HomeMy Public PortalAbout9340 OLIVE ST_Building__ d APPLICATION FOR BUILDING PERMIT �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING 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 e_ A' S / 3
copy thereof(Sec.3600,Lab.C.) CI zIP
- r,,�, LOCAL L c �
Policy No. Company SIZE OF T NO.OF BLDGS.NOW ON LOT
[ICertified copy is hereby furnished. /10 (o cS ;z_ NEAREST CROSS ST
❑ Certified copy Is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO.
department.
ASSESSOR
Date ApplicantMAP BOOK PAGE PARCEL 7 SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER- _ TEL NO.
COMPENSATION INSURANCE AD is � WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed If the permit is for one hundred V0 � � DISTRICT GROUP TYPE CONST.' FIRE ZONEOC BY
�¢
dollars($100)or less.) CITY ZIP l
I certify that in the performance of the work for which this permit p � ��3 3
Is issued, I shall not employ any person in any manner so as to CH O E EER- J'TEL NO.
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION A ONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate ofREQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SETBACK 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 LIC.NO. PL
LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE }
PL p
I hereby affirm that I am licensed under provisions of Chapter 9 —Wo. SEWER MAP v
(commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE OF STORES NO. FAMILIES
Professions Code,and my license is in full force and effect. NEW ❑ VALUATION
PG
❑ W
License Number LID.Class DRIPTION OF WORK ADD ®
a
Contractor Date ALTER ❑ _�
IJ uvS vim' REPAIR
❑ I am exempt under Sec.
B.BP.C.for this reason F, INS.-Por DEMOL ❑ LDMA P/C#
U E F IN BLDG. URM ❑
Date: -
Signature APPLICANT(PRINT) TEL.NO. LDMA Perm#
❑ I, as owner of the property, or my employees with wages as p (4:(;T■v
their sole compensation,will do the work and the structure is ADDRESS F,
not Intended or offered for sale (Section 7044, Business and I FINAL DATE Q 3307 53.75
Professions Code.) WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL
❑ I, as owner Of the property, am exclusively contracting with ITEMS,OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN i ITE lS,
THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed contractors to construct the project (Section 7044, YES❑ NO❑ i T 1 TOTAL 59.75
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUlV).JE�•(J58.75
TH '1 Citi
CONSTRUCTION LENDING AGENCY COAST AIR DUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST 1
FOR GUIDELINES CHANGE A0
I]{
I hereby affirm that there is a construction lending agency for YES❑ NO❑
the performance of the work for which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD y�
3097,ti1V.ti.). PERMITTING CHECKLIST.I COUNTY CODE.TITLE ZCCH UAPTER 220 SECTIONS 22M100THROUGH 2.2MI40 CCONDERffrAND MY REQUIREMENTS UNDER THE NCERNIANGENG 13000-C GI 7/30}71.)
Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.
Lenders Addresse,oBAoM 108 1 QM 06
GM
0 1 certify that I have read this appllcatio lend tat
that the above
Information Is Correct. I agree Dmp with all County P.C.FEE PERMIT FEE
ordinances State laws relati to bull g construction,and
hereby a rize represents' t unty to enter upon ISSUANCE FEE
the do d p s ion purposes.
