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Home My Public Portal About6129 MUSCATEL AVE_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR B U I L D 1,N G 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 Policy No. � �3/;ompany .r<6l� ❑ Certified co is hereby furnished.c�rP_=1 & FOR APPLICANT TO FILL IN BUILDING copy • y ADDRESS •f Z Al r M.bl,5 Cc(�'� • ❑ Certified copy is filed with the county building inspec- BUILDING r ,2 , $�,� n c� �,aI �y , _75 tion department. ADDRESS 1p� Nx b Date / pplicant`/ ' CITY S C ZIP 011 7 7 s LOCALITY 101 % _11 NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT �X r ( 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 d +� PAGE Com/ PARCEL hundred dollars ($100)or less.) MOV NO USE ZONE NO. /t�0 OWNER H I certify that in the performance of the work for which this 1 _n SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS 612 (v, M GL$Cq"�XJ� / CONDITIONSCL so as to become subject to the Workers'Compensation Laws. �` _QO CITY S� •abr�ct ZIP 117-15' U Date Applicant ARCHITECT OR / TEL.SAIC,57 DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER J� « NO. CONS ZONE Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS �'7 �! .I �/ i�/-7��L to L �CO D�3 �/ L* � a with comply with such provisions or this permit shall beTEL• y�; '�a STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR 6'� � NO. J �+ Z LICENSED CONTRACTORS DECLARATIONLIC. / CLASS NO. DWELL. UNITS/ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS r T 3 L r�ciS - l j NO ?'f" J�/ 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. PG. VALIDATION SQ. FT./y .• NO. OF NO. OF CHECK License Number �� 5W �Li/c. Class \ SIZE % STORIES FAMILIES ONE VALUATION Contractor a'< /-u/V 4;; A, ate DESCRIPTION OF WORK AND El ❑ $ Cg 1 am exempt under Sec. go ► ALTER B.BP.C. for this reason REPAIR ❑ $ USE OF DEMOL•❑ Date: EXISTING BLDG. 1/�� / Signature APPLICANT . TEL, { 1"� OWNER-BUILDER DECLARATION (PRINT) w!/)f 1019-# NO. FINAL DATE 23 Lawfortheoff irfollowingnr reason(Sect(Som ection 31 5,actor's License Business and ADDRESS ✓1"�P' �'8 /V Orrl !'%�. 5�� FINAL ', a Professions Code): PRESENT By AGS T BUIL ® I, as owner of the property, or my employees with ADDDR SS i•��7 ING 48.75 wages as their sole compensation,will do the work and ; the structure is not intended or offered for sale(Section LOCALITY 1 7044, Business and Professions Code.) MOVING TEL. CONTRACTOR NO. A�`�'T o T ❑ I,as owner of the property,am exclusively contracting ;:f with licensed contractors to construct the project (Sec- )� ADDRESS X07 70e76 tion 7044, Business and Professions Code.) ITEM�H� CONSTRUCTION LENDING AGENCY SE°BACK YARD HWY TOTAL SETBACK IEFROM EXIST. d ITE la 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. TOTAL 1039.71 (Sec. 3097, Civ. C.). SIDE (;,! P.L. 1039,71 Lender's Name .011 BLDMA Ref. # CHANGE Lender's Address a P.C. Fee$ _11-If Permit Fee E J I certify that I have read this application and state that the Issuance Fee r LDMA P/C# , 'y '7 above information is correct. I agree to comply with all County Investigation Fee Q //�� 0000'0001 11/� �9� 3 ordinances and State laws relatingto building construction, Total Fee % !1'• LDMA Perm. # " 0U j'-4 g br0�► 1 A�4 = and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. 7 SEE REVERSE FOR EXPLANATORY LANGUAGE SiodtufW of A icant or Agent Date WORKERS'COMPENSATION DECLARATION hereby affirm fI have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' rn kers'Copensatiorr Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy t�. r Company Cer furnishe - T� P X ified copy is hereby d. BUILDING 91 f!a� Al. c4Z Ave. FOR APPLICANT TO FILL IN ADDRESS �S �L ❑ Certified copy is filed with the county building inspec- BUILDING �'�5 C��T� tion department. ADDRESS -a L AVS. SARI C A$R I G LA C-14`j �r/�Y Date ( Appliccpnf CITY ZIP / 7 ?