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HomeMy Public PortalAbout10370 KEY WEST ST_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compen,Pion Insurance, or rtifdpy��erof 1Sec. 3800, Lab. COUNTY OF LOS ANGELS ��_ BUILDING D SAF TY Policy`7 � D�i�C�ompany ` BUILDING El Certified copy is hereby fu r fished. /� / FADDRESS FOR APPLICANT TO FILL IN ADDRESS/®� ertified copy is filed with the county/buil ri inspec-Pion department. � j LOCALITY Q 1 NEAREST Date Applicant ZIP { L CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' 9 I NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON.LOT MAP BOOK P PARCEL (This section need not.be completed if the permit is for oneUS ZON MAP hundred dollars ($100)or less.) TRACT 37i;79 BLOCK I LOT NO. ;� NO. q TEL. SPECIAL I certify that in the performance of the work for which'ihis OWNER NO � CONDITIONS permit is issued, I shall not employ any person in any manner STRICT GROUP TYPE FIRE P CES D BY U ADDRESS CONS ZO so as to become subject to the Workers'Compensation Laws. / 99 Date Applicant CITY , ZIP CJ STATISTICAL C A $IFICATIO APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ENGARCINEER OR p TEL. idgq �D Ny Exemption, you should become subject to the Workers' ENGINEER CLASS NO. !/ DWELL. UNITS @� Compensation provisions of the Labor Code, you must forth- 1 ADDRESS SEWER MAP Z with comply with such provisions or this permit shall be TEL. _ deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LICO-266 , t I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS '4 NO. l7 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITY ca CLASS $ S .License Number2(G,523644 Lic.Class?_ SIZEFT STORIIEES AMILLIIES CHECK ONE DESCRIPTIONOF WORK i NEW Contractor��i(��e71��1��yDate ADD 24931 A I am exempt from the licensing requirements as I am a , � licensed architect or a registered professional engineer ALTER FINAL # o o­ 0 23 acting in my professional capacity (Section 7051, Q DATE Business and Professions Code). REPAIR EXISTING BLDG. DEMOL . FINAL 2 ° ° 81.60 By � x (PRINT) NO (/ Lic: or Reg. No. Date APPLICANT TEL.. /) a a o 8 1,6 0 OWNER-BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License M el a lid - �� 0 u.24-81 Law for the following reason (Section 7031.5, Business and ADDRESS t Professions Code): PRESENT a ro ert _ BUILDING I, as owner of the ' property,y, 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. a1, as owner of,the property, am exclusively contracting CONTRACTOR NO. y^o��^�/ with licensed,contractors to construct the project (Sec- 04 9 3.2A tion 7044, Business and Professions Code), ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. Z ° 5 3 0,'5 0 CONSTRUCTION LENDING AGENCY FInvestigation YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for fj�}�i o'° 5 3 (� Jr the performance of the work for which this permit is issued �`T/ LOC (� Jd (Sec. 3097, Civ. C.). 0 G 2.4781 Lender's Name Lender's Address � �f�) Permit Feel! ii�i : w I certify that I have read this application and state that the v Issuance Fee aabove information is correct. I agree to comply with all County ee ordinances and State laws relatingto building construction, and herebyauthorize representatives of this County to enter Total Fee upon the bove-mentioned property for inspection rposes. a s'�// c'y`' SEE REVERSE FOR EXPLANATORY LANGUAGE Si ure of licant r Ag Date ©s i r WORKERS' COMPENSATION DECLARATION � hereby affirm that I have a certificate of consent to self APPLICATION F-mO R BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance, or a certified copy thereof (Sec. 3800, La cy IVota COUNTY OF LOS ANGELES BUILDING AND SAFETY Company Certified copy is hereby furnished. FOR APPLICAN TO FILL IN BUILDING ADDRESS ertified copy is filed with the count building inspec- BUILDING ti n dep rim ADDRE LOCALITY NEAREST Date plicant La CITY ZI CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. O GS. s ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. C1 TEL. SPECIAL I certify that in the performance of