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HomeMy Public PortalAbout10345 LA ROSA DR_Building__ WORKERS' COMPENSATION DECLARATION T hereby affirm that I havecertificate of consent to =elf APPLICATION FOR BUILDING PERMIT LI IS insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab C.) �, Policy N�3 �� Company � ✓e COUNTY OF LOS ANGELES B ILDIN ND SAFETY BUILDING ©/Certified copy is hereby furnished. ' ,5'FOR APPLICANT TO FILL IN ADDRESS �*'-- Certified copy is filed with the county building inspec- BUILDING- tion department. ADDRESS F,469 16�74— LOCALITY NEAREST Date G /4 3 Applicant �r�:- CITY o t/ ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM OR S' 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 l V BLOCK LOT NO. NO. U Q TEL. SPECIAL y - I certify that in the performance.of the work for which this OWNER /Q NO. O CONDITIONS. - d permit is issued, I shall not employ any person in any manner . DISTRICT .GROUP TYPE FIRE PROC ED BY_ O so as to become subject to the Workers'Compensation Laws. ADDRESS z L /)/li CONST. ZONE U CITY C /.9 ZIP /ao �� -3 d 3 ad O Date Applicant STATISTICAL CLASSIFICATlON APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of - ARCHITECT OR TEL. / 'Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. O / DWELL. UNITS_ 1 Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be �V/ r ? deemed revoked. CONTRA � /fi✓ ;r, O. 'BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. ro I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS N LJ 16&I VALUATION (commencing with Section 7000)of Division'3 of the Business and LIC �J Professions Code, and my license is in full force and effect. CITY C ASS, $ , 66 / 1'� SQ. FT. •/'l/ - NO. OF NO:OF CHECK License Number �5 4< Lic.Class` SIZE .v 1 STORIES FAMILIES ONE / $ 00 Contractor �� �,r/s'�`al.r/YDate DESCRIPTION OF WOR �' NEW ql ADD I am exempt under Sec.-- /r r^ ALTER � FINAL / �AdCl7frr, �cCS' 1 `F`rE uf3dEGr� DATE "rho it0f°PaFa e 7f:- se a-. PP?d Vj-, !6b 0V B.BP.C. for this reason REPAIR y y USE OF t•i,,.IL RAZIM15r -(S.l.PPO.�.ffi.13:i///�t'7/ Date: REPAIR FINAL EXISTING BLDG. � Y Signature APPLICANT . TEL. OWNER-BUILDER DECLARATION PRINT co NO. I hereby affirm that I am exempt from the Contractor's License ,.• 1 2 82 7 A Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT '3 * e a e o 23 I, as owner of the property, or my employees with BUILDINGADDRESS q wages as their sole compensation, will do the work and y37 / Q e e 83.38 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL '/ �`� •0 0 o 8 7.3 8 s R NO TO . I, as owner of the property, am exclusively contracting CONTRACTOR / with licensed contractors to construct the project (Sec- ADDRESS O 6 5—8 3 'tion 7044, Business and Professions Code). . REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH f 2 8 2 8 A , I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. 1101. e o e (Sec. 3097, Civ. C.). SIDE ' P.L. 2 ° 593.25 Lender's Name Lender's Address Permit Fee SO �'1• 2 -° ° 593256 . all I'certif that I.have read this application and state that the �1�7 r' (J S Q 6 7 5-83 Y PP .. d 7•..3 0 Issuance Fee above information is correct. I agree to comply with all County Investigation Fee g ordinances and State laws relating to building construction, Tool Fee d and hereby authorize representatives of this County to enter upon /thSpbove-mentioned property for inspection purposes. , SEE REVERSE FOR EXPLANATORY LANGUAGE _ .Sig ura` Aant or AglinDate ¢ ®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 0508160012 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: - IF 37580 LT: 5 SQ. FT STORIES TYPE 10345 LA ROSA DR' STRUCTURE: 234 VN TEMP CA 917803402 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8585-018-046 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/16/05 JR 08/11/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D � FINAL BY: CODE: CHAO LU TANG (626) 452-9093- 71500 �'J 10345 LA ROSA DR ) /- TEMPLE CITY CA 91780 FEES PAID 15ESCRIPJION OF WORK ENCLOSE PATIO 13' X 18' ICBO #3421-P FEE DESCRIPTION: QUANTITY: DOE: AMOUNT: APPLICANT: TEL. NO: HIPOLITO (909) 594-7547- AA BLDG PERMIT ISSUANCE 27.75 786 PINEFALLS AVE AC STRONG MOTION REBID 7500.00 VAL 0.75 SPECIAL CONDITIONS: WALNUT, CA 91789 AX BUILDING REVIEW FEE 54.70 D2 PERMIT W/O EN-HC 7500.00 VAL 183.00 TOTAL FEES 266.20 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE WEST COAST CUSTOM ROOMS (909) 594-7547- 786 PINEFALLS AVE LIC. NO _ LOCATION AND SETBACKS WALNUT CA 91789 471619BHIC - SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR 1 RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION XX 3 O1 FLOOR SHEATHING N0. OF FAMILIES: DWELLING UNITS: APT/CONDI 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 HACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CELL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE (REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT IF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91760 BL OSOB 0811170020 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 37580 HE 5 SQ. FT STORIES TYPE 10345 LA ROSA DR I STRUCTURE: V-B TEMP CA 917803402 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ARDEN 18565-018-046 THOMAS PAGE: 597 GRID- CS LOCALITY: TEMPLE CITY, C I TENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 IIB SUED ON: PROCESSED BY: EXIST OCC GRP: 11/17/08 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL ATE FINAL Y: CODE [YUHUEI TANG, THOMAS TRUONG' (626) 452-9093- 1 5,000 I I 4�� 110345 LA BOAS DR. r [TEMPLE CITY CA 91780 FEES PAID IDUSCRrPTION Ot WORK I [KTICHEN REMODEL/CABINET RENEW/COUNTER TOP IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 IAC STRONG MOTION REBID 5000.00 VAL 0.50 (SPECIAL CONDITIONS: B2.PERMIT W/ENERGY 5000.00 VAL 145.86 [ IFR INV WORK W/O PERMIT 257.00 DOL 257.00 [ TOTAL FEES 431.11 (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE (SAME AS OWNER - I LIC. NO ILOCA'PION AND SETBACKS I [ [ [SOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS I I I I LIC. NO: I SLAB/UNDER FLOOR [ I I I (RAISED FLOOR FRAMING [ [ I I NAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( IUNDF.RFLOOR INSULATION I147H273 3 001 I I I IFLUOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I- I NO 21 IROOF SHEATHING I SCHOOL WITHIN HAZARDOUS ISHE.AR PANELS (AIR QUALITY: 1000 FEET MATERIALS I NO NO NO (FRAME INSPECTION [REQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS [ SET BACK YARD: HWY: PROP LINE: WIDTH: I [ FRONT PL- (INSULATION/WEATHER STRIPI I I I SIDE PL- I (INTERIOR LATH/DRYWALL I [EXTERIOR LATH I [ I IRATED FLOOR/CEIL ASSEM. I IRATED WALL ASSEMBLIES I I [ IRATED SHAFTS/OPENINGS [ T-BAR CEILINGS ILOT DRAINAGE I [REPORT ID: DPR261 ROUTE TO: BS0508 I I [