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HomeMy Public PortalAbout9842 KEY WEST ST_Building__ WORKERS' COMPENSATION DECLARATION - ) hereby,affirm that I have a cert of consent to self t APPLICATION FOR B U I L D I N C_ -P E RM I T insure, or a certificate of.Workers'Compeompenstwn Insurance,or a certified copy thereof'(Sec 3800, Lab C ) COUNTY OF LOS AN� EL U SAFETY i • Policy No - Company DING1 Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN DDRESS Certified copy is filed with the county building inspec- BUILDING tion department _ 7 ADDRESS LOCALIT� i NEAREST Date Applicant CIT -.ZIP 91ZCROSS ST t�� CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR t " COMPENSATION,INSU RANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one 1 7� L!►��E'�ZO E MAP If- hundred dollars ($100)or less ) TRACT I BLOCK LOT NO ! +�� NO SPECIAL I certify that m the performance of the work for which this OWNER ` CONDITIONS O permit is issued, I shall not employ f t person in r manner •t9v I RICT GROUP fPES, FIRE SSED BY V P P Y Y P Y N �^ 6' ADDRESS so as to becom subject to the W ker -C pens n Laws O'S/ 0 r : •\ Date A scant / CITY ZIP STATISTICAL C 5 TION - APT CONDO ~ NOTICE TO APPLICANT Pf afte making this,Certificate of 4 ARCHITECT O TEL �- LU V Exemption, you should beco subject to the Workers' ENGINEER NO CLASS NO DWELL UNITS H Compensation provisions of the Labor Code, you must forth- ` ADDRESS SEWER MAP with comply with such prows ns or this permit shall be TEL deemed revoked / CONTRACTOR NO' BK E PG. ', VALIDATION LICENSED CONTRACTORS DECLARATION LIC _ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS _ NO VALUATION , (commencing with Section 7000)of Division 3 of the Business and LIC 7 Professions Code„and m'y-license is in full force and effect t CITY CLASS ' SQ FT NO OF NO OF CHECK r SIZE STORIES FAMILIES ONE License Number Lic Class ❑ .$ . DESCRIPTION OF WORK ` NEW , Contractor Date p , ❑ "B�' ) ADD _ I am exempt from the licensing requirements as I am a Y�7Zit V licensed architect or a registered professional`engineer, ALTER FINAL acting in my professional capacity (Section 7051, REPAIR DATE Business and Professions Code) - USE OFC FFINAL - , EXISTING BLDG //'K OL Lic or Reg No Date APPLICANT B 1L. ( ANO OWNER-BUILDER DECLARATION, PRINTTEL Y — I hereby�offirm that I am exempt from the,Contractor's License �7) �� Law for the)following,reason (Section 7031'S, Business and' ADDRESS . /Lc. Professions Code) PRESENT _ BUILDING !>C 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 7044, Business and Professions Code) MOVING TEL j, as owner of the property, am exclusively contracting CONTRACTOR NO (�^-a 7 with licensed contractors to construct the,project (Sec- ADDRESS a tion 7044, Business and Professions Code) ` CONSTRUCTION LENDING AGENCY REQUIRED TOTAL SETBACK FROM EXIST SET BACK YARD HWY PROP LINE WIDTH �' :2 3 55.,6 A I hereby affirm that there is a construction lending agency for It1nvestigation the performance of the work for which this permit is issued # 0 0 0 0 0 (Sec 3097, Civ C ) - 2 03,2 3,5 0 Lender's Name/ Lender's Address PermitFee . S � � 323,5060 w I certify that I have read this application bnd state that the Issuance Fee /� L� 229'-80 above information is correct I agree to comply with all County - ee, ordinances and State laws relating to building construction,' ' Total Fee U a hereby authorize representatives of this County to enter ' ` < u nth a=boned pro pert r inspection purposes a � A� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Apphcant or Agent Dote WORKERS'COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to Self APPLICATION VFOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, I or a certified copy thereof (Sec 3800, Lab C ) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY 1 ' PolPolicy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS �'� El Certified copy is filed with the county building inspec- BUILDING tion department ADDRESS _ LOCALITY p��..