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HomeMy Public PortalAbout6106 MUSCATEL AVE_Building__ _ RKERS'COMPENSAJIGN DECLARATION y sure, affirm that I have a certificate of consent to self 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 Polity No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS � 4� F] &-if- Certified copy is filed with the county building inspec- BUILDING 1` I j l tion department. ADDRESS E V W Lq T G V Date Applicant CITY .541 v% 1 C_ ZIP dq 1_7_7J_ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' 4r % NO.OF BLDGS. ! NEAREST F r COMPENSATION INSURANCE SIZE OF LOT 1 c) NOW ON LOT 1 CROSS ST. (This section need not be completed if the permit is for one ASSESSOR ' hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER StGJa �c',� NO. 3�/ NO. Z� permit is issued, I shall not employ any person in any mannerADDRESS (m V �r vv� SPECIAL d so as to become subject to the Workers'Compensation L (p Laws. �- CONDITIONS 0O IIX Date[I I Applicant f> "� CITY e,' ZIP 1 J ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROC SED BY NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE �I V Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS 'r/ Sr ��-" `4' H with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C DO. 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 and LIC. SEWER MAP Professions Code,and my license is in full force and effect. CITY CLASS BK PG "/ VALIDATION NO. EC SO �� ISTORIES Z MIOCO EK 1 License Number Lic.Class SIZE FAMILIESLIES VALUATION Contractor Date DESCRIPTION OF WORK o f�� NEW D ® $ t Z ❑ I am exempt under Sec. ❑ , ALTER B.BP.C. for this reason REPAIR ❑ $ 3 4 S 5 A USE OF Date: EXISTING BLDG. DEMOL ❑ # 0 0 a a 0 1 r Signature APPLICANT C TEL. FINAL _ OWNER-BUILDER DECLARATION PRINT)Std V C H G • �L'C.��•TNO. ZSJ'g 1 34 DATE �� I a - 49.8 1 hereby affirm that I am exempt from the Contractor's License O tJ S Law for the following reason (Section 7031.5, Business and ADDRESS e-,4 G` Ae FIS a a a49,8t�� Professions Code): PRESENT d BUILDING ; I, as owner of the property, or my employees with ADDRESS 1, 1 3 —85 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. ❑ 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 SETBACK pL 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 , o P.L. Lender's Name LDMA Ref. # ° P.C. Fee$ Permit Fee 15 Lender's Address /�1 _ r I certify that I have read this application and state that the Issuance Fee C V S LDMA P/C# 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 3 up the above-me ioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agen Date I ©i. WORKERS'COMPENSATION DECLARATION hereby nWorkers'certificate eof insureoracertifcae of Compensaton Insurance, APPLICATION F ®R BUILDING PERMIT or o 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 ADDRESS &10 ��. Al j - I ej Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS � / 4 v ✓i G `- Date Applicant CITY 6 hVo (J ZIP ' LOCALITY �ir.�y / ,� L CERTIFICATE OF EXEMPTION FROM WORKERS' y C NO.OF BLDGS. / NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. G - (This section need not be completed if the permit is for one ' ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL 1 / TEL. I certify that in the performance of the work for which this OWNER ,r (; . .