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HomeMy Public PortalAbout10400 KEY WEST ST_Building__ v -WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F® U I L®I N G PERMIT ,insure, or a certificate of Workers'Compe ori Insurance, or a certified cop thereof (Sec 3800, Lab COUNTY OF LOS ANG ES BUILDING AND SAFETY � ���' �� P� Z` i_ mPanBUILDINGy rtified copy is-hereby fu ishecl ! - FOR'APPLICANT TO FILL IN' ADDRESS M---�Certifiecl'cop;'is filed with the'county but Ing spec- BUILDING / icon department ADDRESS C/ LOCALIT NEAREST Date ,c Applicant T CITY -ZIP O CROSS ST _ 'CERTIFICATE OF EXEMPTION FROM WORKERS' " I_ 0 NO OF BLDGS ASSESSOR 37 COMPENSATION'INSURANCE �' SIZE OF LOT NOW ON LOT MAP BOOK PA PARCEL This,section need not be completed if the permit is for one r'7 E Z E MAP hundred dollars ($100)or less ) TRACT 7.J ! BLOCK f LOT NO NO } q TEL /Q�} SPECIAL "t - d V OWNER v O 6 CONDITIONS O certify that tn:the performance of the work for;whtch,thts I TRICT kGROUP TYPE� FIRE PRO SED BY,- t{J permit is issued, I shall not emplcy�any person in any manner 1,01- CONST ADDRESS so as,to become sublect to the Workers'Compensattori Laws4,2 ©� VIA '' ;Date ' A Itcant " ' � CITYZIP STATISTICAL CCATION APT CONDO V PP ARCHITECT OR 7-- - TEL �f NOTICE'TO on, APPLICANT If, after making tht the-W6re of ENGINEER O CLASS NO OV' DWELL UNITS/ OW. ' Exemption,, you should become' subject to the-Workers' Compensation provisions of-the Labor Code, you must forth- ADDRESS Ve SEWER MAP with comply with such provisions<or this 'permit shall be _ deemed revoked TEL BK' FG, VALIDATION' ! ti CONTRACTOR NO LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter,9_ ADDRESS NO 2b VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC Profess toris Code, and my license is to full force and effect CITY 1 CLASS $ � « SQ FT NO OF ' NO OF CHECK License Numbe_r/ 1,07 S P 4 Ltc Class J�, SIZE )644�STORIES FAMILIES , ONE ContractorFAi`ICJ3AVe-r1 DldUpate Y DESCRIPTION OF WORK NEW $ - � g,4,933A•, 1 ADD # �'� er2 3 > I am exempt fro m the licensing requirements as I am a _ d r _ .. ALTER FINAL �Org� licensed architect or a registered professional engineer, . .,�_, d 2.0'0 8 1,^(�:Q actin in 'm professional capacity- Section 7051, DATE 9 Y P P Y- ( REPAIR Business and Professions Code) USE OF FINAL ///��� /� 0 e'0 811,6 U EXISTING BLDG DEMOL By ( �_ Ltc or Reg No Date APPLICANT TEL = �} ""��Q••J 01k =8'1 _ OWNER-BU ILDER*DECLARATION (PRINT) ^' NO 49-280 Cj I hereby affirm that I am exempt from the Contractor's License ADDRESS •Pi I� / Law for,the following reason (Section 7031 5, Business and a� Professions Code) PRE EN BUILDING, I, as owner of the property, or my employees with ADDRESS c.wages as their sole`compensation, will do the work and . • l 7 }�C ' the structure is not intended'or offered for sale'(Section LOCALITY y 7044, Business and Professions Code) , ' MOVING TEL I, as owner of the property, am exclusively contracting CONTRACTOR NO a �s7C�=¢�� ;2,4-9 3 4 A ' With licensed contractors to construct the protect (Sec-* ADDRESS # o o'0 0 0 tion 7044, Bustnessrand Professions Code)- - REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION onstru Gon lend Y SET BACK YARD HWY PROP_LINE WIDTH' 2 �"5 3 0'S J d hereby affirm that there is a constructron lending agency for FRONT I the performance of the work for which this permit is Issued P L � � - ie o 543 0 5 0` (Sec 3097, Civ C ) SIDE P L- -0 4,24'—81 Lender's Name r /� a P C Fee$� ice/'� Permit Fee Lender's Address I- > 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 nvestigotion Fee 0 ordinances and State taws relating to building construction, Total Feew and hereby authorize representatives of,this County,to enter Lipari the 7ove-mentioned YTrTy for inspectiori purposes` ' < SEE REVERSE FOR EXPLANATORY LANGUAGE o S1 re of p1 or Agent ell - Dote ©s WORKERS'COMPENSATION DECLARATION ersAPPLICATION FOR BUILDING PERMIT I-hereby affirm that I have a certif,tcate ofrconsent to self insure, or a certificate of Work 'Compenstion Insurance, or ��d th eof $ 3800, Lab C ) �= ,iy L� COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished BUILDING >IrzpFOR APPLICANT TO FILL IN ADDRESS Certified copy is filed•with the county building mspec- BUILDING `Y n dp me 1 ADDRESS LA LOCALITY i \ NEAREST Date pircant ` i CITY CROSS ST CERTIFICATE OF EXEMPTIbN FROM WORKERS' NO OF BLDGS 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 } TEL �/ SPECIAL IL certify that in the performance of the work for which this OWNER NO CONDITIONS ` - O permit is issued,.l shall not employ any person in any manner ISTRICT GROUP TYPE FIRE PROCESSED BY V Im so o b co'me,syjfl to the Workers'C ensu ton Laws ADDRESS / J CONST ZONE 0 ,j CITY ,,j/�-7 Q Date Applicant STATISTICAL CLASSIFICATIO APT CONDO V NOTICE'TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL ss�� / WL t ENGINEER NO CLASS NO_y`LDWELL UNITS Exemption, you should become subject'to the Workers, N Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER,MAP z with-comply with such.provisions or this permit shall be - deemed revoked CONTRAC N L BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION ' LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO V1 1 � _(commencing with Section 7000)of Division 3 of the,Business and , � LIC' Professions Codand m license is in full force and effect CITY CLASS'N 7) S + v ' SQ NO OF FA OF, CHECK License Number I C Class �J SIZ STORIES FAMILIES ONE DESCRIPTION OF WORK NEW 6.ntroc r Date, $ ADD I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer ALTER Ej FINAL O O Z acting in my rprofessional capacity (Section 7051, REPAIR DATE _ Business and Prof o Code) USE OF DEMOL -FINAL EXISTING BLDG Lic or Reg No _Date APPLICAN TEL By ;9 5,7 2 4 A OWNER-BUILDER DECLARATION PRINT NO tLa affirm that I am exempt from the Contractor's License # o 0 0 0 2'1 the following reason (Section 7031 5, Business and ADDRESS % uAts ns Code) PRE N 2 0 0 74,'7 6 BUILDING as owner of the property, or my employees with ADDRESS ages as their sole compensation,will do the work and ° ° ° 7 4,7 6 5 e structure is not intended or offered for sale(Section LOCALITY F44, Business and Professions Code) MOVING TEL 0 81 9—8 2 as owner ofthe property, am exclusively contracting CONTRACTOR NOth licensed contractors to construct the project (Sec- z 5,7 2 5 A ADDRESS tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST # 0'0'0 o s 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that Were is a construction lending agency for FRONT 2'- 1 42 0 0 the'performonce of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE G YO PL 1 4 2.0 015 Lender's Name 0 8. 1 '9'-82 ,,Lender's Address P C Fee$ Permit Fee w I certify that I have read this application and state that the Issuance Fee i ° above information is correct I agree to comply with all County Investigation Fee ordinances and State'laws relating to building constru6ion, Q Q d hereby authorize representatives of this County to enter _ Total Fee a In above-m ntio ed property for ns ection purposes m - _ SEE REVERSE FOR EXPLANATORY LANGUAGE a ' • Signature of Ap t or Agent, if Dote es 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 0508290010 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS TR 37579 LT 15 SQ FT STORIES TYPE 10400 KEY WEST ST STRUCTURE 1675 VN TEMP CA 917803478 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 8585-018-036 THOMAS PAGE 597 GRID C4 LOCALITY TEMPLE CIYT, C TENANT EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY EXPIRES ON EXIST OCC GRP 08/29/05 JK 08/24/06 OWNER TEL NO BLDGS NOW ON LOT VALUATION FIN TE FINAL BY CODE VILLALUZ BENJAMIN N,VILMA C (626) 448-1233- 1 8,000 10400 KEY WEST ST (> TEMP 917803478 FEES PAID D C'IPT ON OF WORK TEAR OFF AND REPLACE WITH 30 YR COMPOS INGLES FEE DESCRIPTION QUANTITY UOM AMOUNT APPLICANT TEL NO SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27 75 AC STRONG MOTION RESID 8000 00 VAL 0 80 SPECIAL CONDITIONS D2 PERMIT W/O EN-HC 8000 00 VAL 183 00 TOTAL FEES 211 55 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/GOND STAT CLASS NO 21 ROOF SHEATHING 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 c _ T-BAR CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO BS0508 4