HomeMy Public PortalAbout9443 LAS TUNAS DR_Building__ WORKERS' COMPENSATION DECLARATION, L-_.� c.1
hereby affirm that-I have a certificate of consent to self APPLICATION .
P P L I C AT I®IV F®R BUILDING PERMIT I I
I nsure, or n,certificate of Workers' Compensation Insurance,
of-a certified copy-thereof (Sec. 3800, ab. C.)
;j2:n,�2 p COUNTY OF LOS ANGELES. BUILDING AND SAFETY
PolicyN man `
❑ Certified copy is he urnis FOR APPLICANT TO FILL IN BUILDING r f. y \
ADDRESS `K`J
Certified copy ' filed'wit a c' b ing inspe - BUILDING CJ l
tion deparim nt.'. ADDRESS q
/Date Lff
Applic CITE &VIA-C C ZIP LOCALITY
CERTIFICATE O _ TI RKERS' NO, OF BLDGS.. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be,completed'if the,permit is for one ASSESSOR
hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL. USE ZONE' MAp
OWNER 1 O JG NO. /j
I certify that in the*performance of the work,for which this / NO.
permit is issued,:)shall not employ any person in any manner / i. SPECIALt
so as to become'subject to the Workers'Compensation Laws. ADDRESS �i�->
�+ CONDITIONS
Date Applicant I CITY a.t✓ ZIP - V
ARCHITECT OR TEL. -
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY O
Exemption, you should become subject to the Workers' CONST.. ZONE H;
Compensation provisions of the Labor Code, you must forth- ADDRESS
with comply-with such provisions or this permit shall be TEL, STATISTICAL CLASSIFICATION APT. KNDO.. U)deemed revoked. CONTRACTOR ISS 5 g� Co. N .�� ���'
LICENSED CONTRACTORS DECLARATION. LIC. G` f CLASS NO. / DWELL.UNITS
I heieby.affirm that l am licensed under provisions of Chapter 9 ADDRESS �ti Q,*--> ANO. -1 ib^"+1
(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-
y�q SQ. FT. " No. OF' FA OF CHECK
License Number 1 Lic.Class ` SIZE STORIES \ FAMILIES ONE
_ $ I (/
Contractor 12)11 J1� Dote" � DESCRIPTION OF WORK ��•� NEW $ •
\ ADD ❑
❑ I am exempt under Sec. T—�
• - ALTER .-❑
B.&P.C. for this reason REPAIR ❑ $
Date: USE OF _ DEMOL ❑
EXISTING BLDG.
Signature APPLICANT TE FINAL
OWNER-BUILDER DECLARATION PRINT C��t�S 5� L0 N DATE
I hereby affirm that I am exempt from the Contractor's License
Law
�y� �, v
Law for the following reason,(Section 7031.5, Business and ADDRESS FIN
Professions Code): PRESENTB
❑ BUILDING
I, as owner of�the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and
the structure isnot intended or offered for sale(Section LOCALITY,
7044, Business and Professions'.Code). MOVING TEL.
I, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contractors construct the project (Sec- ADDRESS � o�� y
' tion 7044, Business and ProfessionsCode).
REQUIRED TOTAL SETBACK
CONSTRUCTION LENDING AGENCY SET BACKYARD 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 C.1P.L. res. 7
C .- -� ,�
Lender's Name a T= x ter-,•,. 3> y
d Ref.! t.
m P.C. Fee$ ermit Fee RkIAA
Lender's-AddressI cam _ a• ave read this application and state that the Issuance Fee V J (f P/C qt
g oa6 ve informati n is.correct. I agree to comply with all County_ Investigation Fee I
°q ordinance Sto e.jreprese
ting to building construction, Tonal Fee TDMA Perm, q
N
and,he utho`ze ffs
of this County to enter
u on ab entifor inspectjnn purposes. t }�, - ,.n
7 SEE REVERSE FOR EXPLANATORY LANGUAGE
C_ej C:_t t-"
Si Applicant or Agent Data r.r .O iii in tm'! cri
/YORKERS'COMPENSATION DECLARATION -
G l i213�
YI (#farm"'that,l have a,certificate of consent.to;.self APPLICATION FOR R U'L®I N G PERMIT 'E R A�0�.
