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HomeMy Public PortalAbout10435 LA ROSA DR_Building__ WORKERS COMPENSATION DECLARATION j - _ •' - .---~ -' -- __.\ --- - 1 I' hereby affirm that have a certificate of consent to self — - _ _ A_ PP_ L_ KATION -FOR• BUILDING, -PERMIT - _ insure, or a-certificate of Workers' Compensation Insurance, or a certified copy t ere 'I�ec. 3800; Lab. C.) "' - - - - - r�I � ,��� ��� COUNTY OF LOS_ANGELES BUILDING AND SAFETY- PolicyNo Company - - ' --` - Certified copy is•hereby furnished. FOR APPLICANT TO FILL IN BUILDING 6' 3S 50- ADDRESS Ceriified'copy ,s filed with the county building mspec- BUILDING „L'3 + III hon de ortment. '- ` ADDRESS V /T Y/ '✓/` Dote L +Applicant''. '[ C'GY'li/I CITY .1 IDI ZIP LOCALITY - CERTIFICATE OF EXEMPTION FROM WORKERS' _- - NO. OF BLDGS. - - NEAREST - COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. - V (This section need not be completed if.the permit is for one - - - - - - - ASSESSOR - - " '� i - hundred dollars ($100)or less.) - TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL//,,((,�'//�� USE ONE MAP - - Icertify that in'the performance of the work for which this OWNER - - T' OWNER permit isIssued, I shall not employ any person in any manner 11 1 ADDR.ESS so as'fo become subject tothe Workers Compensation Lows. 0 � - V Date Applicant` CITY _ ZIP d " - NOTICE TO APPLICANT' If, after making this Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE„ _ FIRE PRO ESSED mhED BY -. bENGINEER NO. CONST Eaeon;� our should become subject to the Workers' - S Q Z7 'f/ ZONE Compensation provisions of.the Labor Code, you must forth- ADDRESS - �- s' -- -✓ - - N with comply with`such provisions or this,permit.shall be -- - -- TEL, - STATISTICAL CLASSIFICATION - APT. - NDO. _Z deemed revoked: . .. CONTRACTO U No_"14-75L17 _,__ - I -_ - -- LICENSED CONTRACTORS DECLARATION - - - LIC�yj�d^7 CLASS IJO. '_DWELL UNITS_ I hereby affirm that l am licensed under provisions of Chapter 9 ADDRESS (/1/ NO. - r (commencing with Section 7000)of Division 3 of the Business and _ LIC ) SEWER MAP Professions Code, and my license is in full force and effect. CITY w �'�V T CLASS f " 'VALIDATION ' p2M-r SO. FT. _ NO.OF NO.OF CHECK BK. PG. •'�(Jps� l ' '' - SIZE- STORIES FAMILIES �� - ONE - License Number Lic.Class � - �/ /�1 �- 11141 - ' DE R PTIONWORK. [ps€' _ VALUATION _ ContractorV�2/ l 0�/ Date 5_ ^ DD ❑ $ g 60" I am'exempt under Sec. -' WOO O K ' ✓': - ALTER- oil.-'❑ �^ B.BP C for this reason - ` 1'CA/D ' _QREPAIR ❑ $- ` Date: USE OF N 00,11 7v e�MoroT S/n, DEMOL ❑ 9 3 3 8 3 A EXISTING BLDG. TEL. @p.,�. - - H- - - Signature ..� - APPLICANTtW_r COF$� NO. Jz�(�S'17. FINAL rr ° 2 3 PRINT 1U/�L�AY 17 OWNER-BUILDER DECLARATION _. _ __ __ _ _ DATE - .000JJJ 11 hereby affirm that Tam exempt from the Contractor's License ADDRESS lJ� O(rV� q FIN - • I � � 2,9.0 2 Law for,the following+'reason.(Section 7031.5, Business and _ _ _ Professions Code):' "" -" - '- "- - PRESEN - B - • •• 2 9.0 2,6 BUILDING r ., ❑ I, as owner of the property, or my employees with ADDRESS. _ _ _. _ _ L _ wages as their sole compensation,will do the work and O�` , �I 1 0-�1.