HomeMy Public PortalAbout6236 IVAR AVE_Building__ WORKERS`COMPENSATION DECLARATION
I.hereby affirm that I have a certificate of consent to self D
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insure,°or a certificate of Workers'Compensation InsuranceAPPMCAUPOMRO D nn
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or a certified copy thereof (Sec. 3800, Lab. C.). COUNTY OF LOS �41�CsELES BUILDING AND SAFETY
CPohc0'*12'-1063 Pony ' Argonaut Ins .
a Certified'copy is hereby furnished:: '` FOR APPLICANT TO FILL IN ADDRESS
a . Certified copy is filed With.the,county building inspec- BUILDING.
tion department. ADDRESS 6-236 N. I V a r LOCALITY
-mow NEAREST
Date' 11_1_.stZ- 'Applicarfd.OWd'rd L Randol CO CITY,. �epl 1e .0 ZIP 01 7go CROSS ST. .
CERTIFICATE'OF:EXEMPTION:FROM WORKERS' C NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT. r NOW ON LOT " MAP BOOK PAGE PARCEL
(This section need:nof be'complet, if'.the'peimit is for one USE ZONE.. ESPECIAL,'
:
Ilar's ($100)or less ) .
TRACT. $LOCK LOT NO. G�
I certify"that OWNER NO. DITIONS'
hundred do
• .,
�/
y at in the'performance'of the'work:for whichthi's
ermitis issued, I shall not em to •an erson in an manlier STRICT; GROUP TYPE FIRE PROCESSED.BY 0
- p P Y Y P Y 6 2 3 6 N. I:v a r � coNST. ZONE
u
so as toIbecome subject to the Workers'Compensation Laws.. ADDRESS
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CITY 'Tem le 'Cit ZIP 91780 / -,3 O
Dote 2 R R � Appl icarK 0 w a r(9 T,,- Ra n d O 1 Co STQTIS ICAL•CLASSI NCONDO. U
NOTICE TO APPLICANT: If; after rimaking-this Certificate'of ARCHITECT OR TEL. V
Exemption, you should become subject to the Workers'' ENGINEER'. NO. CLASS NO. DWELL. UNITS IL
Compensation provisions of'the Labor Code, you.must forth- ADDRESS SEWER MAP z
with comply with such provisions or this permit shall- be
TEL. VALIDATION
deemed reGoked.•. CONTRACTORHOW rd R O. _ BK. PG,
.•LICENSED CONTRACTORS DECLARATION LIC.
I hereby affirm thaYl am licensed under provisions of Chapter 9 ADDRE95 NO. A j �:VALUATION
(commencing with Section 7000)of Division 3 of the.Business and tIC. • 622 . 0 0
Professions'
rofessions Code, and"my license is in full force and effect. CITY Sari Gabriel CLASS C-3 9 D
SQ. FT. NO.OF • NO.OF CHECK
License'Number 186086 Lic.Gloss C-3 9 SIZE STORIES FAMILIES ONE
i.•: NEW $
o va r d L. rR a n d,�•t C o , 2=18 -8 3 DESCRIPTION OF WORK
Contractci U61e. _ ADD
am exempt under Sec roof h.O a G.e Witt' C OIRp 0 .
ALTER 0 FINAL
B.&P.C. for this reason S hi nq 1 e 12 x'18 & F G. 284 7 EPAIR ® DATE J
Dote:' USE OF S F D � FIPlAL -
EXISTING BLDG. DEMOL :e
Signature
APPLICANT TEL. Y
OWNER-BUILDER DECLARATION PRINT N
I hereby affirm-that I am exempt from the Contractors License ADDRESS
529' E . Valley Bi : S a n G a'b'r 1D
Low for the following reason'(Section 7031.5,.:Business.and
Professions Code): PRESENT
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS
wages as their sole cor>ipensation,,will do'the:work and.
-the structure is not intended or offered for sale(Section LOCALITY
7044,Business and Professions Code). MOVING TEL. 0 2.6'7 A
I, as'owner of the property, amex clusively'contracting CONTRACTOR NO. #).
0 0 0 0 0
with"licensed contractors to construct the project,(Sec-. ADDRESS
tion 7044, Business and Professions Code). r
REQUIRED' TOTAL SETBACK FROM EXIST. 2 0 ° 3.200
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY pROP. LINE WIDTH
I hereby affirm that there is a'construction lending agency for FRONT D o 0.0 32.0 0
the performance'of'the work for which this permit is issued P.L.
(Sec.3097, civ:. .).). SIDE 0 3,0 8 8 3
Q Lender's Name
Lender's Address P.C. Fee$ Permit Fee
& I certify that I have read this application and state that the
g Y PP Issuance Fee 5 0
above information is correct. I agree to comply with.all County Investigation Fee
g ordinances and State laws relating to'building construction, Total Fee. 0-400
and hereby authorize representatives of this County to enter
upon the aove-r enti ed property for inspection purposes.
-I$^g SEE REVERSE FOR EXPLANATORY,LANGUAGE
Signature of Appli or.Agent Date - ®s
a COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
` BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0202210016
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 5904 LT: 34 SQ. FT STORIES TYPE OCCUP GROUP 6236 IVAR AV
_ STRUCTURE: 367 1 VN R3 TEMP CA 917801525
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: LAS TUNAS
5384-001-010 OTHER: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
_.__IS—._.--.
SUED — —
TENANT: EXIST BLDG USE: USE ZC%dE: ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 05/29/02 JK 11/25/02
--.-- ___.... .— ._ —�___._ _F1),
04iNER —._—___'_ ... _.. ^_-' — — TEL. N0 ---_ BL.DGS.�.._NOW _UN—LUT—. _
; VALUtsTiON: FI .AL DATE FINAL BY: CODE:
MCGRATH THOMAS P;SUZETTE G (626) 286-8435- 30,000
6236 IVAR AV ' _
TEMP 917801525 FEES°PAID DESCRIPTION OF WORK
ADD BEDRM W/BONUS RM, BATHRM; EXTEND & REMODEL KITCHEN;
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: YL ,SIi
APPLICANT: � TEL. N0:
TANG (626) 793-8387- AA BLDG PERMIT ISSUANCE 27.75 _
745 EARLHAM ST AC STRONG MOTION RESID 30000.00 VAL 3.00 SPECIAL CONDITIONS:
PASADENA B1 PLANCHECK W/ENERGY 30000.00 VAL 501.80
B2 PERMIT W/ENERGY 30000.00 VAL 590.37
_ TOTAL FEES 1,122.92
CONTRACTOR: TEL. NO: I APPROVALS DATE INSPECTOR SIGNATURE
RCON (626) 398-7265• f
P.O.BOX 6427 LIC. NO LOCATION AND SETBACKS
ALTA DENA, CA 91003 757558 B
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. N0: I FOUNDATION/TRENCH FORMS
LIC. N0: ----'- i j i`;, SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
3 01
S�VEL FLOOR SHEATH
NO. OF FAMILIES; DWELLING UNITS: APT/COND: STAT CLASS:
NO 21 ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT.
SET BACK YARD: HWY: PROP LINE: WIDTH: _
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