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HomeMy Public PortalAbout6380 OAK AVE_Building__ %WORKERS'COMPENSATION DECLARATION I hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING 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 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING Pol ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS Date Applicant CIL ZIP LOCALITY _r CERTIFICATE OF EXEMPTION FROM WORKERS' O.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 TEL. USE O q MAP I certify that in the performance of the work for which this OWNER NO. NO. S } permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Workers C Xr. ADDRESS CONDITIONS A CITY __ ZIP Date Applicant ARCHI CT OR TEL. NOTICETO APPLICANT: If, after makin this ertificaJ of NO DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER CONT/, ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS ` ✓ 3 0� with comply with such provisions.or this permit shall be' deemed revoked. TEL. CONTRACTOR STATISTICAL CLASSIFICATION APT. NDO. p A: 0.3 /O LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. — DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ,d (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 D CLASS 110, BK PG VALIDATION (3 / SIIZZE� STORIIES FAMILONE OFCHECK Z 2-9;License Number 36 S Lic.Class - VALUATION Contractor ' Date _7 ,� DESCRIPTION OF WORK NEW ❑ $ % '.49 49 &-9 ADD ® ° I am exempt nder Sec. '� r ❑ ALTER polo. B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMOL ❑ EXISTING BLDG. r,1 L A_3c�. Signature APPLICANT • TEL. FINAL .,7 -72 OWNER-BUILDER DECLARATION (PRINT) O 3 DATE 5 2 Q 1 A 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 1 VLir FI # 0 0 0 0 0 Professions Code): PRESENT' ❑ I, as owner of the property, or my employees with BUILDING I ° - 49.88 wages as their sole compensation,will do the work and 61 LOCALITY , ' ° ° ° 4 9.8 8 cxi 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. 0 8,07-86 with licensed contractors to construct the project (Sec- • ADDRESS tion 7044, Business and Professions Code). " CONSTRUCTION LENDING AGENCY SET BACK YARD HWY TOTAL SETBACK L NEER WIDTOM H 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. Q Lender's Name C LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee 1 .33 Jf r I certify that I have read this application and state that the Issuance Fee ( �• `� O LDMA P/C# ' - i above information is correct. I agree to comply with all County Investigation Fee ' 3 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and her th riz repre ntati,es of this County to enterMMMEMNIA upon t v e ions ro fy for inspection purposes. 0 i 7-?•53 � SEE REVERSE FOR EXPLANATORY LANGUAGE igna re o Appli nor Agent Date O t WORKAS COMPENSATION DECLARATION -T� thereby affirm that I have a certificate of consent to self APPLICATION F R BUILDING PERMIT i)sure, or a certificate of Workers'Compenstion Insurance,or O i certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY 'olicyNo. �d Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS r Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS /' LOCALITY NEAREST late Applicant CITY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT a OF BLDGS. .7 ASSESSOR 67 COMPENSATION INSURANCE �� r OW ON LOT oC MAP BOOK PAGE PARCEL This section need not be completed if the permit is for one f USE ZONE MAP iundred dollars($100)or less.) TRACT I .S BLOCK. LOT NO. NO. •�©�� } TEL. P D SPECIAL p• certify that in the performance of the work for which this OWNER !` CONDITIONS O DISTRICT GROUP TYPE FIRE PRO ESS BY LJ lermit is issued, I shall not employ any person in any manner ADDRESS (Al o as to become subject to the Workers'Compensation Laws. �� CONST, _ZONE o late Applicant CITY ZIP STATISTICAL CLASSIFICATION l��/ APT. CONDO. u JOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL.Q may, xemption, you should become subject to the Workers' ENGINEER _—A NO13 ` CLASS NO. DWELL. UNITS iL :ompensafion provisions of the Labor Code, you must forth- ADDRESS SEWER MAP Ath comply with such provisions or this permit shall bey /�f�7 — leemed revoked. TEL' Op BK.