HomeMy Public PortalAbout6251 IVAR AVE_Building__ tqk b.zsj
-p aPPUC AMOK FOR BULL ISR r�� ��N'T
COUNTY OF LOS ANG �ES'' • AND SAFETY
r' WORKER'S.COMPENSATION DECLARATION 7, FOR APPLICANT TO,FILL IN., BUIL pjF °
DIN AD
I hereby affirm that I have a certificate of consent,to self.insure, BUILDtAdG ADD % /
or a.certificate of Workers' Compensation Insurance,or a certified
copy thereof (Sec 3800,,Lab.C.) C�IT vlZIP LOCALITY
Policy No. Company cl/�%
SIZE OF LOT NO.OF BLDGS.NOW ON LOT
ff-CertifiBd copy is hereby.furnished. NEAREST CROSS ST
❑'Certified copy is filed.with the county building inspection TRACT BLOCK LOT NO. - - USE ZONE MAP NO.
department. �����
Date -���'y Applicant - -' ASSESSOR MAP BOO D/ •PAGE. PARCELO
• r�0 P. 0�0 SPECIAL CONDITIONS
CERTIFICATE OF`EXEMPTION FROM WORKERS' OWNER s TEL NO. NO
�j
COMPENSATION INSURANCE � .35 '� WITHIN.1000 FT.OF SCHOOL? YES NO '
(This section need`hof be completed if the permit is for bne'nundred ADDRE S , )
dollars ($100)or less.) DISTRICT .GROUP TYPE CONST. FIRE ZONE PRC ED BY
CITY - .ZIP { j� e,�/'
I certify that in the performance of the work for which this permit �t jflf 1(,
&11-7 L
is issued, I shall not employ-any person in any manner so as to ARCHITECT OR-ENGINEER - - TEL NO. -
- become subject-to the Workers'Compensation Laws. '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' CU4TRACTOR _ �" ._ • ' TFL NO. - SET BACK YARD HWY PROP LINE ._WIDTH,
Compensation provisions of the.Labor Code; you must forthwith Q� f� FRONT
comply with such provisions or this permit shall be deemed revoked. 9DD�R SqS �1 ^p��y'., LI NO.,, ! 'PL
/ Z 6541-) �B -,U�1_VA— �0(fl/q I SIDE
LICENSED CONTRACTORS DECLARATION CITYG: lq_ LIC:: SS PL
I hereby affirm that I am licensed underprovlsions of Chapter 9 SEWER MAP 23; '
000)of.Division 3 of the Business and
(commencing with Section 7 , SQ. T.SIZE FNO.OF STORIES. .NO.OF FAMILIES NEW 'BK - PG - - }
Professions Code,and'my license Win full force.and 'effect. W6 ( ACCT°JIL
-�. DESCRIPTIONS F.WORK ADD.. ❑ ;VALUATION, - ,303 g Q
14 License Number lE�y� Llc.Class 1 C D
Contractor
. s ate �`'� �Ye— F� ALTER "❑ low g,�?1 ~a.� .1 40.
REPAIR. ❑ � TOTAL. TTECiS 1540°
El am exempt under Sec.
BAP.C. for this reason, DEMOL :❑ LDMA P/C# W
USE OF EXISTING DG.
Date: .g� URM- ❑ E �e�fi�°
.Signature' AP (CANT(PRINT) L O. .- LDMA Perm#4111-2 'Z
�z✓/ ��6 �/3`1 L Z }I�
❑ 1, as owner of the property, or my employees with wages as ^. f�ttnnn 18M,8495
their sole compensation, will'dd the work and the structure is ADR ZSS21YIe �rw� +�� iQ`VVUI b16LL
not intended or offered for sale (Section_7044, Business and % J'' ` ,� �a�—i�R�ai��'`� R"'�//� ... FINAL DATE '...', '. 17ITGt t�31 !i G°YO
A
Professions Code.) - WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A.HAZARDOUS MATERIAL. .._
❑ I, as owner Ot the OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ' J
property, am exclusively Contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL,B , ,`41TAL 118063.84
licensed contractors to construct the project (Section 7044, Yes❑ 'NoO D
Business and Professions Code.) CHECK 1V�}°.'0{�
WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING •. CHANGE
° U
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION.OR MODIFICATION FROM THE SOUTH "'
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR 1 -
- GUIDELINES. J-2
,
I hereby affirm that there is a construction lending agency for YES El Noll tiJpYp/M��w�40LA titlnn` ttt�,�1i ( O.
