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HomeMy Public PortalAbout6027 KAUFFMAN AVE_Building__ WORKERS' COMPENSATION DECLARATION insure, oraafcertithat I f cote of Worke s' Compensation on�cote of Insuran e, APPLICATION FOR, BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. ° Company BUILDING —F1 n� Certified copy is hereby furnished. FOR APPLICANT.TO FILL IN' ADDRESS 60 ZKn„ ,7 � /✓/ /(,/ AV6 ; ❑ Certified copy is filed with the county building inspec- BUILDING �,Z ;/e/ j�2�L� 1 r 7 t i tion department. ADDRESS Av EM N p, /ZvA t Date Applicant CITY �eLE zip q /7p V LOCALITY /� CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NO. OF BLDGS. CROSS ST. e /OO ,elf-f 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 ($100).or less.) �� n'e� ),,/!n, NO$�� y ��y US ZONE MAP OWNER61 ' W6V . I I certify that in the performance of the work for which this `627 V �� Z NOSPECIAL permit is issued, I shall not employ any,person in any manner ADDRESS 6 ��/ / !� v �. CONDITIONS � so as to become subject to the Workers' Compensation Laws. O clv. M/2IE- CITY zip 917$0 u Date Applicant ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER .. NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE � Exemption, you should become subject tothe Workers' �_3 / a Compensation provisions of the Labor Code, you must forth- ADDRESS (/ with comply with such N p y provisions or this permit shall be TEL. STATISTICAL CLASSIFIC TION 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. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE 3 2 STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑I am exempt under Sec. ���pp/I/�— /�(f f CIVCL05-EP -� ADD ❑ /I , /`l/t_E f9z_A1CC- 6--po vE ALTER ❑ $ B.&P.C. for this reason REPAIR ❑ Date: USE OF' EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) " NO. DATE 1 hereby affirm that.l am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT //// /v! By BUILDINGI, as owner of the property, or-my employees with ADDRESS wages as their sole compensation,will do the work and -a-.1Z the structure is not intended or offered for sale(Section LOCALITY , --- ---- 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- _)_o `ii ADDRESS tion 7044, Business and Professions Code.) t-_;t. _ M. REQUIRED TOTAL SETBACK FROM EXIST. `_I-tECK _I=: CONSTRUCTION LENDING AGENCY SET BACK 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. 3097, Civ. C.). SIDE P.L. Lender's Name q _j({p— (') LDMA Ref. # -- P.C. Fee$ Permit Fee Lender's Address -- 0 1 certify that I have read this application and state that the Issuance Fee o? 7S LDMA P/C# 8 above information is correct. I agree to comply with all County nvestigatio9 Fee L ordinances and State laws relating to building construction, Total Fee J LDMA Perm. # a and hereby authorize representatives of this County to enter � up a bove-m n= inspecti n purposes. ' V, / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Ageg Date ^. ', WORKERS'COMPENSATION'DECLARATIC400 E;.;I• •huge, &.ffier tl�at I haWor certificate of ca SelfAPPLICATION FOR BUMPING PERMITinsure, org certificate of Workers' Compensatidnante, or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Po4icy No. Company ' BUILDING 60 /f Certified copy is hereby furnished. ' FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS �D2� Date Applicant CITY MPL-G C I r in P.. y 17� LOCALITY C CERTIFICATE OF'EXEMPTION FROM WORKERS' NO. OF.BtOGS. NEAREST' COMPENSATION INSURANCE SIZE OF LOT SO'r/e S NOW ON LOT `•. CROSS ST. (This section need not be completed if the permit is for one " ' ASSESSOR hundred dollars dollars ($100)or less.) TRACT BLOC LOT NO. s, MAP BOOK PAGE PARCEL TEL. USE ZONE MAP OWNER �� 01ZLVO. aC0 SC77 Zf9 /1 I certify that in the performance of the work for which this 1 NO. (�Z permit is issued, I shall riot employ an person in an manner // �// 1- SPECIAL - - so as to become subject to'the Work y Co pensat o Laws. ADDRESS ((/��� /"/�� D V CONDITIONS. V Date Applicant -ll CITY / . C l� ZIP l [ 01 _ . . ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PR C SSED BY NOTICE TO APPLICANT: If, after making This Certificate of CONST. ZONE Exemption, you should 'become subject to The• Workers' ENGINEER NO. / Compensation provisions of the Labor Code, you must forth- ADDRESS 6 with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFIA710N APT. NDO. g deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC: CLASS NO. Z 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 and LIC: Professions Code, and my license is in full force and effect. CIT � BK.� SN�s� CLASS ' 2 PG) J S VALIDATION S NO. OF _ NO. OF CHECK License Number Lic.•Class SIZE 20 S STORIES FAMILIES ONE 2 y ^ /�� VALUATION Contractor Date DESCRIPTION SOF/WORK/' '�1�1� r/�j C(� EW I am exempt under Sec. auJ�q �6669A _qr ALTER B.BP.C. for this reason _ Gt-i"C�-_ �- a - S - _ REPAIR Date: EXISTING BLDG. /lif1� lIUSE OF `n DEMOL Q # 0 0 0 0 2 3 Signature APPLICANT T L /� y FINAL I - 5.01.08 OWNER-BUILDER DECLARATION PRINTAG eto CIRJ a� 6 DATE I hereby affirm that I om.exempt from the Contractor's License Z7 t���1G/^ . I ° - 5-01.,0 8 c0 Law for the following reason(Section 7031.5, Business and ADDRESS6.027 T l 1 C /V FINAL Professions Code): PRESENT By _ .0 al 37 8 7 BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will clothe work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. aI, as owner of the property, am exclusively contracting CONTRACTOR NO. M with licensed-contractors to construct the project (Sec- \ tion 7044, Business and Professions Code). ADDRESS +' 7 9 3 7 A .REQUIRED TOTAL SETBACK FROM. � ~� z CONSTRUCTION LENDING AGENCY SET BACK YARD HWY" PROP. LINE ]WIDTH. I hereby affirm that there is a construction lending agency for FRONT -y o o .o 0 0 the performance of the work for which this permit is issued P.L. -- - _, (Sec. 3097, Civ. C.).• SIDE I ° 60010.0 P.L. _ - Lender's Name o LDMA Ref. # o o 6 0-Q 0 0 vPC. Fee$ - Permit FeeLender's Address 9, 1 6 87certify that I have read this application and state that the Issuance Fee -• / D 5LDMA,P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction,u and hereby authorize representatives of thi ounty to enterTotal Fee OLDMA Perm. # up a ve-me ti ed o rty for in p 'tion purposes. a / SEE REVERSE FOR EXPLANATORY LANGUAGE a - ^ Signature of Applicant or Agent Date i APPLICATION FOR BUILDING PERMIT �1 C7UNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR d PucaNT TO FILL IN BUILDING ADDRESS �'} BUILDING ADORES - J G 1 M I hereby affirm that I have a certificate of consent elf insure, or a certificate of Workers'Compensation Insu e,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) /l, LOCAUTv Policy No. mpany SIZE OF LOT `! NO.OF BLDGS.NOW ON LOT ❑ Certified co NEAREST CROSS ST. copy is her urnished. ❑ by co s filed with the county building inspection TRACT BLOCK LOT NO. d@partm USE ZONE MAP NO. Data Applicant ASSESSOR MAP BOOK PAGE PARCEL Pp SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER /�!t`'l�� �� TEL.rNsO— YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? ADDRESS /1 (This section need not be completed if the permit is for one hundred �ijV �v�F A� DISTRICT GROUP TYPE CONST.' FIRE ZONE PROC SSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit CI1 � / ze �/ ZIP 5. r\b R 5, IYF IS issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. V become subject to the Workers'9p1 sati aws. 1-1 a �, STATISTICAL CLASSIFICATION T 06ND6 Date 'lr9ZApplican ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: if, after making this C rtificate Of you subject REQUIRED TOTAL SETBACK FROM EXIST Exemption, should become ect t0 the Workers' CONTR R TEL.N P Y J SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith � � FRONT � comply with such provisions or this permit shall be deemed revoked. ADDRESS �_ nl ^ LIC. ���� PL LICENSED CONTRACTORS DECLARATION Cl lY Llc. ss SIDECL yJ� /71 S PL O I hereby affirm that I am licensed under provisions of Chapter 9 �C SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.Of STORES NO.OF FAMILIES G Professions Code,a my license in full force and /effect. NEW BK PG v License Numbs Class ./� DESCRIPTION OF WORK �U ADD ❑ VALUATION d ,5�2-- $ a��d• Oa y Contractor �� � /a d � ALTER ❑ REPAIR C3El _..;;.t;% 'Sw I am exempt under Sec. $ B.✓fP.C.for this reason DEMOL ❑ LDMA P/C# USE OF EXISTING BLDG. Date: /C lG /e�S• URMEl _ ::• ,� Signature APPLICANT(PRINT) EL.NO. LDMA Perm# i ❑ I, as owner of the property, or employees with wages as T ��� "�� O their sole compensation,wil the work and the structure is ADDRESS f /lam /� „,, not intended or offers r sale (Section 7044, Business and ! C�!�'/C FINAL DATE Q " Professions Code.) 011. WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN _ ❑ I, as owner the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY license ontractors to construct the project.(Section 7 YES❑ NQ❑ tiy.s Bus' ss and Professions Code.) -,.:;", ,• ,„, ��� =�, WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION the ENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a struction lending agency for YES❑ NO❑ the performance C nCB Of the W Or which this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.J. PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES Lender, COUNTYCODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING m }"•;-1�M HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Le s Address +r" i0. OWNER OR AGENT , - . .,.- o' I certify that I have read this application and state that the above information Is Correct. I agree to Comply With all county P.C.FEE PERMIT FEE �� ,•„�__..;. w” - ordinances and State laws relating to building construction,and hereby authorize representatives of hi unty to enter upon r ISSUANCE FEE n `1 i the ab tions pert f s on purposes. L- .!�� 2 INVESTIGATION FEE TOTAL FEE SEE REVERSE FOR EXPLANATORY LANGUAGE, ;� 3 WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F O43UILDING P E RM I T sure, or a certificate of Workers'Compenstion Insurance, or certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES �, BUILDING AND SAFETY icy No. Company Certified copy is hereby'furnished. FOR APPLICANT TO FILL IN ADDRESS�y7 Certified copy is filed with the county building inspec- BUILDING / { ./� ( >� tion department. ADDRESS tr©�� vF/�/'/ J� LOCALITY (,.