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Home My Public Portal About9919 OLIVE ST_Building__ WORKERS'COMPENSATION DECLARATION ��+ l � IIIhereby%a certificate I have a cerfiFmpe of,coI u c self A P P L I CAT I O N U I L D I I��P E RM I T insure, or a certificate of Workers'Compenstion Insuranc or a certified copy thereLof �j, 00, La ) i COUNTY OF LOS ANGELES BUILDING AND,SAFETY Polic �l0 7ny �/1 BUILDING Certified copy is y furnis FOR APPLICANT TO FILL IN ADDRESS l— A; , ❑ Certified copy is filed with the county building inspec- BUILDING G� ,/ ,L tion department. ADDRESS / C ej /�/'� �l LOCALITY70 �� ,� �y NEAREST Date Applicant CITY V( r / tri ZIP �� CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT N ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one +§ MAP �J hupdred dollars ($100)or less.) TRACT BLOCK LOT NO. K /�!) NO. (/ a >_ jj' 1 JEL. I QO�I! SPECIAL I certify that in the performance of the work for which this OWNERfi! f1 .f 1L)eWW1 AbNO. CONDITIONS I O permit is issued, I sh I not employ any person in any manner. 'DISTRICT GROUP TYPE FIRE ADDRESS I'/ SZ!(A L f ,cJ �� CONST. ONE so as eco ��3 Workers'Compensation Laws. I / /�IQ' �®• � � I CITY /✓ Z/� ZIP /7 ) tUU Dote App tcanT STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after makingthis Certificate of ARCHITECT OR TEL. ffUJ ENGINEER NO. CLASS NO.��M66ELL. UNITS Exemption, you should become subject to the Workers' y� Compensation provisions of the Labor Code, you must forth- ADDRESS• SEWER MAP z with comply with such provisions or this permit shall be , deemed revoked. CONTRACTOR / } 1/1e(d&I&JJBK.TEL.NO. PG, VALIDATION O? LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1NC.; dO VALUATION (commencing with Section 7000)of Division 3 of the Business and / / LIC. v -$ Professions Code, and my license is in full force and effect. CITY L�l'fJ',LI W— I CLASS L a1 V SQ.FT.J70 NO.OF NO.OF CHECK License Number Lic.Class SIZE 1ggel STORIES, FAMILIES ONE 1 0 0 0 $L Contractor Date DESCRIPTION OF WORK NEW ri�`�'�' 2 o 1 2 3 6(1, ❑ J �/ a ADD ❑ I „ -r I am exempt from the licensing requirements as I am a t✓i?SI fTd� �'e �� o - a licensed architect or a registered professional engineer /` �1 ALTER ❑ FINA / _ acting in my professional capacity (Section 7051, &'f0 C REPAIR ❑ DAT f es' C h 0 1 _ Business and Professions Code). USE OF ,l FINAL /^ EXISTING BLDG d /('�%Zr/f',� DEMOL ❑ FI Lic.or Reg.No. Date APPLICANT TEL. \) OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): BUILDING ` S? ❑ I, as owner of the property, or my employees with ADDRESS `i'a wages as their sole compensation,will do the work and J !L' (/G the structure is not intended or offered for sale(Section LOCALITY r 7044, Business and Professions Code). MOVING TEL. o n 0 o c ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. r t with licensed contractors to construct the project (Sec- ADDRESS �O ' tion 7044, Business and Professions Code). /J 0 REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH C �' I hereby affirm that there is a construction lending agency for FRONT �. C' f. (.t ) —C" 1 the performance of the work for which this permit is issued P.L (Sec. 3097, Civ. C.). SIDE P.L. Lender's Nome �f �1. ' Lender's Address P.C.Fee$ Permit Fee /� � 1 certify that I have read this application and state that the �1 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 P, and herby authorize',epresentatives of this County to enter ` upon tth abo en/toned operty for inspection purposes. I I SEE REVERSE FOR EXPLANATORY LANGUAGE as Signature of Applicant or Agent Dofe � I 14 APPUCATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES =- BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR'APPLICANT TO FILL IN BUILDING ADDRES17,9 BUILAD SS /C 19 ►/�e- Ihereby affirm that I have a certificate of consent to self insure, 17 // or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY' ZIP LOCALITY Policy NO. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CRDSS T ❑ Certified copy is filed with the county building inspection TRACT 13LOCK LOT NO. I l'N department. USE ZONE MAP NO. Date Applicant ASSESSO��OK PAGG�E/ PARCEL cam/ c/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' TEL NO. G -'COMPENSATION INSURANCE v v v��S-2�pOZ WITHIN 1000 FT.OF SCHOOLS -YES No c (This section need not be completed if the permit is for one hundred ADR S / • % dollars($100)or less.) _ V DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED 13V I certify that in the performance of the work for which this permit ,� �l ZIP is issued,;shall not employ arty p rson i� m ner so as to ARRkILTE� OR ENG ER T N become sub' ct 4qJj/tt a Workers p 'ti L / Z 7 STATISTICAL CLASSIFI ATION APT CONDO DateL4Rpplicant L ADDRES CLASS NO. DWELL UNITS IDANOTICE TO APPLICANT.' If, after making this Certificate Of B,44-� �- REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' T CTOR.