HomeMy Public PortalAbout6263 IVAR AVE_Building__ o ...,WORKERS' COMPENSATION DECLARATION
here+by aff'lrm 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,) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. - Company s
❑ Certified copy is her .furnished. FOR APPLICANT TO FILL INBUILDING Z_ ADDRESS
❑ :-:Certified c 0-py is filed with,the count buildin inspec- BUILDING {{ 2 P A d e Q
tion department. Y 9 P ADDRESS W.2 LD J N. 1 V A/K A( T'E'O�'=� (� ,T `f . C / '
CITY' EM�"ILC C.tT Y ZIP 1 t 7 c LOCALITY
Date Applicant—,. I ( NO. OF BLDGS: NEAREST (�
CERTIFICATE OF"EXEMPTION FROM-WORKERS' ' . SIZE OF LOT S1 )•(V NOW ON LOT ' CROSS ST.. L o rJ (3 �'�IJ
e V�+ '
j COMPENSATION INSURANCEASSESSOR p- )
S (This section need not be completed'if'.the permit is for one TRACT J p V�' BLOCK LOT NO. MAP BOOK J JC PAGE �'� D PARCEL Z
hundred dollars ($100)'or less.) e^�n C I\ TEL �U j i�/ �3
( OWNER- N V IR 59 Std 01d'15 P 42 USE.ZONE MAP.
! I certify that in the performance of the'work for which This / A_ NO..
i 1D b �f. V A� �T IJ� SPECIAL a
P is issued, I shall not employ any,Person in any,manner ADDRESS CONDITIONS
I so as to become subject to the•Workers Compensation Lows. ./ q 7 O
CITY TEM �• ZIP 1 ( L�U- U
Date Applicant ARCHITECT OR q TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Q
ENGINEER. AilA �/�� � NO CONST.NOTICE TO APPLICANT: If,'after,making this.Certificateof CONST. _ ZONE
Ezem,tion, :you should become. subject to the .Workers' /� u f Ci � Q � w
'Compensation provisions of the-Labor Code, you must forth- ADDRESS +� 6- 'tl•L� 0SA Gr• � �P�E � a
with comply with such.provisions or;this permit shall beTEL. STATISTICAL CLASSIFICATION.. APT. CONDO. Z
deemed revoked.. CONTRACTOR NO. —
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.- DWELL. UNITS
I 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 LIC.
and Professions Code,and my license is;in full force and effect. BK. PG.
CITY CLASS
VALIDATION
SQ. FT I NO. OF NO. OF CHECK
License Number, Lic.,Class SIZE STORIES FAMILIES ONE
VALUATION
Contractor Date DESCRIPTION OF WORK p b(T`�• NEW a $ gl. Tj
�' {' S❑ i ADD r I am.exempt under Sec.
ALTER ❑
i• . .a AT, � �o�M
B.BP.C. for this reason' REPAIR ❑ $
Date: USE OF ��C LL 1 A M DEMOL ❑
EXISTING BLDG. '
Signature APPLICANT 1 /� �L ,�Q (�'`�-l0 FINAL
(PRINT). PA L A N&O)4 - a
OWNER-BUILDER DECLARATION r DATE
I herebyaffirm that I am exempt from the Contractor's License yl L. ".SA P ADDRESSt�`9f h'E,K�t.SH GIr. -T�F+pc�'Cljti QIP'
Law for the following reason (Section'7031'.5, Business and
Professions Code): PRESENT �BY• '
BUILDING.
I, as owner of the property, or,my employees with ADDRESS --
wages as their sole compensation;will do lite work and LOCALITY _
the structure is not intended or offered for sale(Section D
7044, Business and Professions Code.) MOVING TEL. -
-Ap CONTRACTOR NO.
I,-as owner of the property, am exclusively contracting
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code.) +
REQUIRED TOTAL SETBACK FROM EXIST:
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH y
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this per.mit.is issued P.L.
