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Home My Public Portal About5829 OAK AVE_Building__ N APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES - BUILDING AND SAFETY �- WORKER S COMPENSATION DECLARATION G FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self Insure BUI1?J Ess oa `f V e or a certificate of Workers Compensation Insurance or a cerbfied O n copy thereof(Sec 3800 Lab C) a%m /r,L 0 ! i"D LOCALITY t Policy NO Company SIB OF a (� T NO OF B 3 NOW ON LOT ❑ Certified copy Is hereby furnished SQ p NEAREST CROSS ST + ❑ Certified copy IS filed with the county building Inspection TRACT BLOCK LOT NO department I USE ZONE MAP NO ire Date Applicant ASSESSOR MAP BOOK PAGE PARCEL BBw ®O 3PECu►L CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS OWNER TEL NO COMPENSATION INSURANCE T,eS Z8S ZDS WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit Is for one hundred ADDRESS 5' Z q DA ve. DISTRICT GROUP TYPE CONST FIRE ZONE ESSED BY dollars($100)or less) e I certify that that in the performance of the work for which this permit Q/eG�t ZIP^' �d 0 �� Is Issued I shall not employ any person In arty y manner so as to ARCHTTE OR ENGINEER TEL NO J� become subject to the Workers Compensation Laws STATISTICAL CLLAASS33IIFlCATION AFT CONDO 1 Date Applicant + ADDRESS CLASS NO DWELL UNITS t NOTICE R7 APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you Should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked ADDRESS - LIC NO FRONT LSM + LICENSED CONTRACTORS DECLARATION SIDE CRY LIC CLASS PL I hereby affirm that I am licensed underprovlslons of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ O OF STORIES NO OF FAMILIES Professions Code and my license Is In full force and effect NEW BK PG , }D. IPU License Number LID Class DE WORK _ - ADD [3 %ALUUXTION 9L ) Contractor Date ;a 2 ALTER ❑ $��/ �`"� 8 ❑ 1 am exempt under Sec XV/Cv REPAIR ❑ $ B&PC for this reason DEMOL ❑ LDMq P/C# USE OF EXISTING BLDG Ill Date - URM ❑ ^)�_ � Signature APPLICANT(PRINT) TEL NO LDMA Perm# , s Z E3 as owner of the property or my employees with wages as Z A,"%*T ,< them sole compensation well do the work and the structure Is ADDRESS --c" 90 r-11LL.. not Intended or offered for sale (Section 7044 Business and FINAL DATE a Professions Code) DWILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 00. 1 [3I as owner of the property am exclusively cbntracfinwith Wlh OR A MIXTURE CON011NNG A HAZARDOUS MATERIAL EQuu TO OR GREATER THAN THE a a AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY + 41 T licensed contractors r construct the project (Section 7044 T YES 13 No❑ Business and Professions Code) c WILL THE INTENDED USE OF THE BUIDLNG BY THE APPLICANT OR FUTURE BUILDING 'r'TL x'94 11 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH n CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ITEMv GUIDEUNEa lu I hereby affirm that there is a construction lending agency for YES❑ No❑ TUTAL 404® 65 a the performance of the work for which this permit Is Issued(Sec m Z IN�AN�RREISU�� SSO3097 CV C) CHECKLIST DER51ANDMY EOLRE NTSUR IAANGELES CD �uLIC(T -04 L HAVE READ r TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lenders Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD NaNGE 01io Lenders Address C OWNER OR MEM GI certify that I have read this application and state under penalty �`(�--I�)—I�_ Of perjury that the above Information is Correct t agree t0 comply P C FEE �D �0 PERMIT FEE A D ] i i t Q $ with all c my ordinances and State laws relating to budding ns a ze representatives of this County ISSUANCE FEE / ++-r 1 F M Z-■J I r a 10 property for inspectiqln pu es �O ro INVESTIGATION FEE TOTAL FEE Dtl SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICA 6- N FOR BUILDING PERMIT + Olt COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADD ESS C. / 'e 1 hereby affirm that I have a certificate of consent to self Insure RNGV!RES,gS or a certificate of Workers Compensation Insurance or a certified A f copy thereof(Seo 3800 Lab'C) LP / LOCALITYNO OF BLDGS NOW ON LOT ❑ Certified Copy IS hereby furnished