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Home My Public Portal About9503 OLIVE ST_Building__ c RS'COMPENSATION DECLARATIC/N' I he 'r- that I have a certificate of consent to self P ins a certificate of Workers'Compensation Insurance, APPLIC TION � ®I PERMIT cr a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES 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 BUILDING tion department. ADDRESS /JD J C. �� Q LOCALITY NEAREDate Applicant CITY &&jPL� �� ZIP P AN CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. 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 USE ZONE MAP hundred dollars($100)or less.) TRACT yy�� 1�BLLOCK LOT NTEL. �oOj. t• NO. PECIAL OWNER �iI�� .7L.,(,kg6 �_r NO.is 0 1 SOyr �� CONDITIONS Q- I certify that in the performance of the work for which this _ DISTRICT GROUP TYPE FIRE PR SSED B O permit is issued, I shall not employ any person in any manner ��t vL� P CONST. ZONE so as to become subject to the Workers'Compensation Laws. ADDRESS ,S y Q 4.� CIN l LZ of i y zip 917C-0 C-0 �• Ute" Date Applicant STATISTICAL C IFI TION APT. DO. I= ARCHITECT ORNO.TE d A 3 u NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER / . jy/FiL050CL) CLASS NO. DWELL. UNITS LLI (9 —y�fZQ Exemption, you should become subject to the Workers' IL Compensation provisions of the Labor Code, you must forth- ADDRESS 25.20 W/Lxm ijeZ ?eQSEWER MAP Z with comply with such provisions or this permit shall be TEL. , / e deemed revoked. CONTRACTOR NO. BK.O PG, ! VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 1 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. `) VQ Professions Code,and my license is in full force and effect. CITY CLASS $ 350. SQ.FT. NO.OF 6 NO.OF CHECK License Number Lic.Class SIZE "� STORIES i FAMILIES ONE Contractor Date DESCRIPTION OF WORK A7T!}CH lWf1SdF +' NEW $ I am exempt under Sec. {6CQq&e — Q2QaO? /;UMO rAP611. ADD L ALTER FINAL J B.BP.C. for this reason ADO -rMouitm -ro /� 6A T 84 • DATE 6 REPAIR USE OF ♦ DEMOL FINAL ' Date: i.EXISTING BLDG. root A L D-tr`4f IU 6,- By Signature APPLICANT TEL. nature PRINT M,4iztz 5040.654%1127 N&2 ff5f 5oe OWNER-BUILDER DECLARATION 2 25 1 9 I hereby affirm that I am exempt from the Contractor's License O Law for the following reason (Section 7031.5, Business and °_ADDRESS �b D 3 �Li ut /'7S-C3 a o 0 Pro ions Code): PRE ENT # 1 .BUILDING ► I, as owner of the property, or my employees with ADDRESS 0 2 1 a 6 3 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY o 0 2 1 8 6 3 3 7044, Business and Professions Code). MOVING TEL. I,as owner of the property, am exclusively contracting CONTRACTOR NO. o7.23-85 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. 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. tSec. 3097,Civ. C.). SIDE 0 P.L. 7T 7,51 v Lender's Name ".... ..'. �•. / � Lender's Address P.C. Fee$ Permit Fee Q�r h..! I cern that I have read this application and state that the 't) Q certify pp Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee d3 9 and hereby authorize representatives of this County to enter upon the abo e-men7=77 pection purposes. °i�� 7-Z3= SEE REVERSE FOR EXPLANATORY LANGUAGE � Signature of Applicant or Agent Date ®s 4 COUNTY OF LOS ANGELES I TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 SL 0508 0305190001 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF --CONST BUrLDING ADDRESS: ON FILE SQ. FT STORIES TYPE 9503 OLIVE ST STRUCTURE: VN TEMP CA 917803132 ASSESSOR0 NEAREST CROSS STREET: CLOVERLY 8588-025-018 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY TENANT: EXIST G . RESID S . - D PROCESSED EXIST OCC GRP: 05/19/03 JK 05/13/04 OWNER: TEL. 0: B DGS. NOW ON LOT: VALUATION: FINAL DAT FI AL BY: CODE: SCHOBERT MARK;VALERIE TRS (626) 449-6118- 2,000 9503 OLIVE ST TEMP 917803132 D S I 0 0 REPAIR CRACK IN FOUNDATION PER ENGINEER DETAIL FEE DESCRIPTION: QUANTITY: LION: AMOUNT: APP L. GREG SYLVIS (626) 459-2492- AA BLDG PERMIT ISSUANCE 27.75 500 BELLMORE WAY AC STRONG MOTION RESID 2000.00 VAL 0.50 SPECIAL CONDITIONS: PASADENA D2 PERMIT W/O EN-HC 2000.00 VAL 82.20 TOTAL FEES 110.45 CONTRACTOR: TE 0: APPROVALS DATE INSP OR S G A URE GREG SYLVIS (626) 449-6118- GENERAL CONTRACTOR LIC. NO LOCATION AND SETBACKS 500 BELLMORE WAY 443627 B PASADENA, CA 91103 ARCHITECT OR G ON 0 ORS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING AP 0: SEWER MAP BOO : PAGE: FIRE ZONE: C P. UNDERFLOOR INSULATION 147H269 3 01 FLOOR SHEATHING . 0 F G S: CO D: S T SS: NO 21 ROOF SHEATHING IEHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTALC OM EXIST FIRESPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR EXTERIOR LAT RATED FLOOUC-M-ASSEM. i TED WALL WS-SENBLIES- RATED SHAFTS/OPENINGS . COLINGS IEPORT ID: DPR261 ROUTE TO: BS0508 I 1