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Home My Public Portal About6356 OAK AVE_Building__ & WORKERS'COMPENSATION DECLARATION C APPLICATION FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensfion Insurance, or fesrfified copy thereof�(Sgy 3800, La C.) �i,(, �k�f 10 c� �� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy o. ompany Certified copy is hereby furnished. FOR APPLICANT TO FILL IN LEARE_____r- T - t Certified copy is filed with the county building inspec- BUILDING tion deparfinentt//;C+ ��eG+�l ADDRESS (� Date �Z- Applicant i. CITY ` ZIP .RTIFICATE OF EXEMPTIO FROM ORKERS' NO.OF BLD S.COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT K PAGE PARCEL (Thissection need not be completed if the permit is for one , MAPnhundred dollars ($100)or less.) TRACT BLOCK LOT NO. NO. L'�L _cj� SPECIAL O I certify that in the performance of the work for which this OWNER i dd�� A�- CONDITIONS permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PR ESSED BY U so as to become subject to the Workers'Com ensation Laws. ADDRESS 19 �( CONST/.� ZONE �. I P CITY ZIP 3 Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR = TEL. .�/ LdJ ENGINEER J NO. 3oZ- CLASS NO. ELL. UNITS IL Exemption, you should become subject to the Workers' V rA Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be — TEL deemed revoked. CONTRACTOR NO. -n BK.r— PG, v�� VALIDATION LICENSED CONTRACTORS DECLARATION r, LIC. , I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. P VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. ,g� Professions Code, and my license is in full force and effect. CITY �/ CLASS 'A $ < 00 D SQ. FT. NO.OF NO.OF CHECK License Number Lic.ClassL_ SIZE 1 STORIES FAMILIES ONE "4 3 0. 1 11 DESCRIPTION OF WORK NEW $ Contractor �+�Date '- ADD ° 0 0 0 0 2 I am exempt from the licensing requirements as I am a !�•,�+- licensed architect or a registered professional engineer ALTER �'_ FINAL�� e Of 2 - 240.21- acting 2 4 Q 2[- acting in my professional capacity (Section 7051, REPAIR DATE Business and Professions Code). USE OF 2(L�•2[I 3 EXISTING BLDG. DEMOL FINAL Lic.or Reg.No. _Date APPLICANT n TEL. By 0608,-32 OWNER-BUILDER DECLARATION (PRINT) �J" NO. C,D I hereby affirm that I am exempt from the Contractor's License •+�, Law for the following reason (Section 7031.5, Business and ADDRESS /S J/ Professions Code): PRESENT I, as owner of the property, or my employees with ADIDRESS wages as their sole compensation,will do the work and V 4 3 0.2 A the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. v # 0 0 0•o o ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- 2 - 43750 tion 7044, Business and Professions Code). ADDRESS REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. .'.:'7..j CONSTRUCTION LENDING AGENCY SET BACK 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 C 8-8 C (Sec. 3097, Civ. C.). SIDE /� P L. Lender's Name ,,�/�a_ f P I #P.C. Fee$ „„2 Permit Fee Lender's Address f� yI certify that I have read this application and state that the Issuance Fee �J •'`r� '-` above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to bu'ding construction, Total Fee and hereby authorize representatives. is County to enter Q upon th ve enti ed r GtY nspeZ p purp s S. P'-- SEE REVERSE FOR EXPLANATORY LANGUAGE ig at Ap ica r r g nt to ®s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS , RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9711050053 PHONE: (818) 285-0488 EXT: GA ID: 0. OF CONST NEW BUILDING D S : ON FILE SG. FT STORIES TYPE OCCUP GROUP 6356 OAK AV STRUCTURE: 0 1 VN R3 TEMP CA 917801336 ASSESSOR INFORMATION N B R: GARAGE: NEAREST CROSS STREET: 5382-017-029 OTHER: 197 1 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY I B DG USE: E 0 SSU N: PROCESSED EXPIRES 0 : EXIST OCC GRP: 11/05/97 UT 11/05/98 , OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE-- CASA FINAL BY: DE: 6355 ROBLES MISSIONARY HOME (818) 286-9455- 1 2,000 OAK AV TEMP 917801336 FEES-PAID DESCRIPTION OF WORK ADDITION OF NEW ATTACHED ENCLOSED ATIO FEE DESCRIPTION: QUANTITY: LION: AMOUNT: APPLICANT: TE N0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 2000.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING REVIEW�F E 54.70 D2 PERMIT W/0 EN•-HCo200,0.,00 VAL 82.20 �1� TOTAL FI�EE�S 165.15 SAMERASTOWNER TEL. NO: - APPROy'ALS DATE INSPECTOR SIGNATURE LIC. NO , !� LOCATION KINDS BAC � SOILSIENGINEER APPROVAL ARCHITECT OR ENGINEER: EL. NO: FO DAT 0 TR NC FORMS LIC.-NO; I _e.� SLAB/UNDER FLOOR V RAISE? FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP011 , ,i=a} iti !I� C W- ` _ �I I UNDERFLOOR INSULATION NO. OFFAMILIES" DWELLING ITS: APT/CO D: STA CLAS : I �J-- II -- ® S OOR S A H NO 21 - �`` �` /j' �_ 1 4f1 c1� f/� D LEVEL FLOOR SHEATH SCHOOL IT I HAZARDOUS ` * �� % I_I \�x'17"+I—;//�/�/ �� ROOF TH NG AIR QUALITY: 1000 FEET MATERIALS ,, �•�'`i/ + �� \��_ `,' � Avg I NO NO NO ��.fit` 1y�s`:�� ,� FIRE DEPT. FRAME INSPECT REQ , UIRED TOTAL SETBACK FROM EXIS `�=v� �_- —__ `�� C, BLDG IDEPT. FRAM SPEC SET BACK YARD: HWY: PROP LINE: WIDTH: 'r, :� FRONT PL- I. „mai �"Qsa�,C � SHEAR"P NELS SIDE PL- "vi U ' INSULATION/WEATHER P INTERIOR LATH/DRYWALL X `OR LATH OT DRAINAGE SMOKE C O C S FIRE DEPARTMENT APPROVAL , REPORT ID: DPR261 ROUTE TO: BS0508 , ,