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Home My Public Portal About10409 MILOANN ST_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUI ING(yg / /1 _ �D -/tocf 4166- �2-34--por a certificate of Workers'Compensation Insurance,or a certified 7 / D �I N N copy thereof(Sec.3800,Lab.C.) CI ,' / ZIP v LOCALITY Policy No. Company A At SIZE OF LO L: F. NO.OF BLDGS.NOW ONLOT � ElCertified copy is hereby furnished. 75 S. NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRACT, ao�� BLOCK LOT NO.� department. L,� USE ZONE MAP NO. Date Applicant ASSESSOR MAP BQQK� PAG PARCEL �� SPECIAL CONDITIONS 4047 D/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER +yI !�! TEL NO. COMPENSATION INSURANCE 0ALTA ` , l"!� % q-4%q3 WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) o Iq N '%• DISTRICT GROUP TYPE CONST. FIRE?ANE PROCESSED BY I certify that in the performance of the work for which this permit C 6 Pt 6 C ZIP -7 is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO. STATISTICAL CLASs7�FICATION APT CONDO Date Applicant ADDRESS CLASS NO. � / DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR r� TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith own/c ie FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS UC.NO. P L LICENSED CONTRACTORS DECLARATIONSIDE CITY UC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and So. IZE NO.OF•STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force and effect. NEW BK PG a- DESCRIPTION OF WORK VALUATION License Number Lic.Class ADD ❑ � J D�d. Poo. 0 Contractor Date DD ra oN N 0 /4 D v m-o 511 t4 7-0 X1ALTER � El am exempt under Sec. E T Na REPAIR ❑ $ 0 BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ a L � L V/ / Signature APPLICANT(PRINT) TEL NO. LDMA Perm# Z I, as owner of the property, or my employees with wages as Z ACCT.T'�r their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE a0.3303 50°55C.) Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r i OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ 1, as owner of the property, am exclusively contracting With AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 0 licensed contractors to construct the project (Section 7044, (.�41;°s YES El NO 11 � Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING 3303 ��`)° 7 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1� CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKUST FOR eI ¢ ,/) GUIDEUNES •V I ` (f�// 2 1 TEM I hereby affirm that there is a construction lending agency for YES❑ NO❑ J VG�r J W the performance of the work for which this permit is issued(Sec. T JTA� i 21 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REOUMEMENTS UNDER THE LOS ANGELES COUNTY CODE, ifECK 382. 72. a TITLE 2•CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS C 3 V 2° 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. aLender's Address (1�i�1VE °�'LI C OWNER OR,WENT o I certify that I have read this application and state under penalty c of perjury that the above information is correct.I agree to comply P.C.FEE �� PERMIT FEE �— w with all ounty ordinances and State laws relating to building ✓ 7 1131090-0001 hi 5/95 m constrU n, and hereby authorize representatives of this County ISSUANCE FEE p aco to ent upon theca a ne prop y for inspection purposes. z�p -O 0-120 A1110:09 [7 (�=�s INVESTIGATION FEE TOTAL FEE �/y� ` San:„m W AP i m ax•m a•!0 ��/ 1 / SEE REVERSE FOR EXPLANATORY LANGUAGE ` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0803140029 PHONE: (626) 285-0488 EXT: ILEGAL ID; I NO. OF CONST NEW I BUILDING ADDRESS: ITR: 14053 IT: 26 I SQ. FT STORIES TYPE