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HomeMy Public PortalAbout5743 KAUFFMAN AVE_Building__ r - WORKERS' COMPENSATION DECLARATION 7100Q • insvre for a,certif carte of Workers' CompensatioI have a certificate of n eInsuran of APPLICATION FOR.. BUILDING PERMIT ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Polity No. Company BUILDING ❑ Certified copy is hereby furnished. FOP APPLICANT TO FILL IN Y r ADDRESS 5 ❑ Certified copy is filed with the county building inspec- BUILDING ADDRESS 7 4 3 tion department. _ CITY'' i ' } ZIP LOCALITY Date Applicant t O: OF BLDGS. a' XN � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT ``',JD/ (� NOW:ON L'OT `�� . CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO MAP BOOK PAGE I PARCEL hundred dollars ($100) or less.) TEL: OWNERffwm Y /V NO. -] USE ONE MAP I certify that in the performance of the work for which this 1 SPE 15 permit is issued, I shall,riot employ any person in,any manner ADDRESS �. ' � SPECIAL CONDITIONS so as to become subject to the W rs'Co ation Laws.` `p f f O / CITY �/ /• ZIP a 1 Y Date Applicant ARCHITECT OR TEL. �r DISTRICT GROUP FIRE OCESSED BY 0 /1 NOTICE TO APPLICANT: If, after maki is Certificate of ENGINEER. ' 1 @ 7.� NO. CONST. ZONE Exemption, you should become subj ct to the Workers' Q �s ADDRESS Compensation provisions of the Labor Code, you must forth- with comply with such. provisions or this permit shall be �t�-� TEL STATISTICAL CLASSIFICATION T.T, CS�NDO.T + Z 'CONTRACTOR C/v✓ NO.2�j deemed revoked. � ' i, _:L tis — LICENSED CONTRACTORS DECLARATION '74 �n�� LIC. CLASS DWELL. UNITS . I herebyaffirm that I am licensed under provisions of Chapter 9 ADDRESSL NO. P P � SEWER MAP. �_~ (commencing with Section 7000 of Division 3 of the Business ,� LIC. -.•� ( 9 ) CITY C�V►VLJ iCh� "l� CLASS h and Professions Code,and my license is in full force and effect. BK.�r PG. s VALIDATION SQ. FT. NO. OF NO. OF CHECK `�= = License Number Lic. Class SIZE C� STORIES I NO ONE ? VALUATION =°Ls+ �"'°''-s Contractor Date DESCRIPTION OF WORK�i�ichtm Q Q�e✓ NEW E:1 V —1t/1I I ClL/Y/f ADD ElI am exempt under Sec. ALTER ❑ ► TOTAL I`(-AL �466466 65 B.&P.C. for this reason 1 ;"•+jLt•L; USE REPAIR ❑ $ s,•�• c•: F00. ii•_ Date: �! 77- EXISTING BLDG. S� DEMOL ❑ .i"ANI�C .f 1;Ca APPLICANT `�^ TEL. Signature ( I ' w • rw NO � ''73 FINAL OWNER-BUILDER DECLARATION PRINT DATE 3`�,. / I hereby affirm that I am exempt from the Contractor's License G�� - FINAL r ` I t1i`—t'(=(`� `#40-/.-,� Law for the following reason (Section 7031.5, Business and ADDRESS ''' Professions Code): PRESENT By Y-.`''� ❑ I, as owner of the property, or my employees with BUILDING �7u 3 � �'� wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. Poo j-r`j .CT,g N 55-9.50 CQ s , P I, as owner of the property, am exclusively contractinCONTRACTOR g tiv17 a_, 1 with licensed contractors to construct the project (Sec- o•.cl F rADDsRtESS tion 7044, Business and Professions Code.) 1 ITEMS IRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY ACK YARD HWY PROP. LINE WIDTH 55 � 1 hereby affirm that there is a construction lending agency for TI�i 4L .a_a .—sl[ the performance of the work for which this permit is issued x s f•� .559.50 (Sec. 3097, Civ. C.). CHECK i Lender's Name. CHANGE .00 G / �' x J� LDMA Ref. # e$ Liv,, Permit FeeLender's Address 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# _ 0JI 5i 1.2/89 above information is correct. I agree to comply with'all County ation Fee \< p 249 1 AM 9:28 So ordinances and State laws relating to building construction, Total Fee J / J LDMA Perm. # a and hereby outorize presentatives of.this County to enter m up a abov en io ed property for inspection.pu(r�po esu 3.f�Q SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Ap6licant or Agent Date t i:WORKERS' COMPENSATION DECLARATION j aheebffcertificate ns dor aself APPLICATION F OR� BU L D I N G PERMIT h ory rtified copy thereof (Sec.-3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAF TY Poi, 'o. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 'S • ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS y� /�J� �7 CITY 4� � ZIP (' 1 / LOCALITY Date Applicant NO. OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT J NOW ON LOT � NEAREST / COMPENSATION INSURANCE CROSS ST. ✓N �-� 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.) �� } TEL. ,, -- USE ZONE MAP OWNER 1� NO. (J��� /.