HomeMy Public PortalAbout10330 KEY WEST ST_Building__ WORKERS'COMPENSATION DECLARATION o CO
hereY�y affir� that I have a certificate of consent to,self APPLICATION FOR BUILDING. PERMIT .
0
insure, or certifi ate of Workers' Compensation Insur nce,
j a rt' d co thereof (Sec. 3800, Lab. C.) CITY OF AZUSA BUILDING AND SAFETY
h o. Com any BUILDING
Ce d c py here fur a FOR APPLICANT TO FILL IN ADDRESS
Pied y I wi i in spe UILDING v �3o
ion ADDRESS
e li nt CITY IP LOCALITY
CE ICAT OF EXEMPTION FRO WORKER ' NO. OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL
TRACT OCK LOT NO.
TEL' USE ZONE LJ
I certify that in the performance of the work for which this OWNER NO. SPE ! 14
permit is issued, I shall not employ!ayrson in any manner SPECIALso as to be om subject to the Woompensati n Laws. DDRESS / CONDITIONS
Date_ Applicant CITY ZIP
NOTICE O A PLI ANT: If, after making his rtificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY
Exemption, you should become subject to the Workers' ENGINEER NO. / CONST. y�� ZONE p
Compensation provisions of the Labor Code, you must forth- ADDRESS J ' �� /�/
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO.
deemed revoked. CONTRACTO O. 16
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 and LIC. SEWER MAP
Professions Code, and my license is in full force and effect. CITY yt,li L CLASS BK PG VALIDATION d
SQ. FT. 1�6 F NO. OF (CHECK O
License Numb 30Lic.Class SIZE 1ES FAMILIES ONE L)
A, VALUATIO�1
Contracto Date DESCRIPTIONOF WORK Z( Q NEW
D ❑ $ O C O
I am exem t under Se . Ipill. V
z ALTER
LL
B.BP.C. for this reason REPAIR ❑ $ d
Date: U E OF _ Z
EXISTING BLDG. DEMOL ❑ _
APPLICANT TEL.
Signature S
PRINT L
FINA
OWNER-BUILDER DECLARATION DATE
1 hereby affirm that I am exempt from the Contractor's License
Low for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): PRESENT BY
❑ BUILDING
IACC
, as owner of the property, or my employees with ADDRESS Ft�S•T as
wages as their sole compensation,will do the work and � i
A
the structure is not intended or offered for sale(Section LOCALITY , 3307 68.6
7044, Business and Professions Code). MOVING
I, as owner of the property, am exclusively contracting CONTRACTOR NO. 351ZZ Q
1/ 1 ITEMS
EMS
with licensed contractors to construct the project'(Sec- ADDRESS �S ��,✓ �)��( pa,p m
tion 7044, Business and Professions Code).
63
REQUIRED TOTAL SETBACK F }}�� rig -�
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHECK.. 68.63
1 hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L. CHANGE .ISO
(Sec. 3097, Civ.'C.). SIDE
� 9
P.L.
Lender's Name (L1! x�-^''0fF0{•� 0ri, 13^� q 9
LDMA Ref. # V{JU�—�I.ILIIJ�. ��l��t�.t7
m
P.C. Fee$ Permit Fee
Lender's Address f 5 1 AM 10:38
o I certify that I have read this application and state that the above
oil
o information is correct. I agree to comply with all city ordinances Issuance Fee / -� LDMA P/C#
o Investigation fee
and State laws relating to building construction, and hereby /
R authorize representatives of this city to enter upon the above- Total Fee LDMA Perm. #
a mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Apphc Ant or t4ent Date I _
'WORKERS' COMPENSATION DECLARATION
-r I- hereby affirm that I have a certificate of,consent to self
insure; or-a certificate of Workers' Compensation Insurance, A P P L I CA.T I:O N FOR BUILDING PERMIT �
: .._
or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company BUILDING
Certified copy is hereby furnished. fOR, PPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building*inspec- BUILDING `
tion department. ADDREa �7 \
Date Applicant CITY 1L� (�i�L' ZIP Z/ -4�1LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' f NO. OF BLDGS. NEAREST.