� NEAREST Date Applicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTION 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 one1 tom/ USE ZONE MAP ; hundred dollars ($100)or less ) TRACT BLOCK LOT`NO NO i TEL i f SPECIAL 1 I certify that in the performance of the work for which this OWNER r NO - 2 CONDITIONS i d permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PROCESSED BY '0 so as to be ome sublect to the W kers'Co ens n Laws ADDRESS _ CONST � ZONE U • ) _ r 0 XDate ` A ica t CITY �' ZIP �/ STATISTICAL C SSIFICAI ION T C DO 0 NOTI(fE'TO APPLICANT f, afte making this Certificate of ARCHITECT O ,�n TEL ENGINEER C% NO CLASS NO DWELL UNITS W Exemption, you should beco a sublect to the Workers' IL Compensation provisions of th Labor Code, you must forth- ADDRESS - SEWER MAP to with comply with such provisions or this permit shall be TEL �` Z deemed revoked CONTRACTOR O. NO BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION 1 (commencing with Section 7000)of Division 3 of the Business and LIC i a�Professions Code, and my license is in full force and effect CITY CLASS $ 2 , SQ FT NO OF ` NO OF CHECK License Number Lic Class SIZE aO ISTORIES / FAMILIES ONE DESCRIPTION OF WORK 41VVe.W NEW Contractor Date O - ADD I am exempt under Sec ©Y _ ALTER FINAL _ B 8P C for this reason RDATEEPAIR USE OF DEMOL FINAL Date EXISTING BLDG fl , By Signature APPLICANT TEL r g OWNER-BUILDER DECLARATION PRINT NO 2G 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 BUILDING I, as owner of the property, or my employees with ADDRESS 3 5 9,4 A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY _ 4'0.0 '00 0 0 0 " 7044, Business and Professions Code) MOVING TEL 1, as owner of the property, am exclusively contracting CONTRACTOR NO a 2 815 0 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code) ADDRESS 9.0 0 0 2 8i'5 0 c=� REQUIRED TOTAL SETBACK FROM EXIST ' i i I CONSTRUCTION LENDING'AGENCY SET BACK YARD HWY PROP LINE WIDTH I.hereby affirm that there is a construction lending agency for FRONT polo. 2—813 the performance of the work for which this permit is issued P L (Sec 3097, Civ C ) SIDE Pl. v Lender's Name PC Fee$ Permit Fee Lender's Address 'l I certifythat I have read this application-and state that the V Issuance Fee ( . above information is correct I agree to comply.with all County Investigation Fee ordinances and State jaws relating to building construction, Total Fee and hereby authorize representatives of this ounty to enter j u n the ove- nti n operty for in ionposes , SEE REVERSE FOR EXPLANATORY LANGUAGE ®s Signature of App icant or Agent Date I 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 1402120065 PHONE (626) 285-0468 EXT , ILEGAL ID I NO OF CONST BUILDING ADDRESS I ITR 13986 LT 17 BL 001 UN 002 I SQ FT STORIES TYPE I 9842 KEY WEST ST I I ISTRUCTURE 12000 V-B I TEMP CA 917803918 IASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 18589-02]-008 = t THOMAS PAGE 597 GRID A4 L6CALITY TEMPLE CITY CAI ITENANT (EXIST BLDG USE RESID USE ZONE R-1 TISSUED ON PROCESSED BY IEXIST OCC GRP - 102/12/14 SR I (OWNER TEL NO IBLDGS NOW ON LOT VALUATION (FINAL DATE FIPAL BY CODE IEMANUELLI JOHN,CAROL A TRS (626) 286-5267- 1 4,500 19842 KEY WEST ST 1 ITEMP 