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HomeMy Public PortalAbout9945 LOWER AZUSA RD_Building__ WORKERS'COMPENSATION DECLARATION hereby car that I have r certificate of consent to self a cert - APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, ' or a certified copy thereof(Sec 3800, Lob C) COUNTY OF LOS ANGELES BUILDING AND SAFETY Polity No V1C42JACompony rU-2— ce ❑j� Certified copy is hereby furnished FOR APPLICANT TO FILL IN CRESS IX Certified copy is filed with the county building inspec- BUILDING 5.6 tion department ADDRESS hSLG Dare �� Applicant �`� CITYZIP D LOCALITY CERTI ICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ONB LOT QST COMPENSATION INSURANCE CROSS ST �G/V/fit ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK I LOT NO MAP BOOK I PAGE I PARCEL hundred dollars ($100)or less) TEL OWNEjt NO t USE ZONE MAP 1 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 t CONDITIONS o_ so as to become subject to the Workers'Compensation Laws O CITY ) ZIP Date Applica ARCHITECT OR r DI RICT GROUP TYPE FIRE D BY adO 14 17) NOTICE TO APPLICANT after making this Certificate of ENGINEER NO 'D� CONST Exemption, you sho become subject to The Workers' W Compensation provision of the Labor Code, you must forth- ADDRESS o- with comply with such provisions or this permit shall be 1EL STATISTICAL CLASSIFICATION APT CONDO N deemed revoked CONTRACTOR vt/ NO z LICENSED CONTRACTORS DECLARATION / Ao / CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Apa 77P (commencing with Section 7000)of Division 3 of the Business LIC SEWER MAP and Professions Code,and my license is in full force and eff CITYrl'ACC — BK PG VALIDATION SQ FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date d — DESCRIPTION OF WORK NEW ADD f F]1 am exempt under Sec polo ALTER El B&P C for this reason REPAIR El : e USE OF EXISTING BLDG DEMOL ❑ Signature APPLICANT TEL FINAL OWNER- ILDER DECLARATION (PRINT) 1 � � DATE I hereby affirm that 1.6m exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS ,—~f Professions Code) PRESENT El114BUILDING 4T T 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY 3M7 33'00 the structure is not intended or offered for sole(Section 7044, Business and Professions Code ) MOVING TEL 1 ITEMS ❑ 1, as owner of the property,am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS TOTS 33.00 tion 7044, Business and Professions Code ) , �Ci 33.00 CONSTRUCTION LENDING AGENCY �I CK YARD HWY TOTAL SETBACKPROPEFRONIIo 1 hereby affirm that there is a construction lending agency for FRONT •00 the performance of the work for which this permit is issued PL (Sec 3097, Civ C) SIDE Lender's Name P L �"m1 1011/89 LDMA Ref q 1 1 AM 8:33 Lender's Address P C Fee Permit Fee 1 certify that I have read this application and state }hat the Issuance Fee � LDMA P/C N110. above information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm M and hereby juthorize representatives of this County to enter upon the dve-mentioned prope t-tnspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of APplicant or Agent Df. • ORKERS' • � fCOMPENSATcertificate ON DEC consent TION su� a 'ttonlnelf: certifiofs of WorkerCompeeu►on APPLICATION FOR BUILDING P E RM I T or a certified copy thereof(Sec 3800,}lamb.yC�) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nor- 3�Companyr"//`' 4< f„„'K r`�� Certified copy is hereby furnished FOR APPLICANT TO FILL IN CRESS S j, Uyyv 41 Certified co is filed with t n b Idin nBUILDING tion de rtme ►Y nt sP � ADDRESS 919 ACVW V)9. g1A K ^-2 VTom. Date Applicant -.,/� CITY C l ZIP 1 Q LOCALITY CERTIFICATE OF EXEMPTI FROM ORKERS' pp-� NO OF BLDGS Q NEAREST s COMPENSATION INSURANCE SIZE OF LOT �C I LY�• NOW ON LOT ST (This section need not be completed if the permit is for oneTRAs BLOB LOT NO ASSESSOR hundred dollars($100)or less ) 1 ,� MAP BOOK PAGE PARCEL OWNER J.