COMPENSATION INSURANCE •• SIZE OF LOT . t NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one � �s ASSESSOR
-hundred dollars ($100)or less.) TRACK,6, BLOCK LOT NO. MAP BOOK PAGE PARCEL
OWNER r //�/�� N
TEL
3v USE ZONE MAP �� O
I certify that in the performance of,the work for which this NO. }
permit is issued, I shall not employ any person in any manner //J��r �/: �� SPECIAL '
so as to become subject to the Workers'Compensation Laws. ADDRESS 77 6d N�� CONDITIONS
CITY ZIP e
Date Applicant G
NOTICE TO APPLICANT: If, after making this'Certificate of ARCHITECT OR TEL. DISTRICT ENGINEER NOCONST., ZONE
GROUP. TYPE FIRE 2:��
.
Exemption, you should become subject to the Workers' � Cid i •�
Compensation provisions of--the Labor Code, you must forth- ADDRESS C3 / 3
with comply with such provisions or this permit shall be V �
9116
deemed revoked. STATISTICAL CLASSIFICATION APT. CONDO.
CON292!& ' G9rdG�6J (��
e5i 1/1
LICENSED CONTRACTORS DECLARATION LIC,: 'f CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS
(commencing with Section 7000)of Division 3 of.the Business and •- LIC. SEWER MAP
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 Q STORIES FAMILIES ONE
VALUATION
Contractor Date DESCRIPTION OF WO�RKr_�y/Y NEW
o $
❑ I am exempt under Seca �c`� C ALTER ❑ , 2 5 A
B.&P.C. for this reason REPAIR ❑ $
Date: USE OF DEMOL ft o o o o 23
EXISTING BLDG. ❑
Signature APPL T _ TEL. FINAL / 2,o O 0,
OWNER-BUILDER DECLARATION NO' DATE'f-
I hereby affirm that I am exempt from the Contractor's License FI L ° o , 0, 1 00,
Law for the following reason (Section 703 1.5, Business and ADDRESS S
Professions Code): PRESENT B 2 1
DBUILDING - 8 4
I, as owner of the property_ or my employees with ADDRESS
wages as their sole compensation,will do the work and 1=
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL---
❑ CONTRACTOR NO. V _
I, as owner of the property, am exclusively contracting +� ` '•
with licensed contractors to construct the project(Sec- -
tion 7044, Business and Professions Code). ADDRESS K 2 6 G O A
REQUIRED TOTAL SETBACK.FROM T.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH # 0 0 0 0 3
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.Lr
(Sec. 3097, Civ. C.). SIDE ti t ° 6 1 0, 10
P.L.
; i
Lender's Name ° 6.1 Q, 1 0
m LDMA Ref:# CO o
Lender's Address P.C. Fee$ �� Permit Fee S : , o.° u�8_8 5
> �l
I certify that I have_read this application and state that the O V Issuance Fee LDMA P/C# NISio O' -
a above information is correct. 1 agree to comply with all County Investigation Fee I.9oo0 v
ordinances and State laws relating to building construction, Total Fee i LDMA Perm. # 00r\JN)° O '
U and hereby authorize representatives of this County to enter CT1(Tr TI—
upon the above-mentioned prop ri tion purposes:
GH
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa of Ap cant r t Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1012290021
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
1TR: 36735 LT: 10 SQ. FT STORIES TYPE OCCUP GROUP 10330 KEY WEST ST
I (STRUCTURE: 117 1 V-B R-3 I TEMP CA 917803476
(ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: HALIFAX
18585-018-074 OTHER: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl
(TENANT: IEXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY:
(EXIST OCC GRP: 101/24/11 SR
OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE:
ITRAN, WILLIAM (626) 862-1778- 1 20,000 I
110330 KEY WEST ST I 1 1
TEMP 917803476 1 FEES PAID IDESCRIPTION OF WORK
I IEXTEND (E) DINING RM - 117 SF; RELOCATE DOOR BETWEEN HOUSE &I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IGARAGE; OPEN PORTION OF WALL BETWEEN FAMILY RM & DININGRM 1