Policy No f> NEAREST CROSS ST ❑ Certified copy Is filed with the county budding Inspection TRACT BLOCK LOT NO I department I I USE ZONE MAP NO A�rf Date Applicant ASSESSOR MAP BOOK [ �7 PILE /� FARCEL f pa / OA{�' (�'0 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERSER -f- 'T TEL NO COMPENSATION INSURANCE — ./ LSS S? WITHIN 1000 FT OF SCHOOLS YES NO ADDRESSJ DISTRICT GROUP TYPE CONST FIRE DONE PROCESSED BY (This sedan need not be completed If the permit Is for one hundred f( dollars($100)or less) 57291 � I certify that In the performance of the work for which this permit C 9� Q Q 3 �� 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 CLASAVICATION APT CONDO Date Applicant ADDRESS CLASS NO DWELL UNITS---/- NOTICE 70 APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject to the Workers CONTRACTOR TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATIONSIDE CITY LIC CLASS P L I hereby affirm that I am licensed underprovislons of Chapter 9 SEWER MAP (Commencing with Section 7000)of Division 3 of the Business and SO IFT SIZE NO OF STORIES NO OF FAMILIES Professions Code and my license Is In full force and effect NEW ❑ BK PG loop. d �Icense Number La Class DE IPTION OF WORK /N ADD 13 �►�n� 8 Contractor Date ALTER ❑ $ !r ❑ 1 am exempt under Sec A REPAIR ❑ $ B&PC for this reason DEMOLLDMA PSC• W Date USE OF EXISTING BLDG URM ❑ N Signature APPLICANT(PPAW) TEL NO LDMA Perm f (it g Z ❑ 1 as owner of the property or my employees with wages as ADDRESS O _'(�^ 1 4 + their sole compensation will do the work and the structure Is � � l�� V not Intended or offered for sale (Section 7044 Business and FINAL DATE , Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCIBNWT HANDLE A HAZARDOUS MATERIAL I l TL MS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ' f 5 ❑ I as owner of the property em thelu project contracting with AMOUNTS SPECIFIED ON THE HAZMDOUS MATERIALS INFORMATION GLADE? FINAL BY licensed contractors to construct the project (Sedan 7044 s Business and Professions Code) ES❑ No❑ L{'IEC�� 144 9` WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CONSTRUCTION LENDING AGENCY OCCUP T REQUIRE A PERMIT FOR CONSTRUCTION OR MODIRMION FROM THE SOUTH C MANGE orI COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEELFTRMITTING CHECKLIST FOR GUIDELINES. 1 hereby affirm that there Is a construction lending agency for YES E3 ❑ t rkY a the performance of the work for which this permit Is Issued(Sac YES e- C Ob IHNEREAD THE HAZARDOUSMATERIALSINFORMATIONGUIDEIMDTH6SOALSMDPERMITTING COGC-0001 2f..�/9 t 3097 CN C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER TNEU)S ANGELES Opljt)rV CODEC4 TITLE 2 CHAPTER 2 20 100 � DO13 Lenders Name MATERIALSREPOI TN�ND FOR CONNING A PERMIT FROM THE SCAOMD � 2: [n i J o Lenders Address _ c OWNER OR AGENTl" 7, Z; I certify that I have read this application and state under penalty C of perjury that the above Information Is correct I PC FEE PERMIT FEE i /D N with all ordinances and State laws relating to building d 00 uct n&nzipmseritatives of this County 133UANCE FEE / L�m e ru t rry for Inspection purposes fv �J m INVESTIGATION FEE TOTAL FEE OW SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS COMPENSATION DECLARATf6N herby affirm that 1 have a certificate of consent self APPLICATION FOR BUILDING PERMIT r insure or a certificate of Workers Compenstion Insurance e 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 S e�-� ❑ Certified copy is filed with the county building inspec BUILDING tion department ADDRESS c►�� / fL LOCALITY NEAREST Dote Dote Applicant CITY ZIP V CROSS ST u-o� CERTIFICATE OF EXEMPTION FROM WORKERSO OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT . NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one / USE ZONE MAP ^, hundred dollars ($100)or less ) TRACT StP BLOCK ,{, LOT NO .