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Home My Public Portal About9135 OLEMA ST_Building__ • WORKERS'COMPENSATION DECLARATION� i r hereby affirm that I have a certificate of consent to s+or APPLICATION FOR BUILDING PERMIT insure, or n certificate of Workers'Compensfion Insurance,or acertifiecPiopy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY. t PicyNo.__Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ;ADDRESS t ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 1 3 +0� L S LOCALITY 7—Ig M 4 07 1 7&Q � NEAREST ./ Date Applicant CITY I j' I CY ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. I 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 'y USE ZONE MAP Q()_ ` TRACT BLOCK LOT NO. pC NO. >_ hundred dollars ($100)or less.) 174W%a SPECIAL 9LI certify that in the performance of the work for which this OWNER NO CONDITIONS O permit is issued, I shall not employ any person in any manner C DISTRICT _ GROUP JT�IES FIRE PRO ESSED B`- V so as to become subject to the Workers'Compensation Laws. ADDRESS 3 S D��:! OYr/ CONT. ZONE 0 I P _ �} O .(� � CITY !r I � C r � ZIP f 7 U �' � � - ~ Date I Applicantf♦J�w'��1V STATISTICAL CLASSIFICATION PT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. CL Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER P with comply with such provisions or this permit shall be TEL. �jt • deemed revoked. CONTRACTOR NO. BK. PG, }�� VALIDATION LICENSED CONTRAdORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. 4,2) � Professions Code, and my license is in full force and effect. CITY CLASS $ /e2 -6'19 0 SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ $ ❑ ADD I am exempt from the licensing requirements as I am a licensed architect or a registered professional engineer ALTER FINAL Z_ acting in my professional capacity (Section 7051, REPAIR DATE Business and Professions Code). USE F FINAL EXISTING BLDG. DEMOL ❑ By a_r Lic.or Reg.No. _Date APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY = 1-1 C i�0 A. 7044, Business and Profession's Code). MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. o o 0 0 0 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). �,C C REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH T I hereby affirm that there is a construction lending agency for FRONT 0 ' �� - �- C_ the performance of the work for which this permit is issued PA oQ_ C (Sec. 3097, Civ. C.). SIDE 111"? 1 9— P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee ?3 i� Q > I certify that I have read this application and state that the Issuance Fee S V above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee Z 00 ---- and hereby authorize representatives of this County to enter i upon the above-mentioned property for inspection purposes. J Ak SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Dote ®s 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 1112280014 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 12115 LT: 28 I SQ. FT STORIES TYPE I 9135 OLEMA ST I (STRUCTURE: 480 V-B I TEMP CA 917801340 1 ASSESSOR INFORMATION NUMBER: I I NEAREST CRASS STREET: 5382-023-020 I I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI ITENANT: (EXIST BLDG USE: GARAG USE ZONE: R-1 TISSUED ON: PROCESSED BY: 1 IEX ST OCC GRP: 112/28/11 SR 1 (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FIN Y: CODE: 1 1VIVIAN - 1 1 1,000 1 1 9135 OLEMA ST J I�I ITEMP 917801340 1 FEES PAID [DESCRIPTION OF WORK IRE ROOF GARAGE WITH NEW AND EXISTING PLYWOOD IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( I APPLICANT: TEL. N0: KIM, ALBERT (213) 487-1234- IAA BLDG PERMIT ISSUANCE 27.80 I 1 1521 W VERNON AVE IAB STATE GREEN BLDG FEE 1000.00 VAL 1.00 ISPECIAL CONDITIONS: I LOS ANGELES CA 90057 AC STRONG MOTION RESID 1000.00 VAL 0.50 1 D2 PERMIT W/O EN-HC 1000.00 VAL 65.40 1 I I TOTAL FEES 94.70 1- I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I IVICTORY PAINTING AND ROOFING (213) 487-1234- I 1 1 1521 W. VERNON AVE. LIC. NO I ILOCATION AND SETBACKS I 1 1 LOS ANGELES CA 90037 606479 C39 I_ ISOILS ENGINEER APPROVAL I 1 I (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I LIC. NO: 1 (SLAB/UNDER FLOOR 1 1 IRAXSED FLOOR FRAMING 1 1 1 MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1153H265 3 001 1 I 1 1 I I IFLOOR SHEATHING I I 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I I 0 NO 21 1 IROOF SHEATHING 1` 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I 1 (AIR QUALITY: 1000 FEET MATERIALS 1 v I I I 1 1 NO NO NO 1 IFRAME INSPECTION I I 1 1 I [FIRE SPRINKLER HANGERS I 1 [ [ [ NSULATION/WEATHER STRIPI I [ I (INTERIOR LATH/DRYWALL I I 1 I I 1EXTERIOR LATH I I I I I I I [ [RATED FLOOR/CEIL ASSEM. [ I I IRATED WALL ASSEMBLIES I I 1 1 IRATED SHAFTS/OPENINGS I [ IT-BAR CEILINGS I I 1 1 1 [IAT DRAINAGE I [ 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I 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 1112280015 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 12115 IT: 28 I SQ. FT STORIES TYPE I 9135 OLEMA ST 1 I ISTRUCTURE: 1920 V-B I TEMP CA 917801340 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: I 15382-023-020 I 1 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CA I L I (TENANT: (EXIST BLDG USE: GARAG USE ZONE: R-1 (ISSUED ON: PROCESSED BY: (EXIST OCC GRP: 112/28/11 SR I I I I OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL Y: CODE: VIVIAN - 1 6,200 11 �j 1 9135 OLEMA �/ST I [ �/ 1 , ITEMP 917801340 I FEES PAID ID SCRIPTION OF WORK 1 I IRE ROOF HOUSE WITH NEW AND EXISTING PLYWOOD 1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ [APPLICANT: TEL. NO: I I I IKIM, ALBERT (213) 487-1234- IAA BLDG PERMIT ISSUANCE 27.80 1521 W VERNON AVE IAB STATE GREEN BLDG FEE 6200.00 VAL 1.00 SPECIAL CONDITIONS: (LOS ANGELES CA 90057 IAC STRONG MOTION RESID 6200.00 VAL 0.60 [ ID2 PERMIT W/O EN-HC 6200.00 VAL 166.60 I 1 TOTAL FEES 196.00 I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I IVICTORY PAINTING AND ROOFING (213) 487-1234- 1 1 I 1521 W. VERNON AVE. LIC. NO I ILOCATION AND SETBACKS I [ ILOS ANGELES CA 90037 606479 C39 I I I [ I I ISOILS ENGINEER APPROVAL I I [ [ARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS I I I LIC. NO: I [SLAB/UNDER FLOOR I [ I I I IRA SED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I [UNDERFLOOR INSULATION 1153H265 3 001 1 I I IFLOOR SHEATHING 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I [ [ I [ 0 NO 21 1 [ROOF SHEATHING � � [ SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS 1 (AIR QUALITY: 1000 FEET MATERIALS NO NO NO IFRAME INSPECTION I I [ I IFIRE SPRINKLER HANGERS I I I I I I I I [ I (INSULATION/WEATHER STRIP( I I I I [INTERIOR LATH/DRYWALL I I I I (EXTERIOR LATH I I [ 1 I IRATBD FLOOR/CEIL ASSEM. I I I IRATED WALL ASSEMBLIES [ I I I IRATED SHAFTS/OPENINGS IT-BAR CEILINGS [ I I I ILO.T DRAINAGE I I I IREPORT ID: DPR261 ROUTE TO: BS0508