�.GAiZvd ll.�° t', 5lbS� USE ZONE I certify that in the performance of the work for which this NO permit is issued, I shall not employ any person in any manner ADDRE55� u � i1 SPECIAL so as to become subject to the Workers'Compensation Laws w� (/ CONDITIONS p Date Applicant— CITY M 6L ZIP 9 IT* Ir NOTICE TO APPLICANT If, after making this Certificate of ARCHIENGITECT OR TEL DISTRICT GROUP TMST Z� BY O Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- V with comply with such provisions or this permit shall be ADDRESS 1�- MBO STATISTICAL CLASSIF TION APT deemed revoked CONTRACTOR&-L IVDO N LICENSED CONTRACTORS DECLARATION p T LIC �,/ CLASS NO DWELL UNITS Z I hereby affirm that I am licensed under provisions of Chapter ADDRESS r7a g%. Lmy 1� NO ✓`� (commencing with Section 7000)of Division 3 of the Business and UC SEWER MAP Professions Code,andmylicense is in full force and effect CIN Te,1M � •4TaAss� SK VALIDATION SQ License Number�.`Z)��./&��� Lic class SI �� ORIIEES�1 ��Es © CHECK VALUATION '1 A 7 81.3 A Contractor V V 4 �+ t r Y Date 46Z DESCRIPTION OF WORK ”eLNEW = D/J ' # • e • 023 ❑I am exempt under Sec ' ADD ALTER , 1 1. 15324 B&P C for this reason USE OF REPAIR = • 1. 153245 Date EXISTING BLDG Signature APPUCANTT Ngo$1`aZrlota3 FINAL 0 q 01 —8 7 OWNER-BUILDER DECLARATION p b (���� p c. rT DATi I hereby affirm that 1 am exempt from the Contractor's License ADDRESS 117 `'� � / f"rr L' `� Law for the following reason (Section 7031 5, Business and FI Professions Code) By I, as owner of the property, or my employees with AADIDR� wages as their sole compensation,will do the work and LOCALITY U 4 a 0 A the structure is not intended or offered for sale(Section 7044, Business and Professions Code) MOVING TEL # • • • • • 1 I,as owner of the property,am exclusively contracting CONTRACTOR NO ( 1.667.25 with licensed contractors to construct the project (Sec- • 1.3 b 7.2 5 U tion 7044, Business and Professions Code) ADDRESS SETBACK FROM CONSTRUCTION LENDING AGENCY UUM YARD HWY I TOTALPROP LINE WIDTH 0 j 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 PL lenders Name LDMA Ref Y P C Fees �3, Permit Fee 3 t -7-5- Lender's Address , I certify that 1 have read this application and state that the lssuonce fee /40. above Information is correct I agree to comply with aU County Investigation Fes orciinanc and State laws relat to buildmg construction, Total Fee _3 LDMA Perm i and er cut riz reprev ves of this County to enter u abo pr rty for inspection purposes M RlVE1f[FOR EXPLANATORY LANOUAOi A 51 ......of kaM or Agent bow f # 1 APPLICATION FOR 81JULDING PERMIT COUNTY OF LAS ANdELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers Compensation Insurance,or a certified F21-2. copy thereof(Sec 3800,Lab C) �I. ZIP LOCALITY Policy No Company SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished NEAREST CROSS ST F , 1 E3 Certified copy Is filed with the county building Inspection TRACT BLOCK LOT NO �p`-O W 1 department I USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNERuA�,� w � TESD, WITHIN (� COMPENSATION INSURANCE � WIN 1000 FT OF SCHOOL? YESNo (This section need not be completed If the the permit is for one hundred dollars($100)or leas) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CITY ZIP /� I is Issued, I shall not employ arty in ner so as to �Kvv A-. become subject to the Wo Co laws ARCHITECT OR ENGINEER TEL NO .1- STATISTICAL J FlCATION APT CONDO Date��- Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT er making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the Workers' 9ONTRACTOR NO SET BACK YARD HWY PROP LINE WIDTH Compensabon provisions of the Labor Code, you must forthwith 6 01 �.�'�bra � 5 314.0-3 G FRONT comply with such provisions or this permit shall be deemed revoked ADDRESSLIC ►�Q P L LICENSED CONTRACTORS DECLARATION 1S1G1 v>rw k4U Vz<1 701 64U 1 i-1 SIDE ` i.