HomeMy Public PortalAbout9207 LEMON AVE_Building__ '*WORKERS' COMPENSATION DECLARATION - '
; APPLICATION. F•O.R IJILDIN.G. PERIVIIT
Ihereby affirm;that,I have a certificate'of.consent to self
ingure;:or'b„certificate.`of,Workers' Compensation Insurance,
Eod'9"cerhfled cop thereof;(Sec?3800 C :COUNTY OF LOS ANGELES. BUILDING AND SAFETY -
Folicy Companyr_ BUILDING•'-
Ceirtified,copy isohereby furnsFied:.: <r FOR'APPL'ICANT.TO FILL IN ADDRESS _
2`' ` • ._ :. .'' x BUILDING '
Certified.copy,is.filed with The county butldmg'nspec- a_.
ti n,de irt'ment ADDRESS
Date__'q r`J" . •Sit CITY, �.' "ZIP ' �, t LOCALITY
pelican NO:OF BLDGS> NEAREST
" CERTIFICATE,OF:EXEMPTION FROM-WORKERS`:' SIZE,OF LOT-:': - ^-” NOW ON•LOT,,•' - CRO55"ST '
.`-,,COMPENSATION, •_` ASSESSOR
(This.section'need-"not'be completedfif the permit is•for'one TRACT' BLOCK "y '• LOT'NO "','+' MAP.BOOK �* ^r PAGE �. PARCEL' -
.'hundred dol lays ($•100)-or'less.)' ! e ^ TEL
^ r OWNER W �-NO l' USE^ZONE
I certify that?in•the erformance of the work for which`this SPECIAL
ermit is issued=;I•sha .not em to ° C
an person to an manner ._ ADDRESS.
• E,P. .. � P Y Y P Y - � CONDITIONS - � -
so as to'becomexsubI `t to the-Workers=
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 0110160022
PHONE: (626) 285-0488 EXT:LEGAL ,
ON,FILE SD. FT STORIES TYPE OCCUP GROUP :9207-LEMON AV' "
STRUCTURE: 130 1 VN U1 �'.TEMP:CA191780132T.
ASSESSOR INFORMATION NUMBER: GARAGE: NEAR EST' CROSS:STREET:-SOAK _
5382-015-028 OTHER: THOMAS PAGE-,596;j:!GRID: -Jl,, LOCALITY: TEMPLE CITY-
TENANT: 7_7 S - s'!;`. C S ON:
EXIST OCC GRP: 11/05/01 JK 05/04/02
OWNER: T BLDGS. NOW ON L AT A FINAL B :
BROWN.DALE E•VICTORIA A (626) 447-0062- 1 3 731 '- c•C•. .
9207 LEMON AVS, ;L� `'', r,•.,(���
TEMP'917801327' FEES PA [YESCRIPTION U
. ADD WORKSHOP TO EXISTING GARAGE
FEE DESCRIPTION: QUANTITY: UOM: ' AMOUNT:
APPLICANT- TEL. NO:
SAME AS OWNER - AX BUILDING REVIEW FEE 54.70
AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS:
AC 'STRONG'MOTION-RESID��3731.00 VAL 0.50 FOR WORKSHOP USE ONLY NOT FOR HABITATION
D1 PLANCHECK"'W/.O-EN.HC�3731:,00 VAL 98.43
t:LtSTOTAL�F.EES 181.38 "
CONTRACTOR: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO LOCATIONBAC
6
SO ILS ENGINEER APPROVAL
ARCHITECTf_ Q IO
l' LIC. NOe� llllill SLAB/UNDER FLOOR
RAISED FLOOFTWARFNG
P : SEWgR MAP BOOK: PAGE: ' :FIRE:ZONE':I •, MP:: U -INSULATION "
3 , ' 7').�. IST LEVEL FLooTsNUTTF
O. CLASS:
-NO 21 0` ND LEVEL FLOOR SHE
SCHOOL WITHIN �\
AIR QUALITY: 1000 FEET MATERIALS
SHEATHING
NO NO .• NO Q, ® ®� FIRE DEPT. FRTMT S CREQUIRED TOTAL SETBACK-FROM-, EXISTT
SET BACK YARD: HWY: PROP LINE: WIDTH: (��/� Q- Vtl�e�' G F
FRONT PL- C ��►VICe�ha�• SEA PANELS 2[/J�
SIDE PL-
P
/`?aT
INTERIOR TH/DRYW
TCE
- - OR �L
L
LOT,DRAINAGE
0 DEVICES
FIRE DEPARTMEAPPRO
REPORT ID: DPR261 ROUTE T0: BS0508
ti
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 0906220023
PHONE: (626) 285-0488 EXT:
(LEGAL ID: I NO OF CONST I BUILDING ADDRESS: I
ON FILE SQ. FT STORIES TYPE 9207 LEMON AV 1
I (STRUCTURE: 420 V-B TEMP CA 917801327 1
(ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET- OAK
5382-0.15-028 I I THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: •I
I (EXIST OCC GRP: 106/22/09 SR I
I I I I
1OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DAT FINAL BY: CODE: 1
IBROWN DALE E;VICTORIA A (626) 447-0062- 1 1,500
19207 LEMON AV /1/� 1
TEMP 917801327 1 FEES PAID DES RIPTIO14 OF WORK
I INEW ROOF ON SOUTH SIDE OF STRUCTURE, TEAR OFF OLD ROOF AND
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IINSTALL NEW COMP. 420 SQ.
