HomeMy Public PortalAbout10130 OLIVE ST_Building__ ECLARATION
( erebo affirm that I,have a certificate of consent to self APPLICATION .
P�P L I CAT I O� FOR B lJ I L D I IV G� P E RM I T
insure, or a,"certificate of Workers'Compensation Insurance, •
or a certified copy thereof(See. 3800, Lob. C.)
Policy NO.' Company
COUNTY-OF LOS ANGELES' BUILDING AND SAFETY
Certified co is herebyfurnished''. ' BUILDING•
+� copy FOR APPLICANT TO FILLyIN ADDRESS
❑ Certified copy is'filed,wifh the county building in ec- `
tion prtment. P ADDR SS
Date — icons ITYZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' y 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 i ASSESSOR
hundred dolldrs($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
' TEL. USE ZONE MAP
I certifythat in the OWNER NO.• "6 e R Z• 73
performance of the work for which this
:permit is issued, I shall not employ any person in any anner ��` SPECIAL'
so as to become su to the Workers'Compensat' La ADDRESS CONDITIONS
Date " Applicant 1 ZIP
NOTICE YO_APPLICANT. If, ,ft.
ARCHITECT OR r making this Certificate'of TEL.
ENGINEER NO. DISTRICT, GROUP TYPE FIRE PROCESSED BY
_
Exemption, you should 'become subject to the Workers' 93 CONST.' ZONE'
Compensation'provisi ons of the Labor Code, you must forth ADDRESS
with comply with such provisions or this permit shall, be.
deemed revoked. 1TEL. a 7n STATISTICAL CLASSIFICATION API. DO.
CONTRACTO r
NO. /d r� � ,
LICENSED CONTRACTORS DECLARATION LIC CLASS NO._G.`_DWELL..UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 3'/�•�� NO. . ®• a
(commencing with Section 7000)of Division 3 of the Business-and SEWER-MAP
Professions Code, and my license is in full force and effect. : CITY ��/��v �/ ` LIC•. q
_ CLASS gK• po. .� VALIDATION
SQ.FT. / NO:OF NO.OF CHECK t
License Number Lic.ClassSIZE SO STORIES IFAMILIES ONE U
VALUATION
Contracto r ate — rADDRESS
DESCRIPTION OF WORK NEW { /I 00-ADD `1LJ(/I am exempt under Sec. � / ��/� LTER8.8P.C. for this reason REPAIR ;Date: G BLDG. -/L • r DEMOL ❑ ZSignature ANT :FINAL OWNER-BUILDER DECLARATION INT ���� NO DATE I hereby offirrrf that I am exempt from the Contractor's License' - ��"Low for the following reason (Section 7031.5,-Business and 'FI L
Professions Code):
PRE ENT' B ,
❑ BUILDING v�i;,'' l `,j.iuu
I, as owner of the property, or my employees with' ADDRESS ' L
wages as their sole comRensation,will do the work and', _;
the structure is not intended or offered for sale(Section LOCALITY ® ;` e:
7044, Business and Professions Code). . MOVING TEL. 0101
❑ I, as owner of the'properti,'propertyam exclusively contracting CONTRACTOR NO. `.
,r.•—Lae. �•i EI�I
with licensed contractors to construct the project (Sec-
tion 7044, Business'and Professions Code). ADDRESS
° REQUIRED TOTAL SETBACK + " •LI�I
'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. go 0
(Sec. 3097, Civ. C.). SIDE CH:=i''•_ :•L ;.y�i_� .
P.L. r.o iC
Lender's Name
+ _ RM � •y.
4
P.C.Fee$ Permit Fee .Q7 LDMA Ref. 0
Lender's-Address —7 w�yy���
I certify that I have read this application and state that the Issuance Fee 0®•:7L/ LD MA P/C N
above information is correct. I agree to comply with all County `Investigation Fee
ordima?G—rei#Applicant
tetaws elatin to building construction, Total Fee ;1�•.� IDMA Perm. q
andre dent es of this County to enter,
upoed p erty for inspection purposes..
