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HomeMy Public PortalAbout6122 IVAR AVE_Building__ nENSATION DECLARATION In here 6r4-;ff, r°That e have a certificate of consent to self Alp [P L C 0 M (a n nn �'( insure, or a certificate of.Workers' Compensation Insurance, LI /1-'�1 Ll V LIt1 L�al'�/ LI LlvLll/LI LI or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING'AND SAFETY Policy No. Company BUILDING: lffied copy is hereby,furnished. . FOR APPLICANT TO FILL IN ADDRESS 9-.-'Certified- copy is filed with the county building inspec-. gpDREss �� ✓- tion.department. CITY' �: � ZIP LOCALITY Dare Applicant NO. OF BLDGS. . CERTIFICATE OF EXEMPTION'FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST f `i CROSS 57 4L4 COMPENSATION INSURANCE. .. !�/�,�/ (;/1 , ASSESSOR (Thin section need not be completed'if•the permit is for one TRACT BLOCK LOT NO. MAP BOOK, PAGE PARCEL -hundred dollars ($100)*or less.) > TEL. '• OWNER - C ) &4yN NO.� >rQl�: USE,ZONE MAP I certify that in.the performance of the work for s which this, NO. permit is issued, I shall not employ any person in;any manner ADDRESS SPECIAL d CONDITIONS so as to become'subjectao the Workers'Compensation,Laws. O CITY ZIP U -Date Applicant ARCHITECT OR TEL. DISTRIC O TYPE" FIRE CESSED BY NOTICE TO APPLICANT: If after':making,this Certificate of ENGINEER NO. CONST. E Exemption, you should become subject.•;to the.Workers U Compensation provisions of.the Labor-Code; you must forth- ADDRESS 9 0- with with comply_with such.provisions-or this permit shall be TEL y CO/ ' STATISTICAL CLASSIFICATION ^� APT. CONDO Z deemed revoked: CONTRACTOR !Y�..��af'AlOr�rcj �/t r _ LICENSED CONTRACTORS DECLARATION i LIC. 7 ,3�� CLASS NO. DWELL. UNITS I hereby affirm that am licensed under provisions of Chapter 9 ADDRESS li L A T Wfis oADIQ. ✓. v. SEW L (commencing with Section J000)'of Division 3:of the BusinessER MAP CITY ��'�6 A./J O�L:��— .�� LIC:CLASS C_ � = and Professions Code,and my license is-in full force and effect. JT BK PG. VALIDATION- >/• SQ.'FT. NO. OF. NO. OF CHECK License Number Tr/�33 D Lic. Clas jsSIZE STORIES FAMILIES ONE VALUATION Coniractor7�O'tJR(�3ll Date ( 0: /51DESCRIPTION OF WORK /. NEW ❑ E ❑1 am exempt under Sec. [� %t !©f.rJ J1/ ADD El D ALTER... EJ B.&P.C. for this reason � �r REPAIR ❑ $ D USE OF EXISTING BLDG. DEMOL EX Signatur APPLICANT TEL. FINAL BUILDER DECLARATION" (PRINT). NO. DATE I hereby affirm that I am exempt from the Contractor's.License Law for the following,reason;'(Section 7031:5; BusineADDRESS ss and FINAL Professions PRESENT By Pr qr BUILDING ACCT.ir El 1 as owner of the property,'or my,employees with ADDRESS °3(�7 •_:50wages as their sole compensation,,will do-the work and i• . The structure is not intended or offered for sale(Section LOCALITY 7044, Business and.Professions Code.) MOVING` TEL. D y ITEMS CONTRACTOR NO. I, ds owner of the property, am exclusively contracting _ TOTAL �� e� ® . n with licensed contractors to construct the project.(SeC .t ADDRESS 1. n t�` _ tion 7044, Business and Professions Code.) �1�,H CiV o�:# CONSTRUCTION LENDING AGENCY REQUIRED• TOTAL SETBACK FROM` EXIST. YARD HWY i SET BACK PROP. LINE WIDTH.. I hereby affirm that there'is a construction lending agency for . -FRONT k CHANE . ', .00 the performance of the work for:which this permit is issued P.L.. (Sec. 3097, Civ. C.). SIDE, Lender's Name 1 P:L: 0�7Q(Ji'cIrli 1Ci/M �i�°-y'; P.C. Fee$ Permit Fee V /V LDMA Ref. # 628l 1I �Il�1�111 Lender's:Address I certify that I have,read this application and state that the Issuance Fee • ✓ v LDMA P/C# D 8 above information is correct. I agree to complywith all County Inve"stigation_Fee R ordinances and State laws relating to building constructionTotal Fee r / LDMA Perm. # a and uthorize representatives of.this County to enter. n t ov -mentio d.property for inspection_p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Applicant or Agent Date 1 S'COMPENSATION DECLARATION. i hyre, _ a Ger fica I have r certificate of consent to self LFD, u V ®� 00 (� ®�(� !