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Home My Public Portal About9104 OLEMA ST_Building__ WORKERS'COMPENSATION DECLARATION i e• I hereby affirm that I have certificate of consent to self ® P P L I CAT I O FOR BUILDING P E RM I T 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 9' Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ' ADDRESS Certified copy is filed with th county buil 'ng inspec- BUILDING /►� n� �� tion department. ADDRESS 9)(3-1, Oaf Date Applicant I CITY a ZIP LOCALITY CERTIFICATE OF EXEMPT FRO O KERS' NO.OF BLDGS. NEAREST COMPENSATIO SURA CE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be co Wed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USEONE 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 manner ( SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS - CONDITIONS O Date Applicant- CITY ZIP O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. s DISTRICT GROUP TYPE FIRE PRO SSED BY Exemption, you should become subject to the Workers' ENGINEER NO. CONST. 7S?NE V Compensation provisions Ofthe Labor Code, you must forth- ADDRESS with comply with such provisions or this permit shall be 0 deemed revoked. T F STATISTICAL CLASSIFIC TION APT. CO DO. CONTRACTOR �G Z LICENSED CONTRACTORS DECLARATION r LIC. is CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. !� SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. q Professions Code,and my license is in full force and effect. CITY CLASS C 3 / i. BK VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE q ALUATION Contractor Date / DESCRIPTION OF WORK NEW ❑,FV -03�� f7 ADD ❑I am exempt under Sec. AV 10, ALTERB.BP.C. for this reason REPAIR U ❑ D e: EXISTING BL DEMOL Signature APPLICANT TEL. FINAL NER-B DER DECLARATION PRINT NO. DATE I hereby a r that I a exempt from the Contractor's License Law for t allowing reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESEMT B BUILDING 1, as owner of the property, or myemployees with ADDRESS ;27 8 Q 0 A wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY # 0 0 0 0 0.1 7044, Business and Professions Code). MOVING TEL. I, as owner of the property,am exclusively contracting CONTRACTOR NO. ° ° 6 a 6 3 with licensed contractors to construct the project (Sec- ADDRESS o o - 6a63'0 tion 7044, Business and Professions Code). MW REQUIRED TOTAL SETBACK CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 0 a 3 1 8 7 1 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. q o Lender's Address P.C. Fee$ Permif Fee ) /' 1 certify that I have read this application and state that the Issuance Fee / V- cz) LDMA P/C q ° above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee LDMA Perm. q N and he eby authorize re sentatives of this County to enter $ upon a above-menti a roperty for inspection purposes. rr SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Applicant or Agent Date RS'COMPENSATION DECLARATION certificate lf APPLICATION BUILDING I in fcafe of Wokes'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 ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING F tion department. ADDRESS 6 Date Applicant CITY C C,,Va. ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' 9 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 TEL' cY/! USE ZONE I MAP I certify that in the performance of the work for which this OWNER AVA&lk7 6L42 NO. (J{.� NO. y.� permit is issued,1 shall not emplo a y erson any manner / r SPECIAL f1. so as to become subject to the Woa Comp a ion Laws. ADDRESS y �Q!Wb�/✓1 CONDITIONS U / eM i ZIP Date �1 I—vQ}��pplicant I CITY � NOTICE TO APPLICANT: If, after t s C r fico of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become s e Workers ENGINEER NO. CONST ZONE V P y , AS -3 , Compensation provisions of the Labor ode, ou ust forth- 'ADDRESS with comply with such provisions or this p rmit shall be / TEL. �, OJ STATISTICAL CLASSIFIC TION APT. CONDO. N deemed revoked. CONTRACTOR V NO. ` 17"'1 P Z LICENSED CONTRACTORS DECLARATION jA LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 'ADDRESS NO.Y30q SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. �+ Professions Code, and my license is in full force and effect. CITY EJ�y1 CLASS C—Z I BK PG VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class �� SIZE STORIES FAMILIES ONE VALUATION Contractor Date ::> —' DESCRIPTION OF WORK a NEW EJ $ ADD ❑ ❑ I am exempt under Sec. GIm ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL .Q OWNER-BUILDER DECLARATION PRINT NO. DA '�� t/O 1 hereby affirm that I am exempt from the Contractor's License 9 Jr S A Law for the following reason (Section 7031.5, Business and ADDRESS FI Professions Code): PRESER B BUILDING ,, # 0 0 0.0 0 ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and r' ( o - 49.88 the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. { 4 9 8 8 ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. 0 0 0 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS t� �+8 8 CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.L NE ^WIDTC'K FROM 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. Lender's Name mom 7 � LDMA Ref. N o P.C.Fee$ Permit Fee Lender's Addre s I certify that I ead thi I ation and state that the Issuance Fee 40 t LDMA P/C iy above informatio r ect. I e comply with all County L::� ordinances and S r 1 g uilding construction, Total Feet" and hereby authorr a nt es ounty to enter r LDMA Perm. # $ upon the above-m p fo in on purposes. n SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applic or Ag t ate 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 0210180003 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF CONSTBUILDING ADDRESS: TR: 12115 LT: 34 SQ. FT STORIES TYPE 9104 OLEMA ST STRUCTURE: VN TEMP CA 917801339 ASSESSOR : NEAREST CROSS STREET: ENCINITA 5382-023-026 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY YOU-910 US -RES I D USE ZONE: -1 TS—SUED_0N PROCESSED 8 P ON: EXIST OCC GRP: 10/18/02 JK 04/16/03 OWNER: TEL. NO: B DGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: SANGREN MYRTLE (626) 286-6585- 2,250 9104 OLEMA ST 6 (� TEMP 917801339 FEES PAID DMRIPTIONOf WURK�- INSTALL 30YR ELK R EXISTING 1LAYER COMP FEE DESCRIPTION: QUANTITY: UDM: AMOUNT: APPLICANT: L. NO: GRATER (626) 355-2755- AA BLDG PERMIT ISSUANCE 27.75 7115 MONTEREY ST AC STRONG MOTION RESID 2250.00 VAL 0.50 SPECIAL CONDITIONS: LA VERNE D2 PERMIT W/0 EN-HC.. _ --2250.00 VAL 99.00 - TOTAL-FEES 127.25 CONTRA TOR: TEL. N0: sr f;.:.. ;,. '' APPROVALS TE IN SIGN TU E D AND G ROOFING (626) 593-4982- - 7115 MONTEREY ST LIC. NO �., OCA D S CKS LA VERNE, CA 91750 534986/C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: 0: ;, FOUNDATIO TRE C OR S LIC. NO: ,1; SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: cm—p. UNDERFLOOR� INSULATION 153H265 3 01 - =_ �_ �• FLOOR SHEA79ING NO. OF FAMILIES: DWELLING S: APT/ OND: STAT CLASS-' L SS NO 21 �,s. i ROOF SHEATHING SCHOOL HAZARDOUS i + '.� �' , SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS ' NO NO NO FRAMf INSPECTION QUIRED TOTAL SETBACK FROM EXIS * :`f; ' . FIRE SPRINKLER A G S SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- C :i -- _" �'.`_ INSULATION/WEATHER RIP SIDE PL- INTERIORLATH/DRYWALL EXTERIOR L H RATED FLOOW7EM RATED WALL ASSEMBLIES RATEDSHAFTS/OPENINGS T-8 R CEILINGS LOT DRAINA69 REPORT ID: DPR261 ROUTE TO: BS0508