w the performance Of the Work for Wf11Ch this permit IS ISSUed(Seg' I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND TH.E SCAQMD PERMITTING
0000"-0001 12/ 7/75 .
3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, [ �} { �y ('y i 1'
a TITLE 2,CHAPTER 2.20 SECTIONS 2.20:100 THROUGH 2.20.140 CONCERNING HAZARDOUS h/.f ` JV,7 . .- 1'' .AI 110:44
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT-FROM THE SCAQMD. Cl1
IL L'ender's Address
O OWNER OR ENT h-
oI certify that I have read this application and state under penalty �U\
° 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 �✓��o� �� �� � �ffii
construction, and hereby authorize representatives of this County 4ISSUANCE FEEOD
0
t u e _ ve mentioned property for inspection purposes. 'J1v �f
- -ay� INVESTIGATION FEE •�`. TOTALFEE
m a (O 1
r ��nawre of pplicant« gem Dare - -
SEE REVERSE F.OR,EXPLANATORY LANGUAGE
i
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 0305020015
PHONE: (626) 285-0488 EXT:
EG 0. OF CONST E BUILDING ADDRESS:
TR: 5904 LT: 28 UN: .002 SQ. FT STORIES TYPE OCCUP GROUP 6251 IVAR AV
STRUCTURE: 308 1 VN U1 TEMP CA 917801526
ASSESSOR INFORMT 0 GARAGE: NEAREST CROSS STREET: LONGDEN
5386-010-037 OTHER: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
TENANT: E S LDG SE- USE ZONE: ISSUED 0 : PROCESSED B EXPIRES 0 :
\ EXIST OCC GRP: 05/02/03 JK 04/26/04
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY CODE:
DE DIOS CAMILLE VERBEL (626) 309-1202- 7,750 II
6251 IVAR AV &, 106-o-3
TEMP 917801526 F P D D SCRIPT ON OF WORK
141X22' LATTICE PATIO COVER (ICBG 2228P)
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
RAFAEL C JARA (909) 594-7547- AA BLDG PERMIT ISSUANCE 27.75
786 PINE FALLS AVE AC STRONG MOTION RESID 7750.00 VAL 0.78 SPECIAL CONDITIONS:
WALNUT D2 PERMIT W/O EN-HC 7750.00 VAL 183.00
TOTAL-FEES 211.53
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
WEST COAST CUSTOM ROOMS (909) 594-7547
786 PINEFALLS AVENUE LIC. NO �,�/ i LOCATION AND SETBACKS
WALNUT CA 91789 B/L 2731
SOILS ENGINEER APPROVAL
ARCHITECT OR NGINEER: TEL. NO: -- - FOUNDATION/TRENCH FORMS
LIC. N0: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
3 01
ST LEVEL FLOOR SHEATH
NO. OF FAMILIES: DWEL G UNI S: APT/COND: STAT CLASS:
NO 21 2ND LEVEL FLOOR SHEATH
SCHOOL WI HIN HAZARDOUS ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPEC ,70 Oj
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- SHEAR PANELS
SIDE PL-
INSULATION/WEATHER
L-
INSULATION/W AT R STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
LOT DRAINAGE
SMOKE D E ION DEVICES
FIRE DEPARTMENT APPROVAL
* ADDITIONAL DATA ON FILE
REPORT ID: DPR261 ROUTE TO: BS0508