The URL can be used to link to this page

Home My Public Portal About9682 LIVE OAK AVE_Building__ WORKERS' COMPENSATION DECLARATION t I hereby.affirm that I have a certificate of consent,to self O O O O O 'insure ;t1r a certificate of Workers' Compensation Insurance; Q p p d 0 Cep&u NON N _0,m Q M�d D 0.[�l� p��0'� or certified copy 4hereof �-�ec. 3800, Lab'. C.) 1 COUNTY O1�OS ANGELES BUILDING AND SAFETY Policy No. Company `' Certified copy is hereby furnished. }� ,5 BUILDING ❑ FOR APPLICANT,:TQ IN�. ADDRESS. Q ❑ Certified'copy is filed with the county building inspec- BUILDING ti6mdepartment.. ADDRESS Date Applicant CITY 4 ZIP TO' LOCALITY l CERTIFICATE OF EXEMPTION FROM WORKERS' NO°'OF'B(DGS. NEAREST, COMPENSATION INSURANCE. SIZE OF LOT -NOW ON LOT CROSS ST. (This section needASSESSOR -not be completed if the permit is for one. TRACT. BLOCK LOT NO. - MAP BOOK ' PAGE PARCEL hundred dollars($100)or less.). `TEL., 9 OWNER N07&-7�P`'�g7 USE Z NE` MAP I certify that-in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner SPECIAL 1 so as to become subject to the Workers'Compensation Laws. ADDRESS CONDITIONS 0 2 P lL�t af)C� t7 CITY C"\��[�i C.(-'LIP \ Ul Date Applicant 0.' ARCHITECT OR TEL. DISTRICT GR fPE FIRE PROCESSED 8Y O' NOTIC O:AP LICANT: If, after making this Certificate of � N NE 0 Exemption,'you should become subject to the 'Workers' ENGINEER NO. Como'ensation provisions of the Labor Code, you must forth- 1 v V` P Y ADDRESS ' with comply,with;such provisions:or this permit shall be R, deemed revoked. E STATISTICAL CLASSIFICATION APT. CO t) CONTRACTOR LICENSED CONTRACTORS DECLARATION ,. LIC. " CLASS NO. DWELL. UNITS \' I.hereby affirm that I am licensed under provisions of.Chapter 9 ADDRESS NO. (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 ✓ CLASS BK VALIDATION. SQ. FT. NO. OF NO:OF CHECK License°Number Lic..Class SIZE STORIES FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW ❑ dQo Contractor Date $ (� nz— ADD ❑ am exempt under Sec. ��9i1.(�� S' t • ALTER D ,•, B.&P.C. for this reason a REPAIR PG Date: USE OF y,Q �zn 2 9, EXISTING BLDG. ( DEMOL ❑ # o.r;'o o Signature (9 NO 77— FINAL APPLICANT OWNER-BUILDER DECLARATION PRINT V 6g ;DATE U 5 CJ`s a I-herebyaffirm that I am exempt from the Contractor's License .(B(y��(LO �Lt SDN �2�f J Profe for he o ss and ADDRESS FI o'o o Q 0 o Law for the following.reason Section,7031�5, Business PRESENT _. ,�a BY ( 0. 5 ❑ BUILDING I, as owner of the property, or.my employees with ADDRESS wages as their sole compensation,will do the work and - 7,2 81y 8 8 the structure is not intended or offered for sole(Section LOCALITY 7044,Business and Professions Code). MOVING TEL. ` I;as owner of.the property.; am exclusively contracting CONTRACTOR NO. 'With`licensed'contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS REQUIRED. , TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY. SET BACK YARD HWY 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.L. (Sec. 3097,Civ. C.). SIDE P.L. Lender's Name ^' LDMA Ref. # m 01 Lender's Address P:C. Fee'$ Permit Fee 3 I certify that I have read this.application and state.that the .o Y PP - Issuance Fee ( - J. CDMA P/C# - - above information is correct. I agree to comply with all County Investigation Fee o ordinances and State laws relating to.building construction, Total Fee V t CDMA Perm. # $ and hereby authorize representatives of this County to enter 'upon the above- d property for inspection,purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ignat—ur6rdrApplicant or Agent Da APPWq,.CAM01M FOR BULIMHO [PIERM7 COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUI DING ADDRESS I hereby affirm that I have a certificate of consent to self insure, cfbq (��r �Y�• or a certificate of Workers'Compensation Insurance,or a certified CI zIP copy thereof(Sec.3800,Lab.C.) Poli No. l!42_x/ —company ^ '� l L LOCALITY P Y �� SIZE OF L �" NO.OF BLDGS.NOW ON LOT �✓ El.Certified copy is hereby furnished. e,&o k 60 -7-- NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. �" II department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL ,6 6 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER dTEpL�.\NO. COMPENSATION INSURANCE _24R,7 WITHIN 1000 FT OF SCHOOL? YES NO. . ADDRESS _ (This section need not be completed if the permit is for one hundred iQ 1y I5r(�T�p DISTRICT GROUP TYPE CONST,' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP. I certify that in the performance of the work for which this permit Me .