�'•iri - - ® Bd®
',-or a certificate of Workers' Compensation Insurance,
or a certified copy thereof (Sec.,3800,Aab. C))'
'COUNTY OF LOS ANGELES BUI DNG A D SAFETY
Pol icy No (1a Y6'1 7411 Company F}CTC .�1��
Certified copy is hereby furnished. FOR APPLICANT TO'F(LL 1N
BUILDING —T
❑ .`Certified copy'is'filed'with the,county building inspec- BUILDING r _
t on'de artment. " §' ADDRESS D
AD RE55 UN
p -rip
Date '7 -�lS` APPliconf'` CITY, E1''\1 .Lt " . ZIP v_V LOCALITY
'CERTIFICATE OF'-EXEMPTION`.FRO WORKERS'' - NO.OF BLDGS. NEAREST
COMPENSATION INSURA CE'. SIZE OF LOT NOW ON'LOT CROSS ST. .dty
+ ASSESSOR
(This section need`not be completed.if the'permit
'is for one
hundred:dollars,($100).or less'`) - TRACT' BLOCK' LOT NO MAP'BOOK PAGE .' PARCEL
TELNO.'
I certify that in the performance of the.work for which this
OWNER W NO .0 �O-{ZJ�"'
USE �ONE MAP
permit is issued, I shall not employ any person in any manner ? SPECIAL i
s as"to become sub ect-to the Workers "Com ensation Laws. ADDRESS �.1 fj`� CONDITIONS C1'i
o, I P-
a
_ CITY d �\
Date Applicant ZIP
g 'Certificate• ARCHITECT OR TEC. D B
DISTRICT "G OUP TYPE FIRE PROCESSED
Y O
p y I ENGINEER NO. U.
-NOTICE,-.Tb.ptio ,, APPLICANT:*
oul1 shouIdP becotme- subject tFto the Workers,'
;Com ensation rovisions.of the.labor Code, ou must forth- r OW-
CONST ZONE
P PY ADDRESS" Jl�
with comply with.such provisions'or this permit shall, be ;
, STATISTICAL CLASSIFICATION APT. ONDO. . to
R Ydeemed rCONT .?• NO.CL7 'G
�'
LICENSED CONTRACTORS DECLARATION LiC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chopter•9 -ADDRESS uo OV,-pi: tCTC� NO. C3 xU SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and LIC.
Professions Code, and my license`is in full force'and effect.' CITY.'' }9\np�' CLASS,
BK G VALIDATION
- _
Q
SQ. FT. NO. OF NO.OF CHECK '.
IS
License Number 'S22O� Lic.Class SIZE STORIES FAMILIES ONE
FIG
' s ESGRIPTION OF WORK 1. `I11(!RVt7il1 ]— N VAL
(� A ION
Contract or '` 5�'�/N`� Date - D NEW
ti ADD ❑ 9 ` t/ D40,3A
Liam exempt under Sec. Y! 1KIL9 �S i(�c.
ALTER #-0,9:0 023
B:&P C for,.lhis reason REPAIR s' o
USE OF Q ❑ I. ;237,80.
Date EXISTING BLDG. t-W"�P�� S r/-1L DEMOL :Q c e 2 3 7,8.0 5.
Signatur ►g 7�f� � FINAL ..
APPLICANT TEL.
PRINT)•
OWNER-BIL ER DECLARATION No'6_ DATE 0 �' A�818
I hereby affirm that I am exempt from the Contractors License
Law for.the,'fol low,mg.reason (Section 7031:.5, Business and,. ADDRESS i � Q!V' a474L. `Jt71 �ZS��'�te� FI
Professions Code):' PRESENT ° .
BUILDING
a" 1, 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.
I"as owner o`f the'propejty_om exclusively contracting
CONTRACTOR . NO.
with licensed contractors-to consiructthe•'project (Sec
`ADDRESS V c<* l+
tion 7044, Business and•Professio_ns,Code): ti ° y-c'` �� �1 z 7,b A
CONSTRUCTION LE REQUIRED TOTAL SETBACK F
LENDING AGENCY SET BACK PROP, LINE WIDTH t5 `�
YARD,' HWY
I
hereby,affirm,that thereis a construction lending agency for •, FRONT ,. ':i # o g`o'o •'�
the performance of the work for which"this permit is issued PA. .
(Sec: 3097;Civ.:c..). SIDE h`o 290.25
I .n
Lender's Name /�1 A ( e o 2 9 0,�5�
�^ Ref. #y..
