HomeMy Public PortalAbout5913 IVAR AVE_Building__ COUNTY OF LOS ANGELES A BUILDING AND SAFETY
0
WORKER'S_COMPENSATION DECLARATION FOR APPLICANT TO FILL IN ' ;a7., 1
BUILDING ADDREss
BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure,' KCA /�
) 11/
or a certificate of Workers'.Compensation Insurance,or a certified CITY �tt ZIP -rem f
copy thereof(Sec.3800,Lab.C.) "Cem I•� �/kl i 6o LOCALITY /
Policy No. Company SIZE OF LOT LTTii l./�'1 NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO..
:department. - USE ZONEMAP NO.
Date Applicant ASSESSOR MAP OOK PAGE PARCEL
SPECIAL CONDITIONS
I on
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER. �,,.y,� TELp O. /.j.�
COMPENSATION INSURANCE '�1 a 6 11✓ WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDRESS
DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED,BY_„
dollars ($100)or less.)
CITY ZIP n / -
I certify that in the performance of the work for which this permit - ail vt ` �� ,
is issued,i shall not employ any person in any manner so as to r
become subject to the Workers'Compensation Laws. ARCHITECT R ENGINEER TEL NO.
p - STATISTICAL CLASSIFICATION 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 TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must.forthwithFRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L
LICENSED CONTRACTORS DECLARATION SIDE
CITY LIC.CLASS P L
hereby affirm that I am licensed underprovisions of Chapter 9 >_
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP a
Professions Code,and my license is in full force and effect. NEW ❑ BK' PG U
DESCRIPJ40N OF W KVALUATION
License Number Lic.Class ADD o
Contractor Date E—
ALTER $ �Ia w
❑ CL
I am exempt REPAIR El under Sec. $ z
BAP.C.for this reason -1 _ vL eC'Gi—,e"GC/� OL ❑
_ LDMA PIC#
Date: USE OF EXISTING B D - .URM ❑
Ignature APPLICANT(PRINT.).° TEL NO. LDMA Perm'# -
)(It�heir
asowner of the property, or my employees,with wages as -Z sole compensation, will do the work and the structure is ADDRESS -
L,1.._;- FINAL DATE.,.. .,. .. - 4 ..''.
not intended or offered for sale (Section 7044, Business and Q __ .�± -
Professions Code.) _ _
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
- /1'U
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL.TO OR GREATER THAN THE _ ✓ ` _J
I,.as owner of the property, am exclusively contracting Wltn AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044; -
Business and Professions Code.) ves❑ No El
WILL THE INTENDED USE OF THE BUIDLING.BY THE APPLICANT OR FUTURE BUILDING ""• "' " i I.' "" ""`"" "' '•
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM.THE SOUTH --_
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR Y ..
GUIDELINES. ,� �,,*� } a.•i...
I ,
I hereby affirm that there is a-construction lending agency for YES❑ No❑ - -
—
-.' .... .. .... � 1 a..,
a: the performance of the work for which this permit is issued(Sec. I j_ t_.. ''
IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING. �
3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, "r '•
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.213.140 CONCERNING HAZARDOUS - `..S'�s�1vS: +'=1��•�•^
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD.
oLender's Address t =L
O• OWNER OR AGENT .. ••Pi:"T.•i. -
I certify,that I have read this application and state.under penalty
of perjury that the above information is correct.I agree to comply P.C.FEE ,. ,y w PERMIT FEE �;- _ 4. I�e•= _
N with all county ordinances and State laws relating to building
construction, and hereby authorize representatives of this County ISSUANCE FEE
oo
to. on the ab entione pI 'erty for inspection purposes.
