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HomeMy Public PortalAbout9518 LIVE OAK AVE_Building__ WORKERS' COMPENSATION DECLARATION i insure borax ce of caste of Workers' Comtpensat on Insuran of A P P L I Cent to T I.O N*F R BUILD.1 'G �P E RM I T or a certified copy thereof (Sec. 3800, La C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. �6 Company BUILDIN Certified copy is hereby furnished. J—1-7;)— FOR APPLICANT TO FILL IN ADDRES Certified copy is filed wVthe ounty b ilding in ec- BUILDING etion department. ADDRESS IV9N & Milk 71 Datey Applica _I le CITY �, U ZIP / 9�/ LOCALITY �l.G ��j NO. OF BLDGS. NEAREST CERTIFICATE OF EXEoON FROM WORKERS' SIZE OF LOT @ 2 NOW ON LOT CROSS ST. COMPENSASURANCE ^ ASSESSOR /(This section need not be cd if the permit is for one TRACT z BLOCK LOT NO. (✓ MAP BOOK PAGE TO rO PARCEL hundred dollars ($100) or less.) TEL. P USE ZONE MA OWNER NO. I certify that in the performance of the work for which this NO.SPECIAL } permit is issued, I shall not employ any person in any manner 1 ADDRESS CONDITIONS so as to become subject to the Workers' Compensation Laws. 1*j O CITY P V Date Applicant RCHITECT RTEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of U NO. 2 6 CONST. ZONE 0 Exemption, you should become subject to the Workers' p,, �/ /J V Compensation provisions of the Labor Code, you must forth- ADDRESS O � U f0 /�"� � ��/ zC " t1� a- with comply with such provisions or this permit shall beTE . �2 CSG STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. "•� CONTRACTOR J�i/�10. lSS u56 Z LICENSED CONTRACTORS DECLARATION � _ LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS •(� Ax 7 NO. SZ7 S7 (commencing with Section 7000)of Division 3 of the Business QQQ���,,, LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY /a CLASS BK PG VALIDATION SQ. F.T. NO. OF - NO. OF CHECK License Number 5;7767lic. Class SIZE STORIES FAMILIES ONE /nomG VALUATION Contractor / ldF' M05te 0- /2 DESCRIPTION OF WORK NEW S U o v , ❑I am exempt under Sec. ` ALTER [0]�� � C? ADD i z B.&P.C. for this reason i ,Li USE OF REPAIR ❑ ; U(�%/1!� Dote` 7 7EXISTING BLDG. DEMnI ❑ /l I tj Signature APPLICANT (PRINT). Np � FINAL WNER-BUILDER DECLARATION 1 n' DATE ,.Q L I hereby affi hat I am exempt from the Contractor's License gDDRESS 0 / V d�E•7 Law for the following reason (Section 7031.5, Business and \ FINAL Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS _t1�✓ l ' wages as their sole compensation;will do the work and RLi` , the structure is not intended or offered for sale(Section LOCALITY/ _„_• �”-- 7044, Business and Professions Code.) I MOVING TEL. • !!!11111 CONTRACTOR NO. - }'.=1!=' ❑ I, as owner of the property, am exclusively contracting �.�✓ with licensed contractors to construct the ! I (Sec-S ect ro tion 7044, Business and Professions Code.) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. J� "V�.r� _= CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH � d -' I hereby affirm That there-is a construction lending agency for FRONT' i•i ^aS-i• ;, ; the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ.-C.). SIDE P.L.- Lender's Name, J J J �� LDMA Ref. # P.C. Fee$ Permit Fee LS_,_ _ tlh Lender's Address 0 1 certify that I have read this application and state that the Issuance Fee 7S LDMA P/C# above information is correct. I agree to comply with all County InvestigationFee n� J ,� 0 ordinances and State laws relating to building construction, Total Fee J/ LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned pr perty for inspection urposes. a 10 I SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of pplicant A ent Date WORKERS' COMPENSATION DECLARATION to sf insure,ora certificatffirm e of Workers' CompensaT on I have a certificate of coent Insuran e, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab: C.)