SEE REVERSE FOR EXPLAIOATORY LANGUAGE
ant or Agent Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1311140093
PHONE: (626) 285-0488 EXT:
ILEGAL ID: NO. OF CONST NEW I BUILDING ADDRESS: I
ITR: 10558 LT. 23 I SQ. FT STORIES TYPE OCCUP GROUPI 10130 OLIVE ST [
ISTRUCTURE: 146 1 V-B R-3 I TEMP CA 917803344 I
(ASSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET: BALDWIN 1
18585-002-013 I OTHER: 635 1 V-B U I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
[TENANT: (EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: 1
1 1EXIST OCC GRP: 102/18/14 SR 1
(OWNER: TEL NO: JBLDGS. NOW ON LOT: VALUATION: IFI AL DA FI AL BY: CODE: 1
1JANKLY JOHN B;ROSA (626) 442-2862- 1 77,540 1
110130 OLIVE ST I I I
ITEMP 917803344 1 FEES PAID In qCATP'rTIDN OF WORK
I I ITO EXTEND & RENOVATE KITCHEN RELOCATE (E) FAMILY RM, BATHRM, 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:JLAUNDRY, CONVERT (E) FAMILY RM, TO BEDRM, ADD ROOF OVER I
APPLICANT: TEL. NO: I I (E) PORCH, REROOF ENTIRE MAIN HOUSE J
JAQUINO, JAIME (626) 810-0946- IBI PLANCHECK W/ENERGY 77540.00 VAL 1,008.00 1 [
12419 PAULINE ST IAA BLDG PERMIT ISSUANCE 27.80 ISPEC=AL CONDITIONS: 1
WEST COVINA CA 91792 IAB STATE GREEN BLDG FEE 77540.00 VAL 4.00 ICOVENANT RECORDED 1
IAC STRONG MOTION RESID 77540.00 VAL 7.80 I I
JB2 PERMIT W/ENERGY 77540.00 VAL 1,185.90 I I
ICONTRACTOR: TEL. NO: 108 CERTIF OF OCCUPANCY 101.40 JAPPROVALS DATE INSPECTOR SIGNATURE 1
IM M RAMOS CONSTRUCTION INC. (818) 224-2422- 1 TOTAL FEES 2,334.90 1 [
138519 2TH STREET LIC. NO I ILOCAT_ION AND SETBACKS I I
IPALMDALE CA 93550 500772 1 1- I
I ISOILS ENGINEER APPROVAL I I
i
JARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNOATION/TRENCH FORMS 1 I
1 LIC. NO. 1 JSLAB/UNDER FLOOR �I i
[ I 1RAISED FLOOR FRAMING 1 1
[MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-1 IUNUF.RFLOOR INSULATION I I
I 3 OOI ! I _I _I
I I 11ST LEVEL FLOOR SHEATH 1
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I__ I I I
1 0 NO 21-i 12ND LEVEL FLOOR SHEATH
1 SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING P i
1AIR QUALITY: 1000 FEET MATERIALS J I__.__. ` I
1 NO NO NO i IFIRE DEPT. FRAME INSPECT[ I I
J -1 1BLDG DEPT. FRAME INSPECT( I I
I J I I
I I ISHEAR PANELS
I I
I I JINSULAT_ION/WEATHER STRIP) 1
I I JINTERIOR LATH/DRYWALL 1 -1
I i JEXTERIOR LATH 1 I
I I I I I
I I ILOT DRAINAGE I I I
1 I ISMOKE DETECTION DEVICES 1 I 1
I I IFIRE DEPARTMENT APPROVAL[ I. I
I I I I I I
I I I i I I
IREPORT ID: DPR261 ROUTE TO: BS0508
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COUNTY40; LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
D?PARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1402180071
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BIIILDING ADDRESS: I
ITR: 10558 IT: 23 I SQ. FT STORIES TYPE OCCUP GROUP[ 10130 OLIVE ST I
ISTRUCTURE: 0 1 V-B U I TEMP CA 917803344 I
(ASSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET: BALDWIN 1
18585-002-013 I OTHER: [ THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
1(TENANT: (EXIST BLDG USE: USE ZONE: [ISSUED ON: PROCESSED BY: I
EXIST OCC GRP: 102/18/14 SR [
[OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL J?ATE FINAL Y: CODE: [
1JANKLY JOHN B;ROSA (626) 442-2862- 1 2,500 [
110130 OLIVE ST I [
ITEMP 917803344 1 FEES PAID IDEISCRIPTfON10F WORK [
I I IREMODEL EXISTING RUMPUS R00 AND ADD NEW BATHROOM 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I (REMOVE KITCHEN) 1
]APPLICANT: TEL. NO: I I I
IAQUINO, JAIME (626) 810-0946- IAA BLDG PERMIT ISSUANCE 27.80 1 I