�sv NOECIAL GOO d I certify that in the performance of the work for which this OWNER / NO TEL� apl � �� CONDITIONS - O permit is issued 1 shall not employ on person in an manner DIST ICT GROUP TYPE FIRE PR ESSEQBY V P P Y Y P Y ADDRESS o 2 CONST ZONE so as to become subject to the Workers Compensation Laws _ ne �.,p /Lt� 13 O Dote Applicant CITY ZIP STATISTICAL CLASSIFICATION tZ APT CONDO V wmlm- NOTICE TO APPLICANT If after making this Certificate of OR TEL EER NO CLASS NO DWELL UNITS W Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth N P P Y ADDRESS � SEWER MAP Z with comply with such provisions or this permit shall be R (�/ deemed revoked CONTRACTOR NoL 70 BK � IG ! v VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby off irm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (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 $ SQ FT i NO OF NO OF CHECK License Number Lic Class SIZE t0 STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK J A D ❑ $ IU&f ®0 z 2 3 Q 6 A ❑ I am exempt from the licensing requirements as I am a Ci/ licensed architect or a registered professional engineer ALTER ❑ FINAL # • • • • 2 3 acting in my professional capacity (Section 7051 REPAIR C] DATE 2 1 6 8 0 0 Business and Professions Code) U F FINAL EXISTING BLDG DEMOL ❑ Lic or Reg No Date i APPLICANT !/ By * 916a005 OWNER BUILDER DECLARATION -(PRINT) NO d P G° Q�� 0930-80 I hereby affirm that I am exempt from the Contractor s License 3 Law for the following reason (Section 7031 5 Business and ADDRESS Professions Code) PR E 7'7 �l7-Z p BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will clothe work and s`.) -,FO 22367A the structure is not intended or offered for sale(Section LOCALITY 7044 Business and Professions Code) MOVING TEL # • • • • • 1 ❑ 1 as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec ADDRESS 2 • 4 8 a 5 0 tion 7044 Busirfess and Professions Code) _ REQUIRED TOTAL SETBACK FROM EXIST • • 4 8 8,S 0 U CONSTRUCTION LENDING AGENCY SET BACK YARD iHWY PROP LINE WIDTH I hereby affirm that there is o construction lending agency for FRONT 0 930-80 the performance of the work for which this permit is issued P L (Sec 3097 Civ C ) SIDE PL Lender s Name Lender s Address P C Fee$ i �� o�o Perm t Fee L=� 0'/��(`r Q > I certify that I have read this application and state that the d Issuance Fee f above information is correct I agree to comply with all County Invest gat on Fee ordinances and State laws relating to building construction Total Fee and hereby authorize representatives of this County to enter upon/thbove mentioned prop r fo inspection purposes 1 t a � SEE REVERSE FOR EXPLANATORY LANGUAGE Q i ®s Sigpplicant or gent Do nature of 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 0103230029 PHONE (626) 285 0488 EXT LEGAL ID No OF CONST BUILDING ADDRESS TR 6561 LT 737 SG FT STORIES TYPE 5829 OAK AV STRUCTURE 1000 VN TEMP CA 917802132 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LAS TUNS DR 8587 006 007 THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY TENANT G -inaff-ar PROCESSED BY EXPIRES EXIST OCC GRP 03/23/01 UT 09/19/01 OWNER TEL NO BLDGS NOW ON LOT VALWT-161 FINAL DAT FIN B CODE FUKAMI KEIKO 2 830 �� Z 547 N ALTA VISTA MONROVIA CA 91016 FEES PAID DESCRIPTION FLAT ROOF HOUSE TEAR OFF ALL ROOFING INSTALLL 4 PLY FIBER FEE DESCRIPTION QUANTITY UOM AMOUNT GLASS BUILT UP ROOF APPLICANT MASSIE ROOFING COMP (626) 796 3928 AA BLDG PERMIT ISSUANCE 27 75 2548 E WALNUT ST AC STRONG MOTION RESID 2830 00 VAL 0 50 SPECIAL CONDITIONS PASADENA CA 91107 D2 PERMIT W/O EN HC=_�_ 2830 00 VAL 99 00 ��TOTAL-FE\ 127 25 MASSIECONTRACROOFING CO INC (626)TOR N796 3928 a® �_ APPROVALS DATE INSPECTOR SIGNATURE 2548 E WALNUT ST LIC NO LOCATION AND SETBACKS PASADENA CA 501048039 SOILS ENGINEER APPROVAL ARCHITECT LIC NO ( \1111111 1 SLAB/UNDER FLOOR U l t-J_ ``�' RAISED FLOOR MUM MAP NO SEWER MAP BOOK PAGE FIRE ZONEU DER LOOR INSULATION XX 3 EA H I G NO NO OF FAMILIES DWELLING UNITS APT/COND S TAT L21 �; -^— -- ROOF SHEATHII HAZARDOUSSCHOOL WITHIN lSHEAR PANELS AIR QUALITY 1000 FEET MATERIALS = lJ FRAME INSPECTION NO NO NO / REQUIREDA FROM 1 SET BACK YARD HWY PROP LINE WIDTH 7/ L j �p �F R S FRONT PPL eC �0@-�pipSU ION/WEA HE RIP SIDEINTERIOR LATH7MMEU- EXTERIOR LATH RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS BAR CEILINGS DRAINAGELOT i REPORT ID DPR261 ROUTE TO BS0508