(Sec. 3097, Civ. C.). SIDE .i.: }::,r•..::
Lender's Name, r
.r� / s� TDMA Ref. #-
m - - - P:C. Fee$ Q, / Permit Fee Cs/-!.�s I r•� } �f
3 Lender's Address
$ 1 certify that I have read this application and state that the Issuance Fee LDMA P/C#
t i
above information is correct. I agree to comply with'all County Investigation,Fee �' _�. I' ' - I I
8 ordinances and State lows relating.to building construction, Total Fee a LDMA Perm:# _rrj } AN VD,t s ;�
a and hereby authorize representatives of this County.to enter
upon thea ve-A�ioned*pr;rrty for inspection.p rposes.
-- �' SEE REVERSE FOR EXPLANATORY LANGUAGE
gnatuie 16f Applicanfof Agent Date
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 0708290012
PHONE: (626) 285-0488 EXT:
LEGAL ID: �. NO. OF CONST I BUILDING ADDRESS:
ITR: 5904 LT: 29 UN: .002 SQ. FT STORIES TYPE 6263 IVAR AV
I (STRUCTURE: VN TEMP CA 917801526
(ASSESSOR INFORMATION NUMBER: ' NEAREST CROSS STREET:
15386-010-029 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
I
TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 IISSPED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 108/29/07 SR 02/25/08
1
OWNER: TEL. NO: IBLDGS. NOW 014 LOT: VALUATION: P A FI L CODE:
ISU ANDREW.W;LI SHAN L TRS (626) 286-2544- 1 2,000
16263 IVAR AVE
TEMP 917800525 FEES PAID IDESCRI TIOn OF WORK
- IREPIACE.7 WINDOWS NEW WINDOWS TO BE VINYL, DUAL GLAZED LOW E1
1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( . I
(APPLICANT: TEL. NO: -
IIRWINDALE WINDOWS CO. (626) 814-3302- 1AA BLDG PERMIT ISSUANCE 27:75
112731 RAMONA BLVD. JAC STRONG MOTION RESID 2000.00 VAL 0.50 ISPE.CIAL CONDITIONS: I
IIRWINDALE CA 91706 ID2 PERMIT W/O EN-HC 2000.00 VAL 82.20
I TOTAL FEES 110.45
I
CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IIRWINDALE WINDOWS CO. (626) 814-3302- i 1
112731 RAMONA BLVD. #206 LIC. NO ILOCATION AND SETBACKS
IIRWINDALE, CA 91706 846482 C17 1 I
ISOIL'SENGINEER APPROVAL
I
(ARCHITECT OR ENGINEER: TEL. N0: (FOUNDATION/TRENCH FORMS
I I
I LIC. NO: I ISLAB/UNDER FLOOR I I I
I i I I I
IRAISED FLOOR FRAMING I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ' (UNDERFLOOR INSULATION
1153H261 3 011 - I
I I FLGO_R'SHEATHING I I ` 1
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I I
I NO 21 IROOF,SHEATHING I I 1
I
I SCHOOL WITHIN HAZARDOUS li _ ISHEAR'PANELS I I I
(AIR QUALITY: 1000 FEET MATERIALS I - I I
I NO NO NO I IFRAME INSPECTION I I I
I I II I I
IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE-'SPRINKLER HANGERS I I I
ISET BACK YARD: HWY: PROP LINE: WIDTH:
(FRONT PL- I (INSULATION/WEATHER STRIPI I I
I SIDE PL- I I
I I (INTERIOR LATH/DRYWALL 1 1
(EXTERIOR LATH I I
I I I + I I I
IRATED,.FLOOR/CEIL ASSEM. I I 1 -
I R I I
I I IRATE ID WALL ASSEMBLIES I I 1
1
I I (RATED- SHAFTS/OPENINGS I I I
I I I A', -1-1 I
I I IT-BAR,-CEILINGS I I I
I I, I •• 11 I
I I ILOT DRAINAGE I I I
I I . I
I IREPORT ID: DPR261 ROUTE TO: BS0508 I 1
I I
V
f t -
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 0706260025
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:!. '
ITR: 5904 LT: 29 UN: .002 � SQ. FT STORIES ' "TYPE 6263 IVAR AV
I , (STRUCTURE: VN TEMP CA 917801526
ASSESSOR INFORMATION NUMBER: = NEAREST CROSS STREET: LONGDEN
15386-010-029 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
TENANT: 'EXIST BLDG USE: RESID USE ZONE: R-1 .. TISSUED ON: PROCESSED BY: EXPIRES ON:
; IEXIST OCC GRP: 106/26/07 SR 06/20/08
OWNER: TEL. NO: IBLDGS. NOW ON IAT: - VALUATION: TF•AL D FI CODE: T
ISU ANDREW W;LI SHAN L TRS - ' 4,800 .