� [D�2 nn �(' ms�re, or a certificate of Workers' Compensation Insurance, [�=�1 LL(( /J�� LI IJV LL H 1�5 [� [C IJ�UIILI lJ �J 10 of a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS AINGELES BUILDING.AND SAFETY Policy No. Company I & ,EJ. BUILDING Certified copy is hereby.furnished..: FOR APPLICANT TO FILL IN ADDRESS c Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS o! ./ oT Date Applicant CITY `11 l,•I`/ ZIP' I�/ C/ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF.B,DGS. NEAREST. COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed,if.the permit is for one •• t' ASSESSOR Hundred dollars ($100)or less.) TRACT - BLOCK LOT NO. MAP BOOK IPAGE PARCEL TEL. $/ USE NE MAP I certify that in the performance of th far which,this OWNER O NO. .NO. permit is issued', I shall not employ y pegs any man r SPECIAL so as to become subject to the rkers' any L s. ADDRESS /^ CONDITIONS Date f Applica _ CITY IP NOT TO PPLICANT: If, afte W. is"Certificate of ARC ITECT OR T DISTRICT G UP TYPE FIRE PROC ED BY C) Exemption, you should. become subject •to. the 'Workers' ` ' ENGINEER le NO. �` CONST. ` ZONE U Compensation provisions of the Lobar Code, you must forth- ADDRESS t. V W with comply with,such provisions or this permit' shall be TEL: STATISTICAL CLASSIFIYATION APT. C DO. N deemed revoked. CONTRACTOR N LICENSED CONTRACTORS DECLARATION L CLASS NO. DWELL. 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 and / LIC. SEWER P Professions Code, and my license is in full force.and effect. CITY / CLASSBK PG VALIDATION ° SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW C VA (� ❑ ADD 0 $ I am exempt under Sec. ALTER a_ B.BP.C. for this reasonREPAIR :.a> $' 9 3,73 A USE OF Date: DEMOL EXISTING BLDG. ° #,o 0 0 0�0,1 Signature APPLICANT. TEL. FINAL. OWNER-BUILDER DECLARATION PRINT NO. DATE l dt'—zo-43 0 2.1 S 6 3 1 hereby affirm that I am exempt from the Contractor's License ADDRESS FINAL. t Law for the following.reason;(Section 7031.5, Business and o�0 2 1 8.6 3 • Professions Code): POESENT BY BUILDING I, as owner of the property, or my employees'with ADDRESS 5 >, \' + ( a '.• 0 IL 1 2`s$• wagesas their sole compensation,will do the work and LOCALITY ff the structure is not intended or oered for sale(Section ` S 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- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY RETQBACK UIRED YARD HWY:. TOTAL ETBACK FROM.,. 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. (Sec. 3097, Civ. C.).. SIDE P.L. Lender's Name w P:C. Fee$ Permit Fee /_3 LDMA Ref. # Lender's•Address _ I certify that I have read this application and state that the Issuance Fee l S U LDMA'P/C# D gabove' anon is correct. I agree to comply with all County Investigation Fee $ -rd nces State laws luting to building construction, Total Fee �( a her y uthorize rep sentatives of this County to enter (J r C/ LDMA Perm. # m pan a ov endo d property for inspection purposes. l � SEE REVERSE FOR EXPLANATORY LANGUAGE n Si nure of Applicant or Agent Date APPUCAMORFOR BULDNIG COUNTY OF LOSANGELES BUILDING AND SAFETY . WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO,FILL IN BUI ING ADDRESS ., _ .. .. O� /�.d•F-l��.G. C/'�� C-Ca C.CV I hereby affirm that I,have a certificate;of consent to•self insure, or a certificate of Workers' Compensation Insurance,or a certified 1p� copy thereof(Sec.,3800,Lab.C.), t'''/J�- moi' _ z91��� LOCALITY Policy No. _5 - Company. `" � -r SIZE OF LOT T j� .lam- NO.OF BLDGS.NOW ON LOT ❑ Certifled'copy Is hereby furnished NEAREST CROSS ST. Certified,copy is.filed.with the county building_inspection TRACT - - BLOCK LOT NO. So -f I/V(' �GN `�- ✓^t/G G' � department. USE ZONE MAP NO. Date/6 ��pplicant C —. ASSESSOR MAP BOOK �i PAGE PARCEL ,��jg g:_ DO Z Q/� SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM-WORKERS' o NE �yTEEL(Iyp S d COMPENSATION INSURANCE �`fJJ 6 WITHIN*1000 FT.OF-SCHOOL? YES NO (This section need not be'completed if the permit is for one hundred AS RES .-T— �( DISTRICT GROUP' TYPE CONST, FIRE,ZONE PROCESSED BY - dollars'($100)or less.) - T Q �Q •y. p p CIT .. .. 'ZIP 91 7 lJ. .. I certif that in the performance of the work'.tor which'this permit.