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Home My Public Portal About6247 IVAR AVE_Building__ WORKERS' COMPENSATION DECLARATION Cby affirm that I have.r certificate of consent to self /n1 n[P L CAC O F(a R' D2 U�L D�N G [.ERIM =/nn�U i'risure, or'a certificate of Workers' Compensation Insurance, (r•��f' l! [1=�1 Llai LJ LI fJVU V Ll U or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING;AND SAFETY Policy No. Company �• Certified copy is hereby-furnished: FOR APPLICANT TO FILL IN ADDRESS 1 ❑ Certified copy is filed with the county building inspec- BUILDING/ "T� , / tion department.' ADDRESS (J _J_ /,� G Date Applicant' CITY -t-y' ZIP ,1�O 0 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be,completed if the permit is for•oneASSESSOR hundred dollars ($100)or less.) TRACT BLOCK" LOT NO. MAP BOOK PAGE, PARCEL / TEL. G USE ZONE MAP /I I certify that in the performance of the work for which this OWNER43O�k/it _ /'� NO O �' S�� SPECIAL permit is issued, l shall not employ any person in any manner ADDRESS - � � Cl d � I CONDITIONS so as to become subject to the Workers'Co pensation Lows.. ! / O. Date — -Applicant � '�!� CITY -en,,:"� (f,'= A ZIP < 7 U U NOTICE TO APPLICANT: If; after making this Certificate of ARCHITECT OR TEL. DISTRICT • _GROUP TYPE FIRE PROCESSED BY O ENGINEER NO. CONST. ZONE Exemption, you should become subject to .the 'Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS y_ C v V with comply with such.provisions or this permit shall be deemed revoked. STATISTICAL CLASSIFICATION APT. JtONDO. tq CONTRACTOR NO. • Z LICENSED CONTRACTORS DECLARATION LIC: CLASS NO. / DWELL. UNITS 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in•full force and effect. CITY CLASS BK VALIDATION SQ. FT. NO.OFNO. OF CHECK` License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION•OF WORK NEW Contractor Date ADD - $ I am exempt under Sec. D . ALTER.- B.O.C.:for this reason REPAIR, Q „ $ Date: USE OF DEMOL 1•;1 28A . EXISTING BLDG. <L✓ra e- Signature APPLICANT TEL FINAL OWNER BUILDER DECLARATION PRINT CL/ �' G/'/'Gt NO. Fj7- DATE — 1 hereby,affirm that I am.exempt from the Contractor's license / �` °. 060.50 Law for the following reason (Section 7031.5, Business and [ADDRESS IC� ;7 !�� fi��Pf� Cb r FINAL 0 Professions Code): PRE E By. J I ° ° 6 Q 5,Q c=t BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and IJ 1. 1 4`8 8 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code).• MOVING TEL. �! 1, as owner of the property, am exclusively contracting ICONTRACTOR -NO. with licensed contractors to construct the project(Sec- ADDRESS tion 7044;Business and Professions Code). CONSTRUCTION LENDING AGENCY . SETT BACKK YARD HWY_ TOTAPROPLINE 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.I. (Sec. 3097, Civ. C. SIDE l P.L. Lender's Name 'l� m LDMA Ref. P.C. Fee$ Permit Fee Lender's Address I certify that I have read.this application and state that the Issuance Fee �, LDMA P/C# D o above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee (/t (/ LDMA Perm. # Rand hereby authorize representatives of this County'to enter upon the abov mentioneedj property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date . WORKERS' COMPENSATION DECLARATION hereby affirm that,I have a certificate 'of consent to self O O 4~ nn insure,"or cYcerrificdte of Workers' Compensation Insurance, o or a certified copy thereof (Sec: 3800; Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAF TY Policy No. Company 'I Certified copy is hereby furnished. BUILDING. FOR APPLICANT-TO-FILL IN . ADDRESS ' Certified copy is filed with the county building inspec- BUILDING - ' tion department. . ADDRESS A� Date D / Applican CITY ZIP LOCALITY CERTIFICATE OF EXEMPTION FRO'WORK_ERSNO. OF BLDGS. NEAREST COMPENSATION INSLMANCE SIZE OF LOT NOW ON LOT CROSS SL (This section-need.not be,completed if the permit•is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP OWNER ' .. rC7A // NO. NO: I certify that in the performance'of the work for which this, , permit is