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Home My Public Portal About6214 LOMA AVE_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent,to self APPLICATION FOR BUILDING^ PERMIT V insure; or a certificate of Worr kers' Compensation Insurance, �. �or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING-AND SAFETY Policy,No. Company. a Certified copy is hereby furnished. FOR APPLICANT TO FILL IN - BUILDING ADDRESS DCertified copy is filled with the county building i`spec- BUILDING tion department. ` ADDRESS. Date(o-/43'Grt'�( Applicant \ CITY Q �/ ZIP LOCALITY CERTIFICATE OF EXEMPTION"FROM WORK R NO. OF BLDGS. NEAREST . •COMPENSATION INSURANCE SIZE OF LOT fy v >( / NOW ON LOT � CROSS ST. (This section need not;be completed if the permit is for one �-� G ASSESSOR hundred dollars ($100)or less;) TRACT /O BLOCK LOT NO. 9-/p MAP BOOK PAGE PARCEL TEL.- USE ZONE MAP I certify that in the performance of the work for which this OWNER/< O Ott/pS' NO. NO. 7 permit is issued, I shall not employ any person in any manner SPECIAL, CL so cis to become subject to the Workers'Compensation Laws. ADDRESS , /!O^J�j ra- �/'� CONDITIONS Date Applicant CITY Pius /� ` Jf ZIP_ �- , lag NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. O DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER NO. Exemption, you should become subject to the Workers' - CONST. ZONE � Compensation provisions of the Labor'Code,-you must forth- ADDRESSLU with comply with such provisions or this permit shall be J TEL. STATIS ICAL CLA SIFIC TION PT. CONDO. deemed revoked. CONTRACTOR �/r✓—C�►� NO.s� �CJ LICENSED CONTRACTORS DECLARATION / LIC• CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS��/�GS��I S NO.<'<5 �S 3 (commencing with Section 7000)of Division 3 of the Business and LIC { SEWER MAP Professions Code, my license is in full force and effect. CITY � �` CLASs �?� VALIDATION SQ..FT. NO. OF NO.OF _ CHECK BK.� License Number Y�� Lic.Clas SIZE STORIES FAMILIES ONE { �[ V LUATION. ConiracTor Or�`� `��' * Date �O�!! DESCRIPTION OF WORKe! � /30�1.�'c��+. NEW O ADD " I am exempt under Sec: 2211 Ilcal ` a+'Y!L -- , ALTER B.BP.C. for this reasonS. � _ REPAIR Date- USE OF / DEMOL EXISTING BLDG. Signature /1� APPLICANT C1 TEL. FINAL 9 OWNER-BUILDER DECLARATION PRINT . .r NOSE y v DATE - I hereby affirm that I am exempt from the Contractor's License / S S Law for the following reason (Section 7031.5, Business and ADDRES�!' 7 B O"r/-1 e,,�qFINA Professions Code): PRESENT By BUILDING El I, as owner of the property, or my employees with ADDRESS - '� '-��•�A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , a o o 7044, Business and Professions Code): MOVING TEL. ❑ I, as owner of the properly, am exclusively contracting CONTRACTOR NO. 1 2 R 2 Q Q with licensed contractors to construct the project (Sec- FRIRED tion 7044, Business and Professions Code). 