�PG,sG 3 VALIDATION] A CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS • N VALUATION 2 1 commencing with Section 7000)of Division 3 of the Business and LIC. ° 2 3 6 0 4 'rofessions Code, and my license is in full force and effect. CITY r CLASS $ SQ. FT. L NO.OF NO.OF / CHECK icense Number Lir.Class SIZE STORIES FAMILIES / ONE I ° o 2-6 6, (� s �B :ontractor Date DESCRIPTION OF WORK NEW $ ��I O CElI am exempt from the licensing requirements as I am a ADD licensed architect or a registered professional engineer ALTER E] FINAL acting in my professional capacity, (Section 7051, REPAIR ❑ DATE !r Business and Professions Code). USE OF EXISTING BLDG. DEMOL ❑ ay AL 1 4 i A ic,or Reg.No. Date APPLICANT 7 OWNER-BUILDER DECLARATION (PRINT) i — � ° p`t 2 1 hereby affirm that I am exempt from the Contractor's License /. c IV ow for the following reason (Section 7031.5, Business and ADDRESS CR 6 G� U V.1 .]3,0 b 'rofessions Code): PRESENT t V BUILDING '� o a 1 '7 3 0 /I u I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY I O,0 6_81 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. CONTRACTOR NO. I, as owner of the property, am exclusively contracting S./6- 4001 � with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. °CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTHIhereby affirm that there is a construction lending agency for FRONT2\oy0 he performance of the work for which this permit is issued P.L.Sec. 3097, Civ. C.). SIDE •° -ir ender's Name /I.f]f^7/�• P.L. t. c. ender's Address P. . Fee Permit Fe€ certifyff that I have read this application and state that the �� ° ro Pp Issuance Fee // O o o ° N1n above information is correct. I agree to comply with all County Investigation Fee O O -`�- 4.-- 0, rdinances and State laws relating to building construction, r�3G,0y'l�"� ind hereby authorize representatives of this County to enter Total Fee I r\) N o pon the above-menti 01 OD (,I property for' spection purposes. ( 4'0 (J1 0 00 10 SEE REVERSE FOR EXPLANATORY LANGUAGE C-) C: Signa re of A plica r Agent are CH es e '+ COUNTY OF LOS ANGELES I TEMPLE CITY # 0108' } -BUI=LDI:Nt---2ERM-T DEPARTMENT OF PUBLIC WORKS 9701 LAS JUNAS RE$T-0E1( IATADD-:ice BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9902100015 PHONE: (626) 285-0488 EXT: EG D: NO. OF CONSTE B___ G-ADDRESS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP ==-RR.Et�K`b STRUCTURE: 0 1 VN R3 ";ZiEMP-C*-9V78D'1352 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: LONGDEN 5382-014-041 OTHER: 240 1 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY ENA : IS BDG USE: USE ONE: ISSUED ON: PROCESSED BY' EXPIRES ON: EXIST OCC GRP: 02/10/99 UT 02/10/00 OWNER: TEL. 0: BLDGS. NOW ON LOT: VALUATION: FINAL DATE INAL B ODE: CASA ROBLES NAZARENE MISSIONARY - 2,000 1546 WASHINGTON BL -/a i-.o PASD 911042657 FEES PAIDES.CR P - 0 0._ . -� E_NCLOSER�EXI:ST�.N G=PA-T-I�O FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO. SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RES 2000.00 VAL 0.50 SPECIA CONDITIONS: AX BUILDING AVX RE. E 54.70 D2 PERMI WYA -�I;i��� 1000 0 VAL 82.20 CONTRACTOR: TEL. NO: �o� P`N O.T@I-10 E 165.15 APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCWrION AND SETBACKS eSOILS ENGINEER A PROVAL ARCHITECT OR ENGINEER: 0: - FOUNDA ION/TRE CH FOR S LIC. N 1111111 SLAB/UNDER FLOOR 1 ISED FLOOR FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: u�? U D UNDERFLOOR INSULATION3 --WC w ��uJ "' ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/CO D: STAT CTAS. NO 21�� ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS OOF 5 G AIR QUALITY: 1000 FEET MATERIALSI NO NO NO El ® �� FIRE DEPT. FRAME INSPECT EQUIRED TOTAL SETBACK FROM EXIST. 46 11 0BLDG DEPT. FRAME I S C FRONT PL-SET BACK YARD: HWY: PROP LINE: WIDTH ,�C Serlic �lbo SHEAR PANELS SIDE PL- INSULAT IO / ER S R INTERIOR LATH/DRYWALL EXTERIOR LAT LOT DRAINAGE SMOKE DE C 0 DE ICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 i