�E JZIP '/O ® NEAREST k/0010 ote Applicant CITY CROSS ST. del CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT X NOW ON LOT , MAP BOOK PAGE PARCEL his section need not be completed if the permit is for one USE ZONE MAP /1�� indred dollars ($100)or less.) TRACT BLOCK LOT NO. ^ NO. 1 f TEL. SPECIAL CL certify that in the performance of the work for which tHis OWNER RIC'HAeO Nza—NO. x Z-©� ` CONDITIONS ermit is'issued, I shall not employ any person in any manner �y� DISTRICT GROUP TYPE FIRE PROCE ED BY U as,to become subject to the Workers'Compensation Laws. ADDRESS 2,( 519N 6 GOS G CONST. 2, ONF / I 1; ate Applicant CITY d�l EL ZIP 7a Q STATISTICAL CLASSIC ION ��AP . CONDO. OTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. / tL (emption, you should become subject to the Workers' CLASS NO. / DWELL. UNITS ompensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP ith comply with such provisions or this permit shall be o TEL aemCONTRACTOR NO,revoked. , BK. PG, VALIDATION , LICENSED CONTRACTORS DECLARATION hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION ommencing with Section-7000)of Division 3 of the Business and o p 0 ofessions Code, and my license is in full force and effect. CITY CLASS $ U--- SQ. FT. NO. OF NO. OF CHECK cense Number Lic.Class SIZE STORIES FAMILIES ONE ES T. _ ®�K G`� NEW ❑ $ oniractor Date ❑ ] am exempt from the licensing requirements as I am a C ADD A licensed architect-or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business and Professions Code). USE OF DEMOL FINAL EXISTING BLDG. ❑ By -¢/ •t a�T, c.or Reg. No. Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO, her by affirm that I am exempt from the Contractor's License a for the following reason (Section 7031.5, Business and ADDRESS essions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS 2 2'4,'7,4 A, wages as their sole compensation, will do the work and the structure is not intended or offered for sale(Section LOCALITY #.0 0,0 0.0 1 7044, Business and Professions Code). MOVING TEL. I , CONTRACTOR NO. 1 I, as owner of the property, am exclusively contracting 2'0 0 2 3,50 with licensed contractors to construct the project (Sec- ADDRESS tion 7044,.Business and Professions Code). 0 0 0 2 3,•5 0 c=i REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for FRONT 2,3 0 8 1 ie performance of the work for which this permit is issued P.L.' iec. 3097, Civ: C.). SIDE P.I. tinder's Name � ender's Address P.C. Fee$ _ Permit Fee certify that I have read this application and state that the Issuance Fee c3 bove information is correct. I agree to comply with all County Investigation Fee /l S� rdinances and State laws relatingto buildingconstruction, Total Fe nd hereby authorize representatives of this County to enter po/� e bove-m nt, ed pr rty for iJec tion urpo es. I// �J/ �Z v SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Da ©5 i WORKERS'COMPENSATION DECLARATION ` hereby affirm that 1 have a certificate of consent to self. A p P L I CATION FOR .BUILDING PERMIT ','insure, or a certificate of Workers' Compensation Insurance, or a certified copy'thereof (Sec. 3800, Lob. C.)' • COUNTY OF LOS ANGELES BUILDING AND SAFETY , Policy N Company t Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN ADDRESS /Certified copy is filed with the county building inspec- BUILDING L� �_ y 2tiondeparrtment. ADDRESS Date 9_ .._lJJ -81 Applicant CITY�'� `e- (Z,'` ZIP LOCALITY CERTIFICATE OF EXEMPTION RO ORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE' SIZE OF LOT NOW ON LOT U ^'"" CROSS.ST. (This'section-need not be completed if the permit is for one (j r BLOCK LOT NO. , ASSESSOR hundred dollars ($100)or less.) TRACT MAP BOOK PAGE PARCEL T.EL.. �r�U USE ZONE MAP OWNER �lV� 7 I certify that in the performance of the work for-which this �' �' v { NO. aD�i y. permit is issued, I-shall not employ any person in any manner ADDRESS A '- I[ !