—8 5 ' the structure is not intended ar offered for sale(Section LOCALITY t ' -7044, Business and Professions Code). MOVING "- - - - TEL. I, as owner of the property; am exclusively contracting CONTRACTOR NO. ; _ _ _ �3384A with licensed'contractors to construct the project (Sec- ADDRESS , tion 7044, Business and Professions Code). I • - 59.2 5 EX CONSTRUCTION LENDING-AGENCY SETOBACR YARD HWY - TOTA FROP.L NESETBFR M. 'WIDTH ' I hereby affirm that there is a construction lending agency for FRONT - , • ­ 5 9.2 5 U the performance of the work-for which this permit-is issued PL, - (Sec. 3097, Civ. C.). SIDE 1 1.0 4'r-8 5 ender's Name P.L. L -- CDMA R.I. N - rLender's Address - - - P.0-Fee$ - PCM-• V - Permit Fee t `� - ////'� C certify.that I have.read this applicationand statethat the - ksoonce Fee - C.0 J Q -CDMA P/C N - - - a. above information is correct. I agree to comply with all County Investigation Feej " g ordinances and State laws relating to building construction, - Total Fee-- f, r CDMA Per : W' u and hereby authorize`representatives of this County to enter a .upon the ove-menti d property for inspection p rpos s. //71/s:5— a ' qtly(((, SEE REVERSE FOR EXPLANATORY LANGUAGE --Signature of Applicant of A e - - - Date r � WORKERS'COMPENSATION DECLARATION 7- 1 hereby affirm that I hovecertificate of consent to self APPLICATION FOR BUILDING PERMIT LI IS insure, or a certificate of Workers' Compensation Insurance, - ' or a certified copy thereof(Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDI D SAFETY Policy No./ Company JA ertified copy is hereby furnished - f FOR APPLICANT TO FILL IN ADDRESS d, AtIlA Certified copy is filed with the county building inspec- IBUILDING / tion department. _� ADDRESS �G sz4 LOCALITY p /J/ NEAREST Date 6r 1�C2.�7 Applic0m`5 l-� CITY _ ZIP CROSS ST, CERTIFICATE OF EXEMPTION F W K NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT Z�O NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE MAP (This section need not be completed if the permit is Forane hundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. ¢Ul'� TEL —/ SPECIAL } I certify that in the performance of the work for which this OWNE — NO. CONDITIONS 0 permit is issued, I shall not employ any person in any manner DISTRICT .GROUP TYPE FIRE PR ESSEDPY O � � so as to become subject to the Workers'Compensation Laws. A D D R E Z /f'/frCONST. ZONE V ,-,Ori cifCITY R 1/ Date Applicant - ARCHITECT OR ZIP TEL �L STATISTICAL CLASSIFICATION APT. CONDO. o ARC NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO - �T ) V Exemption, you should become subject to the Workers' . CLASS NO. /I UNITS Nle Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP CA with comply with such provisions or this permit shall. be TEL ��{{ deemed revoked. CONTR N0.�7SG�8Q5 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NS�'.G VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. '3 Professions Code, and my license is in full force and effect. CITY —,/ CLASS J $ , License Number?� � Lic��Cass SIZE FT C.ID STORIOES FAMILIES CO EKI� 000 O $ p Cont oa' te DESCRIPTION OF WOK NEW I am exe at and r Seell Jf ADD lr`Jt ALTER ❑ FIG PieMIU.PPE NAL c CRA0111T R" o .B BP.C. for this reason DE �G REPAIR ❑ ATFVUG GAt?R4't?u �1PP4?GOIE�Je�'�"��p Date:- USE OF FINAL //.r EXISTING BLDG. DEMOL ❑ By a�..l- �.l�r. Fl;in'sl GRPID;3!Et faQ P�Lt.