917803918 I FEES PAID 1 ES RI�01ORK IREMOVE EXISTING ASPHALT SHINGLE ROOF AND RE-ROOF WITH 30 1 IFEE DESCRIPTION QUANTITY UOM AMOUNT IYEAR MOLARKEY SHINGLES FOR RESIDENCE 1APPLICANT TEL NO ITHOMSEN, MIKE (661) 713-9005- IAA BLDG PERMIT ISSUANCE 27 80 1 129546 SAND CANYON RD IAB STATE GREEN BLDG FEE 4500 00 VAL 1 00 ISPECIAL CONDITIONS 1 ICANYON COUNTRY 91387 IAC STRONG MOTION RESID 4500 00 VAL 0 50 1 ID2 PERMIT W/O EN-HC 4500 00 VAL 132 60 1 TOTAL FEES 161 90 I (CONTRACTOR TEL NO 'I IAPPRJVALS DATE INSPECTOR SIGNATURE 1 ITHOMSEN ROOFING (661) 552-5000- - 1 1 129546 SAND CANYON ROAD LIC NO ILOCATION AND SETBACKS 1 1 ICANYON COUNTRY, CA 91387 401158 1 1 I 1 ISOIL4 ENGINEER APPROVAL (ARCHITECT OR ENGINEER TEL NO 11FOUNDATION/TRENCH FORMS I I LIC NO (SLAB/UNDER FLOOR 1 I I I �— • 3� -�_ _— � (RAISED FLOOR FRAMING 1 (MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDERFLOOR INSULATION 1 1 I I I 3 001 /' IFLOOR SHEATRING INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I s I 1 NO 21 <` � IROOF SHEATHING f _ SCHOOL WITHIN HAZARDOUS / 1 ISHEAR PANELS / (AIR QUALITY 1000 FEET MATERIALS 1 I I I I 1 NO NO NO I IFRAME INSPECTION IFIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIPI I I 1 IINTEPIOR LATH/DRYWALL 1 1 I I I 1 (EXTERIOR LATH I I I I I IRATED FLOOR/CEIL ASSEM I I I I I ' IRATED WALL ASSEMBLIES 1 1 I I I i 1 1 IRATED SHAFTS/OPENINGS I 1 1 I IT—BAR CEILINGS I ILOT DRAINAGE I IREPORT ID DPR261 ROUTE TO BSO508 { 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 SL 0508 1402120067 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ITR 13986 LT 17 BL 001 UN 002 SQ FT STORIES TYPE 9842 KEY WEST ST 1 1 ISTRUCTURE 400 V—B I TEMP CA 917803918 1 ASSESSOR INFORMATION NUMBER _ NEAREST CROSS STREET 18589-021-008 1 — � .�� L 1 THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY CAI TENANT IEXIST BLDG USE RESID USE ZONE R-1 JISSUED ON PROCESSED BY EXIST OCC GRP 102/12/14 SR I i OWNER TEL NO 1BLDGS NOW ON LOT VALUATION 1FINAL DATE FINAL BY CODE 1 JEMANUELLI JOHN,CAROL A TRS (626) 286-5267— 1 1,000 19842 KEY WEST ST TEMP 917803918 I FEES PAID IDtSCAIPTION OF WORK I 1 IREMOVE EXISTING ASPHALT SHINGLE ROOF AND RE—ROOF WITH 30 1 1 IFEE DESCRIPTION QUANTITY UOM AMOUNT 130 YEAR MALARKEY SHINGLES FOR GARAGE 1APPLICANT TEL NO ITHOMSEN, MIKE (661) 713-9005— 1AA BLDG PERMIT ISSUANCE 27 80 1 1 129546 SAND CANYON RD JAB STATE GREEN BLDG FEE 1000 00 VAL 1 00 ISPECIAL CONDITIONS 1 CANYON COUNTY 91387 IAC STRONG MOTION RESID 1000 00 VAL 0 50 J 1 J ID2 PERMIT W/O EN—HC 1000 00 VAL 65 40 J I 1 1 TOTAL FEES '94 70 1 I ICONTRACTOR TEL NO J 1APPROVALS DATE INSPECTOR SIGNATURE 1 ITHOMSEN ROOFING (661) 552-5000— J 1 1 129546 SAND CANYON ROAD LIC NO 1 JLOCA^_ION AND SETBACKS 1 1 1 ICANYON COUNTRY, CA 91387 401158 111 1 I 1 ISOILS ENGINEER APPROVAL 1 1 JARCHITECT OR ENGINEER TEL NO I IFOUNDATION/TRENCH FORMS J I 1 LIC NO 1 1SLAB/UNDER FLOOR I _1 I I I 1 s 1 { JRAISED FLOOR FRAMING I I I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I 1UNDERFLOOR INSULATION I I 1 3 001 1 11 (FLOOR SHEATHING JNO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 1 NO 21 1 JROOF SHEATHING 1 J SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS 1AIR QUALITY 1000 FEET MATERIALS , 1 NO NO NO 1 1FRAME INSPECTION I J 1 1 1 IFIRE SPRINKLER HANGERS I ' r r _JINSULATION/WEATHER STRIPI 1 1 JINTERIOR LATH/DRYWALL I I 1 I J IEXTERIOR LATH I J J I I I I I 1 1 IRATED FLOOR/CEIL ASSEM J J 1 I J I J IRATED WALL ASSEMBLIES 1 I IRATED SHAFTS/OPENINGS I J 1 I I I I 1 IT—BAR CEILINGS 1 I J I I I J A ILOT DRAINAGE 1 ( 1 t J J I I IREPORT ID DPR261 ROUTE TO BS0508 1 I I I 1 I I I I I is