U "''� a WORKERS' COMPENSATION DECLARATION. ,. I hereby o certificate that haver certificate of consent to self APPLICATION -.FORS BUILDING PERMIT' ' insure, or o certificate of Workers( Compensation.Insurance, ' , or a certified copy thereof (Sec. 3800, Lab C:) COUNTY OF LOS ANGELESBUILDING AND SAFETY -policy No. Company, ❑ Certified copy'i`shereby furnished. . - FOR APPLICANT TO FILL IN ADDRESS _ ) ❑ Certified copy is filed with the,county building..inspec- " BUILDING / �� - -- tion.department. ADDRESS pp ,,00 "7.,h ' - Date , Applicant CITY" l� �. l/ 0 / / •r a' LOCALIN _ • CERTIFICATE OF EXEMPTION FROM WORKERS' , SIZE OF LOT NOW N LOT ' NEAREST . COMPENSATION INSURANCE CROSS SL LL ASSESSOR _ _ (This section need not be completed iftFe.Permit is for one - TRACT' BLOCK LOT NO. Iv1APBOOK _ pAGE PARCEL hundred dollars ($100).or less.) - - _ TEL. USE ZONE. MAP OWNER . L' .NO. 'q - NO. . -I certify that in the,performance of.the work for which this - . k I/ SPECIAL' - .d permit is issued,'I shall not employ any person in any manner ADDRESS- �f �. - CONDITIONS O so as to become subject to the Workers' Compensation Laws. — _ .. T U - CITV - - C/� ZIP 70 — - - , 2' Dote - Applicant - - ARCH TECT O TEL. DISTRICT' ' GROUP TYPE FIRE "PROCESSED BY O NOTICE TO,APPLICANT: If, after makingthis Certificate of ENGINEER NO. •"' t- CONST: ZONE .(.J Exemption, ou,should become subject .to the Workers' ? ' / Compensation provisions of the Labor Code you must forth- - ADDRESS - - - • ��' -J V N with,comply with. such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION - .. APT. - CONDO. Z deemed revoked.' - CONTRACTO NO. _ LICENSED CONTRACTORS.DECLARATION )'. - LIC. CLASS NO. DWELL. UNITS— ADDRESS NO. hereby affirm ith I am licensed of Division of Chapters SEWER MAP '(com mencinq with Section 7000)of'Division 3 of�the'Business ". � � LIC. ' and Professions Code,and my license is in full force and effect. _ CITY CLASS BK VALIDATION ' SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE - Contractor Date— DESCRIPTION OF RK/ - NEW VALUATION -❑ _ $ �v � - ❑I am exempt under Sec. - ADD EJa ALTER ElS B.BP:C. for this reason ) O U r REPAIR ❑. $ Date: USE OF. _ - EXISTING BLDG. DEMOL ❑ Signature - - - APPLICANT - TEL. . FINAL " OWNER-BUILDER DECLARATION '(PRINT) NO. q , 1 hereby affirm that I am exempt from the Contractor's License • - - _ , - DATE 7 "Law for the'following reason (Section 7031.5„Business and ADDRESS FINAL Proff Scions Code): - PRESENT - - By ® BUILDING _ y I, as owner of the property, or'myemployees with ADDRESS - wages as theirrsole 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 theproperty,am exclusively contracting CONTRACTOR NO. - with licensed contractors to construct the project'(Sec_- - i'tli?L i-=s ,� =r ADDRESS tion 7044, Business and Professions Code.) REQUIRED YARD HWY TOTAL'SETBACK FROM' EXIST.,' "CONSTRUCTION LENDING AGENCY SET BACK . PROP. LINE WIDTH I hereby affirm that there is o construction lending agency for FRONT - me performance ofthework for which this'permit is issued P.L. - (Sec. 3097, Civ. C.). .-SIDE.' . - .R Lender's Name LDMA Ref: N Permit Fee -� - 14_�_r ) ,ilii Lender's.Address a I certify that I have read this application and state that the Issuance Fee LDMA P/C q 8 ,above information is correct.i agree to comply with all County Investigation fee - R ordinances and St6fe laws relatirig to building construction, Total Fee' - 6 LDMA perm. p. a and hereby authorize representatives of this County to enter o e q ve-rn ed.prope y for.'Lpst' purpose}. -? /y 91. fL(j $EE REVERSE FOR EXPLANATORY LANGUAGE - Signotur f Ad icant or Agent Date , COUNTY OF LOS ANGELES TEMPLE CITY 4 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0909210015 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO, OF CONST ' BUILDING ADDRESS: ITR: 5904 IT 334 SQ. FT STORIES TYPE 9073 HERMOSA DR STRUCTURE: V-B TEMP CA 917801917 ( ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HART 5384-015-032THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl (TENANT: IIEXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: I IEXIST OCC GRP: 109/21/09 SR I IOWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: (FINAL DATE ///JJJ FINjjjU, BY: CODE: I 1TRAN, TAM T (626) 602-6118- 1 15,000 11 9073 HERMOSA DR TEMP 917801917 FEES PAID DESCRIPTION OF WORK I IKITCHEN, BATHROOM REMODEL AND REPLACE 14 WINDOWS I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 1 (APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 1 AB STATE GREEN BLDG FEE 15000.00 VAL 1.00 SPECIAL CONDITIONS: AC STRONG MOTION REBID 15000.00 VAL 1.50 82 PERMIT W/ENERGY 15000.00 VAL 33D.66 IFR INV WORK W/O PERMIT 257.00 DOL 257.00 `�f urltYA�I�IM�IL�iQ�'"�W UAIe�eY CONTRACTOR: TEL. NO: I TOTAL FEES 617.91 APPROVALS k DATE INSPECTOR SIGNATURE ISAME AS OWNER - I LIC NO I LOCATION AND SETBAC%S I I ISOILS ENGINEER APPROVAL IARCHITECT OR ENGINEER: TEL, NO: I FOUNDATION/TRENCH FORMS I - I I_ I LIC. NO: I (SLAP/UNDER FLOOR 1 I I IRA,SSED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( IUNDERFLOOR INSULATION 115OH265 3 001 1 FLOOR SHEATHING IND. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I NO 21 ROOF-SHEATHING I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS 1AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION IREQUIRED TOTAL SETBACK FROM EXIST AFIRE SPRINKLER HANGERS ISET BACK YARD: HAY: PROP LINE: WIDTH: I IFRONT PL- (INSULATION/WEATHER STRIPI I SIDE PL- -I (INTERIOR LATH/DRYWALL I I EXTERIOR LATH I IRATED FLOOR/CEIL ASSEM. I I - RATED WALL ASSEMHLIEB RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE IREPORT ID: DPR261 ROUTE TO: ES0508 I j