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Home My Public Portal About9118 HERMOSA DR_Building__ ..WORKERS' COMPENSATION DECLARATION f hereby affirm that I have certificate of con5pnt to ce, - . APPLICATION FOR BUILDING PERMIT - "insure,-or a cerRfxate of.Worr kers`Compensation_Insurance, - .« or a certrfied copy thereof (Sec. 3800, Lab. C.) - ., - _ .COUNTY OFLOS ANGELES- BUILDING AND SAFETY' - Polrcyr No. -Company ❑ Certified co s fiereb furnished. FDESCRIPTION'OFF OR APPLICANT TO FILL IN BUILDING PY Y ADDRESS Certified copy is filed with the county building inspec ' LDING. n p /�tion department. _ RESS `J ��p // „Date Applicant e / lr) N7.ZIP 7ffu LOCALITY Il r4 NO. OF BLDGSNEAREST /1CER7IFICATE'OF EXEMPTION FROMWORKERS' OF LOT 3, NOW'ON LOT COSSSTCOMPENSATION INSURANCE. ASSESSOR '(This 'sectioKneed not be completed if-the-permit is for one CT- BLOCK L07 NO. - MAPBOOK PAGE PARCEL hundred dollars.($100)or less ) ;•• " T^ +' ,TEL p �qq NER J/7 R � ( O �fV��•S/” y US ONE MAP _certify that.in the performance of the•workfor which this NO.permit is issued, I shall notemp oy any person in any manner RESS �� N M- - J.r SPECIALa��ddCONDITIONSso as to-become subject tothe Workers' Co pens torLaws.I . `� �� <MZTP g Q O O Applicant • HITECT OR TEL. �NOTICE TO APPLICANT: If,. after makin this Certifi cat of INEER "NO.. .DI RICT e GROUP' TYPE FIRE PROCESSED BY9 � CONST. \ � ZONEExemption, you should become subject to u musoforth- - - YCompensation provisions.of the Labor Code, you must forth RESSN with comply with such provisions or this permit shall beTEL STATISTICAL CLASS( (CATION APT. CONDO. Z deemed revoked. -.:: TRACTOR NO. - - -LICENSED CONTRACTORS*DECLARATION C. CLASS NOQDWEIF. UNITS_RESS NO. hereby affirm that I dm licensed under prows ons of Chapter 9 - LIC .SEWER MAP(commencing with Section 7000) of Division 3 of the Business . CIA55 „ , VALIDATION. .and Professions Code,and my'license is in full force and effect _ a •sBK JJJ:FT. NO:OF . OCHECK”License Number Lic.-Closs STORIES �n� FAMILIES Vn` ONE" C" _. OYALUATION..Contractor Date CRIPTION OF WORK Il S NEW r�ry ADD ❑1 am exempt under Sec. - , r - S ... Vl1 ALTER ❑ " -"Q ► / d/� `nn " BARE for this reason - � �+ � r"30 h REPAIR"❑ $ /�-!) /(�))/)� v' Dote: .. ✓ VV''�<. 1 9:1r EXISTING BLDG. - DEMOL ❑ - • APPLICANT A' L� -TEL/ J :° 4 , - <_t •.-1•�� Signature - -. ( ) �A,�,.. ,. 1f46P NClF/� 1c�1.>9 FINAL - - OWNER-BUILDER DECLARATION 'PRIM I hereby affirm that I am exempt from the Contractor's License I - �11 g DATE y _ -Law^for the following 7easor (Section 7031.5, Business and ADDRESS ' TFt=/ 14 f / L°.�it� FINAL Professions Code): PRESENT - By - fy� BUILDING - O'1 I, as owner of..the property,'or my employees-with ADDRESS ' _ y 1 LJ -- ' wagesos their sole compensation,willdo theworkand - - -- - — - - A�. the structure isnot intended or offered for sole(Section LOCALITY �• ACCTe`. _ 7044, Business-and Professions Code.) MOVING . . TEL. ' Il7 '1 �0 ❑ I, as owner of the property, am exclusively'contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS � �- " ' '1 ITEM$- - - - tion 7044, Business and,Professions-Code.) _ - CONSTRUCTION LENDING AGENCY � SETBACKYARD HWV TOTAL SETPROACK FROM EXIST, V I , TOTAL 272.05_ • ,V WIDTH I hereby affirm that there is a construction lending agency for FRONT .- ` '2 05 the performance of the work for which th e[feit Is Issue' PL _ (Sec. 3097, CY:'C.). STL r-� _i _ . . _"h3 .