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Home My Public Portal About10663 KEY WEST ST_Building__ WORKERS'COMPENSATION DECLARATION r ' insure,hereby certif cane off have ke srlCompensat on eInsuran ificate of consnt to of APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Seca 3800, Lab C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company" BUILDING ET Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is.filed with the county building inspec- BUILDING tion department. ADDRESS — LOCALITY { �f NEAREST Date : Applicant CITY ZIP / `� CROSS ST. ,CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 17 NOW ON LOT MAP BOOK PAGE I 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 } • I certify that in the performance of the work'for which this OWNER NO CONDITIONS d 'DISTRICT GROUP TYPE FIRE P OCESSED BY O permit.is issued, I shall not employ any person in any manner ADDRESS r. CONST ZONE., so as to become sub ect to the,Wor m cation La s - n 01, vdr Date / Applicant CITY ZIP �� STATISTICAL CLASSI ICATION APT CONDO. 0 NOTICE TO,APPLICANT- df, after making.this Certificate of ARCHITECT O :TEL U ENGINEER NO CLASS NO. DWELL UNITS W Exemption, ,you should- become subject to..tKe Workers' d Compensation provisions of the Labor Code, .you must forth- ADDRESS SEWER MAP N with comply with such provisions or'this permit shall be TELz deemed revoked. CONTRACTOR NO. BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VA ATION (commencing with Section 7000)of Division 3 of the Business and LIC Professions Code, and•my license is in full force and effect CITY CLASS $ SQ.'FT NO. OF NO.OF CHECK ' License Number Lic.Class SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK^ NEW Contractor Date ' ADD I am exempt under Sec. ri ALTER E] 'FINAL 9 - B.BP.Cr for_ihis reason REPAIR DATE 3 /// Date: USE OF DEMOL' FINAL NAL- EXISTING BLDG. � J APPLICANT TEL. Y Signature - ... OWNER-BUILDER'DECLARATIONs•, PRINT NO I hereby affirm that I am exempt from the Contractor's License Law for the.following reason (Section 7031.5, Business and ADDRESS , 3 802 A ` Professions Code): PRESENT - U1 BUILDING # o o,0 0 0 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 ? ° ° 4 Q,5-Q 7044, Business and Professions Code). MOVING TEL.(E] I, as owner of the property, om exclusively contracting CONTRACTOR. NO. :0,° ° 4 0,,;5.0.5: with licensed contractors to"construct the project (Sec- ADDRESS 0.7 9°-8 3 tion 7044, Business and Profess i6ns'Cod'e). ,,. REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LIN WIDTH I hereby affirm that there is a constructiori lending agency for FRONT , -.the performance of the work-for which this permit is:issued P L. (Sec. 3097„Civ. C.). SIDE- m., P L.. v Lender's.Name Lender's Address P.C. Fee$ Permit Fee I certify thaf'I,have read this application and state that the, Issuance Fee a above information is correct. I-agree to comply with'all County Investigation Fee ordinances and State laws relating to building construction, Total Fee d and hereby authorize.representatives of this County to enter J upon a-mtz enti d pro arty fo inspection purposes. e SEE REVERSE FOR EXPLANATORY LANGUAGE / Signature of App icant or Agent Date ®s r_ 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 1101180047 PHONE- (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST TR: 12205 LT: 17 I BUILDING ADDRESS: 1 1 � SQ. FT STORIES TYPE 1 ,•10663 KEY WEST ST I STRUCTURE: 27 V-B I TEMP CA 917803467 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LOWER AZUSA 18585-030-021 1 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY: (EXIST OCC GRP: 101/18/11 SR 1 TOWNER: TEL. N0: iBLDGS. NOW ON LOT: VALUATION: iFINAL. FINAL CODE: IALDERETE RUDY;VELIA (626) 443-8782- 1 5,800 10663 KEY WEST ST ITEMP 917803467 I FEES PAID IDESCRIPTION OF WORK 1 I I IRECOVER OVER (E) ONE LAYER OF COMP ROOFING ON HOUSE & GARAGEI IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IINSTALL THE 30# A.S.T.M. FELT INSTALL THE 30 YR CLASS"A" * 1 (APPLICANT: TEL. NO: I I (MARTIN, BLAKE (626) 333-5615- IAA BLDG PERMIT ISSUANCE 27.80 1 I IAB STATE GREEN BLDG FEE 5800.00 VAL 1.00 ISPECIAL CONDITIONS: 1 I IAC STRONG MOTION RESID 5800.00 VAL 0 60 1 1 102 PERMIT W/O EN-HC 5800.00 VAL 149.70 1 I 1 TOTAL FEES 179.10 1 ICONTRACTOR: TEL. N0- I 1APPROVALS DATE INSPECTOR SIGNATURE 1 1REXWAY ROOFING INC. (626) 333-5615- 1 1_ 1 1507 N AZUSA AVE #C LIC. NO I ILOCATION AND SETBACKS I 1 1 ILA PUENTE CA 91744 655986 C39 I I 1 I I I ISOILS ENGINEER APPROVAL 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 (FOUNDATION/TRENCH FORMS I I I LIC. NO: 1 (SLAB/UNDER FLOOR 1 1 I I I 1 IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( - "(UNDERFLOOR INSULATION I I I 1147H273 3 001 1 I I I I I IFLOOR SHEATHING 1 I INO. OF FAMILIES DWELLING UNITS: APT/GOND: STAT CLASS: I I I NO 21 1 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS 1 1 (AIR QUALITY: 1000 FEET MATERIALS I I I 1 1 NO NO NO IFRAME INSPECTION I I I IFIRE SPRINKLER HANGERS I I I 1 I (INSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL I 1 I I I 1EXTERIOR LATH I 1 I IRATED FLOOR/CEIL ASSEM. 1 1 I IRATED WALL ASSEMBLIES I I I 1 IRATED SHAFTS/OPENINGS I 1 I I I 1 IT-BAR CEILINGS 1 I* ADDITIONAL DATA ON FILE I 1 I I 1 ILOT DRAINAGE 1I I I I (REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I