�r sem'.LC L// J/I7_7 Signature - APPLICA ��. TEL. I `' g PRIt 4`� {TlICG,J r� NO. q OWNER-BUILDER DECLARATION , P` �4/� rr 2 a S 7 A I hereby affirm that I am exempt from the Contractor's License _ Low for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT J BUILDING 9 6_3S_ 2 e - 57.37 ' I, as owner of the property, or my employees with ADDRESS '116_,3S_ J wages as their sole,compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 0 3 e e o 5 7,3 7 v 7044, Business and Professions Code). MOVING TEL. 7 1, as owner of the property, am exclusively contracting CONTRACTOR NO. O 15.-83 with licensed contractors to construct the project (Sec- ADDRESS 'tion 7044, Business and Professions Code). REQUIRED YARD HWV TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH , I hereby affirm that there is a construction lending agency for FRONT ffe 1 0 o e' e the performance of the work for which this permit is issued P.I. . (Sec 3097, Civ. C.). SIDE P.L. 2 e 66 0.7 5 m Lender's Name r ,I P.C..Fee$ J '�S Permit Fee �(/ -.Z (],7 5 6 Lender's Address Orb 1 57 8 3 I certify that I have read this application and state that the 577 3 Issuance Fee �� 4 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, LfSlva 7s, . G and hereby authorize representatives of this County to enter Total Fee I upon the above-mentioned proper for ins ection purposes. ya. SEE REVERSE FOR EXPLANATORY LANGUAGE Signet of App lic t gent Date ®s r 'WORKERS'COMPENSATION DECLARATION W - hereby�offirm that I have a•certificote of consent to self _ - APPLICATION FOR BUILDING PERMIT ' atsu/a, ara•certificote of Workers'Compensation Insurance, or a certified copy thereof (Sec. 3800,t C.) .. �'�r �p��•ypy L / COUNTY OF LOS ANGELES BUILDING AND SAFETY . Polic No.A e__, MCompony U I - - Certified copy is herebyfurnished. FOR APPLICANT TO FILL IN BUILDING S� n^ I , ❑ ADDRESS I/ Ic..� A%/l Certified copy is filed witFlhe'county building inspec- BUILDING lion department. I. O ADDRESS Date 0 a Applicnt CITY ` ZIP % Q r LOCALITY • CEEXEMPTION FROMW RS" O.OF BLDGS. - NEAREST. . - -.. r COMPENSATION INSURANCE SIZE OF LOT �© Ow ON LOT CR055 ST. (This section need not be completed if the permit is for one v -- ASSESSOR- - ' hundred dollars ($100)or less.) TRACT BLOCK LOT NO. / MAR ASSESSOR PAGE PARCEL TEL �G USE ZONE MAP I certify that in the performance of the work for which this OWNER NO' /f NO. .LLJI y permit is issued, I shall not employ any personinany manner S � y�' SPECIAL - d so as to becomer3ubject to the'Workers'Compensation Laws. ADDRESS ll/��� CONDITIONS 0 CITYZIP Date Applicant _ _ �- NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, _ ENGINEER NO. CONST. ZONE p ryop should become subject No 'the Workers' , - n_ - /- Compensation provisions of the Labor Code, youmustforth- ADDRESS (!;-toy 't(L `I- _ with comply with such provisions or this permit shall be JJEL. n STATISTICAL CLA$$If ID TION APT. CON deemed revoked. . . , CONTRACTOR oC 5-677 _ DJ LICENSED CONTRACTORS DECLARATION - L/ IC n//' L/ CLASS No.- DWELL. UNITS - I hereby affirm that am licensed under provisions of Chapter 9 ADDRESS /� NO.