-• �`)/�p is issued I`shall not employ any person In any manner so'aS to l/V )C-3 IiLGCL ,become subject to.the Workers' Com ensation Laws. ARCHITECT OR ENGINEER - TEL NO. P STATISTICAL CLASSIFICATION - APT CONDO Date Applicant, ADDRESS CLASS.NO. .1 DWELL UNITS NOTICE 'TO APPLICANT.' If after making` this Certificate of ':.REQUIRED TOTAL SETBACK FROM EXIST Exemption, .you should become subject .to the .Workers CONTRACjOR TEL N / SET:BACK YARD `HWY- PROP LINE WIDTH Compensation.provisions of--the'Labor.Code, you must forthwith 'FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.N P L LICENSED CONTRACTORS DECLARATION C. V SIDE - O CITY :LIC.CLASS P L. I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP Professions Code,and in 100 f Di full force and effect. ' ' SIZE -NQ,.OF STORIES NO.OF FAMILIES. ' (commencing with Section 7000)of Division 3 of the.Business and SQ.FT.S NEW ❑ Y V License Num er•- Lia Class ,, CL _DESCRIPTION OFWORK •-- 'ADD ❑ `VALUATION - PG � ' p Contractor ( cIKOM Of+ Date IO � ll.�o,� 0� An1d, �bJS`ffC X11 ALTER ❑ $ O ❑ 1 am exempt under Sec. REPAIR a$ 0 B.&P.C.'for this reason flotJ*� � W �L. ►1J DEMOL ❑ W r �y LDMA P/C# _ •• D- e: U E OF EXISTING-BLDG. N�tv. tl• - -URM C1 UGC - Signatur APP NT,(PRINT) TEL LOMA Perm-# Z ElI,'`as owner of the property, or my employees with wages as bYL r7� � �J T'• Z1 +! '• u� X their sole compensation, will.do the Work,and.the.structure is ADD SS not intended or offered for sale (Section 7044, Business and 2 /':�� i �," FINAL DATE Q ice! r _ii=°•_: Professions Code.) - - WILL THE;APPUCANT OR FUTURE BUILDING,OCCUPANT HANDLE A-HAZARDOUS MATERIAL /2. .. I, as owner of the property, am exclusive) contractin With OR A IXTURE CONTAINING A HAZARDOUS,MATERIAL EQUAL TO OR GREATER THAN THE J Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? 'FINAL BY < _ licensed contractors to construct the•project (Section 7044, YEs❑ - No } 4R.- f: ° i Business and Professions Code.) , WILL'.THE INTENDED USE OF THE BUIDUNG 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(SOAQMD)SEE PERMITTING CHECKLIST,FOR - -. GUIDELINES. , �,' •'TE 3' I hereby.affirm that,there is a construction lending,agency for. yES❑- No N the performance of the work for which this permit is,issued(Sec:' .I.--L ,�v..U3-� rn I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING , 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, "'• ' C TITLE 2,CHAPTER 2:20 SECTIONS 220.100:THROUGH 2.20..140 CONCERNING HAZARDOUS - C v'+. Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. CL Lender's Address - OWNER OR AGENT . o I certify that I have read this application and state under penalty o P.C.FEE" .✓ -PERMIT FEE �/ -F•, of perjury that the above intormation is correct.I agree to comply n -0 p( } ,:I p (/ _ �_S_S I`I SS`.'�{�• a Sf ^-S�• — a with all r finances and State laws relating to building - - con cti ereby authorize resentatives of'this County ISSUANCE FEE' �j /^ i•j Z t ent mentione perty for inspection purposes. o[ 7"(J m • Iry INVESTIGATIONFEE­ - TOTAL FEE '-•� ' Sig d A - SEE REVERSEFOR 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 0510240038 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 5904 LT: 42 UN: .002 SQ. FT STORIES TYPE 6122 IVAR AV STRUCTURE: VN TEMP CA 917801523 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5384-002-012 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/24/05 JK 10/19/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DTE FINAL BY: CODE: LIAO, HSI CHUNG (626) 451-5805- 700 .�/� 6122 IVAR AV TEMP 917801523 FEES PAID DESCR•IP/TION OF WORK INSTALL 2 WINDOWS ON WORKSOP AND 1 BACK OF THE GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (SAME SIZE) APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG 'PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 700.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 700.00 VAL 43.65 .TOTAL FEES 71.90 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. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP.: UNDERFLOOR INSULATION XX 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS - NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD_ : HWY: PROP LINE: WIDTH: FRONT PL- 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