� SPECIAL - d so as To become subject to the Workers'Compensation Laws. CONDITIONS V CITY ZIP Date Applicant AC NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DIS ICT GROUP TYPE FIRE .. PRO SSED BY ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' � Compensation provisions of the Labor Code, you must forth- ADDRESS 9 with comply with. such provisions or this,permit shall be TEL. STATISTICAL CLASSIFIC TION APT. CONDO. deemed revoked: CONTRACTOR �!QIO. LICENSED CONTRACTORS DECLARATION LIC. CLASS tJO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �7L(7 Fr�S Otis N62244 y (cortmmencing with Section 7000)of Division 3 of the Business and n1 - » ,,,, n/ LIC _ o SEWER MAP Professions Code, and my license is in full force and effect. CITY , F��+ .+� CLASS B BK. VALIDATION SQ. FT. NO. OF NO. OF _ CHECK ZZ.-1 �L's' e SIZE STORIES NO I ONE License Number Lic.Class (� VALUATIO ContractorMASO'CQ CZ""'VAU60,� /—I ! u L DESCRIPTION OF WORK �"pp' NEW ❑ a /%/� ewt o�-o- (SPA 1 II� ADD ❑ /0 , I am exempt under Sec. ALTER ❑ B.BP.C. for this reason r\e.U3 ti's REPAIR $ DUSE OF ate: DEMOL EXISTING BLDG. ❑ APPLICANT TEL. FINA Signature L N OWNER-BUILDER DECLARATION PRINT NO. DATE / I hereby affirm that I am exempt from the Contractor's License / Law for the following'redson '(Section 7031.5, Business and ADDRESS FINAL Professions'Code): PRESENT By 2 5 �,0'A BUILDING I, as owner of The properly, or my employees with ADDRESS # 0 0 0 0 0,� wages as their sole compensation,will do the work and ��;�f �f{+ 1 the structure is not intended or offered for sale(Section LOCALITY ' ! .2 a o 59.2 5 •7044, Business and Professions Code). MOVING TEL. 33 I, as owner of the property, am exclusively contracting CONTRACTOR NO. J 3� 0 0 o 5j 9,2 5 with licensed contractors,to construct the project (Sec- ' I " tion-7044, Business and Professions Code). ADDRESS 07,05-84' REQUIRED TOTAL.SETBACK FROM T. CONSTRUCTION LENDING"AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT r the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE m P.L. Lender's Name m LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address rQ I certify that I have read this.application and state that the _ Issuance Fee !! LDMA P/C# oil, - above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, y � and hereby authorize representatives of this County to enter Total Fee LDMA Perm. # m up n the above- entioned property for inspection purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of-Applicant or Agent "- Date 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 1202240020 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: ITR: 6561 LT: 115 UN: .002 I SQ. FT STORIES TYPE I 6027 KAUFFMAN AV I. ISTRUCTURE: 400 V-B I TEMP CA 917801742 1 (ASSESSOR INFORMATION NUMBER: 1 1 NEAREST CROSS STREET: 1 15385-018-008 1 1 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CAI I I (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-2 (ISSUED ON: PROCESSED BY: I I 1EXIST OCC GRP: 102/24/12 SR 1 10WNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: (F IN A jL .