issued,'I shall not employ any person in any manner' SPECIAL so as to become:.3ubject to the Workers'Compensation Laws. ADDRESS �' CONDITIONS CITY Date Applicant NOTICE TO.APPLICANT: If, after making this Certificate of, ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE CESSED BY ENGINEER NO. �-9 CONST. ZONE Exemption, you should become subject to the Workers' t Compensation provisions of the Labor Code,,you must forth- ADDRESS withcom ply with such provisions or this permit shall be TEL. t STATISTICAL CLASSIFICATION APT. CONDO. deemed'revoked, CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 2 LDWELL.'UNITS I hereby affirm,that I am licensed under provisions of Chapter ADDRESS. 4� SEWER MAP' (commencing with Section 7000)of Division 3!of the Business and LIC. ,Q Professions Code; and my license.is in full force and effect. CITY CLASS J BK PGVALIDATION n/� SQ. FT. NO. OF NO.OF . CHECK License Number-S�Da�O,/ Lic.,Class SIZE STORIES FAMILIES, ONEVALUATION V . NEW '� Contractor it/S Date"% ��— D DESCRIPTION•OF WORK O $ v P 0 0 ADD' 1.am exempt under"Sec. _ . ALTER ❑ W "B.BP.C. for this reason REPAIR $ D 59 USE OF DEMOL Q Z EXISTING BLDG. FINAL APPLICANT TEL. Si natu 9 OWNER-BUI ER.D CLARATIO PRINT) NO. DATE ' /� X _.T hereby affirm that I a xemptfrom the Co ractor's License . Law for the following reason,(Section 7031.5, Business and ADDRESS J FIN j ''�'}r` 1-06.13 Professions Code):,. PRESENTBy 1 T BUILDING ,:. 1 as owner of the property, or my' employees with ADDRESS —o wages asaFieir sole compensation,will do the work and � • " the structure is not intended or'offered for sale(Section' LOCALITY CHECK ��IZ 7044, Business and Professions Code). MOVING TEL:. 106.13 CONTRACTOR NO. t I, as owner of the property, am exclusively contracting a CHANGE .00 ' El with licensed contractors to construct the project (Sec- tion 7044, Business and7Professions Code). ADDRESS REQUIRED TOTAL SETBACK FRUM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP:LINE WIDTH (I (_I _ (``I( 1;1i1,• ;_ .1 hereby affirm that there is a construction lending agency for FRONT A the'performance of the work for which this permit is issued P.L. [( y6 1 H1{;=f_t (Sec, 3097, Civ. C.). 'SIDE s P.L. Lender's Name LDMA Ref.# ' m - a P.C. Fee$ - Permit Fee F,5, 6_3 - Lender's Address g I certify that I have read this application and state that the Issuance Fee' 0 LDMA.P/C# ' above.information is correct. I agree to comply with all County Investigation Fee' a ordinances and State laws relating to building construction, Total'Fee C; / LDMA Perm. # $ and hereby authorize representatives of this County to enter upon ove-men ' d o ty;or inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si Lure of Applico Agent _ _ Date La ", WORKERS'COMPENSATION DECLARATION 'ere offirmIthat I have a certificate of consent to self D Q t] PUNT Q �-insure,`oi."a certificate of Workers Compensation Insurance, L! �`!J U �, �,�,� ®� kU P��LI V U��'' or a certified copy thereof'(Sec.`3800, Lab. C.) „ COUNTY OF LOS /ANGELES BUILDING.AND"SAFETY Policy No. Company 0 'Certified copy is hereby furnished:' -FOR APPLICANT TO,FILL-IN BUILDI NG W v ADDRESS Certified copy is filed with the county building inspec ` BUILDING' lion department. ADDRESS21 Date,'.` :+. Applicant CITY OA P ZIP 1. ' ^E= LOCALITY NO. OF,BLDGS.•«. NEAREST _ CERTIFICATE OF'EXEMPTION FROM WORKERS' SIZE OF LOT r ,. NOW ON LOT CROSS ST-r, COMPENSATION INSURANCE r ` ASSESSOR" (This section need not be.completed if:the permit,is for one " `` 'k, hundred dollars($100)or less.) - TRACT BLOCfK NQO�{/ �//) MAP BOOK PAGE PARCEL OWNER rl f< NC4-�f G✓ USE NE MAP I certify that in the performance of"the work for which this NO. permit is issued, I shall not employ any person i'n arty manner " SPECIAL ADDRESS CONDITIONS so,as to b co su_bject to the:Workers'Compensation Laws. `� U, Date Applicant CITY. • ._I e4G� .cl' - Z1P, L�� NOTICE TO APPLICANT: If, after Makin thi ertificote of ARCHITECT OR TEL DISTRICT GR UP TYPE FIRE JPCE,SSED BY O ENGINEER NO. Exemption, you should• become subj t t he- Workers' - U Compensation provisions of the Labor'Cod'e, you must forth- ADDRESS• � " � CONST� ZO� with,comply with such provisions or, this permit shall be deemed revoked.. CONTRACTOR T O STATISTICAL C N' Z ST LAS IFI ATIO APT. CONDO. LICENSED CONTRACTORS DECLARATION t>. LIC. 