a
�'�. -INVESTIGATION FEE TOTAL FEE
SgnaNre.ol or Agent _ Date / / ..✓
SEE REVERSE FOR EXPLANATORY LANGUAGE
r
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have'a 'certificate of consent to self l �" O � O LJ M
insure, or a certificate of Workers'Compensation IrisoI'ance,- °°LTV P_PI �C. AUPON ON F O Q ' U R L��LI V�•
or cerrttiffiied copy thereof (Sec. 3800, Lab. C.),
icy,f�of Company l���b Nf�
COUNTY OF LOS ANGELES BUILDING�`AND SAFETY
Certified co is hereby,furnished. BUILDING,
Pr „Y FOR APPLICANT TO FILL IN,,, ADDRESS
Certified copy is filed•with the county building inspec- BUILDING r �'"' y� /� /
tion department. ADDRESS:'.' y� iV - ��v Iy V Y LOCALITY
�ff NEAREST r
Date��Z7 4 Applican CITY Fr�1 1i�i� '( 1- ZIP ' 1 7�� CROSS ST. J
CERTIFICATE OF EXEMPTI N FROM,WORKERS' O: OF BLDG ASSESSOR
N S.' O
COMPENSATION INSURANCE' SIZE OFLOTNOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the erm' �is for one USE ZONE',: OP'
hundred dollars ($100)or.less.)
p TRACT��O BLOCK LOT NO. �:
TEC 7�j SPECIAL
I cert'if that in the erformance:of the .work for which this OWNS � AAdC..�. NO?_S5 CONDITIONS IL
y P DISTRICT GROUP TYPE` • FIRE PRO SSED BY Ct
permit is issued, I_sholl,not employ any.person in any manner ADDRESS G ZONE U
so as to become lsubject to the Workers'-Compensation_Laws.
-. .. _ /wJ. ®.
.. - 'GLV
'CITY• ZIP
4 CON
Date - ` Applicant; STATISTICAL CLAS ICATION 7 APT.: CONDO. F-
ARCHITECT OR TEL 3
NOTICE TO APPLICANT: 'If, of ng this Certificate of ENGINEER NO. LU
CLASS.NO: DWELL. UNITSLU
Exemption; you should become subject ,to the Worker's''
Compensation provisions of the Labor Code you must forth- ADDRESS• SEWER MAP
with-comply with such provisions or this permit.shall, be M m
' - deemed revoked'. , ^ TEL: + BK: /"PG;
CONTRACTOR A,.,719 �/ NO.• VALIDATION
LICENSED'CONTRACTORS'-DECLARATION
I hereby affirm that I am licensed under provisioni of Chapter 9 ADDRESSf�l7 �tJ ��Lc44-. NC. �77 VALUATION.
(commencing with Section 7000)of Divisioh 3 of the,Busihess and LIC
Professions..Code, and my license is in'full force and effect. CITY. a 'i*`�P,le: CLASS` :$ 0
/ SQ. FT NO. OF NO..OF CHECK
License Numb e�TLic.Class8_I SIZE STORIES ' FAMILIES �': ONE
#I/.
Contractol' Dare. '" '. DESCRIPTION OF WO I�O �35_ NEW ❑ ' (J 01519 A
$
. D C aJ/ ADD
❑I am exempt under Sec C.,�N1 • G/U e°l.dSCv, d' 1k 6 of o.o 0`.0 2',3
s ALTER ❑ FINAL
"Et.&P.C. foe this reason .-DATE.. �/,
: p PAIR R
�""YL.I A1�q ..: � �.f a/NC, �jd ❑ `� a.�c 4 1.•4 5'
Date: SE'OF FINAL-
- EXISTING BLDG.�. e - �. DEMOL': ❑ ►�
Signature APPLICANT TEL - By o o �,4 5 0
OWNER-BUILDER.DECLARATION "� - NO.
PRINT + _� �..t1
'(.hereby affirm That I am ex1.empt from the'Contractor's License p 7 2 9 3
Law for the•following recison(Section-7031..5, Business and ADDRESS -1- L� ;
Professions Code): PRESENT
BUILDIN NG
as owner of the property, or•my employees with ADDRESS '
ADDRESS
ages'as thed.sole,compensation',will d6thework and
the structure is not intended'or offered for sale(Section
LOCALITY
7044',-Business;and Professions Code): MOVING TEL. 4 o6 Q A
❑ 1,as owner ofahe'propeTty; am exclusively contracting CONTRACTOR NOe'
r •
with licensed'contractors to'`construct the_prolect (Sec''• o.o oo
tion 7044,Business and Professions.Code), ADDRESS.
