HomeMy Public PortalAbout10206 OLIVE ST_Building__ i
r -T: D LW/r"1TI®N FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL-IN BL'LDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS /,
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.) CITT ZIP,fJ
LOCALITY
Policy No. Company SIZE O LOT NO.OF BLDGS.NOW ON LOT
11 Certified copy is hereby furnished. .0 NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCKLOT NO.
department. USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
e-9 I SPECIAL CONDITIONS 0
CERTIFICATE OF EXEMPTION FROM WO E OWNER TEL NO.
COMPENSATION INSURANCE w WITHIN 1000 FT.OF SCHOOLS YES NO
(This section need not be completed if the permit is for one hundr ADDRE �,``
• � r /'7 V0 /lt7 DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
dollars ($100)or less.)
♦
I certify that in the performance of the work for which this permit CITY 67441-
.1 ZIP a.
is issued, I Shall not employ any person i any manner SO as t0 ARCHITECT OR ENGINEER % � TEL NO. `mow
become subject to the Workers'Compensatt ion Laws. ` . STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDR S l_ d_ CLASS NO. DWELL UNITS
N077CE TO APPLICANT. If, after making this Certificate Of -M.304�J "e REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject t0 the Workers' CONTRACTOR TPL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS L�L LIC.NO. PL
LICENSED CONTRACTORS DECLARATION SIDE
CITY LIC.CLASS PL
I hereby affirm that I am licensed underprovlsions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES
Professions Code,and my license is in full force and effect. /p? �o / NEW 11BK PG // }
23
License Number Lic.Class DESCRIPT tF RK �ff ADD VALUATION ® G4T C
Contractor Date ALTER 11 $
° C:
r3303 1131°2b a
[II am exempt under Sec. 7 REPAIR ❑ H
$ 1 ITEMSS
B.BP.C.for this reason P DEMOL ❑ LDMA PJC s �'
Date: 'USE OF ING DG.
Signature APPLICA ( NT) JLpNO. LDMA Perm r'
❑ I, as owner of the property, or my employees with wages as >mAgsd C to �3 ZGE 1r'�
their sole compensation, will d0 the work and the structure is ADDRE — ` O
of intended or offered for sale (Section 7044, Business and Gt Gd�j�% b E=• FINAL DATE Q ACCT°v
rofessions Code.) D •+
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL fQ^ ..1 -ODO1
I, f owner of the property, am exclusively contracting with OR A MIXTURE CONTAIN'!NG A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q WJLFLI U G
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE
licensed contractors to construct the project (Section 7044, FINAL BY > 1bG81 ITEfS A� °7
Business and Professions Code.) YES El NO 11WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING TOTAL 13 .30
OCCUCOASTAIRQUALITY MANAGEMENTRDISTRICT SCAOMDUCTION RSEEDIFICATION FROM THE PERMITTTNG CHECKLIST OUTH
FOR /••IJChI( 1372] 2
CONSTRUCTION LENDING AGENCY GUIDELINES CHEC•
I hereby affirm that there is a construction lending agency for YES❑ NO❑ CHANGE 00
a the performance of the work for which this permit is issued(Sec. 1� _� .. °
W I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE 3CAOMD PERMITTING
3097,Civ.C.) CHECKLIST I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, JV 0
N TITLE 2 CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING HAZARDOUS
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. � 011 1 +/-" . QOQO-0001 9/28/95.)2O/O
io Lender's Address (LII (� U 7A/�iCQI°7�1
Q2/h'cR OR ALERT 2539' 1 °
o I certify that I have read this application and stale under penalty Lf
of perjur that the above information is correct.I agree to comply P.C.FEE / / PERMIT FEE �+
N with count in n es nd State laws relatin to build' it �JJ �d/yJ9
s ruction, an h r y a orize representatives of his o ty ISSUANCE FEE 30 ��v
ro t en o - n d rop ty for ins{ ti �f6/'� a
CD INVESTIGATION FEE TOTAL FEE � e
T` b]a Jua•a1 Atm .r t m A;Tl D'a
SEE REVERSE FOR EXPLANATORY LANGUAGE
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 0509270022
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 10558 LT: 35 SQ. FT STORIES TYPE 10206 OLIVE ST
STRUCTURE: 1500 VN TEMP CA 917803346
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8585-004-029 , THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 09/27/05 JK 09/22/06
OWNER: TEL. NO: SLUGS. NOW ON LOT: VALUATION: FINAL DATEHY: CODE:
WEN, FRANK - 3,500
10206 OLIVE ST
TEMP 917803346 FEES PAID DESCRIPTION OF WORK
REMOVE FLAT ROOF BUILT-UP CAPSHEET
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
YANG (213) 400-7744- AA BLDG PERMIT ISSUANCE 27.75
501 MIGUEL PL AC STRONG MOTION RESID 3500.00 VAL 0.50 SPECIAL CONDITIONS:
FULLERTON, CA 92835 D2 PERMIT W/O EN-HC 3500.00 VAL 115.80
TOTAL FEES 144.05
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
BEST ROOFING AND CONSTRUCTION (714) 321-0335-
501 MIGUEL PLACE LIC. NO LOCATION AND SETBACKS
FULLERTON, CA 92835 552156 C39
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS
LIC. NO: SLAB UNDER FLOOR
i
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: i UNDERFLOOR INSULATION
147H273 3 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH: f
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH DRYWALL
EXTERIOR LATH
i
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508