HomeMy Public PortalAbout10404 MILOANN ST_Building__ r"
s ^, !WORKERS' COMPENSATION DECLARATION I t
• I hereby 6firm that I have certificate of consent to self APPLICATION FOR S U I L IJ�NG P ERM�T
insut'e,,.ocertificate of Workers'Compensation Insurance,
I a cert! ied copy thereof (Sec. 380, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company BUILDING u
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING
tion department. ADDRESS
Date Applicant CITY ZIP LOCALITY •�G
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT O Q CROSS ST. 664::34
(This
COMPENSATION INSURANCE ASSESSOR p
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK �� PAGE ��G PARCEL LSD a`
hundred dollars ($100)or less.) TEL• USE ZONE MAP -3 G
OWNER J#" N TN I— NO. I"! 7
I certify that in the performance of the work for which this C �. /J SPECIAL >'-
permit is issued, I shall not employ any person in any manner ADDRESS c.7 �i /G—� CONDITIONS a-
so as to become subject to the Wrs'Compensation Laws. O
•lig AL2 CITY ZIP U .
Date Applicant ARCHITECT OR l TEW4Xfi �� DISTRICT GROUP TYPE FIRE :.: PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER {,� NO. 'Y�'C� O
LU
Exemption, you should become subject to the Workers' CONST. Z NE' U
Compensation provisions of the Labor Code, you must forth- ADDRESS �e r'l�0 /P
CL
with comply with such provisions or this permit shall beTEL• r �` STATISTICAL CLASSIFICATION _r_,A-PT. CONDO. N
deemed revoked. CONTRACTOR j
LICENSED CONTRACTORS DECLARATION �" LIC. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 2-1 IS .a Qr_�', NO.SU 7`I 1
SEWER MAP "'Offr�� "� 3T �.' t
(commencing with Section 7000)of Division 3 of the Business ^ LIC. 'x s !f
CITY \ Eti (4 j BK. G PG.
and Professions Code,and my license is in full force and effect. +� �/ CLASS VALIDATION
License Number a III Lic. Class SIIZESQ. FT STORIES / FAMILIES ONE K :V .
- r t,;:_'
j� VALUATION •-•�y f}h?�= i`•
Contractor �° `�� Date '1��Z DESCRIPTION OF WORK NEW ❑ $
ADD
BI am exempt under Sec. — krr
ALTER ► `I"I"I��'I 7.('
B.BP.C. for this reason Co • REPAIR tit�l i:=
❑ $ s AIM
Date: USE EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL FINAL
OWNER-BUILDER DECLARATION (PRINT) NO.
I hereby affirm that I am exempt from the Contractor's License DATE ,'0Al
Law for the following reason (Section 7031.5, Business and ADDRESS J4 FINAL I -
Professions Code): PRESENT B
❑ I, as owner of the property, or m employees with BUILDING y �-;L.7
P P Y� YADDRESS • =:.•`:"
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. .--�^-t ��,: _
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. >is I A', �* .._r li_,• �, —
with licensed contractors.to construct the project (Sec- ADDRESS -
tion 7044, Business and Professions Code.) _ .• ' -' '
REQUIRED TOTAL SETBACK FROM EXIST. .!-!;
CONSTRUCTION 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.
(Sec. 3097, Civ. C.). SIDE
P.L. - __. ....
Lender's Name
P.C. Fee$ Permit Fee p��, LDMA Ref. # 1
Lender's Address q ,
I certify that I have read this application and state that the LDMA P/C#
' above information is correct.I agree to comply with all County Investigation Fee r
ordinances and State laws relating to building construction, Total Fee �10 �' / LDMA Perm. #
1 and hereby authorize representatives of this County to enter
upon the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant 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 1305300027
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST
BUILDING ADDRESS:
TR: 14053 IT: 2
SQ. FT STORIES TYPE 10400 MILOANN ST
[STRUCTURE: V-B TEMP CA 917803471
[ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
18585-018-002 I I THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY CAI
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 IISSUED ON: PROCESSED BY:
1EXIST OCC GRP: 106/03/13 SR
OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: FIVAL DATE FIIJAL BY: CODE: I
IFERTIG, DAVID - 1 500
110400 MILOANN ST I I 1
TEMP 917803471 FEES PAID DEPCIZIPTIOS OF WORK 1
DRYWALL REPAIR FOR BATHROOM REMODEL
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I
[APPLICANT: TEL. NO: I
[GREEN, EDUARDO - JAA BLDG PERMIT ISSUANCE 27.80
15001 LINCOLN AVE JAB STATE GREEN BLDG FEE 500.00 VAL 1.00 ISPECIAL CONDITIONS:
LOS ANGELES CA 90042 JAC STRONG MOTION RESID 500.00 VAL 0.50
ID2 PERMIT W/0 EN-HC 500.00 VAL 43.70
TOTAL FEES 73.00 1
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
IMR FIX, INC. (800) 995-2107- I 1
5681 YORK BLVD LIC. NO ILOCATION AND SETBACKS
1#202 932510 B I_
]LOS ANGELES, CA 90042 I SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO., FOUNDATION/TRENCH FORMS I I
1 LIC. NO: ISLAB/UNDER FLOOR
RAISED FLOOR FRAMING I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP;( (UNDERFLOOR INSULATION I I I I
I I
1 3 OOI IFLOOR SHEATHING
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I
NO 21 I IROOF SHEATHING
I _ I [
SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I
LAIR QUALITY: 1000 FEET MATERIALS I [
NO NO NO IFRAME INSPECTION 1
IFIRE SPRINKLER HANGERS
� I I I I I
I 1LNSULATION/WEATHER STRIPI
(INTERIOR LATH/DRYWALL 1
[ [EXTERIOR LATH I I [
[ I IRATED FLOOR/CEIL ASSEM. I I [
1 1 (RATED WALL ASSEMBLIES
I IRATED SHAFTS/OPENINGS
I I
IT-BAR CEILINGS I [ [
I I [
ILOT DRAINAGE I [
I �
IREPORT ID: DPR261 ROUTE TO: BS0508 I