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Home My Public Portal About5730 LOMA AVE_Building__ WORKERS' COMPENSATION DECLARATION to insure, or a certif catte of Worke s'-tComtpensation ent Insuran elf APPLICATION FOR BUILDING P E RM I T ora ertif' d copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Mir. s V Poli No.- 1'1� Company BUILDING El ��Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building insia c- BUILDING Tion department. ADDRESS J Z-elV7, 11 t P6 R Date :2—ZCpplicanti CITY E ZIP p l ; LOCALITY V 49jZ� G?✓ NO. OF BLDGS, NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT CK LOT NO. MAP BOOK-5-313 PAGE PARCEL BLO hundred dollars ($100) or less.) TEL. OWNER - No..2 USE ZONE MAP 1 certify that in the performance of the work for which this SPE CIAL permit is issued, I shall not employ any person in any manner ADDRESS,$ CONDITIONS a so as to become subject to the Workers' Compensation Laws. q�} 0 CITY ZIP l/7J C/ Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY � NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST.. ZONE Exemption, you should become subject to the Workers' `'� �.� U G e4-•r-e.. w Compensation provisions of the Labor Code, you must forth- ADDRESS a- with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR O. J Z LICENSED CONTRACTORS DECLARATIONLIC, L/ CLASS NO. �" DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter ADDRESSP1 ZD SEWER MAP (commencing with Section 7000)of Division 3 of the Business iP_ �" LIC. and Professions Code,and my license is in full force d effect. CITY C//v CLASS BK PG VALIDATION U 7. `] SQ. FT. NO. OF NO. OF CHECK License Number r/�Lic. CI6ss SIZE STORIES FAMILIES ONE 4�w < VALUATION� J�� Contracto Date DESCRIPTION OF WORK �jf/s�/ '�i�- NEW El ❑I am exempt under Sec. L j"�D T ADD 101 pool � ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. Signature APPLICANT FINAL T L. O OWNER-BUILDER DECLARATION (PRINT) L f f / O. 2 E r1�� DATE G _ I hereby affirm that I am exempt from the Contractor's License ADDRESS b m7� C�G�/Y61�/�sf` FINAL ""' Law for The following reason (Section 7031.5, Business and sfL•_; ,c Professions Code): PRESENT BY BUILDING ❑ I, as owner of the property, or my employees with ADDRESS 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. CONTRACTOR❑ NO. _I, as owner of the property,am exclusively contracting - _ with licensed contractors to construct the project (Sec- ADDRESS. _a__. tion 7044, Business and Professions Code.). T•-�-:•t;_ REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT a)_;¢E?_ _ s the performance of the work for which this permit is issued P L. (Sec. 3097, Civ. C.). SIDE _;HF P.L. _ Lender's Name - ' LDMA Ret. # Lender's Address P.C. Fee$ Permit Fee @7 � Poo. _ _ 0 I certify That I have read this application and state that the Issuance Fee ' ' LDMA P/C# ? (-`=s_f.' ",�'`7J above information is correct. I agree to comply with all County Investigation Fee / I 8 ordinances and State laws relating to building construction, Total Fee �!�� LDMA Perm. # and hereby authorize representatives of this County to enter upon the ab Ae- Vtio edoperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date L- COUNTY OF LOS ANGELES TEMPLE CITY 4 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1301280062 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST BUILDING ADDRESS: I ITR: 12977 LT: 21 SQ. FT STORIES TYPE ( 5730 LOMA AV J (STRUCTURE: 1000 V-B I TEMP CA 917802452 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15387-017-041 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI I I TENANT: IEXIST BLDG. USE: RESID USE ZONE: R-1 ITSSUED ON: PROCESSED BY: I IEXIST CCC GRP: 101/28/13 SR I I I I I (OWNER: TEL, NO: JBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FINAL BY: CODE: 1 IHU ABIGAIL