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HomeMy Public PortalAbout5715 KAUFFMAN AVE_Building__ y WORKERS' COMPENSATION DECLARATION `I-hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insi,�re, or a certificate of Workers' Compensation Insurance, o� alcertified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY TPolicy No.—Co"I pany 1:1BUILDIN G tion department. ADDRESS Certified copy is herebfurnished. FOR APPLICANT TO FILL IN ADDRESS � El Certified copy is filed with the county building �l¢ inspec- BUILDING // CITY 'EF ZIP 9/ 786 LOCALITY Date Applicant NO.OF BLDGS. S T TE CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT , X ���' NOW ON LOT f�,�.,Q , CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) �-+ �++ p TEL. /, 7 USE ZONE MAP /V,r^� r� OWNER .J6 , 5,e,-yS6fJ N0.�737-3678 NO. JRoa G 9V I certify that in the performance of the work for which this permit is issued, I shall not employ ny pe on in any manner ADDRESS /� LJ�1�f�9AA� SPECIAL, 0 so as To becomer/subjecT to the W r• rs m ens i n s. p-- 9/ 790 � �y CONDITIONS Q! CITY / A5 Ileo l L ZIP // / 9 0 U Date CJ Applicant ARCHITECT OR l TEL. 1. 0 NOTICE TO APPLICANT:-If, after mo in this Certificate of - ENGINEER $ / � A) NO. — /,gZ DISTRICT GROUP TYPE FIRE PROCESSED BY Q 9 CONST. ZONE U Exemption, you.should beco subject To the Workers' V ��� Compensation provisions of th Labor Code, you must forth- ADDRESS 2.ZZ 3 /� U%6�/!'�,t/ D�, �T�, !V d with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. 1'23 Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. IQDWELL. UNITS — I ADDRESS NO. hereby affirm that I am licensed under provisions of Chapter'9 SEWER MAP ' (commencing with Section 7000)of Division 3 of the Business LIC. l J and Professions Code,and my license is in full force and effect. CITY CLASS BK r_ PG /Ll VALIDATION SQ. FT.//- NO. OF NO. OF CHECK License Number tic. Class SIZE .cv�0 STORIES IFAMILIES ONE VALUATION 0 Contractor Date DESCRIPTION OF WORK �l2 © NEW ❑ $ ' V E]I am exempt under Sec. &b /10 A) /Fp—R"Cis ADD ❑ ► r A /� ALTER ❑ B.&P.C. for this reason /T/} Ell A&b, �4#4,16ee-A REPAIR ❑ $ Date: USE EXISTOING BLDG. A) DEMOL ❑ Signature APPLICANTTEL. ,r, FINAL , OWNER-BUILDER DECLARATION (PRINT) � � 91os j� NO. '367a DATE - 1 hereby affirm that I am exempt from the Contractor's License ADDRESS /.5 ��U �'� _F# Law for the following reason.(Section 7031.5, Business andFINAL 7 Professions Code): PRESENT By IV BUILDING I, as owner of the property, or.my employees with ADDRESS l � )� °'H' a wages as their sole compensation,will do the work and 3307 237.811 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. ' ITEMS ❑ I, as owner of the,property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- TOTAL 237 .80 ADDRESS tion 7044, Business and Professions Code.) CHECK, {� . REQUIRED TOTAL SETBACK FROM EXIST. CHECK 2,:x7°1.03 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT i CHANGE °[III the performance of the work for whicFi this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE r/ P.L: c7 Lender's Name, 00013-0001 3I2a. - 9 $ r, LDMA Ref. # ' Lender's Address P.C. Fee$ Permit Fee ---" �� 47 O; ` V � 0 1*certify that I have read this application and state that the A31-90 Issuance Fee 09.5 LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee Q f' s 0 ordinances and State laws relating to building construction, Total Fee J. O� LDMA Perm. # ACC .111' a and hereby aut rize representatives of this County to enter 3_1137 ; it upon t abov mention ope f r inspection purposes. 07 ?90>r�.