HomeMy Public PortalAbout10360 KEY WEST ST_Building__ WORKERS' COMPENSATION DECLARATION
•1 hereby affirm that I have a certificate of consent to self , q p p L]CATION FO U I L D I N G PERMIT
insure, or a,certificate of Workers'Compe tion Insurance, or
a certified copy thereof (Sec 3800,. Lab
Policy
A
y COUNTY OF'LOS ANGE S BUILDING AND SAF Y
Certified copy is'hereby urnished� / FOR APPLICANT TO FILL IN BUILDING/B 9 6 C_•
ADDRESS ,7
Certified copy,is filed 'wrth the count but mg inspec- BUILDING n //
tion department ADDRESS �(O� LOCALITY
1� OO NEAREST
Date, Applicant CITY -re C'I ZIP CROSS ST ;
CERTIFICATE OF EXEMPTION FROM WORKERS' I I NO OF BLDGS ASSESSOR
COMPENSATION-INSURANCE 'SIZE OF LOT NOW ON LOT - O MAP BOOK P PARCEL
(Thts�sectton'need not be completed if the permit is for oneZION/E ( MAP D f]
hundred dollars ($100)or less ); TRACT 3 57R BLOCK LOT NO ' �Ldd47 SPOECIAL �(/ }
I certify that in'the performance of the work for which this OWNER ► NO —.( 'DISTRICT
CONDITIONS O
permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE P O SED BY U
ADDRESS CONST Z
so-as to become subject to the Workers'Compensation Laws � f�� O
Date Applicant CITY ZIP STATISTICAL CLAS$!F(QTION ` APT JCOND(2�/' V
NOTICE TO APPLICANT If; after making this Certificate of ARCHITECT OR ♦ TEL (�(J /
you should become subject. to the Workers' ENGINEER NO _ CLASS NO DWELL UNITS—
Exemption, N
-Compensation provisions of the Labor.Code, you must forth- ADDRESS Co I SEWER MAP
33
with comply with such provisions-or this permit shall be TYL
deemed revoked CONTRACTOR OW n e NO BK PG, VALIDATION
,LICENSED CONTRACTORS DECLARATION n r
I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS- ,2. �e NO26� VALUATION
(commencing with Section 7000)of Division 3 of the Business and ^ . LIC i hrl
Professions Code, arid my license is.m full force and effect CITY CLASS _
2(0-45R64
� p - �{ ass FA SQ FT NO OF �] OF CHECK _
License `�Number b45R 6L_Lic ClSIZE STORIES G. FAMILIES ONE 9 4 9 4'5 A
" - ® $ ��
Contractor a l r njw_YI �,pate DESCRIPTION OF WORK 1 NEW #,o o o to 2,3
0 ` ADD
' I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer ALTER FINAL 2 ° - 91.2 0
DATE
acting m. my professional capacity (Section 7051, REPAIR
Business and Professions Code o'o'o
USE OF- FINAL 9 1,2 0
EXISTING BLDG DEMOL
Lic or Reg No Date APPLICANT) NO 6y 0 i.2'4-8 1
OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Pi �a 1
Law for the following reason (Section 7031 5, Business and - ADDRESS
Professions Code) - PRESENT
BUILDING
F-1' I, as owner of the property, or my employees with ADDRESS
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 if a��/ 4 9 4 6 A'
1, as owner of the property, am exclusively contracting CONTRACTOR NO v(
with licensed contractors to construct the project,(Sec-
tion 704 Business and Professions Code) ADDRESS ,# o o, o 0 0.1
CONSTRUCTION LENDING AGENCY
'REQUIRED YARD HWY TOTAL SETBACK FROM EXIST
I hereby affirm that SET BACK PROP LINE WIDTH 2'-,5.,514,5 0 there is a construction lending agency for FRONT ' a
the performance of the work for which this permit is issued P L � ���� o 0,'5,5 4,5 0 5 .
(Sec 3097, Civ' C) SIDE }
Lender's Name P L 0 4,2;41'-8 1
in
PC Fee$rL:!5 .'CJ V Permit F
Lender's Address
W I certify that I have read this application and state that the Issuance Fee .�
above information is correct I agree to comply with all County Investigation Fee l
ordinances and State laws relating to-building construction, Total Fe
and hereby outhorize representatives of this County to enter
aupon t above-mentione erty.for m ection purposes
' - - - SEE•REVERSE FOR EXPLANATORY LANGUAGE
Si Lure of pjt or Agent Date
is
I
f COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTPdENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDJNG AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0109120033
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUnlYING ADDRESS:
TR: 37579 LT: 12 SQ. FT STORIES TYPE 10360 KEY WEST ST
STRUCTURE: 2400 VN TEMP CA 917803476
ASSESSOR R: NEAREST CROSS STREET: EL MONTE
8585-018-033 G THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY
EXIST BL S ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 09/12/01 UT 03/11/02
OWNER: TEL. BL GS. NOW 0 VALUATION: I LD TE F CODE:
SHUE CHIAYI TR - 7,000 Q
10360 KEY WEST ST Z /
TEMP 917803476 FEES PAID DESCRIPTIF VORV
TEAR-OFF NEW PL OODJOSB 1/2 REROOF MONIRLIFE DURALITE
APPLICANT: TEL. I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I,8,6 2043 5.8 LB.