=� NO. ?c,) 813 U ZONE p b �� permit is issued, I shall not employ any person in any manner ,r �// SPECIAL D. so as to become subject to the Work rs'Compensatio Laws. ADDRESS / Cq i"=C/ I CONDITIONS U f CITY ZIP Date ^l Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making t is Certificate ofENGINEER NO. DISTRICT GROUP TYPE7]7 FIRE PROFESSED BY O Exemption, you should become subject to the Workers' CON ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS s o� ��� DW.. with comply with such provisions or this permit shall be TEL. ;STATISTICAL CLASSIFICATION PT. CONDO, N deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. r 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. CITY CLASS BK PG VALIDATION SQ. FT. 'e NO.OFNO.OF CHECK License Number Lic.Class SIZE 1 / STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK 4' ADD C]NEW $ ' �v 13 1 am exempt under Sec. r v4L-Ir, G� _ ALTER 0111� B.BP.C. for this reason I I V r r/ev rJ v REPAIR $ Date: USE OF aD ❑ ;20123A EXISTING BLDG. Signature APPLICANT /// TEL CC FINAL # 0 0 0 0 0 1 PRINT 6� EctaO.Z3 ' •77 �( gy OWNER-BUILDER DECLARATION C � � DATE h� � 0190 190_ I hereby affirm that I am exempt from the Contractor's License ADDRESS �' �✓ �7o%S L l�G 'FOC FIN U Law for the following reason (Section 7031.5, Business and Professions Code): PR E B BUILDING I, as owner of the property, or my employees with ADDRESS 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. 1, 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). REQUIRED TOTAL SETBACK F CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH J' 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 /j LDMA Ref. N m Lender's Address P.C.Fee$ Permit Fee 1 certify that I have read this application and state that the Issuance Fee 111je 43 LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA perm.q R and hereby authorize representatives of this County to enter upon he above-mentioned, roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' signature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION heraffirm that I have certificate of"✓consent self APPLICATION FORBUILDING PERMIT s��or a certificate of Workers' Compensation Insurance, 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 '`ADDRESS ri BUILDING rq ❑ Certified copy is filed with the county building inspec- ADDRESS / 0 () 4 V tion department. �i Dare Applicant CITY (OOJ 1f i , zip LOCALITY NO.OF BLDGS. "•.NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT C 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 BOOK PAGE PARCEL hundred dollars ($100)or less.) �L, OWNER gip, - �f " USE ZPONE MAP I certify that in the performance of the work for which this , NO. SPECIAL ? permit is issued, I shall not employ any person in any manner ADDRESS J CONDITIONS �- so as to become subject to the Workers'Compensation Laws. OO CITY d/ y. ZIP Date Applicant ARCHITECT OR TEL. DISTRICT G OUP TYPE 1� FIRE OCESS D BY Q NOTICE TO APPLICANT: If, after making this Certificate of ;•=ENGINEER NO. � CONS . ZS Exemption, you should become subject to the Workers' �jK �y 9 Compensation provisions of the Labor Code, you must forth- a ADDRESS r '/ K J ° aa_ with comply with such provisions or this permit shall be TEL. t`;STATISTICAL CLASS TION 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. VALIDATION ;.SQ. FT. NO.OF NO.OF CHECK License Number Lic. Class r SIZE I STORIES FAMILIES ONE VALUATION y� Contractor Date DESCRIPTION OF WORK So+' G-e � NEW $ 00 ADD ❑ s ❑I am exempt under Sec. ALTER ❑ B.BP.C. for this reason REPAIR ❑ }:: $ Date: USE OF EXISTING BLDG. O i e- DEMOL ❑ , Signature APPLICANT �L• FINAL OWNER-BUILDER DECLARATION (PRINT) NO• / ; DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS !Q t'.