JTD— INVESTIGATION FEE TOTAL FEE
s
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 1110050062
PHONE: (626) 285-0488 EXT:
LEGAL ID: N0. OF CONST BUILDING ADDRESS:
TR: 11492 LT: 7 BL: B SQ. FT STORIES TYPE 9340 OLIVE ST
II
[ASSfiSSOR INFORMATION NUMBER: STRUCTURE: 1166 V-B TEMP CA 917803127
NEAREST CROSS STREET: ALESSANDRO
8590-002-007 I I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
[TENANT: -1[EXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY:
[EXIST OCC GRP: 110/05/11 SR [
[
[OWNER: TEL. NO: [SLOGS. NOW ON LOT: VALUATION: [ INAL D FI BY: CODE: [
INGOON-HOU, JANET (626) 731-0611- I 4,500 I [
19340 OLIVE ST
[TEMP 917803127 [ FEES PAID ID :RIPTION OF WORK [
I [ IT1602ROOF AND REROOF WITH COMPOSITION SHINGLE, INSTALL 30 LB [
I [FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:IASTM UNDERLAYMENT, INSTALL ALL NEW GALVANIZED RED & PIPE [
[APPLICANT: TEL. NO: I IFASHING, INSTALL WEATER BARRIER (MAIN HOUSE) [
Y00, JIFENG (626) 202-7811- IAA BLDG PERMIT ISSUANCE 27.80 I [
IAB STATE GREEN BLDG FEE 4500.00 VAL 1.00 SPECIAL CONDITIONS:
IAC STRONG MOTION RESID 4500.00 VAL 0.50 [
I ID2 PERMIT W/O EN-HC 4500.00 VAL 132.80
[ [ TOTAL FEES 162.10
[CONTRACTOR: TEL. NO: I [APPROVALS DATE INSPECTOR SIGNATURE
[
IJIFENG YAO (626) 202-7811- [
120616 DREXEL DRIVELIC. NO I [LOCATION AND SETBACKS [ [ [
[WALNUT, CA 91789 945757
[SOILS ENGINEER APPROVAL [ [ I
(ARCHITECT OR ENGINEER: TEL. NO: - I IFOUNDATION/TRENCH FORMS [ [ [
LIC. NO: I [SLAB/UNDER FLOOR [ I
IRAISED FLOOR FRAMING [ [ [
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMOPoI UNDERFLOOR INSULATION [ [ [
I147H265
I I
[ IFLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I
0 NO 21 I IROOF SHEATHING [
[ SCHOOL WITHIN HAZARDOUSI (SHEAR PANELS I�'I [
[AIR QUALITY: 1000 FEET MATERIALS
NO NO NO I IFRAME INSPECTION I I I
I
I I [FIRfi SPRINKLER HANGERS [ I I
(INSULATION/WEATHER STRIP[ I
[ I [ I I I
(INTERIOR LATH/DRYWALL
[ I [EXTERIOR LATH I I [
[ I (RATED FLOOR/CEIL ASSEM. I I [
[ RATED WALL ASSEMBLIES
[ [ I
(RATED SHAFTS/OPENINGS I I
[ I IT-BAR CEILINGS [ I I
I
j[ [ LOT DRAINAGE [ [
i :=. REPORT ID-. DPR26+1 `�_ ROUTE:Ta:_BS0 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 1110050063
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: ]
ITR: 11492 LT: 7 BL: B I SQ. FT STORIES TYPE 9340 OLIVE ST 1
ISTRUCTURE: V-B 1 TEMP CA 917803127
(ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ALESSANDRO
18590-002-007 I I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
ITENANT: EXIST BLDG USE: RESID USE ZONE: R-1 [ISSUED ON: PROCESSED BY:
] [EXIST OCC GRP: 110/05/11 SR
(OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: [FINAL DATE FIN BY: CODE: [
INGOON-HOU, JANET (626) 731-0611- 1 1,500
19340 OLIVE ST I ] �1
TEMP 917803127 1 FEES PAID ID SCRIPTION OF WORK m1
1 I -2 b&OOF AND REROOF WITH COMPOSITION SHINGLE, INSTALL 30 LB 1
IFEE DESCRIPTION: QUANTITY: QOM: AMOUNT: ASTM UNDERLAYMENT, INSTALL ALL NEW GALVANIZED RED & PIPE 1
[APPLICANT: TEL. NO: I 1FASHING, INSTALL WEATER BARRIER (DETACHED GARAGE) 1
