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HomeMy Public PortalAbout6303 OAK AVE_Building__ a %QRKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION P P L I C®T I F® B I L®I N G PER �T insure, or a certificate of Workers'Compensation Insurance, �! or a certifiPZP9:"1 y thereof(Sec. 3800, Lob. C.) Com ��iu/� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. pany BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS 4O30 V Certified copy is filed with the county buildin ' s BUILDING /� tion #part ent. ADDRESS �v.303 �� V z- 4 DateAppli nt CITY di ZIP LOCALITY ERTIFI ATE OF EXE 1 O RKERS' NO.OF BLDGS. NEAREST COMPENSATION I UR CE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the perms s r one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. AMP BOC I PAGE PARCEL TEL. g ;,,USE Z E MAP I certify that in the performance of the work for which this OWNER NO. NO. permit is Issued, I shall not employ any person in any manners SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS Q'Q �— CONDITIONS U Date Applicant CITY ZIP , X ARCHITECT OR TEL. DISTRICT G OUP TYPE FIRE P"ESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER 0 & NO. CONST.) ZONE Exemption, you should become subject to the Workers' V Compensation provisions of the Labor Code, you must forth- ADDRESS &Z) a with comply with such provisions or this permit shall be T STATISTICAL CLASSIF CATION APT. I'dONDO. N deemed revoked. CONTRACTOR © um, NO /�OMU Z LICENSED CONTRACTORS DECLARATION C�LLIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS/3/0 ��fJNa 3� /�/ (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 6&r BK VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number A- 1919Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date �� DESCRIPTION OF WORK f/V �� NEW ❑ ' $ �P- ® ADD 1 am exempt under Sec. rr ❑ B.&P.C. for this reason d �891.0A ��3 d� ALTER REPAIR ❑' $ USE OF /'^ DEMOL '# o 0 0 0 0 l EXISTING BLDG. J ❑. ��tt Signatu APPLICANT" �A TEL.OFINAL ��Y 0 o49.88 OW DECLARATI PRINT 6• W ArZT/RIS ;—IN . DATE U I hereby t I am a mpt from the Confris ADDRESS License 1"AJA&g ( o o o 49, 88Law for the following reason (Section 7031.5, B ess andFI L 0203-88 Professions Code): PR ZD� �]�� ❑ BUILDING / / r I, as owner of the property, or myemployees with ADDRESS wages as their sole compensation,will do the work and LOCALITY �1 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- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBAC KUM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. 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 P.L. Lender's Name " $ LDMA Ref. N P.C.Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee DSO LDMA P/C p g above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State law /relating to building construction, Total Fee v LDMA Perm.# and hereby authorize re bsentatives of this County to enter � upon b e-men' pection urpo s. '00$ d SEE REVERSE FOR EXPLANATORY LANGUAGE e ign o nt r Agent Dafe 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 1011020059 PHONE: (626) 285-0488 EXT: DUPLICATE LEGAL ID: NO. OF CONST BUILDING ADDRESS: I ON FILE SQ. FT STORIES TYPE 1 6303 OAK AV 1 I 1STRUCTURE: 1000 V-B TEMP CA 917801336 ASSESSOR INFORMATION NUMBER: -042 � NEAREST CROSS STREET: LONGDEN 5382-017 I 1 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C1 ITENANT= EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 111/02/10 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATEFI SY: CODE: BURTON-SHEFFIELD PAMELA K (626) 285-2805- I 4,800 �J 6303 OAR AV I I-IL-g--Lo TEMP 917801336 FEES PAID G1 IDCRIPTION OF WORK I ITEAR OFF EXISTING 3 ROOFS APPLY APA RATED 1/2" SHEETING APPLI IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IY 401B FELT INSTALL CLASS A OVERS COVERING SHINGLES (APPLICANT: TEL. NO: ILANSFORD, ROBERT (626) 390-3480- 1AA BLDG PERMIT ISSUANCE 27.80 I I I IAB STATE GREEN BLDG FEE 4800.00 VAL 1.00 ISPECIAL CONDITIONS: iIAC STRONG MOTION REBID 4800.00 VAL 0.50 1 it D2 PERMIT W/O EN-HC 4800.00 VAL 132.80 IFR INV WORK W/O PERMIT 257.00 DOL 257.00 I (AN\ I (CONTRACTOR: TEL. NO: I TOTAL FEES 419.10 (APPROVALS DATE INSPECTOR SIGNATURE I ILANSFORD ROOFING INC. (626) 390-3480- 13535 LANDFAIR ROAD LIC. NO I ILOCATION AND SETBACKS 1 I I (PASADENA CA 91107 775436C39 1 1 ISOILS ENGINEER APPROVAL I I I ARCHITECT OR ENGINEER: TEL. NO: - 1 IFOUNDATION/TRENCH FORMS 1 I I LIC. NO: 1 1SLAB/UNDER FLOOR I 1 1 IRAISED FLOOR FRAMING I 1 (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I 1 I 1153H265 3 001 11 I 1FLOOR SHEATHING I I I [NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 1 NO 21 1 1ROOF SHEATHING 1 I SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS 1 1 I (AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO I (FRAME INSPECTION I I I I I1 1 I (FIRE SPRINKLER HANGERS I I 1 1 [INSULATION/WEATHER STRIP( I I I 1 II (INTERIOR LATH/DRYWALL 1 1 I 1 I 1EXTERIOR LATH 1 I II 1RATED FLOOR/CEIL ASSEM. 1 I I IRATED WALL ASSEMBLIES I 1 1RATED SHAFTS/OPENINGS 1 1T-BAR CEILINGS 1 I 1 1 iLOT DRAINAGE [ 1 1 1REPORT ID: DPR261 ROUTE TO: BS0508 1 1 I