(APPLICANT: TEL. NO: I I I
SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 1 1
IAB STATE GREEN BLDG FEE 1500.00 VAL 1.00 ISPECIAL CONDITIONS- I
_ IAC STRONG MOTION RESID 1500.00 VAL 0 50 I 1
' ID2 PERMIT W/O EN-HC 1500.00 VAL 8220 I
I 1 TOTAL FEES 111.45 I"`SWI;` ��\ CV7•
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
ISAME AS OWNER - - I
LIC. NO i ILOCATION AND SETBACKS
ISOILS ENGINEER APPROVAL I 1
1ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I I
LIC. NO: i '� JSLAB/UNDER FLOOR I I I
IRAISED FLOOR FRAMING I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE- CMP:( (UNDERFLOOR INSULATION I I I
1153H265 3 001 1 1 I
I I 1FLOOR SHEATHING I I 1
INO. OF FAMILIES- DWELLING UNITS: APT/COND: STAT CLASS: I- I I
NO 21 i (ROOF SHEATHING
1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I
(AIR QUALITY: 1000 FEET MATERIALS 1 I I I I
NO NO NO IFRAME INSPECTION
I I I
IREQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS I I I
ISET BACK YARD: HWY: PROP LINE: WIDTH:
IFRONT PL- IINSULATION/WEATHER STRIPI I I
SIDE PL- ,
I 11NTERIOR LATH/DRYWALL I 1
1 1EXTERIOR LATH
I - IRATED FLOOR/CEIL ASSEM. I
1 (RATED WALL ASSEMBLIES
I I I
1 IRATED SHAFTS/OPENINGS I I 1
I I I
I IT-BAR CEILINGS I I 1
I I I
ILOT DRAINAGE
I I I
IREPORT ID: DPR261 ROUTE TO: BS0508 I I I
I I I I I I
^ CO'OrNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
' xDEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0906090057
PHONE: (626) 285-0488 EXT: -
ILEGAL ID: NO. OF CONST I BUILDING ADDRESS: 1
ON FILE SQ. FT STORIES TYPE
9207 LEMON AV
(STRUCTURE. V-B I I
(ASSESSOR INFORMATION NUMBER: I I TEMP CA 917801327 I
NEAREST CROSS STREET:
15382-015-028 - THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl
I I I I
(TENANT: (EXIST BLDG USE: _RESID USE ZONE: R-1 I'ISSUED ON: PROCESSED BY:
(EXIST OCC GRP: 106/15/09 SR
I I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DA FIN BY: CODE:
BROWN DALE
19207 LEMON AV 27,000 t
1
TEMP 917801327
I I FEES PAID I ESCRIPTION OF WORK 1
- (INSTALL SOLAR PANEL ROOF MOUNTED I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( 1
(APPLICANT: - TEL. NO: I I I
ICHAVEZ (626) 622-0511- IAX BUILDING REVIEW FEE 54.70 I -
117011 GREEN DR. IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: I
ICITY OF INDUSTRY IAB STATE GREEN BLDG FEE 27000.00 VAL 2.00 1
1 ID2 PERMIT W/O EN-HC 27000.00 VAL 497.55 1
I 1 TOTAL FEES 582.00 I
ICONTRACTOR: TEL. NO: I IAPFROVALS DATE INSPECTOR SIGNATURE
(ELITE ELECTRIC (951) 681-5811-
19415 BELLEGRAVE LIC. NO I ILOCATION AND SETBACKS
I I I
1RIVERSIDE CA 92509 - 418242 C10 I _ -
I I ISOILS ENGINEER APPROVAL I
(ARCHITECT OR ENGINEER: TEL. NO: 7 •.i, IFOUNDATION/TRENCH FORMS I I I
LIC. NO: I � ISLAB/UNDER FLOOR
I I I
I IRAISED FLOOR FRAMING
I1I I I
P N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I
53H265 3 '001 1 1
I I (FLOOR SHEATHING I I
INO. OF FAMILIES: DWELLING UNITS- APT/GOND: STAT CLASS: I _ I I I
NO 21 1 (ROOF SHEATHING
I I
SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I
(AIR QUALITY: 1000 FEET MATERIALS
NO NO NO I IFRAME INSPECTION
IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS . I I
ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I I
IFRONT PL- (INSULATION/WEATHER STRIPI I i
I SIDE PL- I 1-1 1
IINTERIOR LATH/DRYWALL
I I 1EXTERIOR LATH
I I I I I I
RATED FLOOR/CEIL ASSEM.
I I
I 1 IRATED WALL ASSEMBLIES
I I
IRATED SHAFTS/OPENINGS I I I
• IT=BAR CEILINGS 1 1 1
I I I
ILOT DRAINAGE 1 I I
IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I
I I I I I I