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Home My Public Portal About9556 LOWER AZUSA RD_Building__ WORKERS COMPENSATION DECLARATION . , hereby affirm that I have a certificate of tangent to ,elf 4 APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers Compensation Insurance 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 Appy qs` p Certified copy is filed with the county building inspec BUILDING -7 fl tion department ADDRESS Z v Date Applicant CITY ZIP V LOCALITY Ie CERTIFICATE OF EXEMPTION FROM WORKERS OF BI DGS7� NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT ST (This section need not be completed if the permit is for one TRACT BLOCK LOT NO ASSESSOOORK PAGE PARCEL hundred dollars($100)or less ) TEL USE ZONE OWNER ra Q 0- I MAP Icertify that in the performance of the work for which this y.� � NO 0 > permit is issued I shall not employ any person in any manner ADDRESS a W Z(J s Kd � ' SPECIAL d as to become subject to the Workers Compensation Laws / CONDITIONS O Date —� Applicant CITY < ZIP 4 9(7 ru NOTICE TO AP CANT If after making this Certificat ENGIiNEER OR DISTRICT UP TYPE FIRE PROCESSED BY O Exemption you should become subject to the Workers NO CONST ZONE ® ri Compensation provisions of the Labor Code you must forth 3 IW ADDRESSIL with comply with such provisions or this permit shall be STATISTICAL CLASSIFICATIONAPT CON Z deemed revoked CONTRACTOR NO LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO 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 CLASS BK [.�� VALIDATION SQ FT NO OF NO OF CHECK License Number Lic Class SIZE ISTORIES FAMILIES ONE YALUArION Contractor Date DESCRIPTION OF WORKV1 4tL NEW _ -70 FiI am exempt under Sec r yy-- L d ALTER ADD , B&P C for this reason XAM� C sides It W BW REPAIR $ Date OF EXISTING BLDG &yV4cWck a<1wDEMOL Signature APPLICANT TEL FINAL OWNER BUILDER DECLARATION PRINTNO DATE 1 hereby affirm that 1 am exempt from the Contractor s License , Law for the following reason (Section 7031 5 Business and ADDRESS FINAL Professions Code) WENT By I as owner of the property or my employees with ADDRESS wages as their sole compensation will clothe work and t +. r r the structure Is not intended or offered for sale(Section LOCALITY / � + 7044 Business and Professions Code) MOVING TEL J}[ E3I as owner of the property am exclusively contracting CONTACTOR NO with licensed contractors to construct the project (Sec ADDRE tion 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY SET BAp YARD HWY TOTAL 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 Sd P L d Lender s Name LDMA Ref # Lender s Address PC Fee$ Permit Fee (�} I certify that I have read this application and state that the Issuance Fee 0 J"' LDMA PSC# Pool above information is correct I agree to comply with all CountyInv."gotion Fee ordinances and State laws relating to building construction Total Fee � i � TDMA,Perm # and hereby authorize representatives of this County to enter urapn the above mentioned roperty for inspection purposes ^ �� Y1. gb � L lt. �„ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Age pate O 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 1203010036 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ITR 12998 IT 18 SQ FT STORIES TYPE 9556 LOWER AZUSA RD STRUCTURE 1500 V-B TEMP CA 917804224 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 8592 001-032 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY C TEST 'EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY (EXIST OCC GRP 03/01/12 SR OWNER TEL NO JBLOGS NOW ON LOT VALUATION (FINAL TEF BY CODE CHAFFMAN CHARLES 1 5 900 li 9556 LOWER AZUSA RD TEMP 917804224 FEES PAID IMSCRIPTION OF WORK FEE DESCRIPTION QUANTITY UOM AMOUNT lHOUSS AFIRERRRATED SVE SHHIINGLES AND RIDGE CAP'S OD SHINGLES INSTALL OS3 B 1/20 PLYWOOD CLASS APPLICANT TEL NO BRIAN REfiFER (909) 608-0622 JAA BLDG PMU41T ISSUANCE 27 80 AB STATE GREEN BLDG FEE 5900 00 VAL 1 00 SPECIAL CONDITIONS AC STRONG MOTION RESID 5900 00 VAL 0 60 D2 PERMIT W/O EN HC 5900 00 VAL 149 40 TOTAL FEES 178 80 CONTRACTOR TEL NO APPROVALS DATE INSPECTOR SIGNATURE IKEEFER S ROOFING (909) 608 0622 1216 BEGONIA COURT LIC NO LOCATION AND SETBACKS UPLAND CA 91784 760903 C39 ! I SOILS ENGINEER APPROVAL ARCHITfiCT OR ENGINEER TEL NO JFOUNDATION/TRENCH FORMS lil LIC NO SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 144H269 3 00 NO OF FAMILIfi9 DWELLING UNITS APT/GOND STAT CLASS FLOOR SHEATHING 0 NO 21 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS I SHEAR PANELS AIR QUALITY 1000 FEET MATERIALS I NO NO NO FRAME INSPECTION (FIRE SPRINKLER HANGERS JINSULATION/WEATHER STRIP 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 I COUNTY OF IAS 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 1203010037 PHONE (626) 285-0488 EXT LEGAL ID I NO OF CONST I BUILDING ADDRESS ITR 12998 LT 18 I SQ FT STORIES TYPE 9556 LOWER AZUSA RD IA93fiSS0R INFORMATION NUMBER STRUCTURE 600 V-B I TEMP CA 917804224 I NEAREST CROSS STREET 8592 001 032 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY C TENANT EXIST BLDG USE DETAC USE ZONE R 1 ISSUED ON PROCESSED BY IfiXIST OCC GRP 03/01/12 SR OWNER TEL NO BLDGS NOW ON IAT VALUATION FINAL F CODE CHAFFMAN CHARLES - 2 000 9556 LOWER AZUSA RD Z TEMP 917804224 FEES PAID D CR.9�I�' I N OF WORK 7 DETACHED GARAGE REMOVE WOOD SHINGLE INSTALL 0 S B 1/2 PLYW APPLICANT TEL NO FEE DESCRIPTION QUANTITY UOM AMOUNT JOOD AND CLASS A FIRE RATED SHINGLES AND RIDGE CAP'S BRIAN KE PER (909) 608 0622 AA BLD() PERMIT ISSUANCE 27 80 AB STATE GREEN BLDG FEE 2000 00 VAL 1 00 ISPECIAL CONDITIONS AC STRONG MOTION RESID 2000 00 VAL 0 50 D2 PERMIT W/O EN HC 2000 00 VAL 82 20 TOTAL FEES 111 50 I I CONTRACTOR TEL NO (APPROVALS DATE INSPECTOR SIGNATURE KEEFER S ROOFING (909) 608 0622 I 1216 BEGONIA COURT LIC NO iLOCATION AND SETBACKS UPLAND CA 91784 760903 C39 ISOILS ENGINEER APPROVAL I (ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS I LIC NO SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP (UNDERFLOOR INSULATION 14411269 3 00 INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS (FLOOR SHEATHING 0 NO 21ROOF SHEATHING SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS AIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS IAT DRAINAGE REPORT ID DPR261 ROUTE TO ES0508 I