the work for which this. OWNER C NO. CONDITIONS permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIREPRO SSED BY V so as to become subject to the Workers'Compensation Laws. ADDRESS CONST. ZONE Date Applicant CITY ZIP STATISTICAL CLASSIFJZATION APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. LU Exemption, you should become subject to the 'WorkerENGINEER NO. CLASS N0.9 l DWELL. UNITS #A Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP � e with comply with such provisions .or this permit shall be deemed revoked. CONTR T _ BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS10 (commencing with Section 7000)•of Division 3 of the Business'and LIC Professions Cod nd m cen� sin full force and effect. CITY CLASS $ �\/ `f_/) SQ. FT. NO. OF NO. OF CHECK License Nu er `J�7`--tic.Class SIZE STORIES FAMILIES ONE $ Conir Date DES• N ORK NEW I m exempt from the licensing requirements as I am a ADD ❑ licensed architect or a registered professional engineer ALTER ❑ FINALS i� acting in my professional capacity (Section 7051, REPAIR ❑ DATE Business a P ssi s de). USE OF FINAL lS 1 EXISTING BLDG. DEMOL ❑ By Lic.or Reg. No. _Date APPLICANT T L. OWNER-BUILDER DECLARATION (PRINT) I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT a 3 5 0,9 A BUILDING ❑ I,, as owner of the property, or my employees with ADDRESS # o a'o o 2.1 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 2r7 7 6 o.o 7044, Business and Professions Code). MOVING TEL. F-1CONTRACTOR NO. 77 6 U e I, as owner of the property, am exclusively contracting o o'.o with licensed contractors,to construct the project (Sec- ADDRESS tion 7044,Business and Professions Code). 0 IL 0 5'—8 2 REQUIREDTOTAL SETBACK FROM EXIST. 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. `' P 351, 0 A (Sec. 3097, Civ. C.). SIDE P.L. #'0 0 0 0 0 1 Lender.'s Name , //,,' • m P.C. Fee$ t Permit fees. 2- 1 4 2 0 0 Lender's Address p w I certify that, I have read this application and state that the ssuance Fee U r 0 0 1 [( ?'00C-1 Qabove information is correct. I agree to�comply with all County Investigation Fee dinances and State laws relating to building construction, / v V 0 4:'05'—8 2 hereby'authorize representatives of this County to enter Total Fee VUlMbo ' a u bove- entione p erty for inspection purposes. ` a SEE REVERSE FOR EXPLANATORY LANGUAGE r ' Signature of mApplicant pr Agent. Date ®s WORKERS' COMPENSATION DECLARATION 7 , C ereby affirm that l have a certificate of conseNt to self -APPLICATION FOR BUILDING PERMIT ure, or a certificate of Workers'Compenstion Insurance, or ertiNo. copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY lis icy No. Company � Certified copy.is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS (� iL �i�S ST' Certified copy is filed with the county building inspec- BUILDING 1 /+ tion department. ADDRESS Q �� ��V f LOCALITY -Ti,--.4ex Cr AL �n NEAREST o Applicant CITY /�J C./ ZIP CROSS SL CERTIFICATE OF EXEMPTION FROM WORKERS' ,/ O'OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT T NOW ON LOT MAP BOOK PAGE - PARCEL section need not be completed if the permit is for one � USE ZONE MAP effA ndred dollars ($100)or less.) TRACT BLOCK LOT NO. 3 _1 NO. �n TEL. SPECIAL ertify that in the performance of the work for which this OWNER ti I�2i�i[2 NO. J 7S o[pj� 7i�� CONDITIONS rmit is issued, I shall not employ any person in any manner �— DISTRICT GROUP TYPE FIRE PROCESSED BY . U as to become subject to the Workers' pensation Law ADDRESS �� oG LdrL$ r ��/ CO/�NST. /Z-OHNE /I'j CITY .c �t i ZIP d -� T*T/® h� to Applic STATISTICAL CLASSIFICATION APT. CONDO. 6U8a TICE TO APPLICANT: If, a ing this Certific to of ARCHITECT OR TEL. - emption, you,should become subject to the Workers` ENGINEER NO. CLASS NO.--I DWELL. UNITS 9L mpensation provisions of the Labor Code, you must forth- Z ith comply with such provisions or this permit shall be ADDRESS SEWER MAP _ emed V BK.revoked. TEL VALIDATION CONTRACTOR �f/BQ (Qd2s N PG, LICENSED CONTRACTORS DECLARATION �+ LIC. iereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ,y'C��I tit/ C/2, NO.