16263 IVAR AVE
TEMP 917800525 1 } FEES PAID IDESCRIPTION10F WORK
tI IROOF REPAIR FRONT SIDE REROOF BACK SIDE OVER LAY (NEW
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IEXTENTION) COMPOSITION SHINGLES
APPLICANT: TEL. NO: I I '
IRHEE (323) 864-7388- IAA BLDG,PERMIT ISSUANCE 27.75 I 1
11034 FEDORA ST. IAC STRONG MOTION RESID 4800.00 VAL 0.50 ISPF.CIAL CONDITIONS: 1
ILOS ANGELES 90006 ID2 PERMIT W/O EN-HC 4800.00 VAL 132.60 1
TOTAL FEES 160.85
� I
(CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
IPACIFIC COAST CONSTRUCTION (323) 864-7388- I-'1
11034 FEDORA ST. LIC. NO ILOtATION AND SETBACKS
ILOS ANGELES, CA 90006 829737 I �
' :- ISOILS ENGINEER APPROVAL
1
(ARCHITECT OR ENGINEER: TEL. NO: I IFOiJNDATION/TRENCH FORMS I I I
_ I
LIC. NO: T 'ISLAB/UNDER FLOOR I I I
I I IRAISED FLOOR FRAMING I I I
)
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I (UNDERFLOOR INSULATION I I I
I153H261 3 0_I I � -1-1 I
I .I '(FLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: '( I P. I I I
NO 21 -i i ROf F SHEATHING
SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS
1AIR QUALITY: 1000 FEET MATERIALS I I
NO NO NO i (FRAME INSPECTION I I
IREQUIRED TOTAL SETBACK FROM EXIST ,T IFIRE SPRINKLER HANGERS I I
ISET BACK YARD: HWY: PROP LINE: WIDTH: T I
IFRONT PL- T INSULATION/WEATHER STRIPI I
I SIDE PL- 1 -1-1
11NTERIOR LATH/DRYWALL
i
(EXTERIOR LATH I I I
I IRATED FLOOR/CEIL ASSEM. I I
IRATED WALL ASSEMBLIES
I IRATED SHAFTS/OPENINGS 1
IT-BAR CEILINGS I I
I I ILOT DRAINAGE I I I
IREPORT ID: DPR261 ROUTE TO: ES0508 I I I
I I I I I I
9
• ` ' CGUNTY OF LOS ANGELES TEMPLE CITY #«0508 •r BUILDING PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL. 0508 0002180001
PHONE:'(626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 5904 LT: 29 UN: .002 SQ. FT STORIES TYPE OCCUP GROUP 6263 IVAR AV
STRUCTURE: 395 1 VN R3 TEMP CA 917801526
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET:
5386-010-029 OTHER: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 02/22/00 UT 08/20/00
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
SU ANDREW W;LI SHAN L TRS (626) 286-2544- 1 29,230
6263 IVAR
TEMP 917800525 FEES PAID DESCRIPTION OF WORK
ADDITION OF FAMILY ROOM AND FULL BATHROOM
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 29230.00 VAL 2.92 SPECIAL CONDITIONS:
AX BUILDING REV-I=EW=FEES 54.70
B2 PERMIT W/,ENERGY.—`29230:00 VAL 590.37
(��Q-�o�TO,TAL�FEES 675.74
CONTRAOWNER
TEL. NO: ®� ��/fVAPPROVALS DATE INSPECTOR SIGNATURE
SAMELIC. NO [ON AND SETBACKS
ARCHITECT OR ENGINEER: TEL. NO: FO N/TRE S
LIC. N0: 1111111 LAB/U FLOOR
WRAISED FLOOR FRAMING
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CM0-1=�n n O n UNDERFLOOR INSULATION
'I U L C W G IlJvll1ILJK(�3 ST LEVEL FLOOR SHEATH
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:—