OCCUP GROUP[ 10409 MILOANN ST I I [STRUCTURE: 91 1 VN R-3 TEMP CA 917803472 I [ASSESSOR INFORMATION NUMBER: [ GARAGE: I NEAREST CROSS STREET: HALIFAX [ 18585-019-039 I OTHER: [ THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: I (EXIST OCC GRP: 110/01/06 SR [OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IF L DATEFI Y: CODE: 1 [FLORES, LAURA (626) 235-4722- 1 13,490 110409 MILOANN ST I I ITEMP 917803472 1 FEES PAID IDENCRfPtION F WORK [ I I r (EXTEND MAST BEDROOM, CLOS T, NEW 2 WINDOWS AND REMOVE [ I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:12 EXISTING WINDOWS IN THE BEDROOMS. 1 [APPLICANT: TEL. NO: I I I ISAME AS OWNER - IB1 PLANCHECK W/ENERGY 13490.00 VAL 265.35 1 I I 1AA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: I IAC STRONG MOTION RESID 13490.00 VAL 1.35 I I B2 PERMIT W/ENERGY 13490.00 VAL 312.18 [ I I IFR INV WORK W/O PERMIT 257.00 DOL 257.00 [ I [CONTRACTOR: TEL. NO: 1 TOTAL FEES 863.63 [APPROVALS DATE INSPECTOR SIGNATURE 1 SAME AS OWNER LIC. NO 1 [LOCATION AND SETBACKS 1 I [SOILS ENGINEER APPROVAL I [ (ARCHITECT OR ENGINEER: TEL. NO: 1 FOUNDATION/TRENCH FORMS I [ I LIC. NO: I (SLAB/UNDER FLOOR I I I I I IRAIS$D FLOOR FRAMING I I [MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMOil JUNDERFLOOR INSULATION I I I I I 11ST LEVEL FLOOR SHEATH 1 1 I IND. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I I I NO 21 [ 12ND LEVEL FLOOR SHEATH [ 1 1 SCHOOL WITHIN HAZARDOUS I IROOF SHEATHING [ I [ [AIR QUALITY: 1000 FEET MATERIALS 1 I I I I I NO NO NO 1 IFIRE DEPT. FRAME INSPECT[ I (REQUIRED TOTAL SETBACK FROM EXIST I (BLDG DEPT. FRAME INSPECT[ I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I IFRONT PL- I ISHEAR PANELS [ I [ SIDE PL- I (INSULATION/WEATHER STRIP[ I I INTERIOR LATH/DRYWALL I I [ I [EXTERIOR LATH 1 I I [LOT DRAINAGE 1 I I I ISMOKE DETECTION DEVICES 1 1 I [FIRE DEPARTMENT APPROVAL 1 I [ I I I I I (REPORT ID: DPR261 ROUTE T0: BS0508 I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0404090011 PHONE: (626) 285-0488 EXT: GAL ID: No. OF CONST W B ILD N ADDRESS: TR: 14053 LT; 26 SQ. FT STORIES TYPE OCCUP GROUP 10409 MILOANN ST �� STRUCTURE: 291 1 VN R3 TEMP CA 917803472 ASSESSOR INFOR AT 0I NUMBER: GARAGE: NEAREST CROSS STREET- 8585-019-039 OTHER: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIR S 0 EXIST OCC GRP: 04/23/04 VG 04/18/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: FLORES/MA, ALBERT/LAURA (626) 625-2855- 28,000 10409 MILOANN ST TEMP 917803472 FEES PAID DESCRIPTIONORK ADD FAMILY RM & DECK AND REMODEL KITCHEN FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: FLORES (626) 625-2855- B1 PLANCHECK W/ENERGY 28000.00 VAL 477.40 _ AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 28000.00 VAL 2.80 B2 PERMIT W/ENERGY 28000.00 VAL 561.66 CONTRACTOR: TEL. N0: TOTAL FEES 1,069.61 APPROVALS DATE INSPECTOR SIGNATURE FLORES, ALBERT (626) 625-2855- 1 10409 MILOANN ST. LIC. NO LOCATION AND SETBACKS TEMPLE CITY, CA 91780 NONE SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. 0: FXUNnA7I0 RENCH FORMS TRINIDAD, LYDIA 15811 MARY ST. LIC. NO: SLAB/UNDER FLOOR VAN NUYS, CA 91406 NONE RAISED FLOOR FRAMI G `- - -- MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION I 3 01 1,T LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: AP COND: S AT CLASS: NO 21 2NDLEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST §ING DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: I FRONT PL- SHEAR PANELS — SIDE PL- INS'LATION/WEATHER S RIP INTERIOR LATH/DRYWALL / EXTERIOR LATH , Iq L l� LOT DRAINAGE SMOKE DETECT IO DEVIL S FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508