Loading...
HomeMy Public PortalAbout5756 LOMA AVE_Building__ :KERS'COMPENSATION DECLARATION- ' frrt, aceficate o Workers' Compensat on nsuran oOR PERIl Trrt ° tefAPPLICATI® ti F ` or a certified copy-thereof (Sec. 3800, Lab. C.') '7 •Company f"e�ly'Mdf�7F' COUNTY-'OF LOS ANGELES BUILDING AND SAFETY Policy NoRIC' Certified copy is hereby furnished. FOR APPLICANT-TO FILL IN .+ BUILDING ]Y / ADDRESS / Fj L-f> Certified copy is filed.with the county building inspec- BUILDING (� / tion department. ADDRESS S ' ((, LOCALITY • ! e"/h �C' ` r'•� NEAREST 1 Date /IC/ �S Applicant 's` CITY / ZIP, CROSS ST. SVS e_ CERTIFICATE OF EXEMPTION FROM WORKERS' y NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT S'� /� NOW.ON LOT.'• �' MAP BOOK PAGE PARCEL (This section need not be completed:if the permit is for one USE ONE 0 MAP hundred dollars ($100)or less:) TRACT BLOCK LOT NO VNO. TEL �� SPECIAL d I certify that in the performance of'the'work for which this OWNER / S �j , NO. '. CONDITIONS Y DISTRICT GROUP TYPE FIRE PRO SSED BY O permit is issued, I shall not employ any person in any manner CONST. ZONE sous to become subject to the Workers'Compensation Laws. ADDRESS. y, ` +�`_ D_ ad Date Applicant CITY ZIP STATISTICAL CLAS IFICATION APT.. CONDO O NOTICE TO APPLICANT: If, after'making this Certificate,*of ARCHITECT OR TEL. LU ENGINEER NO. � CLASS NO. DWELL. UNITS � Exemption, you should become subject to. the.Workers' C Compensation provisionsof.the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall'be p / deemed revoked.' CONTRACTOR /` NO.TEL .Q e�C!')0 S BK. F^' PG,/ VALIDATION LICENSED CONTRACTORS DECLARATION r� LIC. I hereby affirm that I am licensed Under provisions of Chapter 9 ADDRESS OS / � �� N6.� S'SS VALUATION (commencing with Section 7000)of Division 3 of the Business.and S�� L LIC. Gr.T, )nboo v 3 1 (( (L a Professions Code, and my license is in full•force and effect. CITYc7!// f CLASS $ v SQ. FT.• NO. OF NO_OF CHECK # 0 0`0 0 0 1 License Number Lic.Class f SIZE Q STORIES FAMILIES r�� ONE / �, /f DESCRIPTION OF WORK f^ /(} f� NEW $ I a 2 1 8,6 3 Co n tractor�Gd/P"�i'{°'/.�e�/'7 Date D' . / © - , I am exempt under Sec. J— �)�— Li Z f�- e ADD 0 0 2 1 .a 6 35 ALTER FINAL C B.&' for this reason REPAIR DEMOL DATED 1 1.0'9-8 4 Date: USE OF O FINA EXISTING BLDG. es Q/7C P By Signature APPLICANT o. TEL. OWNER-BUILDER DECLARATION PRINT) �, O!!YJ' !� NO./ l�U7 I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING El I; as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and G� the structure is not intended or offered for sale(SectionLOCALITY 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- ADDRESS 'tion'7044', Business and Professions Code). REQUIREDTOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1 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 1 P.L. ' Q Lender's Name 2aS 3 P.C. Fee$ Permit Fee Lender's Address w to I certify that I have read this application and state that the. a y pp / - Issuance , above information is correct. I agree to comply with.all County Investigation Fee 7� $ ordinances and State laws relating to building construction, Total Fee 6 u and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. ^ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date' ®s COUNTI=-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 1204270012 ' PHONE: (626), 285-0488 EXT: DUPLICATE ILEGAL ID: 1 - NO. OF' CONST I BUILDING ADDRESS: I ON FILE SQ. FT _STORIES TYPE 1. 