NO 21VC O O � ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS \ 19 El ?, ROOF SHEATHING F —'�
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO 0 co 0 FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT
SET BACK YARD: HWY: PROP LINE: WIDTH: �/j El
FRONT PL- aSL."voce-T e"L SHEAR PANELS
SIDE PL-
INSULAT'ION/WEATHER STRIP
INTERIOR LATH/DRYWALL
EXTERIOR LATH
LOT DRAINAGE J
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: SS0508
s
.. '. COUaTY-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 05081310280050
PHONE: (626) 285-0488 EXT:
ILEGAL ID: - I NO. OF CONST BUILDING ADDRESS:
ITR: 5904 LT: 29 UN: .002 SQA: 'FT'" ""STORIES TYPE 6263 IVAR AV
_1STRUCTURE:' V-B TEMP CA 917801526 1
(ASSESSOR INFORMATION NUMBER: _ NEAREST CROSS STREET: LONGDEN
15386-010-029 —_i >. �,��.. '+, _ ,.Ir, THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI
(TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 TISSUED ON: PROCESSED BY: 1
IEXIST OCC GRP.: _. 110/28/13 SR
(OWNER; TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINP.L DA E FINAL CODE: 1
ISU ANDREW W;LI SHAN L TRS (626) 286-2544- 1 1,800 1 -
16263 IVAR AVENUE I-
(TEMP 917800525 I FEES .PAID 1 'SCRIPT N OF,. 0RK
1BA:�HROOM REMODEL, (1) EXT AR AND (3) INT DOORS
I __(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (
(APPLICANT: TEL. NO:
ICORREA, MANNY (626) 786-2347- IAA BLDG PERMIT ISSUANCE 27.80 1 _
12509 EUCLID CREST E 1AB STATE GREEN BLDG FEE 1800.00 VAL 1.00 -I,SPECIAL CONDITIONS: 1
(UPLAND CA 91784 IAC STRONG MOTION RESID 1800.00 VAL 0.50.1
I IB2 PERMIT W/ENERGY 1800.00 VAL 90.40 1
TOTAL FEES 119.70
ICONTRACTOR: TEL. NO: I IAPP'ROVALS DATE INSPECTOR SIGNATURE 1
IB X D CONSTRUCTION (626) 786-2347- _
12509 EUCLID CRES E LIC. NO ILOCATION AND SETBACKS_ 1 4 1
(UPLAND CA 91784 627142 1 1—!-,
ISOILS ENGINEER APPROVAL 1 _
1ARCHITECT OR ENGINEER: TEL. NO: 1 IF07NDATION/TRENCH FORMS I
1 LIC. NO: 1 ISLA:,/UNDER FLOOR
I I I
i I IRAISED FLOOR FRAMING ( 1
I I I
IMAP NO: SEWER MAP BOOK: PACE: FIRE ZONE: cm--:1 1UNDERFL00R INSULATION
- 3 00 I FLOE:`.. SHEATHING
INC. OF FAMILIES:. DWELLING UNITS: APT/COND: STAT CLASS: 1 ,I-
1 NO 21 I IROOF: SHEATHING
1 SCHOOL WITHIN HAZARDOUS r J I--
j (SHEAR PANELS I _
(AIR QUALITY: .1000 FEET MATERIALS I I— I
1 NO NO NO 1FRAM2 INSPECTION I
I FIRE� SPRINKLER HANGERS
~� (INSULATION/WEATHER STRIPI I I
1 1 I
I _I 11NTERIOR LATH/DRYWALL
1 I ,
(EXTERIOR LATH
I II
I I IRATFD FLOOR/CEIL ASSEM. 1 I
i I 1RA'PED WALL ASSEMBLIES
I
1 I I RA'T'ED SHAFTS/OPENINGS
I I i
IT-,B:R CEILINGS
ILOT DRAINAGE
I � •� I I_ I f I
- , - q IREPORT ID: DPR261 ROUTE TO: BS0508
t
DEPARTMENT OF hUILDI.YG AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
p1
WAI. J. FOX, CHIMP ENGINRER BUILDING
PLANE BLDG. FIRE- DISTRICT No. PLAN CHK. Fax PERMIT No.
