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HomeMy Public PortalAbout10380 KEY WEST ST_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATIONinsure,or a certificate of Worker 'Compe FOR BUILDING PERMIT or a certifiecLcopy e f S c Lab. _ COUNTY OF LOS ANGELES BUILDING ND SAFETY Policy Company El rtified co BUILDING Pv is hereb v furnied. �.z/�inl � FOR APPLICANT TO FILL IN. ADDRESS Certified copy is filed with the countylo g nspec- BUILDING GG J tion department. ADDRESS O LOCALITY G NEAREST Dote Applicant CITY_ ZIP Q CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' _ NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LO )( 123 NOW ON LOT O MAP BOOK P PARCEL (This'section need not be completed if the permit is for one �C�NE MAP hundred dollars ($100) or less.) TRACT r J� BLOCK LOT NO. NO. � TEL. SPECIALIL I certify, that_in the performance of the work for which this OWNER NO. CONDITIONS permit is issued, I shall not employ an person in an manner DISTRICT GROUP TYPE FIRE O .SED BY U P P Y Y P Y CONS�f— so as to become subject to the Workers'Compensation Laws. ADDRESS '/ CITY 1 C s ZIP19 11? Date Applicant STATISTICAL CLASSIFICATION AP CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR "' ® TEL. Exemption, you should become subject to the Workers' ENGINEER 7 Q�j1J0. CLASS NO. �� DWELL. UNITS #A Compensation provisions of the Labor Code, you must forth- ADDRESS �� SEWER MAP with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. /�A I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 14 2 NO. 0 64 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. pp Professions Code, and my license its in full force and effect. CITY A i' CLASS .9 l $ 26 7Z7 Y Lic.Class SO. FT. ^STORIES IE L FAMILIES 1 CHECK License Number SIZE (� STORIES l ONE a��y01 NEW Contractor�75chaveh s"1—u,pote DESCRIPTION OF WORK ® ✓ I El am exem pt from the licensin re uirements as I am•a ` ADD licensed architect or a registered professional engineer ALTER � FINAL m c 4 9 5 7 A acting in my professional capacity (Section 7051, REPAIR [F:] DATE Business and Professions Code). USE OF OL FINAL # o 0 o o 2 3 DEM EXISTING BLDG. By1 �..s 2 - 8640 0 0 8 6 4 0 Lic.or Reg. No. Date APPLICANT TEL.A ^ 1 _ OWNER-BUILDER DECLARATION (PRINT) NO. �( /J / / 0 0 0 8 6 4v I hereby affirm that I am exempt from the Contractor's License 1 ( . Law for the following reason (Section 7031.5, Business and ADDRESS 141-S Mellon I e— ,g Professions Code): PRESENT • - G�� 0 BULDING i,24-81 El1, as owner of the property, or my employees with ADIDRESS �� 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. I, as owner of the property, am exclusively contracting CONTRACTOR NO. �t with licensed contractors to construct the project (Sec- ADDRESS :2 4 9 5,8 A tion 7044, Business and Professions Code). _ REQUIRED TOTAL SETBACK FROM EXIST. # 0 0 0 0 0 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT i the performance of the work for which this permit is issued P.L. ? ° 5 6 050 . . (Sec. 3097, Civ. C.). SIDE 3 P.L. a a.56Q5O� Lender's Name Z20i,2.4-81 Lender's Address P.C. Fee Permit Feq W I certify that I have read this application and state that the Issuance Fee L✓�/ above information is correct. I agree to comply with all County Investigation Fee - 0 ordinances and State laws relating to building construction, Total Fe and hereby authorize representatives of this County to enter a upon the ove-mentioned prop y for inspecii n purposes. a _ ` SEE REVERSE FOR EXPLANATORY LANGUAGE Sign e of ApOJ.ican gent 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 0510060041 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 37579 LT: 14 SQ. FT STORIES TYPE 10380 KEY WEST ST STRUCTURE: 1794 VN TEMP CA 917803476 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8585-018-035 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/06/05 JK 10/01/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL OTE FINAL BY: CODE: HAROLD, TAFT (213) 494-9443- 7,000 10380 KEY WEST ST ` 2_ TEMP 917803476 FEES PAID D SC IPT ON OF WORK TEA OF AND REROOF 30 YR COMPOSITION SHINGLES FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 7000.00 VAL 0.70 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 7000.00 VAL 166.20 TOTAL FEES 194.65 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 147H273 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING 7 SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 - ROUTE TO: BS0508