IYOO, JIFENG (626) 202-7811- JAA BLDG PERMIT ISSUANCE 27.80 1. I
IAB STATE GREEN BLDG FEE 1500.00 VAL 1.00 [SPECIAL CONDITIONS:
JAC STRONG MOTION RESID 1500.00 VAL 0.50 I
D2 PERMIT W/O EN-HC 1500.00 VAL 82.20 1 I
TOTAL FEES 111.50 1 I
ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE 1
IJIFENG YAO (626) 202-7811- I
[20616 DREXEL DRIVE LIC. NO1 [LOCATION AND SETBACKS
UT1
WALN , CA 91789 945757
] 1 ISOILS ENGINEER APPROVAL I I
[ARCHITECT OR ENGINEER: TEL. NO: - 1 [FOUNDATION/TRENCH FORMS I I
LIC. NO: 1
[ ] ISLAB/UNDER FLOOR
1RAISED FLOOR FRAMINGII I]
I
� I
]MAP NO:
SEWER MAP BOOK: PAGE: FIRE ZONE: CMUNDERFLOOR INSULATION
PH3 001 I I I
I I I
I I [FLOOR SHEATHING I [
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I
] 0 NO 21 1 [ROOF SHEATHING [ I
SCHOOL WITHIN HAZARDOUS ISHEAR PANELS [
I I I
[AIR QUALITY: 1000 FEET MATERIALS I
] NO NO NO ] [FRAME INSPECTION i I
1 ] IFIRE SPRINKLER HANGERS I 1 [
] 1 (INSULATION/WEATHER STRIPI I I
] 1 (INTERIOR LATH/DRYWALL I I
1 I (EXTERIOR LATH [ I I
1 I
I (RATED FLOOR/CELL ASSEM. I I I
1 I IRATED WALL ASSEMBLIES I I I
]RATED SHAFTS/OPENINGS
I I
1 1 1T-13AR CEILINGS I I I
I
.. - . . . -• _ _ •' I .- I LOT DRAINAGE - •-
I
RSPORT ms'DPR261' ROUTS TO: B8O5081
Q 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 1208060069
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS:
ITR: 11492 IT: 7 BL: B I SQ. FT STORIES TYPE [ 9340 OLIVE ST
I ISTRUCTURE: V-B I TEMP CA 917803127
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18590-002-007 1 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 11SSUED ON: PROCESSED BY:
1 1EXIST OCC GRP: 108/06/12 SR
IDWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: [FINAL DATE FINAL BY: CODE: 1
1HOU ERIC S;JANET N (626) 731-0611- 1 2,000
9340 OLIVE ST
[TEMP 917803127 [ FEES PAID ID CR PTION OF WORK [
I [ [KITCHEN REMODEL [
I [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ [
[APPLICANT: TEL. NO: I I [
ISAME AS OWNER - [AA BLDG PERMIT ISSUANCE 27.80 I
I [AB STATE GREEN BLDG FEE 2000.00 VAL 1.00 [SPECIAL CONDITIONS:
[AC STRONG MOTION RESID 2000.00 VAL 0.50 [
[B2 PERMIT W/ENERGY 2000.00 VAL 90.40 1 [
IFR INV WORK W/O PERMIT 166.20 DOL 166.20
[CONTRACTOR: TEL. NO: I TOTAL FEES 285.90 [APPROVALS DATE INSPECTOR SIGNATURE [
(SAME AS OWNER -
LIC. NO 1 1LOCATION AND SETBACKS I I
I [ [SOILS ENGINEER APPROVAL [ 1 [
1ARCHITECT OR ENGINEER: TEL. NO: - 1 (FOUNDATION/TRENCH FORMS I [ I
1 LIC. NO. [ [SLAB/UNDER FLOOR I [
1 RAISED FLOOR FRAMING 1
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION [ I
1147H265 3 001 I I
I I (FLOOR SHEATHING [ [ I
[NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: [ [ I I
1 ,0 NO 21 1 [ROOF SHEATHING [
SCHOOL WITHIN HAZARDOUS1 SHEAR PANELS
[AIR QUALITY: 1000 FEET MATERIALS I
NO NO NO [ [FRAME INSPECTION I1
(FIRE SPRINKLER HANGERS
I
(INSULATION/WEATHER STRIP I [
I 1 [INTERIOR LATH/DRYWALL 1
EXTERIOR LATH 1 1 I
1 IRATED FLOOR/CEIL ASSEM. [ [
1 I (RATED WALL ASSEMBLIES 1 [ [
IRATED SHAFTS/OPENINGS [
I 1 1T-BAR CEILINGS [ 1
ILOT DRAINAGE 1 1 1
IREPORT ID: DPR261 ROUTE TO: BS0508
I I I I I I