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Home My Public Portal About10305 LA ROSA DR_Building__ WORKERS'COMPENSATION DECLARATION I T ,j r Q hereby affirm that I have certificate of consent to Self rWorkers' . APPLICATION FOR BUILDING PERMIT 11SI insure, or certificate of Compensation Insurance, i or a certified'copy thereof (Sec. 3800, Lab. 3 y7l COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N Company -� r+ = - BUILDING ®�Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 30 C- OSTT LOCALITY QtJ NEAREST Dateppl icon / CITY .mss - � ZIP CROSS ST. CERTIFICATE OF EXEMPTION FRO ORK O. OF BLDGS. ,�cc,, ASSESSOR COMPENSATION INSURANCE SIZE OF LOT �G'C7 NOW ON LOT 6s 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 7� BLOCK LOT NO. NO. O TEL i/ SPECIAL - y I certify that in the performance of the work for which this OwN � NO. CONDITIONS d permit is issued, I shall not employ any person in any manner n/l�/N G DISTRICT .GROUP TYPE FIRE PRO SSED BY O so as to become subject to the Workers'Compensation Laws. ADDRES �y� CONST. ZONE U s 0 i 3 1 tz W Date Applicant - CITY ZIP - STATISTICAL CLASSIFICATION APT. CONDO. 0 NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS_ W Exemption, you should become subject to the 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 Z deemed revoked. - CONTRA QrO 6 'N0.7�S BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LICC/ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS E N��+.l wow VALUATION - (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 6` $ ► SQ. FT. a NO.OF NO.OF CHECK License Numb �S�(� 7 Lic Class SIZE G STORIES Z� FAMILIES ONE ac te DOUt- a 4 __� DESCRIPTION OF WORK AD ContrC1E., _, s9 ^.DiD1i3.5 fa V`HCVEDId�/f�J I am axe and r S4Z f L 1i[?/< M'dI t ALTER � FINAL FVL �/ 7O •q,7� i APPISOVEDn�!/�� B.BP.C. for this reason ! REPAIR DATE USE OF ? Date: EXISTING BLDG. DEMOL ❑ FINAL By Signature APPUCAN �- TEL. OWNER-BUILDER DECLARATION NO. 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 / 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 1, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS J 'tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY YARD Hwv REQUIRED TOTAL SETBACK FROM EXIST. SET BACK PROP. LINE WIDTH , I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec 3097, Civ. C.). SIDE .`. P. m Lender's.Name Lender's Address P.C. Fee S S 3S Permit Fee I certify that I have read this application and state that the 3 / 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 - Y 0� 7J u and hereby authorize representatives of this County to enter upon the above-mentio/n/!!/5 S�perry for i pection purposes. < -� SEE REVERSE FOR EXPLANATORY LANGUAGE Spofe of Ap io or Agent Dote ®s WORKERS' COMPENSATION:DECLARATION hereby affirm that 1 have a certificate of'consent fo self APPLICATION FOR BUILDING PERMIT insure, or a certificate of%orkers'Compensation Insurance, - or a certified copy thereof (Sec. 3800, Lab. C:) COUNTY OF LOS ANGELES - BUILDING AND SAFETY Policy No. Company ' BUILDING / .� �j Q A O R ❑ Certified copy is hereby furnished. , � ' FOR APPLICANT.TO FILL IN ADDRESS V /c , ' ❑ Certified copy is filed with the county building inspec- BOLDING - - - - -- - tion department. ADORERS /030.5LA RO$A DR, Date Applicant CITY <'A • ZIP 801 o LOCALITY NO. OF BLDGS. NEAREST - CERTIFICATE OF COMPENSATION IN FROM WORKERS' SIZE OF LOT NOW ON LOT / CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one - - TRACT 7 gQ BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.); _ - H� AC(CE.M 7MNo. 350-4(40 USE ZONE MAP OWNER NO. ' I certify that in the performance of the work for which this permit is issued, I shall not employ any.person in any manner -• ADDRESS ID306 J.* RASA- Die. SPECIAL >_ CONDITIONS a_ so as to become subject to the Workers'Compensation Laws. _ O city 7ZEWL _ CITY CH. ZIP 91nO I - _ V Date Applicant ARCHITECT OR TEL. � NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER - NO -DISTRICT GROUP TYPE FIRE ROCESSED BY •�/ CONST ONE O ' Exemption, you should become subject to the, Workers' J!