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HomeMy Public PortalAbout9165 HERMOSA DR_Building__ APPLICATION FOR BUILDING PERMIT ,COUNTY OF LOS;ANGELESBUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN' JBIJILDIN ADDRESS hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS T or a certificate of Workers' Compensation Insurance,or a Certified 1 1Ymt?SOL ,r Copy thereof (Sec.3800, Lab.C.) CITVIe �c ZIP /]1-I O� LOCALITY Policy No. Company SIZE OF LOT // NO.OF BLDGS NOW OON LOT El Certified Copy is hereby furnished. SO.},l 50 _ Z NEAREST CROSS Sor ❑ Certified copy is filed with the county buildirig inspectionTRA�CTv 'L BLOCK LOT NO Q department. %rt ��O T � pcl0 USE ZONE MAP NO, 0 Date Applicant ASSESSOR MAP BOOK PAGE PARCEL - �01SPECIAL CONDITIONS ���©i CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 1 Wa/`� TEL No; $l8 - ves No COMPENSATION INSURANCE I`• 9. h Nt r 2465:2,l WITHIN 1000 FT.OF.SCHOOL' (This section need not,be completed if the permit is for one hundred ADDRESScompletedp 1 1 — r) dollars US 100) Or less.) 1 165 �//11K.f{{.�(.LjO\• ZIP DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY GITV. IQ�.iu IQ� L._•L ZIP g11So I certify that in the performance of the work for which this permit `�1 bissued, shall not employ any person at any manner so as f0 ARCHITECT OR ENGINEER - - TEL NO. become-subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date - Applicant ADDRESS - CLASS N0. y DWELL UNITS NOTICE TO APPL(CANT.' If; after making this Certificate of RECURRED TOTAL SETBACK FROM EXIST Exemption, you should become Subject t0 the Workers' CONTRACTOR TEL NQ - SET BACK VARD HWY PROP LINE WIDTH Compensation.provisions of the Labor Code, you must forthwith I 4 - ONT comply with such provisions or this permit shall AL be deemetlrevOked, ADDRESS � LIC.NO. p L LICENSED CONTRACTORS DECLARATION SIDE G� cLAss P L I hereby affirm that I am licensed underprovisionS Of Chapter g �zO SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO.OF STO 0,OF FAMILI - Professions Code,and my license is Hill force and effect. - NEW BK PG } DESCR ION F WORK VALUATION po , License Number Lie.Class i A ❑ $ J d0 `— 0 Contractor- Date ER V 'j; ' Elam exempt under Sec. a`tgrooi Ce�rl.� G Q eI - Y 0 REPAIR ❑ `r:�- x w a41 .a I. e.&P.C.for this reason ,� DEMOL ❑ LDMA P/C s '1_ - .,11. I)W Date: USE OF EXISTING BLDG. URM ❑ { Q. Signature APPLICANT(PRINT) TEL NO LOMA Perm# 1 1, z ❑ I, as owner of the property, or my employees with wages as Z their sole compensation,_will do the work and the structure is ADDRESS 'O - Tj jL I not intended or offered for sale (Section 7044, Business and FINAL DATE /t Q �� _ PfOfESSIODS Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL IP/ ✓ ,� i OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ en owner of the property, am exclusively contracting with •Q /^�yI AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 'FINAL BY I 7 f 25`2 q �q`_i y Yicenses contractors to construct the project (Section 7044, YES❑ No❑ R i 1 i Business and Professions Code.) p L�-.1 WILL THE INTENDED USE MI THE CONSTRUCTION TI THE APPLICANT OR FUTURE BUILDING t.7Et_1\ --c-- CCCUPA IR REQUIRE A PERMIT FOR CONSTRUCTION OR EEPERMITMODIFICATION G CH THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR OUgUTV MANAGEMENT DISTRICT RSCAQMDI SEE PERMITTING CHEERIEST FOR `. PHII NGE cI I culDeurvEs. ''t9L I hereby affirm that there is a construction lending agency for YES❑ No❑ ^ m the performance of the work for which this permit is issued(Sec. o� [HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING _ fy�;_._ N 3097,CIV.L'i.) CHECKUST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE I�I�II)11-1 R)11�1 1-412 .