KUEI-CHEN (626) 285-4398- 1 4,000 1� 1 71 / 1 15730 LOMA AV ITEMP 917802452 I FEES PAID I SE C�RIPTION OF WORK J I i (HOUSE T/O EX ROOF COVER UP 1/2" PLYWOOD AND 30 YR COMP/ I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ISHINGLES I (APPLICANT: TEL, NO: I I I IFUNG WAI KUEN (626) 625-5748- IAA BLDG PERMIT ISSUANCE 27.80 1 1 1437 W WELLS STREET JAB STATE GREEN BLDG FEE 4000,00 VAL 1.00 ISPECIAL CONDITIONS: ISAN GABRIEL CA 91776 IAC STRONG MOTION RESID 4000,00 VAL 0.50 1 ID2 PERMIT W/O EN-HC 4000,00 VAL 115.80 1 I 1 1 TOTAL FEES 145.10 ICONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE 1 IFUNG'S CONSTRUCTION CO INC (626) 625-7048- 1 1 1437 W WELLS STREET LIC. NO I ILOCATION AND SETBACKS ISAN GABRIEL CA 91776 753441 1 1 I 1 J 1 ISOILS ENGINEER APPROVAL I I I I I I I JARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS I 1 LIC. NO: 1 ISLAB/UNDER FLOOR I 1 I I 11 1 IRAISED FLOOR FRAMING I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: J JUNDERFLOOR INSULATION I I 1150H265 3 001 11 1 I I IFLOOR SHEATHING 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I 0 NO 21 1 IROOF SHEATHING I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS ISI 1AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION 1 J I IFIRE SPRINKLER HANGERS I I 1 I I I J (INSULATION/WEATHER STRIPI I I I 1 I I i I JINTERIOR LATH/DRYWALL J I I I I I I I I IEXTERIOR LATH 1 1 I I I I I I 1 1 (RATED FLOOR/CEIL ASSEM. I I 1 IRATED WALL ASSEMBLIES 1 1 (RATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS I I I I I I 1 I ILOT DRAINAGE I I I I I I I 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I 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 1301280063 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 12977 LT: 21 SQ. FT STORIES TYPE 5730 LOMA AV I ISTRUCTURE: 1000 V-B TEMP CA 917802452 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 1 15387-017-041 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI I I (TENANT: IEXIST BLDG USE: DETAC USE ZONE: R-1 ISSUED ON: PROCESSED BY: I IEXIST OCC GRP: 101/28/13 SR I I I I IOWNER: TEL. BLDGS. NOW ON LOT: VALUATION: JFINAI. DA� FINAL BACODE: HU ABIGAIL KUEI-CHEN (626) 285-S-4395- 1,000 15730 LOMA AV I / ITEMP 917802452 1 FEES PAID 1DESCRIPT ON OF WORK 1 I IDETACHED GARAGE EX ROOF COVER UP 1/2" PLYWOOD AND 30 YR 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ICOMP/SHINGLES 1 APPLICANT: TEL. NO: IFUNG WAI KUEN (626) 625-5748- 1AA BLDG PERMIT ISSUANCE 27.80 1 1437 W WELLS STREET IAB STATE GREEN BLDG FEE 1000.00 VAL 1.00 ISPECIAL CONDITIONS: 1 ISAN GABRIEL CA 91776 IAC STRONG MOTION RESID 1000.00 VAL 0.50 1 1 ID2 PERMIT W/O EN-HC 1000.00 VAL 65.40 1 1 1 TOTAL FEES 94.70 1 1 (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IFUNG'S CONSTRUCTION CO INC (626) 625-7048- 1 1 1437 W WELLS STREET - LIC. NO 1 ILOCATION AND SETBACKS ISAN GABRIEL CA 91776 753441 1 I 1 1 ISOILS ENGINEER APPROVAL 1 1 (ARCHITECT OR ENGINEER: TEL. NO: (FOUNDATION/TRENCH FORMS I 1 1 LIC. NO: 1 1SLAB/UNDER FLOOR I 1 I I I I I I 1 IRAISED FLOOR FRAMING I 1 I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 (UNDERFLOOR INSULATION I 1150H265 3 001 1 1 1 1 1 -1 1FLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 1 1 1 0 NO 21 1 IROOF SHEATHING 1l Y Li 1 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS 1AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO 1FRAME INSPECTION 1 I I I I I I I IFIRE SPRINKLER HANGERS I I I I I I 1 (INSULATION/WEATHER STRIPI I I I 1 1-1 1 1 (INTERIOR LATH/DRYWALL 1 I I I I I I 1 1 IEXTERIOR LATH I I I I I I 1 IRATED FLOOR/CEIL ASSEM. 1 1 1 I I I I I I 1 1 (RATED WALL ASSEMBLIES 1 1 I I I I I I 1 1 1RATED SHAFTS/OPENINGS 1 1 1 I I I I I I 1 IT-BAR CEILINGS 1 1 1 I I I I I I 1 ILOT DRAINAGE 1 1 I I I I I I IREPORT ID: DPR261 ROUTE TO: BSO508 1 1 I I I I I I