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HomeMy Public PortalAbout9524 LIVE OAK AVE_Building__ WORKERS' COMPENSATION DECLARATION insure,hereby aafism that I havea certificate of conscertif certificate of Workers' Compensation ent Insuran to e',, APPLICATION F O R.. B U I L D I N G PERMIT or a certified copy thereof (Sec. 3800`, Lab. C.) COUNTY OF LOS ANGELES' BUILDING AND SAFETY Policy No./4� 'Company `j �S• 60 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS LZ,%e, ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS -47 6'! / Date '����� Applicant 0 � ��S i�/fr'� �y CITY Cc.1� ZIP J (yv LOCALITY v.. 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 ��lJ p PAGE PARCEL awe hundred dollars ($100) or less.), TEL. ?�j a J f t OWNER j NO / USE ZONE MAP I certify that in the performance.ohe work for which This NO. permit is issued, I shall not.employ any person in any manner ADDRESS "� � �1/u SPECIAL CONDITIONS d so as to become subject to the Workers'Compensation Laws. /' c 0 . CITY�r) /P 4% ZIP JJ72® Date Applicant ARCHITECT OR TEL. DISTRICT. GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making This Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the-Workers' LU Compensation-pro4isions of the Labor Code, you must.forth- ADDRESS +�V `J t' G�%`�-�`� with comply with such provisions.or this permit shall be //11�� TEL. STATISTICAL CLASS ATION APT. CONDO. Z NO. deemed revoked. CONTRACTOR OUr !i _ t LIC. CLASS NO.�t-_ --C-DWEt. IT LICENSED CONTRACTORS DECLARATION ADDRESS •ZG J .N, ,�dlw/"/ NO. xi 1 741I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section-7000)of Division 3 of the Business LIC. �j 10 ' and Professions Code,and my license is in full force and effect. CITY r vt�,1 ' G CLASS BK PG VALIDATION �Lj SQ. FT: NO. OF NO. OF CHECK License Number) ' / / Lic. Class SIZE STORIES FAMILIES ONE _ ��''))_t, 01_05 © VALUATION ContractorC.u'�A ESt"DS '/ `�� Date `' DESCRIPTION OF WORK NEW ❑ ❑I am exempt under Sec. F S � ADD ❑ $ ► ALTER ❑ B.&P.C. for this reason REPAIR ❑ a Date: USE OF EXISTING'BLDG. DEMOL ❑ Signature APPLICANT TEL. ,t FINAL OWNER-BUILDER DECLARATION (PRINT). &4 06e NO.7YJ�GY)�� ,,SS yam" f, DATE -171 ` - I hereby affirm that I am exempt from the Contractor's License ADDRESS 7 265 m r �/'m.��` 4 Law for the following reason (Section 7031.5,.Business and r FINAL Professions Code): PRESENT By - rACCT�v BUILDING ❑ 1, as owner of the property, or my employees with ADDRESS �r?�` -+'S0r L' wages as their sole compensation,will do the work and S .:v°'t" the structure is not intended or offered for sale(Section LOCALITY r 7044, Business and Professions Code.) MOVING' TEL. � `�-%� 1 ITEMS ❑ I, as owner of the property, am exclusively contracting rADDRE NO. <� +o TOTAL 1. ,48®63 with licensed contractors to construct the project (Sec- TOTAL tion 7044, Business and Professions Code.) `j�x, CHECK 128.63 TOTAL SETBACK FROM EXIST. t 3 T CONSTRUCTION LENDING'AGENCY YARD HWY PROP. LINE WIDTH r' I 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.). _ r /i _Ilii-! Ll17y t�.l tI �Lender's Name. LDMA Ref. # r} vC/ /' Permit Fee �� O t7 �� �i t �O 3 Lenders AddressPool o I certify that I have read this application and state that the Issuance Fee 7_r LDMA P/C# , 8 above information is correct. I agree to comply with all County Investigation Fee " 6 ordinances and State laws relating to building construction, Total Fee / LDMA Perm. # a and hereby authorize representatives of this-County to enter upon the above-m tioned property for inspection purposes. lam/- `+� t'3 "/7 SEE REVERSE FOR EXPLANATORY LANGUAGE <_ture.4f Applicant or Agent Date . 'WORKERS' COMPENSATION DECLARATION inure boraafcertif cathat te of WorkersrtCompens tion Insuran ificate of coent to self APPLICATION FOR BUILDING PERMIT or,a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed 'th the county building ins ec- BUILDING v tion department. ADDRESS /V - LA U A1< 7-EI-1— ^}y � �J�1: C{j vl W7 fv LOCALITY �j Date�: Applicant CITY NO. OF BLDGS. CERTIFICATE OF EXEMP 10 FROM WORKERS' SIZE OF LOT O Q,l� NOW ON LOT NEAREST CROSS ST. COMPENSATIO I SURANCE ASSESSOR (This section need not be comp ed if the permit is for one TRACT I Z- BLOCK LOT NO. V MAP BOOK �d(3 PAGE Ino6 PARCEL40/49 hundred dollars ($100) or less.) TEL. ' % ZUSE ZONE MAP �f y OWNER NO. NO. /- >_-7 I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS v / CONDITIONS so as to become subject to the Workers' Compensation Laws. CLQ CITY zip U Date Applicant ARCHITECT OR TEL. Q' t DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT:-If, after making this Certificate of ENGINEER NO. 2,0 7 [„ CONST. ZONE Exemption, you should become subject to the Workers'. _ a (J ' / Compensation provisions of the Labor Code, /i /r D �O !