�DATE FINAL BY: CODE: I IWENZEL RICHARD A;PATRICIA L (818) 285-6446- 1 2 1,000 I/'7 Ili 12- { 16027 KAUFFMAN AV I I I (TEMP 917801742 1 FEES PAID ID SCRIPTION OF WORK 1 I I (REMOVE EXISTING ROOF ON GARAGE INSTALL 30 FELT AND I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IINSTALL 30 YEAR CLASS A SHINGLES 1 1APPLICANT: TEL. NO: I I 1 IHERRERA ROOFING AND GENERAL, CONTRA (626) 644-1875- IAA BLDG PERMIT ISSUANCE 27.80 I I 11846 S CALIFORNIA IAB STATE GREEN BLDG FEE 1000.00 VAL 1.00 (SPECIAL CONDITIONS: (MONROVIA CA 91016 IAC STRONG MOTION RESID 1000.00 VAL 0.50 1 1 I ID2 PERMIT W/O EN-HC 1000.00 VAL 65.40 I 1 TOTAL FEES 94.70 ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IHERRERA ROOFING (626) 793-2825- I 1 11846 S CALIFORNIA AVE LIC. NO I ILOCATION AND SETBACKS 1 I 1 (MONROVIA CA 91016 943801 * I I I I ISOILS ENGINEER APPROVAL I I I i I I I 1ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I ( I I LIC. NO: (SLAB/UNDER FLOOR I I I I I I I I I IRAISED FLOOR FRAMING I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1150H269 3 001 1 11 I I I IFLOOR SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I 0 NO 21 1 (ROOF SHEATHING I �' I I 1 I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS I I I 1 NO NO NO (FRAME INSPECTION 1 1 1 I 1 I I I I I I (FIRE SPRINKLER HANGERS I i i I I I I I I (INSULATION/WEATHER STRIPI I I I l I { I I I I (INTERIOR LATH/DRYWALL I I I I I I I I I I 1 IEXTERIOR LATH 1 1 1 I I I I I I 1 I (RATED FLOOR/CEIL ASSEM. I I I I I I I I I IRATED WALL ASSEMBLIES I I I I IRATED SHAFTS/OPENINGS 1 I 1 I IT-BAR CEILINGS I I 1* ADDITIONAL DATA ON FILE I I I I ILOT DRAINAGE 1 I I I 1 I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 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 1202240018 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 6561 LT: 115 UN: .002 SQ. FT STORIES TYPE 6027 KAUFFMAN AV 1 I ISTRUCTURE: 1900 V-B I TEMP CA 917801742 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15385-018-008 1 1 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY CAI I I I I TENANT: JEXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: 1EXIST OCC GRP: 102/24/12 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FAN CODE: IWENZEL RICHARD A;PATRICIA L (818) 285-6446- 1 2 3,800 I - 16027 KAUFFMAN AV TEMP 917801742 1 FEES PAID IDESCRIPTION OF WORK I I IREMOVE EXISTING ROOF ON HOUSE, INSTALL 30 FELT AND I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IINSTALL 30 YEAR CLASS A SHINGLES I (APPLICANT: TEL. NO: I 1 I IHERRERA ROOFING AND GENERAL, CONTRA (626) 644-1875- IAA BLDG PERMIT ISSUANCE 27.80 11846 S CALIFORNIA IAB STATE GREEN BLDG FEE 3800.00 VAL 1.00 ISPECIAL CONDITIONS: 1 IMONROVIA CA 91016 IAC STRONG MOTION RESID 3800.00 VAL 0.50 I I ID2 PERMIT W/0 EN-HC 3800.00 VAL 115.80 I 1 1 TOTAL FEES 145.10 I 1 ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 IHERRERA ROOFING (626) 793-2825- 1 1 I 11846 S CALIFORNIA AVE LIC. NO 1 ILOCATION AND SETBACKS 1 1 I IMONROVIA CA 91016 943801 * 1 I I I I ISOILS ENGINEER APPROVAL I 1 1 I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I 1 LIC. NO: I 1SLAB/UNDER FLOOR 1 1 1 I I I I I I IRAISED FLOOR FRAMING 1 I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I (UNDERFLOOR INSULATION I I I 1150H269 3 Oo1 1 11 1 _1 IFLOOR SHEATHING 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I 0 NO 21 1 IROOF SHEATHING I I I W-42,I I 1 SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS I I 1AIR QUALITY: 1000 FEET MATERIALS 1 1t I 1 1 NO NO NO I 1FRAME INSPECTION 1 1 1 I I I I I I 1 I IFIRE SPRINKLER HANGERS 1 1 1 1 I IINSULATION/WEATHER STRIP( I 1 I I I I I I 1 1 11NTERIOR LATH/DRYWALL I I 1 I I I I I I 1 1 1EXTERIOR LATH I I 1 1 1 IRATED FLOOR/CEIL ASSEM. I I I 1 1 1 IRATED WALL ASSEMBLIES 1 1 1 1 1 IRATED SHAFTS/OPENINGS 1 1 1 1 1 IT-BAR CEILINGS 1 1 1* ADDITIONAL DATA ON FILE I 1 1 1 1 1 ILOT DRAINAGE I 1 1 IREPORT ID: DPR261 ROUTE TO: BS0508 1 1 I I I I I I