- TITLE 2.CHAPTER 220 SECTIONS 220.100 THROUGH 2.20.140 CONCERNING HAZARDOUS -' - i i. - LE. 20dCI5 Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SOAOMO. - - Q Lender's Address 0 wrvEA OR AGENT - oI certify that I have read this application and State under penalty C, of perjury that the above information- PC.FEE PERMIT FEE- t correct I agree to comply n�D I with allBeautyordinances and State laws relating to building constrUCtion and h ,�SN1 at Drize representatives of this County ISSUANCE FEE / - toe ISr upon the - i�n/ey/Vroperty for inspection purposes. r�' / ,! �i/,! Z— Z-5y' INVESTIGATION FEE TOTAL FEE D q• O sl ,.evIArp—r,A,rN G a of SEE REVERSE FOR EXPLANATORY LANGUAGE Z WnRXER$.CID,4ENSATION bECLARATION - heebv arm fica have r certificate,C6me of consent to self APPLICATION FOR BUILDING PERMIT .in6"tre or a'c�rti6cate of Wdikers Compensation Inmmr?ce, or:o certified cagy thereof (Sec 3800,'Lab. C) ''-"'= - - r �• - ' - - - _. ++ � - - 'COUNTY OF LOS ANGELES BUILDING ANDSAFETY; �` ... - PolicyNo ' - Company. _ +- r -_BUILDING _ -- - - �e Certrfied copy;is hereby furnished. , -FOR APPLICANT-TO FILL IN - goDREss O �y34 dL�f1. ' , ❑ Certified copy is:filed with the county'building inspec- BUILDING tionTdepartment- ` - _.,S ADDRESS C �^ `7ti.H•LG�G .�Q. r Date 'Applicant+. CITY eZIP `r TO`'' LOCALITY - CERTIFICATE OF EXEMPTION FROM,WORKERS' NO, OF BLDGS. - NEAREST_ c'� "•'•t COMPENSATION INSURANCE L,' M.• SIZE OF LOT NOW ON LOT CROSS ST', (Thisl` TRA sectionAeed not be completed if thepermit.is'forrone - - , - - - ASSESSOR - r., hundred.dollars ($100)or less.) CT^ etOCK•- LOT NO. MAP BOOK - PAGErPARCEL '�11 TEL •� " �`. OWNER LJ IkZ N - SOWL NO:+��-� 5] USE ZONE MAP _ _ T certify that in the performance of the work for which this A NO. permit is issued,J shall not employ any person in any manner �j p ,r� Y/ - SPECIAL ' - - --- - - 1 1 ADDRESS - 7�"�`D-- WUOG�Kl.(��--- G j\ CONDITIONS .5, - , V so�ds to become subject to'the Workers Compensation Laws. /� ix ary TE-1111G _.Cil _ I ZIP..-/t.7$O o Date Appbcont' T ARCHITECT OR TEL _ _ NOTICE TO APPLICANT $ otter mokin this Certificate of f r t9 .DISTRICT GROUP TYPE• ' - i FIRE PROCESSED BV g ENGINEER S i%VGfQ$' NO. 'Jb '13jI ~ EiempLon;.you should become-subject to the Workers' CONST ', ZONE ) - W Co hpcorn hom;with rich pr the labor c this ermit h forth- - ADDRESS �7f•�{1 S• ✓_-'(A�-/Gti S% 5-U//Z[-' -.jI 0 � JI-.b ,� � ; _- S� deemd.,evoked. such provisions ar,'this permit shall be -- -- --_ . . ... N deemed,revoked.l ; e t+ - RAC O>`"GrWI C - TEL. STATISTICAL CLASSIFICATION ' .APT. CO I Z CONTRACTOR NO. _ _ LICENSED CONTRACTORS DECLARATION a tt --- .-- 4UN --- - LIC. -- CLASS NO. DWELL.;UNITS 1 hereby:off irm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of"the Business and .. ._. _ .._ ._LIC. .. .- :p. " Professions Code, and my,ficense is in full-force and effect. CITV - CLASS ' '-� - VALIDATION' _ • u _ _ t . e t - 50. FT. r NO. OF _ NO.OF CHECK BK. PG. _ 1 " SIZE J°{-,3' STORIES FAMILIES ONE - License Number t-Lic.Classe - - r \+' VALUATION Contractor c Date DESCRIPTION OF WORK '�K'%GYi Z,,- ey4 AD ❑❑' 1�$ ❑ I am exempt under Sec. ��`- .A.�Ci YY�Ot.n- A, 1. POGtw -s I ALTER B.BP.C. for this reason ` QOM W• Fr rZ �Ooc., "'�G EPAIR $ - .- '. t z 1 7'7;5 A -- ' .. ... _ ._". _. .Date:' .. USE OF DEMOL .