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HomeMy Public PortalAbout9083 OLIVE ST_Building__ WORKERS' COMPMLSATIPN RECLAJRATION + APPLICATION FOR BUILDING PERMIT I lnero:Iy aiffirm that I have a'certificateu of consent to self �insare,-or a certificate of Workers' Compensation Insurance, car Si certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELPS BUILDING AND SAFETY Policy No.Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDINGO g� a�1 1t�. tion department. ".ADDRESS Date ApplicarN w CITY�/n��� CLT,✓ ZIP ��7�G LOCALITY ' ` 2 N0.OF BLDG5. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT I I FT NOW ON LOT 2 CROSS ST. COMPENSATION INSURANCE /, f ASSESSOR (This section need not be completed if the permit is for one TRACT I I BLOCK -D LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL OWNER ,�J/;k &_0 b ift- No. . 12r -'?,T.Td USE ZONE MOP J o I certify that in the performance of the work for which this N . SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS] /, �� Vt� CONDITIONS so as to become subject to the Workers'Compensation Laws. CITY"O"Alt c (� 7 O !� ZIP J"l U Date Applicant ARCHITECT OR / NO. 0 NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER DI RICT GROUP TYPE FIRE PROCESSED BY Q Exemption, you should become subject to the Workers' t CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS J CL W with comply with such provisions or this permit shall be $ ' TEL. G2_ STATISTICAL CLASSIFI ATION APT. CONDO. N deemed revoked. CONTRACTOR / 140:(543- 7B� Z LICENSED CONTRACTORS DECLARATION z LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWWIC13 P � and Professions Code,and my license is in full force and effect. CITY CLASS BK VALIDATION SQ. FT. NO. OF 2 NO. OF CHECK License Number Uc. Class SIZE STORIES FAMILIES ONE 23 LUATION Contractor Date &V DESCRIPTION OF WORK A d,= NEW ML ACCT. �j e✓� C�C� AFI n ❑I am exempt under Sec. �qq� wd ;ADD 3307 392007 B.&P.C. for this reason ALTER ❑ 1 ITEMS USE OF � REPAIR ❑ $ Date: EXISTING BLDG.r4 AJ(k(„� i<r%t 4 V DEMOL ❑ T�TF4[. ' '06� Signature APPLICANT //�� TEL f CHECK 392.07 (PRINT) A/Q/� /�tJ�}(,t1S�L NO. L ,rjr FINAL OWNER-BUILDER DECLARATION — I hereby affirm that I am exempt from the Contractor's License CHANGE oOil DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professibns Code): ; PRESENT By NG I, as owner of the property, or my employees with � ADDRESS COM-6001D1 7/18/�9 El 1, wages as their sole compensation,will do the work and �t�t the structure is not intended or offered for sale(Section LOCALITY — 4535 1 A 1 90u 56 7044, Business and Professions Code.) MOVING TEL. r) I,as owner of the property,am exclusively contracting CONTRACTOR NO. 33177 471,IJ with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) 1 ITEM REQUIRED TOTAL SETBACK FROM EXIST. WY PROP. LINE WIDTH TOTAL o-7 CONSTRUCTION LENDING AGENCY SET BACK YARD H ]1 © ate*5 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. CHECK', 471°75 (Sec. 3097, Civ. C.). i SIDE P.L.. CHANGE ,1313 Lender's Name LDMA Ref. # Lender's Address P.C. Fee S Permit Fee '• - y� OOM-0001 IO/ 2/x,7 I certify that I have read this application and state that the Issuance Fee V .155D LDMA P/C# 'Y above information is correct. I agree to comply with all County �Investigation Fee 0�� 1 ti� G U°-.5. 5 ordinance Obnd State laws relating to building construction, Total Fee 7 ` LDMA Perm. # and her y.aut r' a representatives of this County to enter 3 upo a ak( e- ti erty for inspection yurposes. [ /a/-7?h7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent I Yate it 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 0607180002 PHONE. (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 11218 LT: 19 BL: D SQ. FT STORIES TYPE 9083 OLIVE ST STRUCTURE: VN TEMP CA 917803024 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ROSEMEAD 5388-005-020 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 07/18/06 JK 07/13/07 OWNER: TEL. NO: SLUGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: BRUGGER MARK E;LIA F (626) 287-5580- 10,000 9083 OLIVE ST o TEMP 917803024 FEES PAID DESCRIPTION OF WORK KITCHEN REMODEL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: L AND W KITCHENS & BATHS (626) 287-1131- AA BLDG PERMIT ISSUANCE 27.75 8812 LAS TUNAS DR. AC STRONG MOTION REBID 10000.00 VAL 1.00 SPECIAL CONDITIONS: SAN GABRIEL B2 PERMIT W/ENERGY 10000.00 VAL 238.26 TOTAL FEES 267.01 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE L AND W KITCHEN AND BATHS (626) 287-1131- 8812 LAS TUNAS DR. LIC. NO LOCATION AND SETBACKS SAN GABRIEL, CA 91776 2053448 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 147H265 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: FRONT PL- INSL?.ATION WEATHER STRIP SIDE PL- INTERIOR LATH DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508