5756 LOMA AV "ISTRUCTURE: 1500 V-B I TEMP CA 917802452 (ASSESSOR INFORMATION NUMBER:. I NEAREST CROSS STREET: 1 15387-017-017 I I THOMAS PAGE: 596 GRID: H3 ,LOCALITY: TEMPLE CITY CAI I I I I (TENANT: (EXIST BLDG USE: RESID - USE ZONE: R-1 11SSUED ON: PROCESSED BY: 1 1 (EXIST OCC GRP: 104/27/12 SR' I I I I I (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 HERMOSILLO, SUSAN (626) 286-8273- 1 1 - 15,000 15756 LOMAAV I 1 I ITEMP 917802452 1 - FEES PAID IDESCRIPTION OF WORK •� I IREPAIR HOLD IN THE ROOF, REINFORCE THE RAFTERS, DRYWALL I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IREPLACEMENT I (APPLICANT: TEL. NO: I I - 1 (SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 - 1 JAB STATE GREEN BLDG FEE 15000.00 VAL 1.00 ISPECIAL. CONDITIONS: 1 IAC STRONG MOTION RESID 15000.00 VAL 1.50 I I 1 ID2 PERMIT W/O EN-HC 15000.00 VAL 300.60 I I I I TOTAL FEES 330.90 I I ICONTRACTOR: TEL. NO: I 1APPROVALS- DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I _ - I LIC. NO I (LOCATION AND SETBACKS I I I I I I 1 I (SOILS ENGINEER APPROVAL 1 I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I - I LIC. NO: i JSLAB/UNDER FLOOR I I I I 1 (RAISED FLOOR FRAMING I I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I " I I 1150H265 3 - GOI EXr` tlNp.'.flN I I 1 I I E D" I FLOOR SHEATHING N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I I I• 1 0 NO 21 1 (ROOF SHEATHING I I SCHOOL WITHIN HAZARDOUS (SHEAR PANEL I I 1AIR QUALITY: 1000 FEET MATERIALS I I NO NO NO I 1FRAME INSPECTION- I I IFIRE SPRINKLER HANGERS I - I I I I I I 1 1 11NSULATION/WEATHER STRIPI I 1 I I I I I I I (INTERIOR LATH/DRYWALL I (EXTERIOR LATH 1 I (RATED FLOOR/CEIL ASSEM. ' I IRATED WALL ASSEMBLIES I I - I I I I I I I I (RATED SHAFTS/OPENINGS I I I 1 IT-BAR CEILINGS I I I I I ILOT DRAINAGE 1 (REPORT ID: DPR261 ROUTE TO: BS0508 I I 1 I 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 1204270015 - PHONE: .(626') 285-0488 EXT:, DUPLICATE ILEGAL ID: 1 NO. OF CONST BUILDING ADDRESS: 1 ON FILE SQ. FT STORIES TYPE 5756 LOMA AV 1 I (STRUCTURE: 1500 V-B I TEMP CA 917802452 1 (ASSESSOR INFORMATION NUMBER: _ NEAREST CROSS STREET:. - I 15387-017-017 - THOMAS PAGE: 596 GRID: H3. LOCALITY: TEMPLE CITY CAI I I I f I (TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: : 1 _ IEXIST OCC GRP: _ 104/27/12 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: _ VALUATION: ., IFINAL DATE FINAL BY: CODE: IHERMOSILLO, SUSAN (626) 286-8273- 1 1 5,000" 1 15756 LOMA AV ITEMP 917802452 . - FEES PAID IDESCRIPTION OF WORK IREROOF WITH 25 YEAR ASPHALT SHINGLES IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( (APPLICANT: TEL. NO: ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 1 IAB STATE GREEN BLDG FEE 5000.00 VAL 1.00 ISPECIAL-CONDITIONS: 1 IAC STRONG MOTION RESID 5000.00 VAL 0.50 1 1 1 - ID2 PERMIT W/O EN-HC 5000.00 VAL 132.60 1 1 I I TOTAL FEES 161.90 I 1 ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 