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 MAP Professions Code, and-my license•i's in full force and effect. CITY CLASS VALIDATION SIZE FT' NO. OF NO. OF CHECK i F BK. PG.'... License«Number. ' ' Lic.Class D STORIES FAMILIES } ONE n DESCRIPTION OF.WORK TI N VALUA O Contractor Date NEW 1 ADD 6 M'l 2A U i+� `I: ) lit 17 I am exempt under Sec. a $ ALTER B.BP.C. for this reason IR $ r' USE OF. �97J37ll REPAIR Date. EXISTING BLDG. 1—c F✓t/`' u`� DEMOL E]'# # 0 0 90 0 0 Signature APPLICANT'. TEL. FINAL _ ;�;0 i� I S5 OWNER-BUILDER DECLARATION PRINT) NO. DATEi�J I hereby affirm that I.am exempt from the Contractor's License 0 0;,1 00 'Law for the following,reason (Section 7031.5, Business and ADDRESS r FIN 1 5,5 Professions Code) PRE ENT gY O o T—8 g.... BUILDING ti 1, as owner of,.the property, or my employees with- ADDRESS wages as.their sole"compensatiori,Will do the work and `` v `'. (`� '' ' s v` the structure is not intended or for sale(Section LOCALITY 7044 'Business and Professions Code). MOVING - TEL.- CONTRACTOR EL. w E a I, as owner of the property, am exclusively contracting CONTRACTOR NO.with licensed contractors to construct the project (Sec- ADDRESS tion 7Q44, Business and Professions Code). REQUIRED TOTAL SETBACK FROM X15T. CONSTRUCTION LENDING AGENCY SETBACK YARD HWY 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.' (Sec. 3047, Civ. C.). SIDE' P.L. Lender's Name P.C. Fee$ Permit Fee r �� CDMA Ref. q Lender's Address I certify that I have read this application and.state that the Issuance Fee c l5' CDMA P/C above information is correct. I agree to comply with all County Investigation Fee ; .o,.- ordinances and State laws relating to building construction; .� N and hereby authorize representatives of this County to enter Total Fee, p� CDMA Perm. N < upon the above-mentioned property for inspection purposes. O ��` ,� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f Appl`ic4dor Agent- -Dote _ - - 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 9912280025 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 5904 LT: 27 SQ. FT STORIES TYPE 6247 IVAR AV STRUCTURE: 0 VN TEMP CA 917801526 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5386-010-032 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 12/28/99 UT 06/25/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: { HERRA BARBARA A;JACKSON ALEGRA.M 1 4,000 _ 6247 IVAR AV All TEMP 917801526 FEES PAID DESCRIPTION OF WORK TEAR OFF, INSTALL 7/16 SHEATHING, COVER WITH GAF 20 YR. COMP FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SHINGLE ROOFING APPLICANT: TEL. NO: JERRY'S ROOFING, INC. (562) 691-8111- AA BLDG PERMIT ISSUANCE 27.75 23170 PIEDRAS RD. AC STRONG MOTION RESI.D 4000.00 VAL 0.50 SPECIAL CONDITIONS: GAVILAN HILLS, CA D2 PERMIT W/O_EN=HC=X4000.00 VAL 115.80 n �aTOTA_--�FEES 144.05 CONTRACTOR: TEL. NO: � U �G� APPROVALS DATE INSPECTOR SIGNATURE JERRY'S ROOFING, INC. (310) 691-8111- 23170 PIEDRAS RD. LIC. NO LOCATION AND SETBACKS GAVILAN HILLS, CA 92570 415691 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: p FOUNDATION/TRENCH FORMS LIC. N0: / - x'1111111 SLAB/UNDER FLOOR L —--- RAISED FLOOR FRAMING r_ MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:-- n O 1 TY � 1� UNDERFLOOR INSULATION 153H261 3 0�1 `��ll L� O� ( FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:—— — --- NO 21\� — "—- — ROOF SHEATHING s SCHOOL WITHIN HAZARDOUS of SHEAR PANELS AIR QNAOLITY: 10N00 FEET MANEORIALS J 1JI, FRAME INSPECTION D � � REQUIRED TOTAL SETBACK FROM EXIST (— �G�s FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: �p u_ QI� FRONT PL- �� INSULATION/WEATHER STRIP SIDE PL- �PQ1��l�� 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