The URL can be used to link to this page

Home My Public Portal About9363 LOWER AZUSA RD_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm,"at I have Urs' of,tion Int td self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurar:ce, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 3 V✓�IL,g— ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS CITY ZIP LOCALITY PLC,�!' C/ Date Applicant NO.OF IP 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 TRACTIZZW. BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL OWNER ) N USE ZONE MAP I certify that in the performanceo the work for which this SPE permit is issued, I shall not emplo ny perso in any manner ADDRESS SCONDITIONS PECIAL a- so as to becom bject to the or er' o ensation Laws. �p OU CITY (� ZIP Date Appl Iran 44ARCHITECT TEL. , Ix NOTI T APPLICANT: If, a t r making this Certi e o ENGINEER .r NO DISTRICT G CCOPNST. FIRE E ROCE ED BY O Exemption, you should become subject to the rkers' +� off u Compensation provisions of the Labor Code, you must forth- ?�ADDRESS! �� a- with comply with such provisions or this permit shall be TEL. STATISTICAL CLPASSI ICA710N APT. CO N r, Z deemed revoked. CONTRALTO �� •� „� t� LICENSED CONTRACTORS DECLARATION pp;�� LIC. ' CLASS NO. DWELL. UNITS zx 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRES$�rJ N rt LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business N and Professions Code,a my lice a is in full force a d effect. CITY r C BK. PG. VALIDATION SQ. O.OF NO. OF CHECK License Number Lic. loss- SIZE TORIES FAMILIES ONE VALUATION A Contract Dater DESCRIPTION OF WOR NEW $ p��')/7,oV ADD El am exempt under Sec. ❑ U(,�f / ALTER ❑ BAP.C. for this reason / REPAIR ❑ $ Date: EXISTING BLDG. DEMOL ❑ Signature APPLICANT FINAL OWNER-BUILDER DECLARATION (PRINT) DATE. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRE .t FINAL Professions Code): PRESENT ByBUILDING fit:C I o Ir ❑ I, as owner of the property, or my employees with ADDRESS �� 33017932.1^ wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY Poo . 1 ITEM 7044, Business and Professions Code.) MOVING TEL. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. TOTAL 932 2 e 11.7 with licensed contractors to construct the project (Sec- ADDRESSl- C�-{�ti �.r ' +'7e 1 tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST, CHANGE CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH i.•HE e 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 Lender's Name 9562 1 AM11'-��"` Lender's Address P.C. Fee$ Permit Fee 9 LDMA Ref. # I certify that I have read this application and state that the PIL/ Issuance Fee 3,O LDMA P/C# 3 above i rmation is correct. I agree to comply with all County Investigation Else or 9 s and t laws relating to building construction, PV Total Fee 1 LDMA perm. # = and er by a representatives of this County to enter up t ov io ed pro er for inspection purge s. o SEE REVERSE FOR EXPLANATORY LANGUAGE ignot're 5 Applicant r gent 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 0605160026 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: BK: 228 PG: 04 PC: 2 SQ. FT STORIES TYPE 9363 LOWER AZUSA RD STRUCTURE: 239 VN TEMP CA 917804218 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY 8590-024-029 THOMAS PAGE: 596 GRID: JS LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/16/06 JK 05/11/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: F AL AT/8 F lAL BY: CODE: YU, CHRISTINA (626) 285-1095- 4,780 i ,.�G� /b 9363 LOWER AZUSA RD TEMP 917804218 FEES PAID DESCRIPTION OF WORK PATIO ENCLOSURE 239.25 S.F. PER DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 4780.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING REVIEW FEE 54.70 D2 PERMIT W/O EN-HC 4780.00 VAL 132.60 TOTAL FEES 215.55 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS LIC. NO: SLAB UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:' UNDERFLOOR INSULATION 144H265 3 01 FLOCS 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: 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 LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508