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Home My Public Portal About9810 HOWLAND DR_Building__ WORKERS'COMPENSATION DECLARATIONFOR BUILDING PERMIT der /7 G r nc 'PLICATION hereby affirm that I have a tificate of conse"`nt to self' insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C,) �- o L �� BUILDING COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy NY any s�i!.1/1 ,. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS (J - Certified copy is filed with the county building inspec- ' BUILDING tion department. ADDRESS LOCALITY NEAREST Date Applicant CITY (7_KLC ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS .§ ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT J MAP BOOK PAGE PARCEL (This section need not be completed if.the permit is for one USE ZONE MAP hundred dollars ($100)or less.) TRACT. . BLOCK LOT NO. •,IU n NO. TEL.Z Y' r SPECIAL T I certify that in the performance of the work for which this OWNER LCT` NO.CGx�- „ CONDITIONS d permit is issued, I shall not employ any person in any manner - DISTRICT GROUP TYPE FIRE PROC SSED BY . O ADDRESS CONST. ZONE U so as to become subject to the Workers'Compensation Laws. ` Date Applicant CITY- ZIP STATISTICAL CLASSIFICATION V A CONDO.\ O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. [2 DWELL. UNITS_ W Exemption, you should become subject to the Workers' d Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be p deemed revoked. —+ CONTRACTOR ii,. TEL NO. BK. EPG, /� VALIDATION LICENSED CONTRACTORS DECLARATION - _ uC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION k (commencing with Section 7000)of Division 3 of the Business and r-^t LIC fA r- Professions Code, nd my license is in full force and effect. CITY rr 11GG CLASS g-� $ell ��,_�( -�� 51ZE� STOR3 INC. IES P`-�- FAMIOES CHECK License Number Lic.Class 'T�_ ONE Contract� i Date DESCRIPTION OF WORK NEW ❑ § or_ O 1 am exempt under Sec. K-LTC ADD ALTER FINAL j7 B.BP.C. for this reason REPAIR ❑ DATE -Z_Q 4 Date: USE OF �+ �-T FINAL EXISTING BLDG. DEMOL El By c` Cf P's"`•L.J Signature APPLICANT TEL OWNER-BUILDER DECLARATION PRINT) G�LL NO. I hereby affirm that I am exempt from the Contractor's License G�7J� r � " "C� ® /J T 7" 4 6 7.0 A Law for the following reason (Section 7031.5, Business and 'ADDRESS DeA, Professions Code): RESEN -7 0 6- BUILDING # e o o e ott ❑ I, as owner of the property, or my employees with ADDRESS &,6 3 wages as their sole compensation,will do the work and 12 - 21 the structure is not intended or offered for sale(Section LOCALITY 7044, Business.and Professions Code). MOVING TEL. a 2 1 2.6 3 5 I, as owner of the property, am exclusively contracting CONTRACTOR NO. e' with licensed contractors to construct the project (Sec- OR22-83 tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL CONSTRUCTION LENDING AGENCY SET BACK YARD HWY L SETBACK FROM EXIST.PROP. LINE WIDTH , I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. -.?O 0 (Sec. 3097, Civ. C.). SIDE P.I. Lender's Name -L p Lender's Address P.C. F. § Permit Fee I certi a ave read this application and state that the Issuance Fee -a 0 abo rmati is rreci:'I agree.to comply with all County - Invesligatlon Fee " ry - ordi a nd ws relating-to'building construction, ,�= /O-is 63 U a uth r presenlalives of this County to enter Total.Fee. Uo h b vn ed property for,inspe�ctioonn purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE' " Signatu of Applicant or Agent Dote ®s r e� WORKERS' COMPENSATION DECLARATION - Olr sureaffirm that I have certificate of content to self' AE'P XAT.ION_FO.R BUILDING PERMIT insure,, o or a certificate of Workers' Compensation Insurance, or a certRied copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDREss ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESSy2lp Date Applicant CITM PL - C/TV ZIP LOCALITY LNO OF �G t CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 18'0A Fi r NOW ONLLOTS - ") NEAREST COMPENSATION INSURANCE GROSS ST.ASSESSOR n .�,^ (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK �O PAGE�� PARCELZ.