FILED �6 C2
4 I ONE A ZONE - RMCEIPT NO.
TYPE OF - •_._
!,V` ('��
f II 111 IV X GROUP
BLDG
--� �IN OAT4 OF ADPL. REcmlvco DATE IaGUMD
ORD. Na. `� 1 -14 Q A
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY L
E
NAME -« ! !:_� % ,���.f/ iY'?.�- ADDREBO (/'dJl l� 1y�'�• .
CW /
W ADDRESS /.� ` .�� I I I am•__ - S TI
z LocnuTti
Z Z CITY �" - �.�.�. CROSS11 OT.t"�p!_�...,. T•J' •:+
U W STATE -
<
LICENSE NO. ( TEL. a NAME
WI
z MAIL /,
O I NAME 'I w.. '� A4DR E88 G;,.T_ JYG !"
DR ESS �- I o
< I CITY
i ' 1",A.
..
z I CITY t� I_t�-t. C'v`.•.Cl-� J d OT SIZE OF LOT
OS
TATE' r r� ,1 <¢. -
U -+ TEL. No. ou NO. OP SLOGS.
LICENSE NO. -
jW BLOCK NOW ON LOT ,/Or•o
O UBE OF BLDG.
CLASS OF WORK TRACT S'ci�� NOW ON LOT
NEW ACDESCRIP77ON OF 'ITORK
DITION I OHMOl1sN .
ALTERATION I �`I REPAIR IRONING
S
USE OP NO. OF
BLDG. _ !� G -/r f(,...^ L ROOMS .I -
T—'I SIZE OP STORIES NO. OF
^� HLDG. �� r U = I FAMILIES
CORRE rl NS
fY} SPECIFICATIONS
CLJ FOUNDATION
I
MATERIAL EXTERIOR PIERS I
� - -
I
THICKNESS—TOP
.t
D THICKNGSS_SOTTOM I i J
I� <
DEPTH IN GROUND I _Z
SUP=RSTRUCt, /fE D
9 ad ®17 SPACING GPAN 0
b4 R. W. PLATES (BILL) t
C-1 _
GIRDERS
JOISTO—FLOOR
L, BEARING WALL
C: PARTITIONS
ROOF RAFTERS
FINN. APPROVAL .
SILL BOLTS '
COVERING 'Al
I.IUU
--1" � DATF. � INSPECTOR'S NAM[
WALL --V--t•J-'�. r n ROOF V, •1` I HEREBY ACKNOWLEDGE T}IAT 1 HAVE READ TS1�3
HIAPPLICATION AND STATE TIIAT THE ABOVE IS CORRECT
AND AGREE-1`0 COMPLY WITH ALL COUNTY ORDINANCES b+;r
P.C. FEE $ AND STA 'LAWS REG 11lATINCr UILDING.CONSTRUCTION:
{!p'
VALUATION S F EE 9O<-" slop
• ':
1' O NER OII' AUTHORIZED AGENT
a+: DD-O 4-00 YOM r - I Y