�7 NO. I certify that in the performance of the work for which this ,,l permit is issued, I shall not employ any per on in any manner ADDRESS K. � �l SPECIAL a- CONDITIONS so as to become subject to the W kers'C rr) a sation Laws. l O I � _�- �� CITY L& ZIP L � U Date vL�Applicant ARCHITECT TEL. -� DISTRICT GROUP TYPE FIRE2ESSID BY � NOTICE TO APPLICANT: If, after making his Certificate of ENGINEER NO. G �+ r+ CONST. ZONE 0 Exemption, you should become subject to the .Workers' Compensation provisions of the Labor Code,you must forth- ADDRESS ( r a with comply with such provisions or this permit shall be `�'�ryry TEL., �/I -7 STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR ©W NO.ZEA,/ e Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 02 DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. �^ LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business • CLASS and Professions Code,and my license is in full force and effect. CIN , BK. PG. VALIDATION SQ. FT. NO. OF NO. OF �J CHECK License Number Lic.Class SIZE. STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK �{rj� NEW' ❑ $ ADD ❑ , ❑I am exempt under Sec. 1 ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ USE OF Date: EXISTING BLDG. 54DEMOL Signature APPLICANTr TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) i�6 NO. I hereby affirm that I am exempt from the Contractor's License W DATE Law for the following reason (Section 7031.5, Business and ADDRESS , L. FINALr ! Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS 1714-'' °7 wages as their sole compensation,will do the work and , E i !E i Vit•"" the structure is not intended or offered for sale(Section LOCALITY. _.,l:i <<•a}_ 7044, Business and Professions Code.) MOVING TEL. 1 i{ i tti° I, as owner of the property, am exclusively contracting CONTRACTOR NO. _ with-licensed contractors to construct the project (Sec- ADDRESS I i t e l 60 . 50 tion 7044, Business and Professions Code.) } �, REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. sy3_: I °E( CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT .1 the performance.of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ''l 4t i}'—"`"i i '".l�:':- m LDMA Ref. # ;isj[ x 'it_7 P.C. Fee$ Permit Fee -�_--} e Lender's Address €1!= i '�E i! ° t1 0 1 certify that I have read this application and state that the Issuance Fee LDMA P/C# 11011. 8 above information is correct. I agree to comply with all County Investigation Fee n ordinances and State laws relating to building construction, Total Fee �' `-' - LDMA Perm. # < and hereby auth rize representatives of this County to enter yup t e abov men i ned property for�nspectjg -p ur a SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o pplicant or 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 1207090070 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST I BUILDING ADDRESS: ITR: 6561 IT: 510 SQ. FT STORIES TYPE 1 5743 KAUFFMAN AV 1 I (STRUCTURE: 38 V-B I TEMP CA 917802506 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK 18587-022-010 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: I IEXIST OCC GRP: 107/09/12 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FIV4 DAT FINAL BY: CODE: I IMCCLURE, KEVIN (626) 374-9845- 1 10,950 1 15743 KAUFFMAN AV I (TEMP 917802506 ( FEES PAID 1"D� /-�/�CFZ I N'OF WORK 1 I 1 IREMOVING EXISTING LAYER OF COMP SHINGLE. INSTALL TAR PAPER &I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW CLASS "A" 30 YEAR GAF SHINGLES 1 (APPLICANT: TEL. NO: I I ISHEA ROOFING INC. (818) 847-0470- IAA BLDG PERMIT ISSUANCE 27.80 1 1 IAB STATE GREEN BLDG FEE 10950.00 VAL 1.00 (SPECIAL CONDITIONS: IAC STRONG MOTION RESID 10950.00 VAL 1.10 I I ID2 PERMIT W/O EN-HC 10950.00 VAL 233.40 1 1 _I TOTAL FEES 263.30 1 ICONTRACTOR: TEL. NO: I IAPPP,6VALS DATE INSPECTOR SIGNATURE 1 ISHEA ROOFING, INC. (818) 847-0470- 1 - I 11951 N ONTARIO ST LIC. NOI 1LOCATION AND SETBACKS I IBURBANK CA 91505 730563 1 I I I I ISOIL ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I LIC. NO: 1 (SLAB/UNDER FLOOR I I I I I I IRAISED FLOOR FRAMING I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I 1UNDE?.FLOOR INSULATION I I I 115OH269 3 001 II I I _I IFLOOR SHEATHING I I IND. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I 0 NO 21 (ROOF SHEATHING � I I SCHOOL WITHIN HAZARDOUS JI ISHEAR PANELS I I I 1AIR QUALITY: 1000 FEET MATERIALS NO NO NO I IFRANF INSPECTION I I IFIRE. SPRINKLER HANGERS I I I I IINSUi,ATION/WEATHER STRIPI I I I _I (INTERIOR LATH/DRYWALL I I 1 I I I I I IEXTERIOR LATH I I I I I I I I (RATED FLOOR/CEIL ASSEM. I I I I IRATE', WALL ASSEMBLIES I I I - IRATEL SHAFTS/OPENINGS I I I I I I I IT-BAR CEILINGS I I I I* ADDITIONAL DATA ON FILE I ILOT DRAINAGE I REPORT'ID: DPR261 ROUTE TO: BS0508 I I I I