HomeMy Public PortalAbout9507 LONGDEN AVE_Building__ ;,,%/V.dRI(,F,RS'r-OMPENSATIOI4 DECLARATION
insa-r'11 Rlh e ci irm that I.
cerfif cate of Workers'Compensatio'have a certificate of n Insurancent to e, APPLICATION FOR BUILDING PERMIT .
4 or a ified co thiglVe�,{(Sec. 3800, Lab. C.
�7� 4 '�' - COUNTY OF LOS ANGELES BUILDING A213 SAFETY
Policy No.IM Company J�!l
ertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING x3-07
ADDRESS (tJ
Certified copy is filed with the county buildin insp c- BUILDING `7 / f'
tion)department. ADDRESS ��� / �U� y
Date. / / Applicant CITY ZIP LOCALITY
CERTIFICATE OF EXEMPT FROM WORKERS' NO.OF BLDGS. ,,p NEAREST
COMPENSATIO INSURANCE SIZE OF LOT (' NOW ON LOT ; f✓/ CROSS ST.
(This section need not be completed if the permit is for oneASSESSOR
hundred dollars ($100)or less.) TRACT BLOCK LOT NQ MAP BOOK PAGE PARCEL
TEL. USE ZONE MAP ,{
I certify that in the performance of the work for which this OWNERIZIA Y r NO ///� NO. (l
permit is issued, I shall not employ any person in any manner ADDRESS T� t Q �� K`� SPECIAL
so as to become subject to the Workers'Compensation Laws. // -� f ) CONDITIONS 0O
Date Applicant CITIGCIE `(•bIZ�Ke24 ZIP z 0
9
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GR UP TYPE FIRE PRO ESSED BY
ENGINEER NO.
Exemption, you should become subject to the Workers' CONST. NE
Compensation provisions of the Labor Code, you must forth- ADDRESS (Jo A.
with comply with such provisions or this permit shall be N
deemed revoked. p p }� p TEL.'r.)1(^ Se CLASSIFICATION APT. NDO. z
CONTRACTOR �,/3t 4 NO. CLASS NO. DWELL. UNITS
LICENSED CONTRACTORS DECLARATION LIC,
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS4 H Gel ar°R� NO.
(commencing with Section 7000)of Division 3 of the Business andLIC SEWER MAP
Professions Code, and my license is in full force and effect. CITY %+�• �OX �7 LCLASS BK PGVALIDATION
SQ.FT.//� U NO.OF /r r NO.OF / CHECK
License Number Lic.Class SIZE /7, STORIES/ �, FAMILIES ! ONE
ALUPT Ohio t)
Contractor Date DESCRIPTION OF WORK C ! ADD ❑ S 191 v 09.2 9 5,8 A s p
r_1I am exempt under Sec. �C ~2 ALTER ❑ " .,# 0 0 0 0 2 3
BAP.C. for this reason I REPAIR ❑ $ 6 3 8,7 8 '
Date:
USE OF
EXISTING BLDG. 7/vDEMOL El
Signature APPLPRINTICANT �i `� NO.�TEL FINA
OWNER-BUILDER DECLARATION DATEJ 0 0 6 3 8,7 8 c=,
�j �� 0/0 FINA
I hereby affirm that I am exempt from the Contractor's License �l�� A.{iy�'l.�g�(�QL,J �� .09,20-85
Law for the following reason (Section 7031.5, Business and ADDRESS a
Professions Code): PRESENT Byz
!
❑ /;
I, as owner of the property, or my employees with BUILDING
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 of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- rDDsR
tion 7044, Business and Professions Code). 9 3 1 Q 0 A
ED TOTAL SETBACK FROM T.
CONSTRUCTION LENDING AGENCY CK YARD HWY PROP. LINE WIDTH # 0 0 0 0 0 1
1 hereby affirm that there is a construction lending agency for I o 7 6 2 0 0
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.). o - 762
x.
0,09-99
e Lender's Name
$ $ Permit Fee 1Ref. #
Lender's Addressx I certify that I have read this application and state that the Issuance Fee Q 'll LDMA P/C#
above information is correct. I ogre o comply with all County tion Fee J►
ordinances and State laws re ti to building construction, Total Fee 117 LDMA Perm. #
J and here authorize repres nt • es of this County to enter
3 upon tie a og lent' e r rty for inspe tion purposes.
o
SEE REVERSE FOR EXPLANATORY LANGUAGE
6111,Signature of Ap icant or Agent Date
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 0811170003
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
ON FILE I SQ. FT STORIES TYPE ] 9507 LONGDEN AV I
ISTRUCTURE: 32 V-B I TEMP CA 917801611 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: TEMPLE CITY I
15382-020-054 I I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I I I I
TENANT: EXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY:
I (EXIST OCC GRP: 111/17/08 SR
I I I I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFI D TE FI BY: CODE: I
ILI NATHANIEL (626) 285-4501- I 7,500 1 1
19507 LONGDEN AVE. I 1 � 1
ISGAB 917751511 I FEES PAID I CRIPTION OF WORK I
I ITEAR OFF AND REROOF 30 YEA COMPOSITION SHINGLES I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( I
(APPLICANT: TEL. NO: I I 1
ITANG (626) 288-1536- IAA BLDG PERMIT ISSUANCE 27.75 1 1
13912 VACHON DR. IAC STRONG MOTION RESID 7500.00 VAL 0.75 ISPECIAL CONDITIONS: I
IROSEMEAD, CA 91770 ID2 PERMIT W/O EN-HC 7500.00 VAL 183.00 1
1 I TOTAL FEES 211.50
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IYAN HOI TANG (626) 288-1536- 1 1
13912 VACHON DR LIC. NO I ILOCATION AND SETBACKS I I I
IROSEMEAD, CA 91770 620138 C39 *1 I I I I
I ISOIZS ENGINEER APPROVAL I ] ]
(ARCHITECT OR ENGINEER: TEL. N0: I IFOUNDATION/TRENCH FORMS I I I
LIC. NO: I (SLAB/UNDER FLOOR I I
1 1 ]RAISED FLOOR FRAMING ] I
I I ] I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:] JUNDERFLOOR INSULATION I I I
1153H265 3 001 1 I I I
1 _1 IFLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
NO 21 1 IROOF SHEATHINGI I
A I
I I I- 1
SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I
(AIR QUALITY: 1000 FEET MATERIALS I I- I 1
NO NO NO I IFRAME INSPECTION I I
I I I I ] ]
IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I I
ISET BACK YARD: HWY: PROP LINE: WIDTH: I I ] I
IFRONT PL- I IINSULATION/WEATHER STRIPI I 1
I SIDE PL- I 1 I 1 I
I ]INTERIOR LATH/DRYWALL I I 1
I I I I I I
I (EXTERIOR LATH I I
I IRATED FLOOR/CEIL ASSEM. 1 1
I ] I I I I
I IRATED WALL ASSEMBLIES 1 ] 1
I (RATED SHAFTS/OPENINGS ] ] I
I IT-BAR CEILINGS I ]
I ]* ADDITIONAL DATA ON FILE I I 1 ]
1 ] LOT DRAINAGE I 1 ]
IMEPORT ID: DPR261 ROUTE TO: BS0508 1 I 1 1
I I I I I I