54,Z5
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION:LENDING_AGENCY'. ' YARD HWY
SET BACK `PROP. LINE' WIDTH
I hereby afficm;that there is'a construction lending agency for ,FRONT• :o:o' C� Z 5 cam'
the perfoirnanceof the'work for which this permit is issued',• P.L..:
r
(Sec.'3097;ciJ:C.
SIDE 0 7 2 9—8 3 '
P.L.
Lender's Name
Lender's Address P.C. Fee$ Permit Fee
I certify that I have read this ci Ircation and state that the '
Pp - Issuance Fee -
above.information.is correct. I agree.to"comply with:all County Investigation Fee
9 ordinances and Statelaws relating to building construction,•
Total Fee:
u and hereby authorize representatives of this County to enter - _
upo -tab ye-mentioned property for inspection purposes: "
Q ga
o �.��7-�w✓ -t -: SEE REVERSE FOR EXPLANATORY LANGUAGE -
Signature-of Applicant or Agent'. Date ®s
•„ �� COUNTY OF LOS ANGELES TEMPLE CITY #,0508' BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9611010006
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 5904 LT: 112 SQ. FT STORIES TYPE OCCUP GROUP 5913 IVAR AV
STRUCTURE: 86 1 VN R3 TEMP CA 917801520
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET:
5386-011-055 OTHER: THOMAS PAGE: 596 GRID: H3 LOCALITY: CITY OF TEMPLE
TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 11/01/96 LC 11/01/97
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
WANG, HSIANG-LING - 2 1,420 j p
5913 IVAR AV F -,If
TEMP 917801520 FEES PAID DESCRIPTION OF WORK
ADD WOOD FRAME OPEN PORCH ATTACHED TO FRONT OF RESIDENCE
FEE DESCRIPTION: QUANT,rTTY,�UOM'; // AMOUNT: .REMOVE EXISTING 41X 8' FRONT PORCH
APPLICANT: TEL. NO: o '/(�
SAME AS OWNER - AA BLDG PERMIT ISSUANCE-P 27.75
AC STRONG MOTION RESIDE1'420:00-VAL X 0 5 0 SPECIAL CONDITIONS:
AX BUILDING REVIEWFEE // 54J;70
D2 PERMIT W/0 r,EN, HC 1',420.00 VAL\ 8z.-20--
' 'FEES
2:-20=FEES \165.15%
CONTRACTOR: TEL. N0: -' // o� _ V APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER ' GJ/
LIC. NO ��1�7j. ` 0 0 LOCATION AND SETBACKS
/ -�P ��—— ---- �' ��'��1 SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. N0: c�J)}��tl� ������}��f 1�1 I FOUNDATION/TRENCH FORMS
LIC. N0: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CM01 L 11DERFLOOR INSULATION
C
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: QST LEVEL FLOOR SHEATH
NO 21 ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS \v\ ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME TNSPECT
REQUIRED TOTAL PSETBACK FROM EXIST BLDEP FRAME INSPECT
SETT BACK YARD: HWY: ROPLLINE: IDTH:
FRONT PL- SHEAR PANELS
SIDE PL-
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
LOT DRAINAGE
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508
COUNTY OF LOS ANGELES . - TEMPLE CITY # 0.508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9611120009
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 5904 LT: 112 SQ. FT STORIES TYPE 5913 IVAR AV
STRUCTURE: 2100 V TEMP CA 917801520
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5386-011-055 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 11/12/96 TC 11/12/97
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE,:-"
WANG HSIANG-LING - 1 2,8006a�
5913 IVAR AV I ?- J
TEMP 917801520 FEES PAID DESMON OF WORK f
REMOVE/RECOVER WITH PLYWOOD AND 25 YR. COMP. SHINGLE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 2800.00 VAL 0.50 SPECIAL CONDITIONS:
D2 PERMIT W�E C� �I �OTAL FEES VAL 199.15
27.40
CONTRACTOR: TEL. NO: (�� � APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO (�/ LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. N0: _ 11.. 6 ��� }� SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
15OH261 3 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APN/OCOND: STAT CL2SS:
�( ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS ✓� (r L� =,� SHEAR PANELS
1
AIR QUALITY: 1000 FEET MATERIALS rl ��_))
NO NO NO D -� ,/� FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST rt� -� FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- u INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508