0: (
DOUG DEARDEW (626) 287-0669- 1 AA BLDG PERMIT ISSUANCE 27.75 '
4251 BALDWIN AVENUE AC STRONG MOTION RESID 7000.00 VAL 0.70 SPECIAL CONDITIONS:
EL MONTE D2 PERMIT W/O,ENNC—— -7000.00 VAL 166.20
ELESTOTAL-FEES 194.65
CONTRACTOR: NO: ®� P APPROVALS DATE INSPECTOR SIGNATURE
WEATHERITE ROOFING (626) 287-0669-1 �y y
4251 BALDWIN AVE LIC. NOO�CATi S
ELMONTE CA 91731 HIC
SOILS,ENGINEER APPROVAL
ARCHITECT OR ENGINEER: 0: �� ; A FORMS
LIC. NO:. / I I 1111111 SL B/l1NDER FLOOR
WAT b FLOOR FRAMING
it �---------- -------- ----- --�I
MAP NO: SEWER MAPBOOK: PAGE: FIRE ZONE: CMP ), . U D Rf LOOR INSULATIO
XX 3 ll, 0 L� `��
�
L�,L I � � TEWR-I.SHEATHING
0. S: P CLASS
— -- -- --- —— — -----
NO 21 �� � 1 f] �����i � ROOF SHEATHING
SCHOOL WITHIN �t SHEAR A E
AIR QUALITY: 1000 FEET MATERIALS ❑ ?��'` -
NO NO NO
y FRAME, INSPECTION
REQUIRED L SETBACK FROM EXIST
SET BACK YARD: HWY: 0 PROP LINE: WIDTH:
FRONT PL- °�E'�Vic+a'[(DG� INSULATION/WEATHER STRIP
SIDE PL- I _�- I
INTER R LATH/DRYWALL
EXTERIOR LATH
RATEDIFLOOR/CEIL ASSEM.
i
RATEDIWALL ASSEMBLIES
RATED,SHAFTS/70_P_EffTN_GS
* ADDITIONAL DATA ON FILE T-BARICEILINGS
LOT DRAINAGE
w I REPORT ID: DPR261 ROUTE TO: BS0508
., 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 0905060013
PHONE (626) 285-0488 EXT
ILEGAL ID- I NO OF CONST I BUILDING ADDRESS 1
ITR- 37579 LT 12 I SQ. FT STORIES TYPE 1 10360 KEY WEST ST
ISTRUCTURE V-B TEMP CA 917803476 1
(ASSESSOR INFORMATION NUMBER 1 I NEAREST CROSS STREET 1
18585-018-033 1 I THOMAS PAGE- 597 GRID C4 LOCALITY TEMPLE CITY, Cl
ITENANT (EXIST BLDG USE RESID USE ZONE- R-1 JISSUED ON PROCESSED BY 1
1 1EXIST OCC GRP 105/06/09 SR I
1OWNER TEL NO IBLDGS NOW ON IAT VALUATION IFINAL DATE FINAL BY CODE. 1
ISHUE CHIAYI TR - 1 1 30,240 1 1
110360 KEY WEST ST I1
ITEMP 917803476 1 FEES PAID IDESCRIPTION OF WORK I
1 I 11NSTALL 14 SOLAR PANELS 1
I IFEE DESCRIPTION QUANTITY UOM AMOUNT 1 1
(APPLICANT: TEL NO I 1
(AMERICAN HOME CRAFT INC (957) 445-8373- IAX BUILDING REVIEW FEE 54.70 1 1
11251 POMONA RD. #107 1AA BLDG PERMIT ISSUANCE 27 75 ISPECIAL CONDITIONS 1
ICORONA, CA 92882 IAB STATE GREEN BLDG FEE 30240 00 VAL 2.00 I 1
1 ID2 PERMIT W/O EN-HC 30240 00 VAL 549.75 I 1
1 1 TOTAL FEES 634 20 1 1
ICONTRACTOR: TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1
(AMERICAN HOME CRAFT, INC (957) 445-8373- 1 1 1
11251 POMONA ROAD SUITE 107 LIC- NO 1 ILOCATION AND SETBACKS 1 1 1
ICORONA, CA 92882 790709 1 1-
I
I I ISOILS ENGINEER APPROVAL 1 1 I
I I I I I I
1ARCHITECT OR ENGINEER TEL. NO 1 - IFOUNDATION/TRENCH FORMS I I I
1 LIC- NO 1 1SLAB/UNDER FLOOR I I 1
I I I I I I
I I IRAISED FLOOR FRAMING 1 1 1
I I I I I I
IMAP NO SEWER MAP BOOK. PAGE FIRE ZONE CMP:1 1UNDERFLOOR INSULATION I I
1147H273 - 3 001 1 1-1 1
I I IFLOOR SHEATHING I 1 1
INO OF FAMILIES: DWELLING UNITS APT/COND STAT CLASS I I I I
1 NO 21 1 IROOF SHEATHING I 1 1
I I I I I I
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I
(AIR QUALITY 1000 FEET MATERIALS I 1 11 1
NO NO NOFRANIE INSPECTION
IREQUIRED TOTAL SETBACK FROM EXIST 1 E X R E IFIRE SPRINKLER HANGERS 1 1 1
ISET BACK YARD HWY: PROP LINE WIDTH 1 I_ 1 1 1
IFRONT PL- / INSULATION/WEATHER STRIPI I I
SIDE PL-
1 1 (INTERIOR LATH/DRYWALL 1 1 1
I I I I I I
I 1 1EXTERIOR LATH 1 1
I I I I I I
1 1 IRATED FLOOR/CEIL ASSEM I 1 I
I I I I I I
I (RATED WALL ASSEMBLIES
I I I
1 I IRATED SHAFTS/OPENINGS 1 I I
I I I
1 I'" IT-EAR CEILINGS I 1 1
I I I
1 I ILOT DRAINAGE I I 1
I I I
1 IREPORT ID DPR261 ROUTE TO BS0508 I 1 1 1
I I I I I I