2, t- �' TOTAL SETBACK FROM T. CONSTRUCTION LENDING AGENCY •YARD HWY PROP. LINE WIDTH hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). m p Lender's Name g LDMA Ref. # Lender's Address Permit Fee I certify that I have readthis application-and state that the � y � � - � � � Issuance Fee Q• - LDMA P/C# - • a above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee ��% LDMA perm. # v and hereby authorize representatives of this County to enter m upon the abov =mentione perty for inspection pur oses. a � SEE REVERSE FOR EXPLANATORY LANGUAGE ` Signature of Ap i t or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1304250049 PHONE (626) 285-0488 EXT LEGAL ID NO. OF CONST NEW BUILDING ADDRESS J ITR 5904 LT 267 SQ FT STORIES TYPE OCCUP GROUP 6214 LOMA AV I _ISTRUCTURE 0 1 V-B R-3 I TEMP CA 917801634 J ASSESSOR INFORMATION NUMBER GARAGE NEAREST CROSS STREET 15384-012-013 OTHER THOMAS PAGE 596 GRID: H2 LOCALITY TEMPLE CITY, Cl TENANT IEXIST BLDG USE PHOTO (ISSUED ON PROCESSED BY: IEXIST OCC GRP R-3 105/22/13 SR OWNER TEL NO JBLDGS NOW ON LOT VALUATION FINAL. ATE FI Y CODE IWONG, ALAN (626) 863-7784- 20,000 1'1 16214 LOMA AV ITEMP 917801634 J FEES PAID IDESCRTPTION OF WORK 1 IRES ROOF MOUNT 20 PANELS 1 INVERT FOR PHOTOVOLTAIC INSTALL 1 IFEE DESCRIPTION QUANTITY UOM AMOUNT I 1 JAPPLICANT TEL NO (SMITH, LOGAN (909) 973-0226- IP1 RES PV PC<10KW 153 90 J_ J 11755 B IOWA AVE IAA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS J IRIVERSIDE CA 92507 JAB STATE GREEN BLDG FEE 20000 00 VAL 1 00 1 1 IP2 INSPCT RES PV <10KW 138 00 I 1 I TOTAL FEES 320 70 J 1 ICONTRACTOR TEL NO I JAPPROVALS DATE INSPECTOR SIGNATURE 1 ISOLARCITY CORPORATION (650) 638-1028- I 1- 13055 _13055 CLEARVIEW WAY LIC NO ILOCAIION AND SETBACKS ISAN MATEO CA 94402 888104 1 1-' �1 1 I i ISOItS ENGINEER APPROVAL I I ARCHITECT OR ENGINEER TEL NO IFOUrDATION/TRENCH FORMS LIC NO i JSLAE/UNDER FLOOR I I- 1 JRAIS'ED FLOOR FRAMING I 1 1 I I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I 1UNDERFLOOR INSULATION I 1 3 001 1 +' -1-1 1 I IFLOOR SHEATHING INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I II 1 1 NO 20 j IROOF SHEATHING 1 I 1 I SCHOOL WITHIN HAZARDOUS 1 (SHEAR PANELS (AIR QUALITY 1000 FEET MATERIALS 1 NO NO NO J IFRAP;E INSPECTION I I I (FIRE SPRINKLER HANGERS I I I 1 1 (INSULATION/WEATHER STRIPI I I JINT1RIOR LATH/DRYWALL I I I 1 I JEXTFRIOR LATH I I I 1 1 (RATED FLOOR/CEIL ASSEM 1 I 1RAT)D WALL ASSEMBLIES 1 1 I I 1 1 IRATED SHAFTS/OPENINGS I I 1 1I I I T-BAR CEILINGS I � 1 1 ILOT DRAINAGE I 1 1 I _ REPORT ID DPR261 ROUTE TO BS0508 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 0506100011 PHONE (626) 285-0488 EXT ' LEGAL ID NO OF CONST BUILDING ADDRESS TR 5904 LT 267 SQ FT STORIES TYPE - 6214 LOMA AV STRUCTURE. 2900 VN - TEMP CA 917801634 ASSESSOR INFORMATION NUMBER _ NEAREST CROSS STREET LAS TUNAS 5384-012-013 - THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, C TENANT: EXIST BLDG USE .RESID USE,ZONE R-1 ISSUED ON- PROCESSED BY EXPIRES ON EXIST OCC GRP 08/10/05 VG 08/05/06 OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE BY CODE KEH, BLANTON - 5,000 _ 6214 LOMA AV FXPI TEMP 917801634 ` FEES PAID DESCRIPTIO R • - REROOF OVER 1 LAYER OF ROOF WITH COMP SHINGLES FEE DESCRIPTION QUANTITY UOM AMOUNT APPLICANT