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Home My Public Portal About9855 MILOANN ST_Building__ WORKERS' COMPENSATION DECLARATION • % Thereby aFfc ri that I have certificate of consent self A P P L I CATION FOD -RUJ� DIN P M' insure, or a certificate of Workers' Compensation Insurance, 17 a certified%copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY r Itiicy, No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS I ❑ Certified copy is filed with the county building inspec- BUILDING .9 W5 tion department. ADDRESS 7��1✓✓ Date Applicant CITY ZIP ® LOCALITY O.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. gjA 0"J COMPENSATION INSURANCE u ASSESSOR Q [� (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK / PAGE PA �f hundred dollars ($100)or less.) L USE ZONE MAP 7 OWNER TENO. NO I certify that in the performance of the work for which this 1 permit is issued, I shall not employ any person in any manner ADDRESS 0 L ��1 SPECIAL � s' i CONDITIONS Cl- so as to become subject to the Workers'Compensation Laws. O CINIWM IP 91230 Date Applicant ARCHITECT OR L 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER DISTRICT GROUP CONST. ZONE PROCESSED BY O Exemption, you should become subject to the Workers' / Compensation provisions of the Labor Code, you must forth- ADDRESS 0 L �.®8 y a with comply with such provisions or this permit shall beTEL• ;. STATISTICAL CLASSIFICATION APT. CONDO.iiiiiiiij N deemed revoked. CONTRACTOR NO. Z 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 LIC. __. and Professions Code,and my license is in full force and effect. CITY CLASS BK PGf 3A_% VALIDATION SQ. FTV7 N0. OF NO. OF CHECK License Number Lic. Class SIZE / STORIES FAMILIES ONE (. -!•t a VALUATE Contractor Date DESCRIPTION OF WORK NEW ❑ $ -+tf o®o ® 1'_�_ ADD ❑ `. ® T.-r ❑1 am exempt under Sec. M• ALTER ❑ . A:_ 499 -71 BAP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG.,159MIk QtJOA4 DEMOL ❑ Signature APPLICANT TEL. FINAL r•I �li',� OW ELDER DECLARATION (PRINT) NO. DATE Z I hereby affirm t I am exempt from the Contractor's License Law for th ollowing reason (Section 7031.5, Business and ADDRESS t. Lc-: FINAL4W (�l (i—l�iij j , Profess' s Code): PRESENT i ByBUILDING "Y'-� �o-. I, as her of the property, or my employees with ADDRESS +5.t 1 1 M. 3 e__ w s as their sole compensation,will do the work and e structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETBACK YARD HWY 7oTAPROPALIINEFROM EXIST. ID H 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. SIDE (Sec. 3097, Civ. C.). P.L. L• , ' Jr 1 Lender's Name P.C. Fee$ % /� Permit Fee ��. , Lender's Address , r [ t ' d/ DMA P/C# I't I certify that I have read this application and state that the above information is correct.I agree to comply with all County Investigation Fee LIMA ordinances and State laws relating to building construction, LeWe �37. LDMA Perm. # and hereby authorize presentatives of this County to enter u e above-me ned property for inspection purposes. ' ' r,t tl r_-J _ f Cn SEE REVERSE FOR EXPLANATORY LANGUAGE o'n e u ' o Signature of Applicant or Agent ate iJ�� 6 ('�' F ' .QF.e Pe.-Ar Ten dvj i WORKERS' CbMPENSATION DECLARATION ..Ju;ur�6, bot a certif catte of Worke s'tificate Compensat on Insurancelf APPLICATION ® BUILDING P E RM I T or a cm'rtified 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 ADDRESS 55 ❑ Certified copy is filed with the county building inspec- BUILDING ®Qs� �/J f�� p tion department. ADDRESS 77�J MI N //�� —/ Date Applicant --} �1 p NO. F BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT /Z)X yA-® NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR �, . (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOKS / PAGE