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Home My Public Portal About5948 IVAR AVE_Building__ COUNTY-OF LOS-ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT,TO FILL;IN" BUILDING ADDR�s BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C. S CITY ti '' .ZIP �* d �j/ •� TL -(f/ cel. l CE`t� .• .•- Policy No.��b �fy--" ki? `dtFfi �� .LOCALITY ompany SIZE OF LOT NO.OF BLDGS.NOW ON LOT Wertified copy is hereby furnished. NEAREST CROSS ST.• ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department.gd USE ZONE MAP NO. Date '` Applicant / ASSESSOR MAP BOOK :PAGE - PARCEL i SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' �2 �f/(J COMPENSATION INSURANCE ��/W RQ`Q Q 1`t 0 !��3 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS ' ' y DISTRICT GROUP TYPE CONST FIRE ZONE dollars ($100)or less.) PROCESSED BY CIT - /�. [ ZIP I certify that in the performance of the work for which this permit G is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITEC OR 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' CONT CTOR �E O. r/�Q SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith /' ./� WJ-d-47 a �J F% FRONT Comply with such provisions or this permit shall be deemed revoked. DRS �/ �jY� LI N P L LICENSED CONTRACTORS DECLARATION � /u �� / �� SIDE CITYyj�� '� /�� IA•I/ LIC.CLASS. P L - I hereby affirm that I am licensed underprovisions of Chapter 9 ��66 (� SEWER MAP (commencing with Section 7000)Of Division 3 of the.Business and SQ.FT.SIZE_ NO.OF STORIES NO.OF.FAMILIES Professions Code,and my license is In full force an effect. NEW ❑ BK PG License Number �d J /�� Lic, Class DESCRIPTION.-OF WORK01� y ADD ❑ VALUATION D O Contractor !'!Q (JYt 1:1Date. "�r pp�� '� U ` ALTER $ d' �� El 1 $ I'am exempt under Sea REPAIR OO BAP.C. for this reason DEMOL ❑ V LDMA,P/C'# { - - Date: USE OF EXISTING BLDG. .pf -� C��- URM. ❑ Signature - - APPLICANT(PRINT),pp,7� ��`/ - TEL NO. LDMA Perm# •� Z ❑ 1, as owner,of the property, or my employees with'wages as r� '��d `�rd /� ;OZi • their sole compensation, will do'the work and the structure is ADDRESS t not intended or offered for sale (Section 7044, Business and / G�/'ev� y FINAL DATE Q ,_ - Professions Code.) c-�/ J } 'WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL "� OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE '- ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATIOWGUIDE? Q FINAL BY �._.,,••• .1, t":.I..4 licensed contractors to construct the project (Section 7044, f.:,e YES❑� NO❑ Business and Professions Code.) _ ' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR �- GUIDELINES, I hereby affirm that there is a construction len ing agency for YES❑ NO❑ r the performance of the work for which this mit IS ISSUed(SOC. IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, a ' TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS - S t-''-�=—=!,;-j'� •• =,{` -1 3 Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. ? _ D ' lenders Address d S:n z T J o , OWNER OR AGENT O o I.certify that I have re this application and state under penalty 9 of perjury that�the above information is correct.I agree to comply P.C.FEE - PERMIT FEE with all county ordinances and State laws relating to building v df m - construction, and hereby authorize representatives of this County ISSUANCE FEE ato enter u on t ove entioned property for inspection purposes. D INVESTIGATION-.FEE - TOTAL FEEID D fJ / f� - $'na pplk2nt or Agent D21e / (/ � SEE REVERSE FOR EXPLANATORY LANGUAGE 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 1211050087 PHONE: (626) 285-0488 EXT: ' LEGAL ID: N0, OF CONST �, BUILDING ADDRESS: ITR: 5904 LTi 127 UN: .002 SQ. FT STORIES TYPE 5948 IVAR AV ISTRUCTURE: 14 V-B TEMP CA 917801519 1 (ASSESSOR INFORMATION NUMBER: - - ` J '�"�._, NEAREST CROSS STREET: HERMOSA - 15384-018-013 I - THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY I I I I (TENANT: - (EXIST BLDG