TEL NO - - CHUNG (626) 287-0167- AA BLDG PERMIT ISSUANCE 27 75 6140• CAMELLIA AVE. AC STRONG MOTION RESID - 5000 00 VAL 0 50 SPECIAL CONDITIONS TEMPLE CITY 91780 D2 PERMIT W/O EN-HC 5000 00 VAL 132 60 TOTAL FEES 160 85 CONTRACTOR - TEL NO APPROIVALS DATE INSPECTOR SIGNATURE PROTEK CONSTRUCTION CO. (626) 287-0167- ' 6140 CAMELLIA AVE LIC NO LOCATION AND SETBACKS TEMPLE CITY, CA 91780 694176 C39 • SOILS ENGINEER APPROVAL 1 ARCHITECT OR ENGINEER. TEL NO - FOUNDATION/TRENCH FORMS LIC NO- SLAB/UNDER FLOOR i RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK: PAGE FIRE ZONE CMP UNDERFLOOR INSULATION XX 3 01 FLOOR SHEATHING NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME INSPECTION_ REQUIRED TOTAL SETBACK FROM EXIST - FIRE SPRINKLER HANGERS SET BACK YARD. HWY PROP LINE WIDTH t FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS: T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE •- REPORT ID: DPR261 ROUTE TO BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1104200045 PHONE (626) 285-0488 EXT ILEGAL ID F I NO OF CONST NEW I BUILDING ADDRESS ITR 5904 LT- 267 1 SQ FT STORIES TYPE OCCUP GROUPI 6214 LOMA AV 1 I -ISTRUCTURE 578 1 V-B R-3 I TEMP CA 917801634 I (ASSESSOR INFORMATION NUMBER 1 GARAGE I NEAREST CROSS STREET 1 15384-012-013 OTHER 77 1 V-B U I THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl ITENANT IEXIST BLDG USE USE ZONE (ISSUED ON PROCESSED BY 1 1EXIST OCC GRP 108/10/11 SR 1 TOWNER- TEL NO 1BLDGS NOW ON LOT VALUATION IFI Q&T FINPLAY CODE 1 WONG, ALAN I 87,220 I ��•uTJ 16214 LOMA AV 1 I ITEMP 917801634 1 FEES PAID JJESCRIPTION OF WORK 1 1ADD MASTER BEDROOM, BATHROOM, LAUNDRY ROOM, AND PATIO 1 IFEE DESCRIPTION QUANTITY. UOM AMOUNT I 1APPLICANT- TEL NO I 1 1KWOK, TERENCE (323) 697-2120- IB1 PLANCHECK W/ENERGY 87220 00 VAL 1,098 70 1 1760 E GARVEY AVE. S IAA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS- 1 IMONTEREY PARK 91755 IAB STATE GREEN BLDG FEE 87220 00 VAL 4 00 1 I IAC STRONG MOTION RESID 87220 00 VAL 8 70 1 1 IB2 PERMIT W/ENERGY 87220 00 VAL 1,292.60 ICONTRACTOR TEL NO I TOTAL FEES 2,431 80 (APPROVALS DATE INSPECTOR SIGNATURE I IBEN KWOK CONSTRUCTION CO. (626) 922-6181- 1 1720 HILL PLACE #3 LIC NO 1 ILOCATION AND SETBACKS I 1 ILOS ANGELES, CA 90012 591589 B I I x I I I ISOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I 1 IKWOK, TERENCE (323) 697-2120- 1 16 � 1260 E GARVEY AVE LIC NO (SLAB/UNDER FLOOR I MONTEREY PARK, CA 91755 C24796 1 (RAISED FLOOR FRAMING I I I I I I IMAP NO SEWER MAP BOOK: PAGE FIRE ZONE CMP •a 1UNDERFLOOR INSULATION I I i 3 001 ` 1- _ i I 11ST LEVEL FLOOR SHEATH I INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 0 NO 21 1 12ND LEVEL FLOOR SHEATH 1 SCHOOL WITHIN HAZARDOUS IROOT SHEATHING (AIR QUALITY 1000 FEET MATERIALS I NO NO NO 1 IFIRE DEPT FRAME INSPECT IBLDG DEPT FRAME INSPECT I ISHEAR PANELS I 1 I (INSULATION/WEATHER STRI 1 ' (INTERIOR LATH/DRYWALL I IEXTERIOR LATH 1 I I I I I I ILOT DRAINAGE ISMOKE DETECTION DEVICES 1 I IFIRE DEPARTMENT APPROVALI I I I I I I I I I I I IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I i