• - P.L. -
m -. P.C. Fee$ Permit•Fee
ci!�,� ; LDMA
tender.'s Address L 2.°2 0 8 8
o I certify that l.have,read this application`and state that the Issuance Fee. . (�;� LDMA P/C# • ,
` above information is correct: I,agree to'comply with;all County Investi.garion Fee
'o ordinances and State laws.relating,to building construction, - • •�', _ .s
o Total'Fee ' LDMA Perm. #'
and hereby authorize representatives of this County to enter
` upon the above-me ioned•property for inspection purposes "
C SEE REVERSE'FOR EXPLANATORY.LANGUAGE
Signature YApofic6nt or Agent ,.Date „
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS.ANGELES BUILDING AND SAFETY.
WORKER'S,COMPENSATION DECLARATION FOR APPLICANT.TO FILL IN BUI ING ADD SS _
- t
BU NG ADDR SS
I hereby.afftrm that I have a certificate of consent,to self Insure, .FJ-
or a certificate of Workers' Compensation Insurance,or a certified �AJAI� ' M ` / -7 ,v
copy thereof'(Sec.3800,Lab.C.) CITY ZIP
T&MtL E C T LOCALITY
Policy No. Company SIZE OF LOT -NO.OF BLDGS. -
❑ Certified Copy is hereby furnished. NEAREST CROSS S.
❑ Certified copy is filed with the countybuilding inspection TRACT BLOCK LOT NO. XV TLS'•` l/�
department. USE ZONE MAP NO.
- ASSESSOR MAP BOOKPAGE - PARCEL
Date Applicant SPECIAL CONDITIONS
CERTIFICATE
0-
-
CERTIFICATE OF EXEMPTION FROM WORKERS . OWNER )
TEL NO.
COMPENSATION INSURANCE • r-M 0 C TI H ldt,_Ji3 -o WITHIN"1000 FT.OF SCHOOLS YES NO
(This section need not be completed if the permit is for one hundred ADDRESS
.t 3 .
DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100)or less.)
I certify that in the performance the work for which this permit CIT t I Mo IC
is issued, I shall not employ any person in any manner so as t0 •ARCHITECT OR ENGINEER - �1 - TEL NO. S
become subject to the Workers'Compensation Laws. STATISTICAL CL�Ej41�--••ATION APT COND
Date .Applicant - ADDRESS - CLASS NO. �p'SS�/� DWELL UNITS '
NOTICE TO APPLICANTIf, after making this Certificate of
REQUIRED TOTAL SETBACK FROM EXIST .
Exemption, you should', become .subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD, HWY PROP LINE WIDTH
.Compensation provisions of.the Labor Code, you must forthwith
FRONT
comply with such provisions or,this permit shall be deemed revoked. ADDRESS LIC.NO. PL
LICENSED CONTRACTORS DECLARATION
SIDE
-. CITY' LIC.CLASS -P L _
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division.3 of the Business and S0.FT.SIZE NO.OF STORIES - NO.OF FAMILIES
Professions Code,and my license,is in full force and effect. NEW ❑ K PG loll-License Number Lic.Class - DESCRIPTION OF WORK' ` - ADD - VALUATION „dye - 0
Contractor Date r ALTER ❑; Skj�S U/0 Vl/
E1.1 am exempt under Sec. REPAIR 1:1 $ 0
B.&P.C.for this reason DEMOL ❑ V
. _ LD_MA P/C#- W
Date: - USE OF EXISTING-BLDG.. - URM .. ❑ " CL
(n
Signature - APP (CANT(PRINT-L— TEL NO. LDMA Perm# ^{_I4 •�
I, as owner of the property,'or my.employees with wages asI Z
heir sole compensation, will do the work and the structure is AD rI'
ESS _ 7 r O - T �- �• __,
1 "' r FINAL DATE � -
TcI �� . Lt J
not intended.or offered for sale (Section 7044, Business and Q
3 1 �^"0
PfOfeSSIODS Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERI ;S ISL ., 72 =''>.-F
❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN T E _
Y. Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY -q.
licensed contractors to construct the project (Section 7044, ! t
VES❑ NO❑ .:6- 'ir�
Business and Professions Code.) r•= a
WILL THE INTENDED USE OF THE BUIDLING-BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES. -
I hereby affirm that there is a construction lending,agency for YES_❑ No❑
a the performance of the work for which thispermitis issued(Sec.
O� I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING _ _ _ ,
3097, CIV.C.) _ CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, - y� "s is z'_?
_ TITLE 2,CHAPTER 2.20 SECTIONS 2,20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS f` — �' I'
3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT.FROM THE SCAQMD. -
o Lender's Address" -
O - OWNER OR AGENT
o I certify that I have read this application and state under penalty .