PAL hundred dollars ($100)or less.) p TEL OWNER p.. o B LTD Q N5 USE ZONE MAP I certify that in the performance of the work for which this NO. 47 H 2,49 permit is issued, I shall not employ any person in any manner ADDRESS 5.5 CONDITIONS a- so as to become subject to the Workers'Compensation Laws. p 0 g(� a�{ {� (( O "CITY J� IP F O ?: �1-om-65t1 --656q — L)1—0J2 (6 Date Applicant ARCHITECT OR� 1 B �p�jpC{ DISTRICT GROUP TYPE FIRE PROCESSED BY 0 NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER 11I B 2 CONST. ZONE � Exemption, you should become subject to the Workers' sip A �j a/ V Compensation provisions of the Labor Code, you must forth- ;_ADDRESS 0 , � ®� � 5..�� I`-3 t/ � a with comply with such provisions or this permit shall be TEL.NO ;STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR 0 z LICENSED CONTRACTORS DECLARATION CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS i LoPI�iLY/l (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY -Tg CLASS BK PG VALIDATION SQ. FT. N OF NO. F CHECK License Number Lic. Class .SIZE ® STORIES FAMILIES ONE ' VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ $ 4-9 E]I am exempt under Sec. ADD , LTER ❑ BAP.C. for this reason B5M QNQ AA ��4 REPAIR ❑ $ Date: USE OF EXISTING BLD EMOL ❑ Signature APPLICANT TEL. '•; (PRINT) NO. FINAL OWNER-BUILDER DECLARATION DATE J12-7A) I hereby affirm that I am exempt from the Contractor's License Fl, the following reason (Section 7031.5, Business and ADDRESS FINAL Y ons Code): PRESENT By BUILDING as owner of the property, or myemployees with ADDRESS y,eages as their sole compensation,will do the work and i the structure is not intended or offered for sale(Section LOCALITY ® = '+ .'t_ 7044, Business and Professions Code.) MOVING TEL. - I,as owner of the property,am exclusively contracting CONTRACTOR NO. - - -with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL ROP LINEFROM WIDTH I hereby affirm that there is a construction lending agency for FRONT 's: r•' t €f"� the performance of the work for which this permit is issued P.L. L•i�ls`'1= (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name d �J LDMA Ref. # _ "'L P.C. Fee$ Permit Fee ��' / :•�' Lender's Address r -I`r' i €rt + __ I certify that I have read this application and state that the Issuance Fee LDMA P/C# 3 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. # and hereby authorize representatives of this County to enter upon the above-mentio d proper f r inspection purposes. rS—°,� �8 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of App7i'cant or Agent Date /dT 779 ff�pQpJ • WORKERS'COMPENSATION DECLARATION ;he?gby affirm that I have a certificate of consent to Self APPLICATION FOR BUILDING PERMIT iWWI nsure, or a certificate of Workers' Compensation Insurance, pr a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY' Policy No. Company ❑ Certified copy is hereby furnished. d FOR APPLICANT TO FILL IN ADDRIESS NG 985.5 1V 1Lo tEl Certified copy is filed with the county building inspec- BUILDING ADDRESS 985.5 MILD ANN s-r tion department. w Date Applicant CITY 66 ZIP T ALOCALITY A NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSORo (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK C',�� PA-009 PARCEE� hundred dollars ($100)or less.) TEL. USE ZONE NOP r y � OWNER L. NO- M-5-7 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 ' CONDITIONS a so as to become subject to the Workers'Compensation Laws. O CITY ZIP 9®A®®®'�5��9_.®®9•a®�f�® ' IJ a Date Applicant ARCHITE OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' Q � V Compensation provisions of the Labor Code, you must forth- ADDRESS .5i®B —J 3 Guti'�. a with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. 