` 00 1J r1JI r> �, CHANGE $ " . _ O ynS t O 2 imLender's Name3M. rPC. Fee$ J Pemit Fee oO �L ,EC" rp ..r.t+ V r' �W•L�LrWsrs'�_arOWr� i. - 7/24/889Lender's Address 7r, I certify that I have read this application cu s ate that the T' - % Issuance Fee 5 t'tDM,4 P/C N Rl , 46A 1 AM 9'19 8 above information is correct I agree to comply with all County W . irv.vjgwlun,Fee rp C ordinances and State laws relating to building"nstruction r'Y ° - Total Fee I r7 V DMA Perm N a and hereby outhorize representatives of tfii JTQty to ente4,.. V upon the above-mentio ed property for inspection purposesfrl_E V! - - - — �, �• O 7 CO - ^ k ' o + • •��.'n I� ^ SEE REVERSE FOR EXPLANATORY r� �� ' ignature of Applicant or Age ;:;:- ?Dwe O ' C ' DO - u .p _q L.•ff _9 COUNTY OF LOS ANGELES TE*E CI Ti #:?508 BUILDING PERMIT • DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS - - RESIDENTIAL ADD .- - BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9701230061 PHONE: (818) 285-0488 EXT: LEGAL ID: 90. OF CONST NEW BUILDING ADDRESS: TR: 5905 LT: 85 SQ. FT STORIES TYPE OCCUP GROUP 9118 HERMOSA DR STRUCTURE: 0 1 V R3 TEMP CA 917801918 ASSESSOR INFORMATION NUM R: GARAGE: NEAREST CROSS STREET: HART 5387-016-031 OTHER: 199 1 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUE ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/23/97 TC 0 123/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: LIANG JACK C;DORIS T (818) 287-9585- 1 2,000 2-�1 9118 HERMOSA DR TEMP 917801918 FEES PAID DESCR PTION OF WORK n, NEW ENCLOSED PATIO 100 SO. FT. _ FEE DESCRIPTION: �- ,QUANTITY., UOM: /� AMOUNT: AP LI CANT: L. 0: °-4 SAME AS OWNER - AA BLDG PERMIT ISSUANCE) 27.75 AC STRONG MOTION RESIDT 2000OCVAL iiiJJJ 0^.50 SPECIAL CONDITIONS: AX BUILDING REVIEWFEE54!70 D2 PERMIT W/0 EN= 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 1003090013 PHONE: (626) 285-0488 EXT: (LEGAL ID: - N0. OF CONST BUILDING ADDRESS: ITR: 5905 LT: 85 - SQ. FT STORIES TYPE 9118 HERMOSA DR I ISTRUCTURE: 2500 V-B TEMP CA 917801918 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15387-016-031 - THOMAS PAGE: 596 GRID: H3 LOCALITY.: TEMPLE CITY, CI TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 103/69/10 SR I IOWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL6 BY: CODE: CHEN,'PATRICIA 19118 HERMOSA DR 6 200 A f 0 (TEMP 917801918 FEES PAID S=PT ION OF WORK - REMOVE WOODSHAKE, INSTALL OSB PLYWOOD, 30 YR COMPOSITION I I -IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SHINGLE t' � (APPLICANT: TEL. NO: I Ia�� I (SUNSHINE ROOFING (626) 581-7049- IAA BLDG PERMIT ISSUANCE 27.75 - 1 1516 N. pIAMONp BAR AB STATE GREEN BLDG FEE 6200.00 VAL - 1.00 ISPE'CIAL CONDITIONS: I I DIAMOND BAR CA 91765 AC STRONG MOTION RESID 6200.00 VAL 0.62 I D2 PERMIT W/O EN-HC 6200.00 VAL 166.20' ( 1 -1 TOTAL FEES 195.57 (CONTRACTOR: TEL. N0: - (APPROVALS DATE INSPECTOR SIGNATURE (SUNSHINE ROOFING, INC. (626) 581-7688- 1516 N DIAMOND BAR BLVD #183 LIC. NO (LOCATION ADD SETBACKS (DIAMOND BAR CA 91765 755126 C39 I ISOILS ENGINEER APPROVAL I I 1 I 11 ARCHITECT OR ENGINEER: - TEL. NO: 1-r-1-1 FOUNDATION/TRENCH FORMS I .( I I LIC. NO: (SLAB/UNDER FLOOR I - I RAISED FLOOR FRAMINGI I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( '1UNDL'RFLOOR INSULATION 115OH265 3 001 I I IFLOOR SHEATHING I I I NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS I I_ I I NO 21 (ROOF SHEATHING 1,6,1. I I SCHOOL WITHIN HAZARDOUS . .(SHEAR PANELS ` I I (AIR QUALITY: 1000 FEET MATERIALS- I NO NO NOI FRAME INSPECTION I I IREQUIRED TOTAL SETBACK FROM EXIST : IIIFIRE SPRINKLER HANGERS 1 1 SET BACK YARD: HWY: PROP LINE: WIDTH: -.— FRONT PL- (INSULATION/WEATHER STRIPI I I I SIDE PL- II 1 1 (INTERIOR LATH/DRYWALL IEXI'ERIQR LATH II II I I I I (RATED FLOOR/CEIL ASSEM. RAVED WALL ASSEMBLIES I I I RATED SHAFTS/OPENINGS I I I T-EAR CEILINGS j I • (LOT DRAINAGE I REPORT ID: DPR261 ROUTE TO: 850508 I I