�/� hundred dollars ($100) or less.) TEL' USE ZONE MAP OWNER EE/• ON / AJ NQPI19 s, NO. c�- I certify that in the performance of the work for which this OSPECIAL - Y permit is issued, I shall not employ any person in any manner ADDRESS /Q 7 A1,0 /� �� CONDITIONS a- so as to become subject to the Workers'Compensation Laws. / p O CITY CJ ZIP 7p O U Date Applicant ARCHI ECT OR TEL NOTICE TO APPLICANT: If, offer making this Certificate of ENGINEER 61 NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE Exemption, you should become subject to the Workers' ' /J A a U J Compensation provisions of the Labor Cade, you must forth- ADDRESS /Z /S. vEQ T ' DQ 7i9p le-J l� aJ with comply with .such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. deemed revoked. CONTRACTOR G NO. z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. a ELL. UNITS- I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK �16 VAUDATION SQ. FT. NO. OF NO. OF CHECK License Number Lia Class SIZE 3 STORIES FAMILIES ONE VALUATION (L G7 DESCRIPTION OF WORK (�p A16 NEW � $ D OO polo. i Contractor Date CJf ❑1 am exempt under Sec. t ADD ❑ -12 v ALTER •❑ B.BP.C. for this reason rREPAIR ❑ $ ( L Date: USE OF, 1 J i J 7 J EXISTING BLDG. Q DEMOL ❑ Signature APPLICANT TEL / FINAL (PRINT) (7 O. _ Q OWNER-BUILDER DECLARATION DATE 5'Z$� rlJl hereby affirm that I g r exempt from the Contractor's License ADDRESS D L A . Tit- /7 -/ Law for the following reason (Section 7031.5, Business and FINAL, �.rjTLL� -' Professions Code): PRESENT By JV/L- - 8 ® I, as owner of the property, or m employees with BUILDING R(_(_ 4 P P Y• YADDRESS wagesas their sole compensation,will do the'work and - loop - I T -rc the structure is not intended or offered for sale(Section LOCALITY 33L 43.r:" El 1, Business and Professions Code.) MOVING TEL. 1 - I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- fi.�:I CCr.ra tion 7044, Business and Professions Code.) ADDRESS REQUIREDTOTAL SETBACK FROM EXIST. �:.LI/ J (J.Y� CONSTRUCTION LENDING AGENCY SET BACK YARD HWY' PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT _ ITErf j the performance of the work for which this permit is issued P.I. - - (Sec 3097, Civ. C.). SIDE - :.i lITA� 799 - 24 P.I. Lender's Name (_HECK 7'; /:. 99.2 LDMA Ref. # P.C. Permit Fee pop. C:HANUE Lender's Address , a I certify that I have read this application and state that the Issuonce Fee LDMA PTC# above information is correct. I agree to comply with all County Investigation Fee / fl R ordinances and State laws relating to building construction, Total Fee r e^ ,T 9 LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. '- - ' 4976 1 AM iii:4c a pp /q ,_ ��.•r -! �Al,✓,.K-/�ocr SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of App int or Agent Date 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 BE 0508 1311140036 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST , BUILDING ADDRESS: JTR: 12830 LT: 10 SQ. FT • STORIES TYPE D DR TEMP C917 ISTRUCTURE: 25 V-B 9810 CAA 917803232 (ASSESSOR INFORMATION NUMBER- NEAREST CROSS STREET: 18589-009-002 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI I - I 1TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 1EXIST OCC GRP: 111/14/13 SR 1 (OWNER: TEL. 5-7 iBLDGS. NOW ON LOT: VALUATION: F.NpL DAT FIN F}L 9Y�: CODE: 19810 HON LEE (626) 285-7408- 7,000 // 1-%A 19810 HOWLAND DR � ITEM? 917803232 FEES PAID SCR PTION'OF WORK Iu IRE-ROOF COMP SHINGLES TO NEW GAF COMP SHINGLES 25 SF. I IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: (APPLICANT: TEL. NO: I 1 ISHEA, TOM (909) 931-3204- AA BLDG PERMIT ISSUANCE 27.80 1153 N LOTH AVENUE IAB STATE GREEN BLDG FEE 7000.00 VAL 1.00 SPECIAL CONDITIONS: UPLAND CA 91786 1AC STRONG MOTION RESID 7000.00 VAL 0.70 1 ID2 PERMIT W/0 EN-HC 7000.00 VAL 166.20 1 TOTAL FEES 195.70 1 - 1CONFRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IT AND G ROOFING CO. (909) 931-3204- I_ 1153 N 10TH AVE LIC. NO (LOCATION AND SETBACKS (UPLAND CA 91786 583458 1_ I I 1SOILS ENGINEER APPROVAL IARCHITECT OR ENGINEER: TEL. NO: 1 IFDUNDATION/TRENCH FORMS I I I I LIC. NO: SLAB/UNDER FLOOR I I I I I I I 1RF:ISED FLOOR FRAMING I I I MAP NO: SEWER MAP HOOK: PAGE: FIRE ZONE: CMP: ( IUNDERFLOOR INSULATION 1 3 COi I FLOOR SHEATHING INC. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I NO 21 (ROOF SHEATHING MM kp� I I_ SCHOOL WITHIN HAZARDOUS SHEAR PANELS (AIR QUALITY: 1000 FEET MATERIALS I NO NO NO FRAME INSPECTION I I IFIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIP (INTERIOR LATH/DRYWALL I I I EXTERIOR LATH I IRATED FLOOR/CEIL ASSEM. IRATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS I I I T-BAR CEILINGS ADDITIONAL DATA ON FILE 1 ILOT DRAINAGE I_ REPORT ID: DPR261 ROUTE TO: BS0508 I