�I hereby affirm that I am licensed underprovaons of Chapter 9 �:'�M t�`-�'l�� UC CLASS P L (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES SEWER MAP Professions Code,and my license is In full force and effect I NEW ❑ BK PCG DESCRIPTION OF WORK _ ^ License Number ` Lic Class t ADD ❑ VALUATION VX ContractorrX - d.S5r Data 2&1434;;- � ALTER 'K $ c� ❑ 1 am exempt under Sec REPAIR ❑ :i�_ •`L 7 BAPC for this reason DEMOL ❑ USE OF EXISTING LDMA P/C# � �� ¢-I_LU Date URM ❑ a- Signature APPLICANT(PRINT) Ir TEL NO LDMA Perm# z ❑ 1, as owner of the property, or my employees with wages as ''UMC. I =✓31 - u Z z +:CJ2C-CCC1 t/i�.`'r` then sole compensation, will do the work and the structure Is ADDRESSO not intended or offered for sale (Section 7044, Business and t _ --y FINAL DATE a x'_4� y IO�!i.. I� Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ 1, as owner of the property, am exclusIvely contracting with OR A MIXTURE CONDNNNG A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Incensed contractors to construct the project (Section 7044, AMOUNTS SPECFIED ON THE HAZARDOUS MATERIALS PffORMATiON GUIDE? FINAL BY TEs❑ NO❑ Busmess and Professions Code) WILL THE INTENDED USE OF THE SUIDUNG BY THE APRKCANT OR FUTURE BUIMM OCCUPANT REOURE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY GUIDELINESCOAST QUALITY MANAGEMENT DISTRICT(SCAOMaD)SEE PERMITTING CHECKLIST FOR 01 I hereby affirm that there Is a construction lending agency for YES❑ No❑ N the performance of the work for which this permit is Issued(Sec ACCT.T a 3097Civ C) i HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SC�AOMD PERMITTING 240. a , CHECKLIST I UNDERWRND MY REQUIREMENTS UNDER THE Los ANGELES COUNTY CODE30 Lender s Name MATERIALS REPORTM AM FOR OHUWING A PERMI20 100T FROM THE SCAOMD2 20 140 CONCERN�HAZARDOUS Lenders Address 1 ITEMS AGEW I car* that I hate read this application and state under penalty TOTAL 240 .30 $ of perjury that the above Information Is correct I agree to comply PC FEE 17 PERMIT FEE C �40■,Zn N with all county ordinances and State laws relating to building — •w u Korn authorize representatives of this County ISSUANCE FEE aenter n the above-mentioned property for i pu s K6, CWME •00 ro INVESTIGATION FEE TOTAL SEE REVERSE FOR EXPLANATORY LANGUAGE OOM-OW1 5/19/95 nz oz. 1 AM 9:11 • APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARAnON FOR APPLICANT TO FILL IN BUILDWG ADS ESS I hereby affirm that I have a certificate of consent to self Insure, MGA E or a certificate of Workers Compensation Insurance,or a certified copy thereof(Sec 3800 Lab C) j s�o LOCALITY Policy No ' Company SIZE �x NO ON+ NOW ON LOT ❑ Certified copy Is hereby furnished NEAREST CROSS ST P Certified copy is filed with the aunty budding Inspection TRACT BLOCK LOT NO n USE ZONE MAP NO Date ZZ Appl ASSESSOR MAP BOOK WAGE PARCEL SPECIAL CONDITIONS _ CERTIFICATE OF E PTION FROM WORKERS YES�m No COMPEN ON INSURANCE wmNnN I000 FT of scHool� (This section need not be completed if the permit Is for one hundred DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less) I certify that In the performance of the work for which this permit l �`' _ ✓ ./ is Issued, I shall riot employ any person In any manner so as to ARCHITECT OR WEER TEL NO !L ��� become subject to the Workers'Compensation Laws STATISTICAL CLnnASSI2.�FICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPUCAA/T If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 019 o FRONT comply with such provisions or this permit shall be deemed revoked ADLYR11ftLIC NO O PL 97 SIDE LICENSED CONTRACTORS DECLARATION 'G LIC, P L w 0 I hereby affirm that I am licensed underprovlsns of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIES NEW EV BK PG , a Professions Code,and license Is In full force and effect License(dumber Ctass of / �/V ADD ❑ vALuano O /V �"� (� Contractor ate Z ALTER ❑ $ Cr • REPAIR ❑ $ ❑ 1 am BAP forthreason �under Sec `• � a11rE{� A GY DEMOL ❑ Lp,A P/C• W Date USE OF EXISTING BLDG URM ❑ a. 23 Signature APPLICANT(FRWT) TEL NO LDMA Perm f G AGC I.8 Z ❑ I, as owner of the property, or Try employees with wages as their sole compensation, will do the work and the structure Is ADDRESS not Intended or offered for sale (Section 7044, Business and FINAL DATE _� / a 3303 50.5000. Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL va •f'{V = 1 ❑ 1, as owner of the property, am exclusively contracting with OR A MIXTURE CONWHONG A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE licensed contractors to construct the Project (Section 7044, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS WORMATION GUIDE? FINAL BY > ACCT.s 8 BusinessSIneSs and Professions Code) TEs❑ NO 11MILL THE INTENDED USE OF THE BUMLNG BY THE APPLICANT OR FUTURE BUILDING 3303 90.75 OCCUPANT REOURE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR ITEMS GUIDEUNEa I hereby affirm that there is a construction lending agency for YES❑ No❑ 25a the performance of the work for which this permit is Issued(sec IHAVEREAD THE HAZARDOUS MATERW 31PffORMATIONOUIDEANDTHESG10M0PERMTTTN6 TOTAL �' �. a 3097,Civ C) CHECKLIST I UNDERSDIND MY REQUIREMENTS UNDER THE LOS AN COUNT/CODE. CHECK i4 i.25 N TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lenders Name MATERIALS REPORTING AND FOR CHWIING A PERMIT FROM THE SCAOMID Lender a Address a 00 ww+ErN as AOFrr c 1 certify that I have read this application and state under penalty of perjury that the above information Is correct I agree to comply PC FU..r , .Sp PERMIT FEE / �p <KXJIJV—UVV i 5/22/95 N with all county ordinances and State laws relating to budding �i ;5 construdio , and hereby uthonze representatives of this County ISSUANCE FEE 0533 1 AN 9:23 to ent tv orled property far I o�� ro INVESTIGATION FEE TOTAL FEE i Abtaw•u AW. 4 SEE REVERSE FOR EXPLANATORY LANGUAGE • COUNTY OF LOS ANGELES TEMPLE CITY 8 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0108140035 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING BK: 17 PG: 52 PC: 1 SQ. FT STORIES TYPE OCCUP GROUP 9945 LOWER AZUSA:RD STRUCTURE: 5500 1 VN B TEMP CA 917804041 ASSESSOR INFORMATION NUMBER:8589-025-045 THOMASTPAGEE: 597 GRID L651M LOCALITY: TEMPLE CITY UrgrIM" COME USE ZONE: T§Sum-w- PROCESSED BY: EXPIRES ON: TEMPLE:CITY ARTIFICAL KIDNEY CENTER EXIST OCC GRP:�B 03/21/02 JK 09/17/02 OWNER: TEL. NO: BLDGS. ON LOT: VALUATION: F MAJ. DATE FINAL BY: AMMAD, BASHIR - 338,090 �/��� CODE: 717 W. FOOTHILL BLV C MONROVIA CA 91016 FEES PAID DESCRIPTION OF WORK - T.I., REMOVE EXISTING MOM-BEARING PARTITION, NEW NON-BEARING NKTOUITT TEL. NO: FEE DESCRIPTION: QUANTITY: UON: AMOUNT: METAL STUD WALLS, CABINETRY, T-BALL. GOLDEN CONTRUCTION (714) 549-9309- Al PLANCHECK WEN-KC 338090.00 VAL 2,801.71 P.O. BOOP 1872 AA BLDG PERMIT ISSUANCE 27.75 IFIMCCONDI T IONS: CAOSTA MESA CA 92628 AC STRONG MOTION RESID 338M.00 VAL 33.81 A2 PERMIT W/ENfUY-HC 338090.00 VAL 3,296.13 CONT ACTOR: TEL. NO: TOTAL FEES 6,159.40 APPROVALS DATE INSPECTOR SIMUNMF- GOLDEN CONSTRUCTION (714) 549-9309- P. 0. BOX 1872 LIC. NO LOCATION COSTA MESA, CA 603827 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FMW_ KINCANNOM ARCHITECH (714) 730-5995- 13691 REDHILL AVENUE LIC. N0: SLAB/UNDER FLOOR TUSTIN CA 92680 C10523 RAISED FLOOR FRAMING ZONE:MAP NO: SEWER NAP BOOK: PAGE: FIRE a UNDERFLOOR INSULATION 3 04 FLOOR SHEATHING NO. OF FAMILIES: DUELLING UNITS: APT/UMff:_9TlrTUM9_'. NO 22 SCHOOL WITHIN HAZARDOUS SHEAR PANELSi AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION FIRE SPRINKLER HANGERS �- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-GAR CEILINGS . LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508