� ,y R p e=21-5 8 SEE REVERSE FOR EXPLANATORY LANGUAGE1 ITEMS Signature of Applicant or Agent Date .7�,0-25 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 0906040023 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 6561 LT: 506 BL: .001 I SQ, FT STORIES TYPE 5715 KAUFFMAN AV I I (STRUCTURE: V-B TEMP CA 917802506 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK I 18587-022-004 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl TENANT: JEXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY: (EXIST OCC GRP: 106/04/09 SR OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINI/'),L B : CODE: IERSTAD JOHN (626) 287-3678- 1 1,200 15715 KAUFFMAN AV �°'•`•+� VIU, - TEMP 917802506 FEES PAID DESCRIPTION OF WORK 14 WINDOW REPLACEMENTS 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 (APPLICANT: TEL. NO: I I I ISTP ENTERPRISES INC. (626) 533-1324- IAA BLDG PERMIT ISSUANCE 27.75 1 15454 TEMPLE CITY BL IAB STATE GREEN BLDG FEE 1200.00 VAL 1.00 ISPECIAL CONDITIONS: 1 TEMPLE CITY CA 91780 IAC STRONG MOTION RESID 1200.00 VAL 0.50 I ID2 PERMIT W/0 EN-HC 1200.00 VAL 82.20 1 1 1 TOTAL FEES 111.45 I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 ISTP ENTERPRISES, INC. (626) 287-7544- I 15454 TEMPLE CITY BLVD. LIC. NO I (LOCATION AND SETBACKS I I I ITEMPLE CITY, CA 91780 598157BC36 I I 1 I I 1 I ISOILS ENGINEER APPROVAL 1 I 1 I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLAB/UNDER FLOOR I I I I I I I I I I IRAISED FLOOR FRAMING I I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I 1150H269 3 001 I I I 1 I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I NO 21 'I (ROOF SHEATHING I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I (AIR QUALITY: 1000 FEET MATERIALS I I I I I NO NO NO I (FRAME INSPECTION I I I I I I I I (REQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS I II ISET BACK YARD: HWY: PROP LINE: WIDTH: IFRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- I I I I I I (INTERIOR LATH/DRYWALL I I I I IEXTEP,IOR LATH I I I 1 1 IRATED FLOOR/CEIL ASSEM. I I 1 1 I IRATED WALL ASSEMBLIES 1 I 1 I I I I I I (RATED SHAFTS/OPENINGS I IT-BAR CEILINGS I I I 1 I ILOT DRAINAGE I I I 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I i I I I I 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 0909290028 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: J ITR: 6561 LT: 506 BL: .001 SQ. FT STORIES TYPE 1 5715 KAUFFMAN AV 1 I ISTRUCTURE: 2650 _ V-B I TEMP CA 917802506 1 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK J 18587-022-004 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPEL CITY, Cl I I I I (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: I (EXIST OCC GRP: 109/29/09 SR I I I I TOWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: �F\�� DA FIPJAL BY: CODE: JERSTAD, J0�(N (626) 287-3678- 1 7,000 LY,`.4�^C) 5715 KAUFFMAN AV ITEMP 917802506 1 FEES PAID IDE CRIPTI N OF WORK 1 1 1 IROOF TEAR OFF/NEW ROOF SHEATHING/NEW TIMBERLINE 30 ROOF 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: JAPPROX. 2650 S.F. INCLUDING ATTACHED CARPORT ROOF 1 JAPPLICANT: TEL. NO: I I ISTP ENTERPRISES INC. (626) 287-7544- 1AA BLDG PERMIT ISSUANCE 27.75 1 15454 TEMPLE CITY BL. JAB STATE GREEN BLDG FEE 7000.00 VAL 1.00 ISPECIAL CONDITIONS: J ITEMPLE CITY CA 91780 IAC STRONG MOTION RESID 7000.00 VAL 0.70 I I ID2 PERMIT W/O EN-HC 7000.00 VAL 166.20 I 1 I 1 TOTAL FEES 195.65 1 1 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 ISTP ENTERPRISES, INC. (626) 287-7544- 1 1 15454 TEMPLE CITY BLVD. LIC. NO 1 ILOCATION AND SETBACKS 1 1 1 ITEMPLE CITY, CA 91780 598157BC36 I I I ISOILS ENGINEER APPROVAL JARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I LIC. NO: I JSLAB/UNDER FLOOR I I I I I I I I IRAISED FLOOR FRAMING I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J JUNDERFLOOR INSULATION I I I 1150H269 3 001 I 1-1 I I IFLOOR SHEATHING II INC. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I ( I I NO 21 1' IROOF SHEATHING I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I JAIR QUALITY: 1000 FEET MATERIALS 1 I I 1 NO NO NO 1 IFRAME INSPECTION I I I I I I I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS J 1 ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I IFRONT PL- I JINSULATION/WEATHER STRIPI I I I SIDE PL- 1 1-1 1 1 1 11NTERIOR LATH/DRYWALL 1 I f I I I I I I (EXTERIOR LATH I I I I I I I IRATF.D FLOOR/CEIL ASSEM. J I I I I I I I I I. IRATED WALL ASSEMBLIES 1 1 I I I I I I 1 1RATED SHAFTS/OPENINGS IT-BAR CEILINGS 1 I I I I I I I ILOT DRAINAGE I 1 1 I I I I I I REPORT ID: DPR261 ROUTE TO: BS0508 1 I i I I I I I 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 1111080001 PHONE: (626) 285-0488 EXT: . ILEGAL ID: i NO. OF CONST BUILDING ADDRESS: ITR: 6561 LT: 506 BL: .001 I SQ. FT STORIES TYPE 1 5715 KAUFFMAN AV 1 _ISTRUCTURE: V-B I TEMP CA 917802506 I (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LIVE OAK IB587-022-004 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPEL CITY, Cl I I I I (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 1 (EXIST OCC GRP: 111/08/11 SR I I I I I (OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFINA E FINAL B CODE: 1 IERSTAD, JOHN (626) 287-3678- 1 1,875 1 15715 KAUFFMAN AV I 1 1 ITEMP 917802506 I FEES PAID ID SCRIPTION OF WORK v1 I I IINST_-LL 4 NEW /WC VINYL RETRO WINDOWS IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( (APPLICANT: TEL. NO: I I ISTP ENTERPRISES INC. (626) 287-7544- IAA BLDG PERMIT ISSUANCE 27.80 1 15454 TEMPLE CITY BL. JAB STATE GREEN BLDG FEE 1875.00 VAL 1.00 ISPECIAL CONDITIONS: 1 ITEMPLE CITY CA 91780 JAC STRONG MOTION RESID 1875.00 VAL 0.50 ID2 PERMIT W/O EN-HC 1875.00 VAL 82.20 I TOTAL FEES 111.50 I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 ISTP ENTERPRISES, INC. (626) 287-7544- I1 15454 TEMPLE CITY BLVD. LIC. NO ILOCATION AND SETBACKS ITEMPLE CITY, CA 91780 598157BC36 I I ISOILS ENGINEER APPROVAL I I I I I 1 I JARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I I I I I LIC. NO: I SLAB/UNDER FLOOR IRAISED FLOOR FRAMING I I 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: J 1UNDERFLOOR INSULATION I I I 11SOH269 3 001 1_ 11 I I I IFLOOR SHEATHING I I1 INC. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I 0 NO 21 IROOF SHEATHING I I I 1 11 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS 1 I 1 NO NO NO 1 1FRAME INSPECTION 1 I I I I I I IFIRE SPRINKLER HANGERS I I I I I I 1 (INSULATION/WEATHER STRIPI I I I JINTERIOR LATH/DRYWALL I I I I I I 1 (EXTERIOR LATH I 1 I I t I I I IRATED FLOOR/CEIL ASSEM. I 1 I I 1 I RATED WALL ASSEMBLIES 1 I I I I I I I I IRATED SHAFTS/OPENINGS 1 I I I I I I T-BAR CEILINGS I I I I I I ILOT DRAINAGE I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I Q 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 0001180030 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 506 BL: .001 SQ. FT STORIES TYPE 5715 KAUFFMAN AV STRUCTURE: 0 VN TEMP CA 917802506 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-022-004 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-7- ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/18/00 UT 07/16/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: n CODE: ERSTAD JOHN A;DOROTHY V TRUSTEE;ELS (626) 287-3678- 1 1,800 W4 Q� 5715 KAUFFMAN AV "l TEMP 917802506 FEES PAID DESCRIPTION OF WORK VOLUNTARY RETROFIT FOR FOUNDATION FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: WEINSTEIN CONSTRUCTION (818) 789-1400- AA BLDG PERMIT ISSUANCE 27.75 13425 VENTURA BLVD. AC STRONG MOTION RESID 1800.00 VAL 0.50 SPECIAL CONDITIONS: SHERMAN OAKS, CA D2 PERMIT W/0 EN-AC 1800.00 VAL 82.20 TOTAL FEES 110.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE WEINSTEIN CONSTRUCTION (818) 789-1400- 13425 VENTURA BLVD. LIC. NO LOCATION AND SETBACKS SUITE 301 156 SHERMAN OAKS, CA 91423 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: - FOUNDATION/TRENCH FORMS LIC. NO: _ _ _ i - SLAB/UNDER FLOOR i RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150H269 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 * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508