_ Policy No.10-6' 9 om pany OVA ��� 1As •'&,-o COUNTY OF LOS ANGELES BUILDING AND SAFETY �/ ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS PY Y ADDRESS tom. ❑ Certified copy is filed with the county building inspec- BUILDING O X/tion department.. ]h ddd ADDRESS �J Date Applicant ©� �:�5 P/13N��i� CITY Q,�1 C s ZIP () LOCALITY 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 BLOCK LOT NO. MAP BOOK (�� PAGE ODS PARCELa/Q hundred dollars ($100) or less.) / TEL. OWNER ` NO USE ZONE MAP I certify that in'the performance of the work for which this NO. �(2• SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS r d� . CONDITIONS � so as to become subject to the Workers' Compensation Laws. 9���� O CITY �/� E ZIP U Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE 0 Exemption, you should become.subject to the Workers' / U Compensation provisions of the Labor Code,,you must forth- ADDRESS `� �f 3 a with comply with such provisions or this permit shall be I TEL Qr�G.uu� STATISTICAL CASS ATIO I APT. CONDO. Z deemed revoked. CONTRACTOR t��. rG 4 �t� NO.rOr ii�� 77 �, _ LICENSED CONTRACTORS DECLARATION J LIC. 7!' CLASS NO. DW . UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �6S , !l/s�; NO..2_T1 (commencing with Section 7000)of Division 3 of the Business t _ SEWER MAP CITY r P�/e `�J CLASS _�� and Professions Code,and my7 q license is in full force and effect. BK PG. VALIDATION License Number ��1 1' 1- Lic. Class-36_,M SQZEFT STORIIEES MILLIIES O EK S/�`'i/1 OS � G� VALUATION �qj JCS c DESCRIPTION OF WORK NEW ❑ • Contractor ���0�? �Clate � // /z ADD ❑ E Elam exempt under Sec. I ► N , ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. U11l� �yy FINAL OWNER-BUILDER DECLARATION (PRINT) /)I/� ��1Q NO. 'y7��Q0/a7 ,y� J�� DATE — �9 I hereby affirm that I am exempt from the Contractor's License ADDRESS N / (R/i' ///p/IT�' 1 Law for the follow_ing reason (Section 7031.5, Business and FINAL Professions Code): PRESENT By ACCTIF ❑ I, as owner of the property, or my employees with BUILDINGADDRESS � wages as their sole compensation;,will do the work and .�,,4��, r� 3 the structure is not intended or offered for sale(Section LOCALITY f ITEMS 7044, Business and Professions Code.) MOVING TEL. i ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. /f7 TOTAL 158 ®7133 with licensed contractors to construct the project (Sec- ADDRESS �� 15 7'3, tion 7044, Business and Professions Code.) CHECK a'-`=■ '� REQUIRED TOTAL SETBACK FROM ]DISTTH I c CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE CHANGE .00 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 !!�� ,'4 qq O:- P.L.- IJ+J —i.lkJ 1 17 r i Lender's Name. ry i y.� LDMA Ref. # 5�,92 3 A!I t8 o 14 P.C.'Fee$ Permit Fee lJ Lender's Address1 certify that I have read this application and state that the Issuance Fee � LDMA P/C# above information is correct.'I agree to comply with all County Investigation Fee 8 ordinances and State laws relating to building construction, Total Fee 7 LDMA Perm. # a and hereby authorize representatives of this County to.enter u n the above- nti ned property for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE atu of Applicant or Agent Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS. RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0111200009 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: BK: 248 PG: 37 PC: 1 SQ. FT STORIES TYPE OCCUP GROUP 9518 LIVE OAK AV STRUCTURE: 192 1 VN R3 TEMP CA 917802513 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: TEMPLE CITY 8588-006-027 OTHER: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 11/20/01 JK 05/19/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: JIANG JING CHEIN CO TRS - 9,000 / /J 9518 LIVE OAK AV TEMP 917802513 FEES PAID DESCRIPTION OF WORK CONVERT EXISTING PATIO TO ENCLOSED PATIO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: F AND H CONSTRUCTION CO DBA FRANK (626) 255-2312- AA BLDG PERMIT ISSUANCE 27.75 4037 ARDEN DRIVE AC STRONG MOTION RESID 9000.00 VAL 0.90 SPECIAL CONDITIONS: EL MONTE 91731 AX BUILDING REVIEW PEE 54.70 D2 PERMIT W/O EN,HC 9000.00 VAL 199.80 CONTRACTOR: TEL. N0: TOTAL FEES 283.15APPROVALS DATE INSPECTOR SIGNATURE FRANK ZENG (626) 255-2312- 4037 ARDEN DR LIC. NO LOCATION AND SETBACKS EL MONTE CA 91731 C16 A _ SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. N0: _ _- SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: ST LEVEL FLOOR SHEATH NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS l ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL S T ACK FROM EXIST BLDG DEPT. FRAME INSPECT s SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508