� ��/�' t^ ' Compensation provisions of the Labor Code, you must forth- - ADDRESS 5, c.Jr� J 11c, d with comply.with .such provisions,or this permit,shall be TEL STATISTICAL CLASSIFICATIONCOND APT. O. N deemed revoked. - ,. CONTRACTOR NO. t Z LICENSED.CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS ' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. _ SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. ' and Professions Code,and my license is in full force and effect. - CITY _ CLASS BK. PG. VALIDATION' SQ. FT. A'I NO. OF NO. OF CHECK License Number Lic. Class SIZE T (� STORIES FAMILIES ONE - SALUAT Contractor _ -Date DESCRIPTION OF WORK NEW ❑ 1 ❑1 am exempt under'.Sec. GARA&A2 AAD MON ADD pop._- ALTER ❑ t B.BP.C. for this reason REPAIR ❑ $ Date: USE OF - EXISTING BLDG. DEMOL ❑ Signature APPLICANT _ .TEL.. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's license ' Low for the following.reason (Section 7031.5, BBuBUILDING and ADDRESS FINAL i Prof ssions Code): - - PRESENT - B Y act:r as owner o4 the property, 'or m employees with ADDRESS 'T wages as their sole compensation,will do the work and - - -O �c the structure is not intended or offered for sale(Section LOCALITY , '3307 6.r J 7044, Business and Professions Code.) MOVING - _ TEL. 1 iTEMS I ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR - NO. L with licensed contractors to construct the project (Sec- ADDRESS 1 " -t•r C t 0TAL 96 - 75 tion 7044, Business and Professions Code.) - t _ CHECK - REQUIRED TOTAL SETBACK FROM EXIST. - C•HEtCK{ 96.7t 5 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT _ - _ �:f(�MrE ,,C)[I the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE ' P.L. ... .. . - .. , Lender's Name. _ I30I30'17001 ' 1.4 29i 89 m P.C. Fee$ Permit Fee ( LDNW Ref. N- Lender's Address - /) 7Qiv5 1 AMii'�" I certify that I have read this application and state that the _ Issuance Fee 0 1 P/CN 8 above Informatibn is correct. I agree to comply with all County Investigation Fee _ d ordinances and State laws relating to building construction, Total Fee f .5 LDMA Perm. R a and hereby authorize representatives of this County to enter m upon the above-mentioned property for inspection purposes. - 12••29—89 ' SEE REVERSE FOR EXPLANATORY LANGUAGE_ _ Sig azure of Appliof rt or Agent Date- 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 0504070023 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDINGADDRESS: TR: 37580 LT: 1 SO. FT STORIES TYPE 10305 LA ROSA DR STRUCTURE: VN TEMP CA�917803402 Anygn,97_ IO NEAREST CROSS STREET: ARDEN 8585-018-041 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C Tf1YEXIST BLDG S RESID USE ZONE: Rl ISSUEDPROCESSED EXPIRES . EXIST OCC GRP: 04/07/05 JK 04/02/06 TEL. NO: BLDGS. NOW ON 0 VALUATION: FI �DATE FJLNAL BY: CODE: HOYES, JOSEPH (626) 443-4023- 5,000 10305 LA ROSA DR _ TEMP 917803402 FEES PAID bESLkTSi UN OfWORK BATHROOM REMODEL FEE DESCRIPTION: QUANTITY: LION: AMOUNT: APPLICANT: BUCCOLA (626) 287-1131- AA BLDG PERMIT ISSUANCE 27.75 8812 LAS TUNAS DR AC STRONG MOTION RESID 5000.00 VAL 0.50 SPECIAL CONDITIONS: SAN GABRIEL CA 91776 B2 PERMIT W/ENERGY 5000.00 VAL 145.86 TOTAL FEES 174.11 CONTRACTOR: TEL- NO: APPROVALS DATE i S CTOR SIGNATURE L 8 W KITCHEN 8 BATHS (626) 287-1131- 8812 LAS TUNAS DR. LIC. NO LOCATION AND SETBACKS SAN GABRIEL, CA 91776 205344B SLS ENGINEER APPROVAL ARCHITECT OR ENGINEER: EL. T009 ON/T LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRA14ING AP NO: SEWER MAP BOOK: AGE: F RE ZONE: CMP: UNDERFLOOR INSULATION XX 3 01 FAMILIES: FLOOR SHEATHING NO. OF DWELLING UNITS: : S Ass: NO 21 ROOF SHEATHING SCHOOL WITHIN S SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED O L SETBACK FROM I R G RS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRI SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED F OOR C ASSM—. RATED WALL ASSEMBLIES RATED S FTS GS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508