O of perjury that the,above information is correct.I agree t0 Comply P.C.FEE -- PERMIT FEE -
o with all county ordinances and State laws relating to building
construction, and Hereby authorize representatives of this County ISSUANCE FEE
VQI.nter up the the abovoned property for inspection purposes.
Y l - !/ INVESTIGATION FEE TOTAL FEE
�gnaw.e of oior Aeem �-�. [ D to r
SEE REVERSE FOR EXPLANATORY LANGUAGE
i
COUNTY OF LOS ANGELES TEMPLE CITY. # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SIGN
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9610010012
PHONE: (818) 285-0488 EXT:
LEGAL ID: NUMBER OF SIGNS: 1 BUILDING ADDRESS:
TR: 8526 LT: 1 BL: .001 SIGN DESCRIPTION: WALL SIGN WITH ELECTRIC 9443 1/2 LAS TUNAS DR'
TEMP CA 917802100
ASSESSOR INFORMATION UMBER: NEAREST CROSS STREET: OAK
8587-008-018 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON:
HOME BOX VIDEO EXIST OCC GRP: 10/01/96 TC 10/01/97
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: DE:
TEMPLE CITY PROPERTIES - 1,350
533.14TH ST 9-,4'
SANM 904022927 FEES PAID D SCRIPTION OF WORK
WALL SIGN WITH ELECTRICAL
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
ITAL SIGNS (818) 444-6027- AA BLDG PERMIT ISSUANCE 27.75.
2651 N. LEE AVE. #3 AC STRONG MOTION RESID 1350.00 VAL 0.50 SPECIAL CONDITIONS:
SO. EL MONTE, CA D2 PERMI77'
. -, �0 350,00 VAL 82.20
T,OTAL FEES 110.45CONTRACTOR: TEL. NO: � - � j ;? APPROVALS DATE INSPECTOR SIGNATURE
ITAL SIGNS
2651 N. LEE AVE. #3 LIC. NO
\` LOCATION AND SETBACKS
SO. EL MONTE, CA 91733 C45
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: - FOUNDATI N/TREN H FORMS
LIC. N0: _ " 1 SUPPORT STRUCTURE
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMF-.-
00
MP'00 -
N0. OF FA 1LIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 20
SCHOOL WITHIN HAZARDOUS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
* ADDITIONAL DATA ON FILE i
REPORT ID: DPR261 ROUTE TO: BS0508
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0008070038
PHONE: (626) 285-0488 EXT:
LEGAL ID: NUMBER OF SIGNS: 2 BUILDING ADDRESS:
TR: 8526 LT: 1 BL: .001 SIGN DESCRIPTION: ONE WALL SIGN AND REPLACE EXISTING PO 9443 LAS TUNAS DR
TEMP CA 917802100
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OAK AVAE.
8587-008-018 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON:
DOMINO'S PIZZA EXIST OCC GRP: 08/07/00 UT 02/04/01
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FPYNIL3,500 FINAL LY: CODE:
533 14TH ST
TEMPLE CITY PROPERTIES /
D/ y _1.
SANM 904022927 FEES PAID DESURIFYT40N OF WORK
REPLACE EXISITNG ILLUMINATED WALL SIGN WITH NEW/REFACE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
DIVERSIFIED SIGNS & GRAPHICS (714) 744-2845- AA BLDG PERMIT ISSUANCE 27.75
5602 E. LA PALMA AE STRONG MOTION OTHER 3500.00 VAL 0.74 SPECIAL CONDITIONS:
ANAHEIM, CA AX BUILDING REV:I,EWfEEE=—=----,, 54.70
D2 PERMIT W/ON.HC,- 3500t00 VAL 115.80
ELE TOTA&FEES 198.99
CONTRACTOR:
DIVERSIFIIED SIGNS AND GRAPHICS (714)NAPPROVALS DATE INSPECTOR SIGNATURE
701-1330 ®� �����
5602 E. LA PALMA AVE LIC. NO LOCATION AND SETBACKS
ANAHEIM CA 92807 737055/C45
/ SOII:S ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. N0: I 1111111 SUPPORT STRUCTURE
MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:-
00 n n D n n Fl n �r 3
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS--
-NO 20 \�
V\ D 1) 11V
SCHOOL WITHIN HAZARDOUS 0 � ^�t*
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO `-
(m�h ®q�
91"v c 7b�$�
REPORT ID: DPR261 ROUTE TO: BS0508