ISAME AS OWNER - I I 1 I _ LIC. NO 1 ILOCATION AND SETBACKS I I I I I I I I I ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I LIC. NO: 1 (SLAB/UNDER FLOOR I ' I I I I I I I I IRAISED FLOOR FRAMING I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE:, CMP: ( (UNDERFLOOR INSULATION I I 115OH265 3 001 f I I I I IIFLOOR SHEATHING 0 NO 21 EXP NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: II-11�/U I1 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS 1 :-\O ISHEAR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS 1 I I 1 I NO NO NO 1 (FRAME INSPECTION I 1 1 I I I I I I 1 1 IFIRE SPRINKLER HANGERS I I I I I I I I I 1 1 (INSULATION/WEATHER STRIPI I 1 I I I I I (INTERIOR LATH/DRYWALL I I I I I I I 1EXTERIOR LATH I I I I I I 1 IRATED FLOOR/CEIL ASSEM. I 1 I I IRATED WALL ASSEMBLIES I I I I 1 IRATED SHAFTS/OPENINGS 1 I I 1 I I I IT-BAR CEILINGS I I I ILOT DRAINAGE 1 I 1 I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 1 1 1 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 1207160093 PHONE: (626) 285-0488 , EXT: ILEGAL ID: 1 - NO. OF CONST '! 1 BUILDING ADDRESS: 'I 1 ON FILE I SQ. FT STORIES TYPE 1 5756 LOMA AV 1 JSTRUCTURE: V-B TEMP CA 917802452 r (ASSESSOR INFORMATION NUMBER: • 1 - NEAREST CROSS,STREET: 15387-017-017 - 1 - THOMAS PAGE: 596 ..GRID: H3 LOCALITY: TEMPLE CITY CAI I - • I I I (TENANT: _ (EXIST BLDG USE: RESID USE ZONE: R-1 ('ISSUED ON: PROCESSED BY: I (EXIST OCC GRP: 107/17/12 SR 1 (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: I IHERMOSILLO, SUSAN (626) 485-5845- 1 1 8,272 15756 LOMA-AV 1 I I ITEMP 917802452 ., 1 FEES PAID (DESCRIPTION OF WORK 1 I JADD VOLUNTARY BEAM UNDER EXISTING CEILING. JOISTS. NO CHANGE J IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IN WALL LOC F6 PPROVED SLIDING DOOR CHANGED TO FRENCH 1APPLICANT: TEL. NO: 1 (DOOR 3 WINDOWS HANGED LIKE FOR LIKE ONLY ISAME AS OWNER - JB1 PLANCHECK W/ENERGY 8272.00 VAL 186.80 1 - G•�` s�y/ I IAA BLDG PERMIT ISSUANCE . 27.80 ISPECIALC DITIONS: �I JAB STATE GREEN BLDG FEE 8272.00 VAL 1.00 I J JAC STRONG MOTION RESID 8272.00 VAL 0.80 1 rpa �Q.'` JB2 PERMIT W/ENERGY 8272.00 VAL 219.80 1 ell it` N �AI CONTRACTOR: TEL. ,NO:' 1 . . TOTAL FEES 436.20 JAPPROVALS DATE 11 PECTOR SIGNATURE 1 ISAME.AS OWNER - 1 I I I LIC. NO I ]LOCATION AND SETBACKS 1 1 I I I I I I I I (SOILS ENGINEER APPROVAL 1 1 1 I I I I I I JARCHITECT OR ENGINEER: TEL. NO: 1 (FOUNDATION/TRENCH FORMS I I 1 LIC. NO: 1 JSLAB/UNDER FLOOR ( 1 1 I I I I I I I I JRAISED FLOOR FRAMING I I I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I JUNDERFLOOR INSULATION I I 1 1150H265 3 001 - 1 1-1 1 ' I I (FLOOR SHEATHING I 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I Expill NO 21 11ROOF SHEATHING 1SCHOOL WITHIN HAZARDOUS 1 �® ISHEAR PANELSJAIR QUALITY: 1000 FEET MATERIALS 1I I I 1 NO NO NO 1 Z 31- ks (FRAME INSPECTION I I 7 IFIRE SPRINKLER HANGERS . 1 J 1 1 1 11NSULATION/WEATHER STRIPI I I I I 11 I 1 I JINTERIOR LATH/DRYWALL 1 1 1 I I I I I I 1 1 1EXTERIOR LATH I 1 1 I (RATED FLOOR/CEIL ASSEM. J I I IRATED WALL ASSEMBLIES I I 1 1 (RATED SHAFTS/OPENINGS I 1 IT-BAR CEILINGS 1 1 I I I I I I 1 1 ILOT DRAINAGE 1 I I I I I I REPORT ID: DPR261 ROUTE TO: BS0508 1 1