� l ,Q Law for the following reason (Section 7031.5, Business and Gd ,-� , s FINAL Professions Code): PRESENT a By t a I, as owner of the property, or my employees with ;ADDRESS BUILDING �`e' AGT■v wages as their sole compensation,will do the work and LOCALITY ti,SQ! 68.63 the structure is not intended or offered for sale(Section e 7044, Business and Professions Code.) MOVING TEL. 1 ITEMS ❑ 1,as owner of the property,am exclusively contracting CONTRACTOR NO. n w with licensed contractors to construct the project (Sec- ADDRESS TOTAL 68. 63 tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SE°BACK YARD HWY TOTAL SETBACK LINEFROM WIIIDTH CHECK t8.6,+ I hereby affirm that there is a construction lending agency for FRONT CHANGE ■0I the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name I V. SMA Ref. # [ ;l]—[01]1]1 10/12/89 B P.C. Fee$ Permit Fee ,�� 1 w�i I o WLender's Address ' i PM 1 . I certify that I have read this application and state that the Issuance Fee l •50 LDMA P/C# 3 above information is correct.I agree to comply with all County Investigation Fee a ordinances and State laws relating to building construction, Total Fee ' _ LDMA Perm. # and hereby authorize representatives of this County to enter .� upon t abov entioned roperty for inspection pJurposes. o /� ./ � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date • '�r W011-f OF LOS ANGELES TEMPLt Ci!'f ��5�8 6UILDING PERMIT DEI.'ARTME'H OF PUBLIC WORKS 9701 LAS TUt:AS F-SIDENTIAL ADD T,UILDIN6 AND SAFETY / LAND DEVELOP14ENI TEMPLE UITY CA 91780 6L 0508 0410040025 PHONE. +f•261, 285-0488 EXT: LEGAL ID: 0. OF CONST NEW B LCit.'C'i'JCRE S: TR: 5904 LT: 15 UN: .003 SQ. FT STORIES TYPE :COUP GROUP 6106 MUSCATEL AV N ' STRUCTURE: 582 1 VN n,3 SGAB CA 917752625 ASSESSOR INFORMATIOM NUMBER: GARAGE: NEARES'! 'ROSS STREET: HERMOSA 5386-010-052 OTHER: THOMAS 41`E: 596 GRID: H2 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZO E: ISSUED ON: PROCESSED BY: "RFS ON: EEXIST OCC GRP: 10/12/04 JK OWNER: TEL. NO: —' RLDGS. NOW ON LOT: VALUATION FI' DATE --'-'-F NAL BY: TRANG, TONG - 48.190 6106 MUSCATEL AV __ SGAB 917752625 FEES PAID SC IPTION OF WORK _ ADD ON A MASTER BEDROOM W/FULL BATHROOM !:r.lAHD LIVING ROOM APPLICANT: TEL. NO: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 582 SF. ISAME AS OWNER - 31 PLANCHECK Wi';';;RGT 48190.00 VAL 733.65 AA BLDG PERMIT ISSUANCE 2?.75 SPECIAL CONDIiiU11S: i AC STRONG MOTION VESID 48190.00 VAL 4.82 B2 PERMIT W/E'ER&" 48190.00 VAL 863.12 TOTAL FEES 1,629.34 _ 1?6r,NTRACTOR: TEL. NO: 'I APPROVALS DATE ice:;=fr n^SIANATURt !SAME AS OWNER - I LIC. NO I LOCATION AND SETBACKS - - SOILS ENGIt2E�E E1. y0c - I Ou D�Af-IONJTncr::.n FuRMS i PAWN �/� — �lc — I iC. NO: I (SLAB/UNDER r1.JUR — -- — -V�--- 1 i AHED FLOOk FI;nM146 — T�— MAP NO: SE14ER MAP 57:DK: PAGE: FIRE ZO9`: CMUNDERFLOGR TNRULAT1ON u'' ST LEVEL FLU-'R JH=FTei t3�OF FAMILIES: D;c LI G UNI 5: P7 COND: STAY NO 21ND LEVEL� FLI);R SHEATH SCHOOL WITHIN HAZ RDOU ROOF SHEATHING- AIR EAIHINGAIR QUALITY: 1000 FEET MATERIALS NO Nn NO FIRE DEPT. FRA7M TFaSrECT REQUIRED TOTAL SETBACK 0. - E?SSf— BLDG DEPT. ,RA..E ?NSF'E .SET BACK YARD: HUY: PROP LINE: WIDTH: _ FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STRI INTERIOR LATH/DRY4AL1. - XT R OR L TH LOT DRAINAGE V i SMOKE ETEC IC•; E i{�I C'ES FIRE DEPARTMENT APPROVAL ,l REPORT ID: DPR261 ROUTE TO: BS0508 -- -