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Home My Public Portal About5812 MYDA AVE_Building__ WORKERS'COMPENSATION DECLARATION C X1L4k>V— 9�0,9 hereby affirm that I have certificate of consent to self APPLICATION F®RBUILDING 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. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT,TO FILL IN ADDRESS . Certified copy is filed with the county building inspec- BUILDING �� tion department. ADDRESS I /W /�/ �r� `# J� Dote/0 �r Applicant �� CITY 'ef r ZIP �/ ��/ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 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 OWNER J� �,{//NG NO./�, V USE FE MAP I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner 7��Y /�� SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRE S y� y� y, CONDITIONS U CITY �1 -A� tTiT ��✓O'ZIP Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT I GROUP I TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' ENGINEER NO. /rCONST. ZS V Compensation provisions of the Labor Code, you must forth- ADDRESS v L RA - W with comply with such provisions or this permit shall be ' STATISTICAL CLASSIFIC/{gq►►TION APT. C DO. IL deemed revoked. CONT il��l '!It / O LICENSED CONTRACTORS DECLARATION ) LIC, r CLASS NO. DWELL.UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS X� 9 �� ZPjy 10 LN11 (commencing with Section 7000)of Division 3 of the Business andLI / y SEWER MAP Professions Code, and my license is in full force and effect. CITY &,04 CLC ASS e J BK PG VALIDATION ✓ /V Gr SQ.F NO.OF NO.OF CHECK License Number V� Lic.Class `-' 37 SIZE /00 STORIES FAMILIES ONE �l tV0',VJ4A" `'�� ' j 6-f/ ®" DESCRIPTION OF WORK &10 NEW [3VALUATION it fe le) *�a��L ADD � $ I amm exempt under Sec. ALTER B.BP.C. for this reason D>°iZ�1 f'.�" �ciZ7J� C/"V REPAIR ❑ $ atg2 USE OF �y DEMOL ❑ O 931 2 A EXISTING BLDG. AZ Si nature APPLICANT TEL. ///�� p FINAL /��, $� 0 0 0 0 0 1 g OWNER-B ILDE ECLARATION PRINT, ,e b�-� NO. uT `T' DATE CCJ ( ° o49.88 = I hereby affirm that I am exempt from the Contractor's License ��' �, � �� ° ° ° 4 9 8 8 5 Law for the following reason (Section 7031.5, Business and ADDRESS FJVSjJrM IN 18-88 Profess' 01111F ? B Q ❑ BUILDING I, as owner of the property, or my employees with ADDRESS LOCALITY c wages as their sole compensation,will do the work and the structure is not Intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- t tion 7044, Business and Professions Code). ADDRESS CONSTRUCTION LENDING AGENCY SETOBACK YARD HWY TOTAPROP.pCK L NE WIDTFROM H .4 I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. fi o P.C.Fee$ Permit Fee Lender's Address n _ C 1 certify that I have read this a lication and state that the U. y pp Issuance Fee LDMA P/C N 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. ti 3 and hereby authorize representatives of this County to enter $ u he above- one property for inspection purposes. 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date COUNTY OF LOS'ANGELF,S TEMPLE CITY # 0508 ' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BUILDING PERMIT ` BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 RESIDENTIAL ADD/ALT/REP BL 0508 1004130027 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST 1 ITR: 5905 LT: 117 NEW I BUILDING ADDRESS: 1 1 SQ. FT STORIES TYPE OCCUP GROUPI 5812 MYDA AV(ASSESSOR INFORMATION NUMBER: ISTRU�GE: 947 1 V-B R-3 I TEMP CA 917801823 J 15387-014-014 I OTHER: 400 1 V-B I NEAREST CROSS STREET: 1 I I R-3 I USE ZONE: ED THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, CI ITENANT. EXIST BLDG USE: TISSUON: PROCESSED BY: (EXIST OCC GRP: 109/01/10 SR 1 J I I TOWNER: J JUDY TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FIN Y: CODE: I5812�MYDA AV (626) 922-4883- J 159,280 I ITEMP 917801823 I I 1 1 FEES PAID IDESC-IPTION OF WORK vi JADD 2 BEDROOMS, 1 BATHROOM, 1 WET BAR AREA 947 S.F. RELOCATEI IAPPLICANT. IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:IEXISTING KITCHEN REMODEL 400 S.F. 1 J TEL. NO: I IYUM, SAM (626) 410-3113- IBI PLANCHECK W/ENERGY 159280.00 VAL 1,575.29 J 1200 N. HUNTINGTON DR TAA BLDG PERMIT ISSUANCE I 27.80 [SPECIAL CONDITIONS: J ALHAMERA CA 91801 IAB STATE GREEN BLDG FEE 159280.00 VAL 7,00 J J IAC STRONG MOTION RESID 159280.00 VAL 15.90 I I 1CONTRACTOR. JB2 PERMIT W/ENERGY 159280.00 VAL 1,851.10 I (TONG, JUDY K TEL. NO: I TOTAL FEES 3,477.09 1APPRUVALS DATE INSPECTOR SIGNATURE 15812 MYDA AVENUE (626) 922-4883- J LIC. NO J J J (TEMPLE CITY, CA 91780-1823 NONE J ILOCATION AND SETBACKS T 1 (SOILS ENGINEER APPROVAL J I I J ICHAN, TER OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I J 1 KHAN, THUNTINENCE (626) 379-4900- 1 J200 N. HUNTINGTON DRIVE 1 LIC. NO: ISUITE 238 NONE * I [SLAB/UNDER FLOOR 1 I 1 I IALHAMERA, CA 91801 [RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J 1UNDERFLOOR INSULATION Iwol lTi'] 1 J 1 I JNO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I IST LEVEL FLOOR SHEATH NO J J NO 21 12ND LEVEL FLOOR SHEATH 1 SCHOOL WITHIN HAZARDOUS I IJ I 1AIR QUALITY: 1000 FEET MATERIALS I (ROOF SHEATHING J NO NO NO 1 FIRE DEPT. FRAME INSPECIIJ J J _ J BLDG DEPT. FRAME INSPECTJ ' I I ISHEAR PANELS 1 J JINSULATION/WEATHER STRIPI 1 I J I J 1 JINTERIOR LATH/DRYWALL 1 I 1 J 1EXTERIOR LATH I J I ILOT DRAINAGE I I- I 1 II (SMOKE DETECTION DEVICES I 1 (FIRE DEPARTMENT APPROVAL( 1 J* ADDITIONAL DATA ON FILE I I I I I J (REPORT ID: DPR261 ROUTE TO: BS0508 I I J J I I I 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 1011080015 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: [ ITR: 5905 LT: 117 I SQ. FT STORIES TYPE I 5812 MYDA AV I I STRUCTURE: 1096 V-B TEMP CA 917801823 I (ASSESSOR INFORMATION NUMBER: [ [ NEAREST CROSS STREET: I 15387-014-014 I I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C[ (TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: I [ 1EXIST OCC GRP: 111/08/10 SR [ (OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: [FINAL DATE FINAL BY: CODE: TONG, JUDY (626) 922-4883- I 2,250 [ 5812 MYDA AV I I I TEMP 917801823 I FEES PAID IDESCRIPTION OF WORK [ [ ITEAR OFF AND REROOF 20 YR COMPOSITION SHINGLE TO MATCH NEW [ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IADDITION [ [APPLICANT: TEL. NO: I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 I I IAB STATE GREEN BLDG FEE 2250.00 VAL 1.00 ISPECIAL CONDITIONS: [ AC STRONG MOTION RESID 2250.00 VAL 0.50 [ [ D2 PERMIT W/O EN-HC 2250.00 VAL 99.10 [ [ [ TOTAL FEES 128.40 [ [ ICONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I I I LIC. NO I ILOCATION AND SETBACKS I I I [ [SOILS ENGINEER APPROVAL [ [ [ARCHITECT OR ENGINEER: TEL. NO: - [ [FOUNDATION/TRENCH FORMS I [ LIC. NO: i ISLAB/UNDER FLOOR [ IRAISED FLOOR FRAMING I [ [ [[MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ (UNDERFLOOR INSULATION I I I 150H265 3 00 I I I [ IFLOOR SHEATHING [ [ [ INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: [ I [ I I [ NO 21 [ IROOF SHEATHING I I I [ SCHOOL WITHIN HAZARDOUS [ ISHEAR PANELS I [ I LAIR QUALITY: 1000 FEET MATERIALS [ [ I [ NO NO NO [ [FRAME INSPECTION [ [ [ [ FIRE SPRINKLER HANGERS [ [ [ [INSULATION/WEATHER STRIP[ [ [ , [INTERIOR LATH/DRYWALL [ [ I [EXTERIOR LATH [ RATED FLOOR/CEIL ASSEM. I [ I I [ [ I I I !RATED WALL ASSEMBLIES [ [RATED SHAFTS/OPENINGS I [ I [T-BAR CEILINGS [ [ [ [ (LOT DRAINAGE [ IREPORT ID: DPR261 ROUTE TO: BS0508 [ [ I I I I I I