USE: RESID USE ZONE: R-1 IISSUED ON: PROCESSED BY: 1 I IEXIST OCC GRP: 111/05/12 _ SR I I I I (OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFIAL AT. F : • CODE: 1 IHARRISON RAYMA R (626) 287-9284- 1 5,500 15948 IVAR AV 1 I \ � NAli'BYV ITEMP 917801519 FEES PAID IDESCR PTION OF,WORK I. ITEAR OFF & REROOF HOUSE REPLACE DRY ROT AS NEEDED APPLY 30 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: JYR SHINGLES (APPLICANT: TEL. NO: I 1 IVASQUEZ, ROBERTA (626) 444-7555- , ' IAA BLDG PERMIT ISSUANCE 27-.80 1 1 119020 NORTHAM ST JAB STATE GREEN BLDG FEE 5500.00 VAL 1.00 ISPECIAL CONDITIONS: IWEST COVINA91792 IAC STRONG MOTION RESID 5500.00 VAL 0.60 1 7 1 ID2 PERMIT W/O EN-HC 5500.00 VAL 149.40 J I _ TOTAL FEES - 178.80 ICONTRACTOR: TEL. NO: I (APPROVALS DATE `.:- INSPECTOR SIGNATURE 1 ILOUIE RIOS (626) 780-0175- 1 119020 NORTHAM STREET LIC. NO 1 ILOCATION AND SETBACKS IWEST COVINA CA 91792 968981 * 1 1 I ISOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: 1 - (FOUNDATION/TRENCH FORMS LIC. NO: 1. SLAB/UNDER FLOOR J - I I I I I I IRAISED FLOOR FRAMING 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION 115OH261 3 COI I I - I IFLOOR SHEATHING INO. OF;FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS. I 0 NO 21 - (ROOF SHEATHING _ 2,1"I J SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I JAIR QUALITY: 1000 FEET MATERIALS 1 1 NO NO NO - FRANE INSPECTION I I IFIRE' SPRINKLER HANGERS I (INSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL L I I I I I I I . 1EXTERIOR LATH I I I I I I . J RATED FLOOR/CEIL ASSEM. IRATED WALL ASSEMBLIES I 1 .1=' I IRATED SHAFTS/OPENINGS 1 I I I I I I I T-BAR CEILINGS J* ADDITIONAL DATA ON FILE I I ILOT DRAINAGE I I I IREPORT ID: DPR261 - ROUTE TO: BS0508 _ b& l 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 1211050089 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 5904 LT: 127 UN: .002 SQ. FT STORIES TYPE 5948 IVAR AV (STRUCTURE: 4 V-B TEMP CA 917801519 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: HERMOSA 15384-018-013 - THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE'CITY (TENANT: IEXIST BLDG USE: DETAC USE ZONE: R-1 IISSUED ON: PROCESSED BY: IEXIST OCC GRP: 111/05/12 SR (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: 1FINAL T � F1 AL BY: CODE: 1 IHARRISON RAYMA R (626) 287-9284- 1 1,700 15948 IVAR AV 1 1 1 ITEMP 917801519 1 FEES PAID IDESCRIPTION OF WORK 1 I - I ITEAR OFF & REROOF DETACHED GARAGE REPLACE DRY ROT AS NEEDED 1 I IFEE DESCRIPTION: QUANTITY:• UOM: AMOUNT: IAPPLY 30 YR SHINGLES 1 1APPLICANT: TEL. NO: 1 1 1 IVASQUEZ, ROBERTA (626) 444-7555- JAA BLDG PERMIT ISSUANCE 27.80 1 1 119020 NORTHAM ST JAB STATE GREEN BLDG FEE 1700.00 VAL 1.00 ISPECIAL CONDITIONS: 1 IWEST COVINA 91792 JAC STRONG MOTION RESID 1700.00 VAL 0.50 1 1 1D2 PERMIT W/O EN-HC 1700.00 VAL 82.20 1 1 1 1 TOTAL FEES 111.50 1 r 1 ICONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1 ILOUIE RIOS (626) 780-0175- _ 1 1 119020 NORTHAM STREET LIC. NO ( ILOCATION AND SETBACKS 1 1 1 IWEST COVINA CA 91792 968981 1 1 1 1 1 1 1 ISOILS ENGINEER APPROVAL 1 (ARCHITECT OR ENGINEER: TEL. NO: 1FOUNDATION/TRENCH FORMS I 1 LIC. NO: 1 1SLAB/UNDER FLOOR I 1 1 I I I 1 1RAISED FLOOR FRAMING 1 1 1 I I I 1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 1UNDERFLOOR INSULATION I I 1150H261 3 001 1 1 1 1 1 1 IFLOOR SHEATHING 1 1 1 1NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I 1 0 NO 21 1 1ROOF SHEATHING 1 1 SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS 1 1 1 1 1 NO NO NO 1 IFRAME INSPECTION I I I 1 1 IFIRE SPRINKLER HANGERS 1 1 1 I I I 1 1 (INSULATION/WEATHER STRIPI I 1 1 1 11NTERIOR LATH/DRYWALL 1 1 1 I I I 1 1 1FXTERIOR LATH 1 1 1 1 1 IRATED FLOOR/CEIL ASSEM. 1 1 1 1 1 1RATED WALL ASSEMBLIES 1 1 1 I I I 1 1 1RATED SHAFTS/OPENINGS 1 1 1 I I I 1 1 1T-BAR CEILINGS 1 1 1 1 1* ADDITIONAL DATA ON FILE I 1 1 1 1 1 1LOT DRAINAGE I I I 1 1REPORT ID: DPR261 ROUTE TO: BS0508 1 1 1 1 I I I I I I