12419 PAULINE ST IAB STATE GREEN BLDG FEE 2500.00 VAL 1.00 ISPECIAL CONDITIONS: 1
[WEST COVINA CA 91792 1AC STRONG MOTION RESID 2500.00 VAL 0.50 ICOVENANT RECORDED 1
I B2 PERMIT W/ENERGY 2500.00 VAL 108.90 1 I
1 1 TOTAL FEES 138.20 1 I
ICONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE 1
IM M RAMOS CONSTRUCTION INC. (818) 224-2422- I 1 I
138519 2TH STREET LIC. NO 1 ILOCATION AND SETBACKS I I I
IPALMDALE CA 93550 500772 I 1 I I I
I I ISOILS ENGINEER APPROVAL ] I I
[ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I
1 LIC. NO: 1 ISLAB/UNDER FLOOR ] I I
1 ] I 1 [RAISED FLOOR FRAMING 1 I
IMAP NO: SEWER MAP BOOK: PAGE: FIRS ZONE: CMP:[ [UNDERFLOOR INSULATION I I I
1 3 001 I1ST LEVEL FLOOR SHEATH I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I
] 0 NO 21 1 12ND LEVEL FLOOR SHEATH I I
1 SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING ] I I
[AIR QUALITY: 1000 FEET MATERIALS I I I I
] NO NO NO [ IFIRE DEPT. FRAME INSPECT] 1
I I (BLDG DEPT. FRAME INSPECTI I
I I I 1 I I
I I [SHEAR PANELS I I
I (INSULATION/WEATHER STRIP[ I
11NTERIOR LATH/DRYWALL 1 1 1
I I [EXTERIOR LATH I I
I I 1LOT DRAINAGE 1 I I
I 1 [SMOKE DETECTION DEVICES I 1
I I IFIRE DEPARTMENT APPROVAL[ I
I I I 1 1 I
I IREPORT ID: DPR261 ROUTE TO: BS0508 [ I
I I I I 1 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 1402270095
PHONE: (626) 285-0488 EXT:
ILEGAL IDe I NO. OF CONST I BUILDING ADDRESS: I
ITR: 10558 IT: 23 I SQ. FT STORIES TYPE 1 10130 OLIVE ST I
[STRUCTURE: V—B I TEMP CA 917803344 1
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: BALDWIN
18585-002-013 I I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CA
ITENANT: (EXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1
1 (EXIST OCC GRP: 102/27/14 SR 1
(OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: I NAL DATE FINAL BY: CODE: 1
IJANKLY JOHN B;ROSA (626) 442-2862— 4,050 1 I
110130 OLIVE ST I I
TEMP 917803344 1 FEES PAID 1151VCYI T N F WORK 1
I I ICHIMNEY EXTENSION 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 1
IAPPLICANT: TEL. NO: ' I I I
IGORDON, CK BEAU (818) 371-2914— IAA BLDG PERMIT ISSUANCE 27.80 I 1
12138 MENDOCINO IN IAB STATE GREEN BLDG FEE 4050.00 VAL 1.00 SPECIAL CONDITIONS:
LD1 PLANCHECK W/O EN—HC 4050.00 VAL 112.70
D2 PERMIT W/O EN—HC 4050.00 VAL 132.60
1 TOTAL FEES 274.10 1 I
(CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
IBOSTON BRICK AND STONE (626) 296-7700— 1 1 I
12005 LINCOLN AVE LIC. NO 1 ILOCATION AND SETBACKS I I I
IPASADENA CA 91103 783578 * I 1 I I I
I I ISOILS ENGINEER APPROVAL 1 I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUNDATION/TRENCH FORMS 1 1
ILE, THANG (626) 731-1539— 1 I I I [
1155 S EL MONILO AVENUE STE 102 LIC. NO: 1 ISLAB/UNDER FLOOR 1 I [
IPASADENA CA 91101 783578 * * I I I
I I (RAISED FLOOR FRAMING 1 I I
I I I I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 UNDERFLOOR INSULATION 1 I I
3 001 1-
[FLOOR SHEATHING 1 1
[NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
1 NO 21 1 IROOF SHEATHING 1 I [
I I I I I I
SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I
IAIR QUALITY: 1000 FEET MATERIALS I I I I [
1 NO NO NO 1FRAME INSPECTION / I
(FIRE SPRINKLER HANG RS
I I 11NSULATION/WEATHER STRIP[ I I
I I (INTERIOR LATH/DRYWALL I [ I
I (EXTERIOR LATH [ I
1 IRATED FLOOR/CEIL ASSEM. I I
I I IRATED WALL ASSEMBLIES I I I
I I (RATED SHAFTS/OPENINGS I I I
IT—BAR CEILINGS
I 1
I* ADDITIONAL DATA ON FILE I I I I
I 1 ILOT DRAINAGE 1
IREPORT ID: DPR261 ROUTE TO: BS0508 I I I
I I I I I