❑ _ .a.,e'e s a� , EXISTING BLDG. .Signature '- -_." APPLICANT TEL r ,FINAL • '1 e r2.b 550 J �F PRINT) CL..['l,C 0.6b'J - 655' OWNER-BUILDER DECLARATION _ - _ DATE - - - p _ q '' �• 2655 bherebyaffirm that6am.exempt;from.the CoAtractor-s License y" ADDRESS / 4"g (n/UoGCT r4'YG T-C C' t' ILO '-85 Law for the following reason (Section 7031.5, Business•ond FINAL j Prof- sions'Code) '"^ -' BRESENT - v - BY ' •' , ryj BUILDING as owner of the property, or my employees with ADDRESS_ - _ - , __ _ . _ wages os.thelr sole compen.sation,will do the work and' the structure isnot intended or offered for sale(Section LOCALITY ' 7044, Business and Professions Code). - . ' ' MOVING ' -'- 'TEL: - - �' I, as owner of the property, am exclusively contracting CONTRACTOR NO. - / with licensed'contractors to construct the project'(Sec f tion 7044, Business and Professions Code). .. ADDRESS 7 f v,'! - .REQUIRED- TOTAL SETBACK.FROM CONSTRUCTION is a constLENDINGAGENCY -` SET BACK YARD ' HWY PROP. LINE WIDTH -�� - t herebyperformance that there is is construction is per agency for FRONT- - - - - theperformance-of the-workfor which this permit is issued - - - --PA. - (Sec. 3097, Civ. Cr). SIDE - va $ Lender's Name - ♦ - LDMA Ref. _ _ _. .. - _ P.C.-F..$ - - Permit Fee Lender'sAddress , y:. certifyahot-I.have readthisapplication,and state-that the - Issuance Fee S!� LD.P/C K - -• - T - -- -- - a above information.Is correct. I agree to comply with all County Investigation Fee Q-A ) - 1 g ,.....ordinances State laws relating to building construction, Total Fee -- ✓ ✓ " w - __ ... .. -47� i LDMA'Perm...p u and here ullr.,ae r le of this County to ental 1 m upon t ave-me on d property for Inspecti n purposes. - - SEE REVERSE FOR EXPLANATORY LANGUAGE f -•.S gnature of pelican gent—. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0207180106 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF EW BUILDING ADDRESS: TR: 5904 LT: 390 SQ. FT STORIES TYPE OCCUP GROUP 9165 HERMOSA DR STRUCTURE: 1150 1 VN S3 TEMP CA 917801921 ASSESSOR IN ON NUMBER: GARAGE: NEAREST CROSS STREET: ENCINITA 5384-013-034 OTHER: 583 1 VN U1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLD USE: USE ONE: ISSUED ON: PROCESSED BY: EX S ON: EXIST OCC GRP: 09/10/02 JK 03/09/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: SOMERARD F DR JR;PENELOPE S (626) 285-2655- 33,000 �7(o/i1✓fj s--� �.�,.f �yv1y'y�/ TEMP 917801921 FEES PAID DESCRIPTION U� WORK NEW GARAGE & WORKSHOP W/ATTACHED LATTICE PATIO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: - A L N L.—NO- SAME m-o SAME AS OWNER - D1 LANLHEW/0 EN-HC 33000.00 VAL 489.47 tr AA BLDG PERMIT IT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 33000.00 VAL 3.30 D2 PERMIT W/O-EN-HC 33000.00 VAL 575.85 No'v'a"—} re`J" d TOTAh:FEES 1,096.37 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO - LOCATION ID SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: T1N TEL. N0: I i� \ FAT ON NCH FORMS /= LIC. NOa SLAB/UNDER FLOOR �j�� T x-L— '� -Ki • p D L FRAMING / MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMPa UNDERFLOOR INSULATION 3 01 ' - ST LEVEL FLOOR SHEATH 0. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLAS NO 21i , 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS t ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL S B C FR X ST BLDG D AM IN PEC SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER L- N UL /WEA HE STRIP [ TERIOR LATH/ RYWALL EXTERIOR A H LOT—T )-FA I NAG—E SMOKE DETECTIONDEVCS FIRE DEPARTMENT APPRO AL REPORT ID: DPR261 ROUTE TO: BS0508