APPLICANT: TEL. NO: I I
IWENDT, RON (626) 497-6320- IB1 PLANCHECK W/ENERGY 15000.00 VAL 281.90 I
I IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: 1
IAB STATE GREEN BLDG FEE 20000.00 VAL 1.00
IAC STRONG MOTION RESID 20000.00 VAL 2.00
IB2 PERMIT W/ENERGY 20000.00 VAL 424.40
CONTRACTOR: TEL. NO: TOTAL FEES 737.10 (APPROVALS DATE INSPECTOR SIGNATURE
IWENDT AND SONS CONSTRUCTION (626) 497-6320-
16149 LOMA AVENUE LIC. NO I ILOCATION AND SETBACKS
ITEMPLE CITY, CA 91780 432646 1 I 1
1 ISOILS ENGINEER APPROVAL I
I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I
(MONTENEGRO, PEDRO (626) 786-4359- 1 1
18660 MISSION DR LIC. NO: I 1SLAB/UNDER FLOOR I
IROSEMEAD CA 90065 55345 I I1 �l 1
1 I IRAISED FLOOR FRAMING
I I I I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I 1 I
1 3 001 I 11 I
I I 11ST LEVEL FLOOR SHEATH 1 1
INC. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I
NO 21 1 12ND LEVEL FLOOR SHEATH 1
I I I I I I
SCHOOL WITHIN HAZARDOUS IROOF SHEATHING
(AIR QUALITY: 1000 FEET MATERIALS I
I NO NO NO IFIRE DEPT. FRAME INSPECTI I I
I 11 1
I I (BLDG DEPT. FRAME INSPECTI I I
I I I I I
1 I ISHEAR PANELS 1 1
I I I I
I (INSULATION/WEATHER STRIPI I I
I I I
(INTERIOR LATH/DRYWALL
I I I I I I
(EXTERIOR LATH 1
I I I I I I
1 1 ILOT DRAINAGE 1
I I I I I I
ISMOKE DETECTION DEVICES I I
I I I I I I
- IFIRE DEPARTMENT APPROVALI I I
1 1 I
I I I I I
I I 1 11 I
1 (REPORT ID: DPR261 ROUTE TO: BS0508 1 I 1 1
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 1011240041
PHONE: (626) 285-0488 EXT:
(LEGAL ID: NO. OF CONST BUILDING ADDRESS:
ITR: 36735 LT: 10 I SQ. FT STORIES TYPE 10330 KEY WEST ST
I ISTRUCTURE: V-B I TEMP CA 917803476
(ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HALIFAX
18585-018-074 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl
I I I I
(TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY:
I IEXIST OCC GRP: 111/24/10 SR I
I I I I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: FIJJAL DATE i F BY: CODE:
ITRAN, WILLIAM (626) 862-1778- 1 10,500 I 1
110330 KEY WEST ST 1 1 1
ITEMP 917803476 1 FEES PAID (DESCRIPTION OF WORK I1
I I (KITCHEN AND TWO BATHROOMS REMODEL AND REPLACE 7 WINDOWS I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 I
(APPLICANT: TEL. NO: I I I
IWENDT, RON (626) 497-6320- IAA BLDG PERMIT ISSUANCE 27.80 1 I
IAB STATE GREEN BLDG FEE 10500.00 VAL 1.00 (SPECIAL CONDITIONS: 1
IAC STRONG MOTION RESID 10500.00 VAL 1.10 I
IB2 PERMIT W/ENERGY 10500.00 VAL 257.40 I 1
TOTAL FEES 287.30
ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
IWENDT AND SONS CONSTRUCTION (626) 497-6320- I I
16149 LOMA AVENUE LIC. NO ILOCATION AND SETBACKS I I I
(TEMPLE CITY, CA 91780 432646 I I I I
I I (SOILS ENGINEER APPROVAL
(ARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS I
LIC. NO: 1 (SLAB/UNDER FLOOR
t�'�Li RAISED FLOOR FRAMING 1 1
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( V v� ltl -7 (UNDERFLOOR INSULATION
147H273 3 00 i ,'3 � 1 fl -1-1
I FLOOR SHEATHING,., I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21 1 IROO7 SHEATHING
1 SCHOOL WITHIN HAZARDOUS
(AIR QUALITY: 1000 FEET MATERIALS , J (SHEAR PANELS
I �4l��c(A`
I T I
NO NO NO r. ,` (FRAME INSPECTION I I I
o1" 0 W `{e. dl�til!lGt.aI
I C (FIRE SPRINKLER HANGERS I I
1 ) [v i INSULATION/i� A H R S I
� �4 7� ��� � �G� Xn�i INTERIOR LATH/DRYWALL
vt4v�o �A I EXTERIOR LATH
i
IL�SS� ��, r� 4_� �� {�•(' 4 (RATED FLOOR/CEIL ASSEM.
'c> '4 (RATED WALL ASSEMBLIES
IRATED SHAFTS/OPENINGS I
I I I
IT-BAR CEILINGS I I I
ILOT DRAINAGE I 1
I I I
REPORT ID: DPR261 ROUTE TO: BS0508 I
I I I I