�lZ� �� (��. ,®y �'� Is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLA$$IFICATION APT CONDO Date Applicant ADDRESS CLASS NO. 4-9 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should CONT ACTOR TEL.NO.become subject to the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith G Dir ,/ �� 011 comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. FRONT c_O m 6/�Tl.� ir! SIDE LICENSED CONTRACTORS DECLARATION IyY ""�^,4, a00 �'s� Llc•CLASS P L U I hereby affirm that I am licensed under provisions of Chapter 9 so.FTSIZE NO. STORES NO.OF FAMILIES SEWER MAP . .. . (commencing with Section 7000)of Division 3 of the Business and NEW El BK PG �. Professions Code,and my license is in full force and.Offect. v License Number elf DESCRIPTION OF WORK gig- ADD VALUATION � J as Lic.Class Contracto4c2ldehRed D ALTER ❑ Is 010 CSS 7 I c) X _ ❑ I am exempt under Secff ii REPAIR. $ B.&P.C.for this reason MOL ❑ LOMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# -- ❑ I, as owner of theroperty, or my-employees with wages as their sole compensation,will.do the work and the structure is ADDRESS not intended or offered for sale Section 7044, Business and FINAL DATE ' ( V. Professions Code.) LFINAM �;ZWILLTHE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEAHAZARDOUS MATERIAL❑ 1, as Owner of,the r0 ert ,.am.exclusive) contractin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THANP P Y Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES licensed contractors to construct the project.(Section 7044, YES❑ NO❑ :, Business and Pofessions Code.) „�-•� ••�• n„• f WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING •. �_L '' OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTIONOR MODIFICATION FROMTHESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. .-F- I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit is issued(Sec. _-'• ;-_3,:'=."'<. �.--'_1'4 3097,J7,CIV.C. . I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD - ) PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES t-=S.iIL eYIeY� COUNTYCODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100THROUGH 2.20.140 CONCERNING 3 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. LerrdI�s Address - OWNER OR AGENT o' 1 certify that I have read this application and state that the above _ } FEE PERMIT FEEty ^ information is correct. I agree to comply with all county P.C. ordinances and State laws relating to building construction,and a ereby authorize representatives of this County to enter upon ISSUANCE FEE the ve mentioned property to 75- 7 inspection purposes. a �/ti` INVESTIGATION FEE TOTAL FEE j D sgnnurea wApeM wte SEE REVERSE FOR EXPLANATORY LANGUAGE .� CGUNTY 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 1302280081 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE I SQ. FT STORIES TYPE 9682 LIVE OAK AV ' I ISTRUCTURE: V-B I TEMP CA 917802522 . (ASSESSOR INFORMATION NUMBER: - - NEAREST CROSS STREET: KAUFFMAN 18588.-011-031 - J THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI I I I (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: `1 IEXIST OCC GRP: 102/28/13 SR 1 (OWNER: - TEL. NO: BLDGS. NOW ON LOT:- VALUATION: _ IF AL ATE" FINAL Y: '.CODE: IPUI, WAN HO (626) 993-5469- 1 15,200 19682 LIVE OAK AVE ITEMPLE CITY CA 91780 _ _ _ _ FEES PAID IDESCRIPTION OF WORK KITCHEN REMODEL, CONVERT (E) HALLWAY BATHRM, INTO ONE FULL. _(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IBATHRM & 3/4 BATHRM, ADD ONE CLOSET IN MASTER BEDRM & CLOSE 1APPLICANT: TEL. NO: 1 10NE 2'X4' SINGLE HUNG WOOD FRAME WINDOW & REPLACE 33 WOOD * 1 ISAME AS OWNER - IAA_BLDG PERMIT ISSUANCE 27.80 1 IAB STATE GREEN BLDG FEE 15200.00 VAL 1.00 ISPECIAL CONDITIONS: 1 1 " _ IAC STRONG MOTION RESID 15200.00 VAL 1.50 1AX BUILDING REVIEW FEE 54.70 1 1 JB2 PERMIT W/ENERGY 15200.00 VAL " 349.10. ( ICONTRACTOR: TEL NO: I TOTAL FEES '434.10 (APPROVALS DATE _ INSPECTOR SIGNATURE ISAME AS OWNER - - - I _ LIC..NO - - I LOCATION AND SETBACKS ' I I I ISOILS ENGINEER APPROVAL JARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I 1 LIC. NO: I ISLAB/UNDER FLOOR J _ I I I (RAISED FLOOR FRAMING I I = I IMAP NO: SEWER MAP BOOK: PAGE: FIRE-ZONE: CMP:J ( 1UNDERFLOOR INSULATION I .I 1150H269 3 001 I I I IFLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT-CLASS: - � I 0 NO, -. 21 _1 l C I ROOF SHEATHING I I I I SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS 1 1 (AIR QUALITY: 1000 FEET MATERIALS NO NO NO J IFRAME INSPECTION . (FIRE SPRINKLER HANGERS i _ I I I 11NSULATION/WEATHER STRIPI I I 1 I . - I I I INTERIOR. LATH/DRYWALL JEXTERIOR LATH I I I I- IRATED FLOOR/CEIL ASSEM. - - I RATED WALL ASSEMBLIES J I I IRATEL SHAFTS/OPENINGS IT-BAR CEILINGS J * ADDITIONAL DATA ON FILE I I ILOT DRAINAGE J I I I I I - (REPORT ID: DPR261 ROUTE TO: BS0508