� 11-3 L��1�¢ - W p p you must forth- ADDRESS Z11 / 00- with with comply with such provisions or this permit shall be V, TE STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR NO. /. Z LICENSED CONTRACTORS-DECLARATION UC. CLASS NO. .>/LDWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS •�� 7 NO.SZ-7 77 (commencing with Section 7000)of Division 3 of the Business Of" LIC. ^� SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS G BK PG VALIDATION c SQ. FT NO. OF NO. OF CHECK License Number 92_7'579( LLiicc..Class SIZE STORIES FAMILIES ONE Contractor � S/t•/��8 a�17 to q y+ L� VALUATION / `�()��/y \� DESC�ON OF RK NEW � �,G 3 /y ADD ElS 1.ZL NEW ,❑I am exempt under Sec. F J ALTER ❑ B.BP.C. for this reasonS rf USE OF REPAIR ❑ Da EXISTING BLDG. DEMOL ❑ �7'✓ V Signature APPLICANT TEL. (PRINT) NO. WNER-BUILDER DECLARATION. C!. DATEL , I hereby offi t at I am exempt from the Contractor's Lice se Law for the o owing reason (Section 7031.5, Business qty ADDRESS FINAL Professions Code): 6 PRESENT By i BUILDING I, as owner of the property, or my employees Q� ADDRESS wages as their sole compensation,will do the workSection LOCALITY JT :7` the structure is not intended or offered for sole( ❑ 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 tion 7044, Business and Professions Code.) s'')I'�• ___ __ REQUIRED TOTAL SETBACK FROM EXIST. CONSTRCJCTION LENDING AGENCY SET BACK YARD 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. {,!iii';.. (Sec. 3097, Civ. C.). SIDE ` P.L. Lender's Name m /Q /' O LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee j �;��? � :t a^:,,•-, 0 1 certify that I have read this application and state that the Issuance Fee c7,V76 LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State laws relating to building construction, Total Fee C;7 40 3 LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mention d roperty for inspectio put os s. a fj,� SEE REVERSE FOR EXPLANATORY LANGUAGE a e of Applicant'WrAgen` t Dat 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 1103210032 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: 1BK: 248 PG: 37 PC: 2 SQ. FT STORIES TYPE OCCUP GROUP 9524 LIVE OAK AV I (STRUCTURE: 0 1 V-B R-3 I TEMP CA 917802513 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: CLOVERLY 18588-006-028 OTHER: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl TENANT: JEXIST BLDG USE: USE ZONE: JISSUED ON: PROCESSED BY: 1 JEXIST OCC GRP: 111/13/12 SR J DOWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: JFINAL DATE FINAL Y: CODE: J JCHANG, JOSHUA (626) 376-5599- 1 24,080 1 1 19518 LIVE OAK AV I 1�_ JTEMP 917802513 FEES PAID JDESCRIPTION OF WORK SOLAR INSTALLATION FLUSH W/ROOF J IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: J JAPPLICANT: TEL. NO: I J JCHANG, JOSHUA (877) 528-6726- ID7 ADDNL PLANCHECK FEE 1.00 HOU 109.40 J 1412 WEST VALLEY BLVD IAA BLDG PERMIT ISSUANCE 27.80 JSPECIAL CONDITIONS: JSAN GABRIEL CA 91776 JAB STATE GREEN BLDG FEE 24080.00 VAL 1.00 J I 1 - JAC STRONG MOTION RESID 24080.00 VAL 2.400 J VV JD9 PC EXTENSION FEE 38.46 DOL 38.48 �j I (CONTRACTOR: TEL. NO: JPI RES PV PC<10KW 153.90 1APPROVAL DATE INSPECTOR SIGNATURE 1 JUS TOPCO ENERGY INC (977) 528-6726- JP2 INSPCT RES PV <10KW 138.00 1 J 14441 BALDWIN AVE A LIC. NO J TOTAL FEES 470.98 (LOCATION AND SETBACKS 1 J 1 1EL MONTE CA 91731 956994 1 1 1 1 1 1 I (SOILS ENGINEER APPROVAL 1 J 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 (FOUNDATION/TRENCH FORMS I I I IJWDA ARCHITECTS - I 11 1529 E. VALLEY BLVD. LIC. NO: I (SLAB/UNDER FLOOR ISAN GABRIEL, CA 91776 NONE 1 1 I 1 JRAISED FLOOR FRAMING 1 I I I IMAP NO:*SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: J JUNDERFLOOR INSULATION I I I 3 O-1 11ST LEVEL FLOOR SHEATH 1 I I NO. OF FAMILIES: DWELLLING UNITS: APN/COND: STAT CLASS: I IO 21 I 12ND LEVEL FLOOR SHEATH J 1 1 1 SCHOOL WITHIN HAZARDOUS ( IROOF SHEATHING I 1 I 1AIR QUALITY: 1000 FEET MATERIALS I i_ I I 1 J NO NO NO 1 IFIRE DEPT. FRAME INSPECTI I I 1 JBLDG DEPT. FRAME INSPECTI 1 I I J JSHEAR PANELS I 1 I I I 1 JINSULATION/WEATHER STRIPI I I J I 11NTERIOR LATH/DRYWALL I I I I J J JEXTERIOR LATH I I I I 1 1 ILOT DRAINAGE 1 1 I I I 1 I ISMOKE DETECTION DEVICES I I I IFIRE DEPARTMENT APPROVAL( I I I I I I I I I I I I I 1 JREPORT ID: DPR261 ROUTE TO: BS0508 I J I 1