�� LOCALITY b ERTI KATE L3F EXEMPTION FROM WORKS S' j A O.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT 4.S �`- NOW ON LOT CROSS ST. CSAR I B AL W (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT -4 0 3 BLOCK LOT NO. P-3 MAP BOOK PAGE PARCEL TEL. OWNER I j�iLs NO. USE ZONE MAP I certify that in the performance of the work for which this NO* y. permit is issued, I shall not employ any person in any manner ADDRESS A 3 -. SPECIAL so as to become subject to the Workers'Compensation Laws. CONDITIONS 0 Date Applicant CITY R L ZIP ( r 99 ARCHITECT OR TEL. DISTRICT ROUP TYPE FIRE PROCESSED BY NOTICE TO APPLICANT: If, after making this Certificate of 0 ENGINEER NO. Exemption, you should become subject to the Workers' /, CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS l �f with comply with such provisions or this permit shall be TEL. deemed revoked. ryry STATISTICAL CLASSIFICA ION APT. CON . CONTRACTOR NO. /:5 LICENSED CONTRACTORS DECLARATION LIC*13X 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 andLIC SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION d? SO. ?� O.OF NO.OF CHECK License Number dg Lic.Class tV SIZE / TORIES FAMILIES ONE t (�IDatej DESC F WORK N�,,, ❑ VALU�gTIQN �Q Contractor ® $ �/ Ux r! ADD ❑I am exempt under Sec. DO 49,0vc—, ALTER ❑ B.BP.C. for this reason tf3�'F n REPAIR ❑ $ Date: USE OF ❑ EXISTING BLDG. rZ.A 1 1> awc 49 DEMOL Signature APPLICANTTEL, S:&1$ FINAL OWNER-BUILDER DECLARATION PRINT P AU L a. tfi/I0 CP NO. _,L —c) DATE I hereby affirm that I am exempt from the Contractor's License ' ADDRESS YD 13 t� MC�� Ave FINAL Law for the following reason (Section 7031.5, Business and Professions Code): BUILDING By 0 2 S 6 A ❑ I, as owner of the property, or my employees with ADDRESS # 0 0 0 0 0 1 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 1 - 298.50 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- o - 29a506 tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL ETBPROP. LWEFR M WIDTH 0 7, 8 8 ST BACKI 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 a P.L. .r Lender's Name 3LDMA Ref. # Lender's Address P.C. Fee$ Permit Fee t r I certify that I have read this application and state that the Issuance Fee `�9J yO tDNA PSC# 00111. above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction' e r Total FeO LDMA Perm.# and hereby authorize representatives of this County to enter ( upon the above-mentioned operty for inspection purposes. �� l SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ApplicdKor Agent D to 01 X OF �4IDRKERS'COMPENSATION DECLARATION . 1 hereebb y affirm that I have certificate of consent to self ® "WILDING PERMIT insure, or a certificate of Workers' APPLICATION kers'Compensation Insurance, or a certified c y ther (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poll y o. Company BUILDING Ce ified copy is hereby furnished. FOR APPLI ANT TO FILL IN ADDRESS f Certified copy is filed with the county building inspec- BUILDING tion part��n�(�L/I 11 ,per/ ADDRESS Date plicant I ""s _ J CI ZIP LOCALITY A4L TIF TE OF EXEMPTION FROM WORKERS' / O.OF BLDG? NEAREST - I COMPENSATION INSURANCE SIZE OF LOT Q NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSTRACT BLOC LOT NO. MAPF BOOOK PAGE PARCEL hundred dollars($100)or less.) TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER N NO. permit is issued, I shall not employ any person in any manner ADDRESS $; ✓ SPECIAL so as to become subject to the Workers'Compensation Laws. CONDITIONS O Date Applicant— CITY ZIP SM V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TE• DISTRICT GRggP I TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. II�f1Ct/ CONST. ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS W with comply with such provisions or this permit shall be D. deemed revoked. TEL• .STATISTICAL CLASSIFI ATION APT. tJ7 CONTRACTOR N LICENSED CONTRACTORS DECLARATION "PLLIC. CLASS NO. I.L.DWEUNITS J:DO . 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,anqL license is in full force anc�gffect. CITY CLASS BK PGVALIDATION (1�� SQ. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUN ® eaap Contractor DateA DESCRIPTION OF WORK raIry NEWD $ ❑I am exempt under Sec. \UQ� E]A TER B.BP.C. for this reason REPAIR ❑ $ USE OF Date: EXISTING BLDG. DEMOL ❑, Signature APPLICANT. TEL. FIINAL OWNER-BUILDER DECLARATION PRINT NO. DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FI Professions Code): PRES NT BUILDING ❑ I, as owner of the property, or my employees with ADDRESS 9 1 :1 5 5 A wages as their sole compensation,will do the work and LOCALITY # 0 0 0 0 0 1 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. 1 - 171.75 ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- 5 tion 7044, Business and Professions Code). ADDRESS 0 0 1717 J� CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBAC S SET BACK PROP..LINE WIDTH I 1. 16-88 1 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 am LDMA Ref. q P.C.Fee$ Permit Fee Lender's Address 1 I certify that I have read this application and state that the Issuance Fee ? EA P/C# above information is correct. l agree to comply with all County Investigation Fee LDMA Perm.N aq ordinances and State laws relating to building construction, and hereby authorize representatives of this County to enter Total Fee t u on t above-mentioned property for inspection urp es. m l SEE REVERSE FOR EXPLANATORY LANGUAGE nature of pplicant or Agent Da 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 1107140061 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 5903 LT: 53 UN: .002 I SQ. FT STORIES TYPE [ 6129 MUSCATEL AV N I I 1STRUCTURE: 3200 V-B I SGAB CA 917752624 I (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 15386-009-052 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl 1TENANT: 1EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: [ 1EXIST OCC GRP: 107/14/11 SR (OWNER: TEL. NO: ]BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 IMOO PAUL;CHING Y (626) 430-5320- I 6,000 I I 16129 MUSCATEL AV 1 I I ISGAB 917752624 1 FEES PAID DESCRIPTION OF WORK I I I 11NSTALL CLASS A 30 YR COMP ON TOP OF EXISTING ROOF (ONLY 1 1 I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:ILAYER OF ROOF) FLAT ROOF TORCH DOWN I IA3PLICANT: TEL. NO: I I (ALFRED LAU (626) 285-9016- 1AA BLDG PERMIT ISSUANCE 27.80 1 I 14533 SHIRLEY AVE IAB STATE GREEN BLDG FEE 6000.00 VAL 1.00 ISPECIAL CONDITIONS: I IEL MONTE CA 91780 jAC STRONG MOTION RESID 6000.00 VAL 0.60 1 I I ID2 PERMIT W/O EN-HC 6000.00 VAL 149.70 1 I TOTAL FEES 179.10 I I [CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE IGOLDEN KEY INC. (626) 285-9016- I I 14533 SHIRLEY AVE LIC. NO 1 [LOCATION AND SETBACKS IEL MONTE, CA 91731 775115C39 I I I I I I i ISOILS ENGINEER APPROVAL [ I I (ARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS I I I 1 LIC. NO: 1 1SLAB/UNDER FLOOR I I I I I IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1150H201 3 001 I- .11-1 I I I IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I 0 NO 21 IROOF SHEATHING I I I SCHOOL WITHIN HAZARDOUS I (�\�Jn I]� I� I� I SHEAR-PANELS 1 1 (AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO 1 00 aU IlU 1FRAME INSPECTION 1 1 [ I I I I FIRE SPRINKLER HANGERS I I I I 11NSULATION/WEATHER STRIPI I I I I (INTERIOR LATH/DRYWALL I I I I I I I 1EXTERIOR LATH 1 I I I I I I I IRATEDIFLOOR/CEIL ASSEM. I I I IRATED WALL ASSEMBLIES I I I I I I I (RATED SHAFTS/OPENINGS 1 I I I I I I ] IT-BARICEILINGS 1-1 I I I I I ]LOT DRAINAGE 1 I I ] I ] IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I