-: (commencing with Section 7000)of Division 3 of the Business and - pp LIC SEWER MAP -. Professions,Code, and my license is in full force and effect. CITY Q G�- CLASS5­1 BK' -'VALIDATION .9 t`�/ SO. FT. D NO.OF / NO.OF CHECK - License Number J Ip Lic.Class SIZE STORIES FAMILIES ONE VALUATION. DESCRIPTION Contrdctor y -- ""te (O �• O DESCRIPTION OF WORK' ._. .NEW --❑ $ OCD Off' Cs O ADD , 1 01,4 A' F1I am exempt un r Sec - ALTER ❑ # e e e e e 1 B.BP.C. for this reasonREPAIR ❑ $ " 'Date: USE OF ( • e 59.25 , EXISTING BLDG. DEMOL ❑ , Signature 1" -' APPLICANT TEL. - e •FINAL • 5 9 2 5 6 . �:- O ER-BILI DER DECLARATI N (PRINT) NO. . DAT --- I hereby affirm that I om.exempt from the Contractor's License _ I 1.0 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): - - PRESENT El -- BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and I - the structure is not intended or offered for sole(Section LOCALITY - 7044, Business and-Professions Code).- _ MOVING - - - - TEL. - '1 /C/�C ® -//int ❑ CONTRACTOR NO. L. 6 D 1. V OJ . I, as owner of the property, am exclusively contracting .,.55X+T with licensed contractors to construct the project (Sec- ADDRESS G4O7.� tion 7044, Business and Professions Code). t ' REQUIRED. TOTAL SETBACK FR 1 ,,///Ln2. CONSTRUCTION LENDING AGENCY - ' SET BACK YARD- HWY PROP. LINE WIDTH /4a/ �'� 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. --^- - - ,/� (Sec 3097, Civ. C.). SIDE `'� '-[[ . ._ . . _ P.I. Lender's Name I �t LDMA R.I. R ' Permit fee - - Lender's Address - LDMA ' w I.certify that I have read this application and'state that the - - - Issuance Fee /0's-C) P/C N - - -- - - - a above information is correct. I agree to comply with all County Investigation Fee $ ordinances and State laws relating to building construction, _- -- d' and hereby authorize representatives of this County to en er Total Fee reG J LDMA Perm. R a up bove-m tioned property for inspecti712 n urp s. _ .I o �fG !/ / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant o g nt 061. - -' - - - - -- - - • - '- - - - - -- "-\1) '" '� t t COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0106220001 PHONE: (626) 285-0488 EXT: LEG D: NO. OF CONSTNEW BUI NG A RESS: TR: 37580 LT: 11 SQ. FT STORIES TYPE OCCUP GROUP 10435 LA ROSA DR STRUCTURE: 389 1 VN R3 TEMP CA 917803481 ASSESSOR INFORMA ION NUMBER: GARAGE: NEAREST CROSS STREET: ARDEN 8585-018-052 OTHER: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 06/22/01 JK 12/19/01 OWNER: TEL. NO: BLOBS. NOW ON LOT: VALUATION: NAL DATE .F AL 8Y: CODE: WONG; SALLY (626) 229-2993- 1 30,000 Q(QZ ; 10435 LA ROSA OR TEMP 917803481 FEES PAID DESCRIPTION F WORK CONVERT EXISTING ENCLOSED PATIO INTO FAMILY ROOM AND KITCHEN FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: AND CONVERT EXISTING KITCHEN INTO NEW BEDROOM APPLICANT: TEL. N0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 30000.00 VAL 3.00 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE 54.70 B2 PERMITeW/ENERGY- 30000`00 VAL 590.37 —f,V'� --TOTAL-FEES - 675.82 ONTRACTOR: TEL. N0: f- ". �J,� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - r _ LIC. NO LOCATION LOCATION ANDS BACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: / � � FOUNDATION RENCH FORMS CYA LIC. NO' /. SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: LMP: ' UNDERFLOOR INSULATION 3 01 . - - ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASt:- NO 21 '; _ ND LEVEL FLOOR SHEATH SOHO US b �� AIR QUALITY: 1000 FEET MATERIALS ROOF SHEHING NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM XIST BLDG DEPT. A SPECT SET BACK YARD: HWY: PROP LINE: WIDTH: v�i /�1� FRONT PL- Y'0 SHEAR PANELS 72 SIDE PL- - NSUL TION/WEATHER STRIPi6l; INTERIOR LA H/DRYWALL i EXTERIOR LA LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: 850508