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. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK. -. PG'042 VALIDATION SQ. FT. NO. OF NO.OF CHECK License Number Lic. Class SIZE ® STORIES FAMILIES ONE VALUATION Contractor pate DESCRIPTION OF WORK NEW 1:1 $ /500 O Elam exempt under Sec. ADD ❑ ► ALTER ❑ B.BP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL WNER-BUILDER DECLARATION (PRINT) NO. C Z Z} I hereby of' m that I am exempt from the Contractor's License DATE -L Law for a following reason (Section 7031.5, Business and ADDRESS FINAL! y Profe ons Code): PRESENT By _ s BUILDING II, as ner of the property, or my employees with ADDRESS ,, es as their sole compensation,will do the work and MOVING TEL. pop structure is not intended or offered for sale(SectionLOCALITYeA��4, Business and Professions Code.) CONTRACTOR NO. 9�I luas owner of the property,am exclusively contracting --r with licensed contractors to construct the project (Sec- 7101 l tlTAL tion 7044, Business and Professions Code.) ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. . an CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for LInvestigation ;}{; }Lj)_ the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name oma{ 1 - bI LDMA Ref. # 1:I+i`—j)G;C • Permit Fee i c2 R o Lender's Address �-r i,: °=� I certify that I have read this application and state that the Issuance Fee •®v LDMA P/C# above information is correct. I agree to comply with all County ee r ordinances and State laws relat' g to building construction, Total Fee �. 30 LDMA Perm. # I and hereby authorize represen Ives of this County to enter upon the e-mentioned r arty for Inspection purposes. 0 6 SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Applicant or Agent Date i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT ; TEMPLE CITY CA 91780 BL 0508 0202210047 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 12268 LT: 34 SQ. FT STORIES TYPE OCCUP GROUP 9855 MILOANN ST STRUCTURE: 84 1 VN R3 TEMP CA 917803954 ASSESSOR INFORMATION UMBER: GARAGE: NEAREST CROSS STREET: AGNES ' 8589-009-021 OTHER: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY TENANT: T BLDG S : USE ON ISSUED 0 PROCESSED S EXIST OCC GRP: 03/07/02 JK 09/03/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FIN L DATE FINAL BY: CODE: BAROLDI LANCE R;LEANNE W (818) 285-7298- 8,500 9855 MILOANN ST TER F9'I7 03054 FEES PAI DESCRIPTION OF WORK FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ADD STORAGE RM/PANTRY RM OFF OF KITCHEN —' APPLICANT: TEL. NO: CANYON OAK CONSTRICTION (626) 398-9237- AA BLDG PERMIT ISSUANCE 27.75 1564'PALOMA ST AC STRONG MOTION RESIN 8 00.00 VAL• 0.85 SPECIAL CONDITIONS: PASADENA AX BUILDING REVI.E' FE 54.70 62 PERMIT W lfER � 0 V L 219.78 P+N &f A f,E 303.08 CONTRACTOR: TEL. NO: OBJ �/,. APPROVALS DATE INSPECTOR SIGNATURE CANYON OAK CONSTRUCTION (626) 398-9237- y 1564 PALOMA ST LIC. NO LOCATION AND SE B C S PASADENA, CA NONE SOILS ENGINEER APPROVAL I ARCHITECT OR ENGINEER: TEL. N0: FOUNDATION/TRENCH FOR S LIC. NO: SLAB/UNDER FLOOR RAISED FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZON3: CMPO� �n n D �� 11 O�n� � UNDERFLOOR INSULATION (IvJJ v��I u� IST-LEVEL FLOOR SHEAT 0. OF FAMILIES: DWELLING NTS: APT/CO D: STAT CLASS: NO 21O ❑ ND LEVEL FLOOR SHEATH O ❑ �a 9h SCHOOL WITHINHAMA—RD-07S - F> t►� ROOFSHEATHING AIR QUALITY: 1000 FEET MATERIALS O ❑ NO NO NO A �IgFIRE DEPT. FRAME N CT EQU R TOTAL SETBACK FROM E S 4b O� G PT. F AME 5P CT 1� SET ACK YARD: HWY: PROP LINE: WIDTH: FRONT@rV�e 113 � SHEAR PANELS _—� SIDE PL- INSULATION/WEATHER STRIP, INTERIOR LATH/DRYWALL EXTERIOR A /�— LOT DRAINAGE t SMOKE D T C O D C S FIRE DEPARTMENT APP OVAL REPORT ID: DPR261 ROUTE TO: BS0508