�� ® L. VALUATION ommencing with Section 7000)of Division 3 of the Business and LIC: ofessions Code, and my license is in full force and effect. CITY CLASS r $ +�1 p / SQ. FT NO. OF NO. OF CHECK ` cense Number 7670 2— Lic.Class 16 SIZE 'v y STORIES FAMILIES ONE aniractor��'� �Y*iCiDiCRS Date s13--�2 DESCRIPTION OF WORK NEW $ I•am exempt from the licensing requirements as I am a L,Vd'J 40 P�/a ADD licensed'.architect or a registered professional engineer ALTER FINAL acting in my professional capacity i(Section 7051, DATE REPAIR Business and Professions Code). USE OF EXISTING BLDG, 5I� C EMOL FINAL c.or Reg. No. _Date APPLICANT 'p TEL By OWNER-BUILDER DECLARATION (PRINT) 40"24cc /,�i+JCaOLQ,IO. --ns to1.7 © 7 t -1 iereby affirm that I am exempt from the Contractor's License tw for the following reason (Section 7031.5, Business and ADDRESS C3✓-5- e"4",-v Ca GII&Afq ofessions Code): PRESENT BUILDING ADDRESS ) 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 �Y3 93 n A 7044, Business and Professions Code). MOVING TEL. ] 'I, as owner of the property, am exclusively contracting CONTRACTOR NO. #.0,0 o ° ° 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 2'° ° 4 3,0 0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 'iereby affirm that there is a construction lending agency for FRONT ° ° ° 4 3,0 0 c=.: e performance of the work for which this permit is issued P.L. ec. 3097, civ. C.). SIDE 05, 1 Y-8 2 P.L. / mder's.Name P.C. Fee$ Permit Fee mcler's Address -ertify that I have read this application and state that the Issuance Fee FJ "�6 )ove information is correct. I agree to comply with all County nvestigation Fee j dinances and State laws relating,to building construction, Total Fee _3 s 9,0 td hereby authorize representatives of thi my to enter )on the ab mentioned property f ection purposes. 13'�Z. SEE REVERSE FOR EXPLANATORY LANGUAGE e of Applicant o Agent Date ©s 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 1001130022 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST I BUILDING ADDRESS: 1 ITR: 37579 LT: 13 j SQ. FT STORIES TYPE 1 10370 KEY WEST ST 1 STRUCTURE: 30 V-B TEMP CA 917803476 1 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 1 8585-016-034 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 101/13/10 SR 1 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 ILIM, JAY (626) 382-6537- 9,000 110370 KEY WEST ST 1 W(^t\ I ITEMP 917803476 I FEES PAID IDESCRIPTION OF WORK IHOUSE ATTACH GARAGE PITCH ROOF REMOVE OLD ROOF DOWN INSTALL 1 !FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IOSB 1/2 PLYWOOD APPLY 2 LAYERS 15LB FELT REROOF CLASS A (APPLICANT: TEL. NO: I I IK S T ROOFING CO INC. (310) 329-2600- IAA BLDG PERMIT ISSUANCE 27.75 I I 11916 W. 150 TH ST. IAB STATE GREEN BLDG FEE 9000.00 VAL 1.00 ISPECIAL CONDITIONS: IGARDENA, CA 90249 IAC STRONG MOTION RESID 9000.00 VAL 0.90 I I 1 ID2 PERMIT W/O EN-HC 9000.00 VAL 199.80 I TOTAL FEES 229.45 1 CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE IK S T ROOFING CO. (310) 329-2600- 1 1 1916 W. 150TH STREET LIC. NO ILOCATION AND SETBACKS I I I IGARDENA, CA 90249 623446 C39 I I I I I I ISOILS ENGINEER APPROVAL I I 1ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I LIC. NO: I (SLAB/UNDER FLOOR I I I IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I 1147H273 3 001 I I I I IFLOOR SHEATHING I I I INC. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I NO 21 1 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS 1 I I I NO NO NO 1 IFRAME INSPECTION I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE'SPRINKLER HANGERS I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I IFRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- 1 I 1-1 I I (INTERIOR LATH/DRYWALL I I I I 1 (EXTERIOR LATH I I IRATED FLOOR/CEIL ASSEM. 1 1 IRATED WALL ASSEMBLIES I I I IRATED SHAFTS/OPENINGS 1 I I I IIT-BAR CEILINGS I I I * ADDITIONAL DATA ON FILE I I I I I ILOT DRAINAGE I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 I I I