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Home My Public Portal About10410 KEY WEST ST_Building__ arWORKERS' COMPENSATION DECLARATION _ _ APPLICATION F® ILD1-1lIG PERMIT I hereby affirm that I have a certificate of consent to self ' insure, or a certificate of Workers'Compens on Insurance, or a cert cry thereof (Se 800, Lab yt 7 COUNTY OF LOS ANGELE�' BUILDING D,,SAFE Y Policy ompany � � • Certrfied'copy is hereby f nished �� - FOR APPLICANT TO FILL IN 'ADDRESSBUILDING0 ------------- Certified copy is filed with the'county uil ng inspec- BUILDING tion department ADDRESS/�� LOCALITY 11 1 ; ' 9 11 O NEAREST Date 'Applrcori CITY ZIP ` l CROSS ST CERTIFICATE OFEXEMPTION FROM WORKERS' t 1 O OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT i NOW ON LOT ® MAP BOOK P E PARCEL (This section need not be completed if thepermit is for one - U ZO E MAP ry hundred dollars ($100) or-less ) , , , TRACT BLOCK LOT NO TEL SPECIAL d :, OWNER O CONDITIONS O I 'certify that in the performance of the work,for which this ISTRICT GROUP TYPE FIRE PROCE ED BY V permit is issuedI shall not employ any person in any manner CONST ADDRESS so as to become subject to the Workers Compensation, /l—D (% Im A.Date Applicant' CITY ZIP STATISTICAL CLASSIFICATION APT CONDO U NOTICE TO APPLICANT If,'after making this Certificate of ' ARCHITECLOR _ TEL Exemption, you should become subject to the Workers' ENGINEER ® O �j CLASS NO DWELL UNITS d Compensation provisions'of the Labor Code, you must forth- ADDRESS �' ) SEWER MAP with comply with such proXisions or'this ,permit shall be T ` deemed revoked, : CONTRACTOR NO BK PG, J VALIDATION 11 LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS I� NO 2 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC a Professions Code,-and my license is in full force and'effect CITY CLASS $ '(I q[( 7 A �� SI F7 NO OF NO OF CHECK, License Number Lic Class SIZE STORIES FAMILIES ONE # o`e•0 0 23 Contractorl"�•I��`f 1lTl�F?17 DL�U�ate' DESCRIPTION OF WORK NEW 2 0 o q 1.2 0 _ ,. 7 ADD O I am exempt from the lice rising requirements as I�am a licensed architect or a registered professional engineer_ ALTER FINAL � o.o o,q 1,2 0 v acting in my professional capacity (Section 7051, 92 REPAIR DATE Business and Professions Code) USE OF FINAL 0 1.2 4—8 1 EXISTING BLDG DEMOL '� BY - � Lic or Reg No Date APPLICANT Of TEL 44 OWNER-BUILDER DECLARATIONPRINT)' NO I hereby affirm that I am exempt from the Contractor's License I 14 2S Me hjte J Law for the following reason ,(SechADDRESS on_7031,5, Business and Professions Code) PRESENTv r/ BUILDING 1, 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 ip ra� 1, as owner of the property, am exclusively contracting CONTRACTOR NO oC 4 9 8 A with licensed contractors to construct the project (Sec- ADDRESS hon 7044, Business and Professions Code) '# 0 0 0 0 0 1 REQUIRED TOTAL 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 �. 12 -,55 4'5 0 the performance of the work for which'this permit is issued P L (Sec .3097,.Gv c ) SIDE o 5 5.4 5 010 PL Lender's Name 0 4,24,-81 P C Fee$ Permit Fee�� Lender's Address /YJ W I certify that I have read this application and state that the', Issuance Fee v aabove information is correct I agree to comply with all CountyInvestigation F e 0 ordinances and State laws relating to building construction, V Total Fe and hereE;y authorize representatives of this County to enter ` upon eabove-mention d erty for t ection purposes - SEE REVERSE FOR EXPLANATORY LANGUAGE azure of ppl or Agent Date ; - ) Ps r� .e.0 '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 0509260009 PHONE (626) 285-0488 EXT LEGAL ID _ NO OF CONST BUILDING ADDRESS TR 37579 LT 16 SQ FT STORIES TYPE 10410 KEY WEST ST STRUCTURE 1700 VN TEMP CA 917803478 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET HALIFAX 8565-018-037 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 09/26/05 JK 09/21/06 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE _ FIN BY CODE SHIEH RAYMOND C TR SHIEH TRUST (626) 445-3007-- 9,600 459 NORMAN AV / ARCD 910077916 FEES PAID DESCRIPTION OF WORK TEAR OFF AND REPLACEMENT OF WOOD SHAKE ROOF WITH LIGHT FEE DESCRIPTION QUANTITY UOM AMOUNT WEIGHT TILES APPLICANT TEL NO SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27 75 AC STRONG MOTION REBID 9600 00 VAL 0 96 SPECIAL CONDITIONS D2 PERMIT W/O EN-HC 9600 00 VAL 216 60 TOTAL FEES 245 31 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 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