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Home My Public Portal About9223 LEMON AVE_Building__ WORKERS' COMPENSATION DECLARATION- hereby,affcrr that I have r certificate',Cotof,ris consent to self A P P L I tAT I OWN, FOR B U I L D.I N G- PERMIT insure or a c�rtificater•Of;Workers'•Com nsation Insurance, or a`-certified copy thereof (Sec'3800, Lab C �2b��6� 9 COUNTI�OF LOS ANGELES ";; BUILDING AND SAFETY Policy No L6 \ 1 �+ ,KAi BUILDING,Certified copy is hereby furnished FOR APPLICANT TO FILL INADDRESSBUILDING:;?Certified copy is filed wit county building ins c- ADDRESS• ation department z __ //J�,,��Date �� A t - CA� ZIPLOCALITY pP NO'.OF•BLDGS c" NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ` SIZE•OF LOT NOW ON LOT ' CROSS ST COMPENSATION INSURANCE =' + t i. - is r' ' ASSESSOR r f7 (This section need not be-completed-if the permit is for one_ L' TRACT BLOCK LOT NO MA � P BOOK c� �O PAGE /J' PARCELD-1/ = hundred dollars'($100) or'less-) TEL-tt - - r OWNER -'+- USE ZONE MAP ' .'•' r" ''�,• ' I certify that in the performance of.the work for wNO Hich�this - SPECIAL -permit is issued, I shall not employ any person in any manner ADDRESS 1_1�OwvV`-'AU CONDITIONS O`• so as to,become subject to the, ker ' Compensation Laws w p U CITY �� -ZIP CA C3 1-'(Q r.-. �Q�2 .� Date L�4- Appl�cani ARCHITECT f��rr � �(�TEL (� DISTRICT GROUP. TYPE " FIRE PROCESSED BY ' O NOTICE TO APPLICANT If, after making this Certificate of ENGINEER r\t�t ' *l N CON ZONE Exemption; -you -should ,become subject to the Workers' 2 U Compensation provisions of the Labor,Code, you must forth- w ADDRESS 4 r G �J a with comply ,with such provisions or this permit shall be Ntlt TEL 1 1 STATISTICAL CLASSIFICATION APT CONDO Z l deemed revoked CONTRACTOR V( G �J � — LICENSED CONTRACTORS DECLARATION gg LIC A} *� CLASS NO QLG!DWELL UNITS ADDRESS A-IpNO'+' `J��4V I'hereby affirm that I am licensed under provisions of Chapter 9 _ 'T LIC SEWER MAP (commencing with Section 7000)of Division 3 of'the Business CITY S CLASS VALIDATION and Professions Code,and my license is in full force and effect - BK PG' !]� SQ FT NO OF NO OF; CHECK License Number b t 5 Lic Class SIZE STORIES FAMILIES f ONE Q Confracto14tU+n C=-C� V%,0k�Date l-2 7 DESCRIPTION OF WORK . _ ❑ r ADD I am exempt under Sec ' :, 77 -2 i- ALTER ❑ t i _ '3 B&P C for this reason -•� t� REPAIR ElS D te. t�GUSE,OF p ,AE,•� —151`A15 BLDG fir— DEMOL ❑ ;• t'�': Signature _ APPLICANT TEL FINAL q OWNER-BUILDER DECLARATION (PRINT) N J a DATE I hereby affirm that I am exempt from the Contractor's License Law`for the following reason (Section 7031 5,'Business and ADDRESS27 FINAL s -t 1{(t i t•' Ir`:`_ Professions Code) t'a j' PRESENT- By 1^¢(o$ - _ ❑ j, as BUILDING owner of the property, or my employees with ADDRESS .k �•t 7 Y ~� 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 E] 'CONTRACTOR NO ,,j, as owner of The property, am exclusively contracting rt = z -,with licensed contractors to construct the project (Sec- ADDRESS 4 r n tion 704, Business and Professions Code ) ? t t ?, '•? REQUIRED TOTAL SETBACK FROM EXIST �, �' :`- - ,i= '' _' r CONSTRUCTION LENDING AGENCY - SET BACK YARD HWY PROP LINE - WIDTH I'hereby'affirrn that there is a construction lending agency for = ' FRONT the performance of the work for which this permit is,iss_ued P L (Sec 3097, Civ C )' SIDE P L -A-- Lender's Name r } i (_- LDMA Ref Lender's Address PC Fee i 9 Permit Fee oc I certify that I have read this application and state that the �tV'QIssuance Fee ��•�� LDMA P/C# , I above information'is correct I agree to comply with all County Investigation Fee sil'l's t-€:.;",�;i :,i i-+j! ordinances and State jaws relating To building construction, Total Fee 1 1. LDMA Perm # y a and hereby a home representatives of this County to enter upon the Qbo -menti o ed propert f r mspection puurrpos s SEE REVERSE FOR EXPLANATORY LANGUAGE C':-- Signature of Apphcan Agent to (` 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 0701310035 PHONE: (626)' 285-0488 EXT- ILEGAL ID. I' NO OF CONST 1 BUILDING ADDRESS 1 I ON FILE I SQ FT STORIES TYPE 1 9223 LEMON AV 1 I ISTRUCTURE 26 VN I TEMP CA 917801327 1 (ASSESSOR INFORMATION NUMBER I 1 y NEAREST CROSS STREET - I 15382-015-031 i 1 THOMAS PAGE 596 GRID J1 LOCALITY: TEMPLE CITY, Cl ITENANT (EXIST BLDG USE RESID USE ZONE R-1 ;11SSLED ON PROCESSED BY: EXPIRES ON 1 I 1EXIST OCC GRP 101/31/07 JK 01/26/08 1 (OWNER- TEL NO IBLDGS NOW ON LOT- 'VALUATION IFINAL DATE FINAL BY CODE I '- ICHIN, DENISE - 1 5,600 19223 LEMON AV I ITEMP 917801327 1 FEES PAID (DESCRIPTION OF WORK I I - IT/O:-REROOF WITH 30 YEARS AS A COMPOSITION SHINGLES I IFEE DESCRIPTION QUANTITY: UOM. AMOUNT.1 (APPLICANT TEL. NO: I -I , - 1 ICORTEZ (909) 865-6782- !AA BLDG PERMIT ISSUANCE 27 75 1 ^ I 145 WESTBROCK LN IAC STRONG MOTION RESID 5600 00 VAL 0.56 ISPECIAL CONDITIONS: I 1POMONA, CA 91766 ID2 PERMIT W/O EN-HC 5600 00 VAL 149 40 1 1 I 1 TOTAL FEES 177 71 I, CONTRACTOR TEL. NO- 1 I APPROVALS ICORTEZ ROOFING (626) 918-1007- - 1- 115884 DOUBLEGROVE ST LIC. NO '1 - - ILOCATION AND SET ACKS I T I ILA PUENTE CA 91744 762520 C39 I I S I 1 I I ISOI-LS ENGINEER APPROVAL I I ' I I I (ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I I I LIC NO: I ISLAB/UNDER FLOOR I I I I I 1 I IRAISED FLOOR FRAMING I I 1 I I 1 1 I I I IMAP NO SEWER MAP BOOK PAGE- FIRE ZONE CMP 1 (UNDERFLOOR INSULATION I I I 1153H265 3 Oil I I IFLOOR SHEATHING 1 INO. OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 1 S, I I I NO 21 - iROOF SHEATHING - � 1 /(/ SCHOOL WITHIN HAZARDOUS 1 1SHRAR PANELS I 1 (AIR QUALITY: 1000 FEET MATERIALS I 1 1 NO NO NO 1 IFRAME INSPECTION I 1 I I I I I I IREQUIRED TOTAL SETBACK FROM EXIST I [FIRE SPRINKLER HANGERS I 1 1 ISET BACK YARD HWY PROP LINE: WIDTH 1 I -1-1 I IFRONT PL- . 1 11NSULATION/WEATHER STRIPI I I I SIDE PL- I . 1-1 1 1 (INTERIOR LATH/DRYWALL 1 I I 1EXTERIOR LATH 1 I 1 I I I I I I IRATED FLOOR/CEIL ASSEM I 1 I 1 IRATED WALL ASSEMBLIES 1 1 I I I I I I I : 1 IRATED SHAFTS/OPENINGS I I I 1 I IT-BAR CEILINGS I 1 I I I I I I 1 ILOT DRAINAGE I I I IREPORT ID• DPR261 ROUTE TO BS0508 I I I I I_ I I