� �� TEL_NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 2 l! FRONT comply with such provisions or this permit shall be deemed revoked. AD ESS LIC.NO. _ P L LICENSED CONTRACTORS DECLARATION CITY •v LC. PILE 23 a 1 hereby affirm that I am licensed underprovisions of Chapter 9 �� CLAS. SEWER MAP f'T A (commencing with'Section 7000)Of ivision 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES N `'' �s Professions Code,and my license' i i full farce a ffect. _ 1 NEW BK PG a ��I3 �4� �c0 License Nulla U S Lic.Class DESCRIPTION OF WORK jj ADD ❑ VALUAT,I.O�Nn�/ Q� , 1J , -:U Contractor A bate� - -Ez=I JT �� ALTER ❑ 47i / O �� 1 1 I G{`E IL t�II c (�5►rX TOTAL REPAIR ❑ , r K ❑ I am exempt n r SO. g c^ BAP.C.for this sson DEMOL ❑ / LDMA P/C e (;�1atlt;F I, Date: USE OF E_11'ISTIN��LDG.(` �r1! L_ C�•�_ URM ❑ w1 Signature APP NT NT 1� ` !may TE Np.� LIMA Perm a r �' G�l,dl1114N tsJ-�'�D zI ' -ItC.01 `�•'r/�/ ❑ I, as owner of the property, or my employees with wages as ti'•o their sole compensation, will do the work and the structure is ADDRES .�( , � � / 1.�1L��y. not intended or offered for sale (Section 7044, Business and / r�2.�J FINAL TE �� C - ?,'. `h 1 Professions Code.) ��;- I WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE TOTAL 22.3-53.34 Ell I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, WES❑ No ff CHECK 2233.g4 Business and Professions Code.) -- WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING CHANGE OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH C�-(ANGE n 00 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES 11 NO the performance of the work for which this permit is issued(Sec. 0000-0001 6/1-1/96 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LAS ANGELES COUNTY CODE, .I p 8:48 rn TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS 682 1 1 AN 8 o i8 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. Lender's Address OWNER OR AGENT 3 1 certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P•C.FEE PERMIT FEE with all county ordinances and State laws relating to building fa construction, and hereby authorize representatives of this County ISSUANCE FEE C to @ e ab -mentioned property for inspection GLl. INVESTIGATION FEE TOTAL FW '9 a F.s,mwo of Ao w l a GAfe dS SEE REVERSE FOR EXPLANATORY LANGUAGE I COUNTY OF LOS ANGELES TEMPLE CITY # 0508' BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1202080021 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1 ON FILE I SQ. FT STORIES TYPE OCCUP GROUP 9919 OLIVE ST 1 I _ISTRUCTURE: 0 2 V—B R-3 I TEMP CA 917803239 I (ASSESSOR INFORMATION NUMBER: I GARAGE: 496 1 V—B U I NEAREST CROSS STREET: CAMBURY 1 18588-019-012 I OTHER: I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl ITENANT: (EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: 1 1 1EXIST OCC GRP: 102/08/12 SR I (OWNER: TEL N0: JBLDGS. NOW ON LOT: VALUATION: IFINAL TE FINAL CODE: 1 INEWMAN ROBERT E;RENEE M (626) 285-2602— 1 22,830 1 I 19919 OLIVE ST `r 3 ITEMP 917803239 1 FEES PAID IDESCRIP ION OF WORK I I I IBUILD DETACHED 2 CAR GARAGE 1 _[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I I (APPLICANT= TEL. N0: ISAME AS OWNER — ID1 PLANCHECK W/O EN—HC 22830.00 VAL 370.90 1 I I IAA BLDG PERMIT ISSUANCE 27.80 SPECIAL CONDITIONS: 1 I IAB STATE GREEN BLDG FEE 22830.00 VAL 1.00 1 I IAC STRONG MOTION RESID 22830.00 VAL 2.30 1 ID2 PERMIT W/O EN—HC 22830.00 VAL 436.40 1 ICONTRACTOR: TEL. NO: I TOTAL FEES 838.40 [APPROVALS DATE INSPECTOR SIGNATURE [ [SAME AS OWNER _ I LIC. NO 1 [LOCATION AND SETBACKS 1ol [ I ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: [ [FOUNDATION/TRENCH FORMS 11 1 I - 1 /. J LIC. NO. 1 (SLAB/UNDER FLOOR I 1 [ I IRAISED FLOOR FRAMING I I I I [MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMU01 [UNDERFLOOR INSULATION I I I I (1ST LEVEL FLOOR SHEATH I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I[ I I I 0 NO 21 1 12ND LEVEL FLOOR SHEATH 102 r SCHOOL WITHIN HAZARDOUS I [ROOF SHEATHING I ) I (AIR QUALITY: 1000 FEET MATERIALS 1 NO NO NO 1 IFIRE DEPT. FRAME INSPECTI I I 1 [ [BLDG DEPT. FRAME INSPE ( CTI I I 1 1 1 ISHEAR PANELS I I I 1 [ [INSULATION/WEATHER STRIP( 1 1 I 1 [INTERIOR LATH/DRYWALL 1 I I 1 [ [EXTERIOR LATH 1' I 1 I ILOT DRAINAGE I I I I 1 ISMOKE DETECTION DEVICES 1 I [ 1 IFIRE DEPARTMENT APPROVAL( I I 1 I I I I I 1 IREPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1202080022 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I I ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 9919 OLIVE ST 1 ISTRUCTURE: 239 2 V-B U I TEMP CA 917803239 I ASSESSOR INFORMATION NUMBER: GARAGE: I NEAREST CROSS STREET: CAMBURY I 18588-019-012 OTHER: 1 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl ITENANT: (EXIST BLDG USE: USE ZONE: IISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 102/08/12 SR I I I 1 (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IF NAL rjATE FI CODE: 1 1NEWMAN ROBERT E;RENEE M (626) 285-2602- 1 4,780 9919 OLIVE ST ITEMP 917803239 I FEES PAID 1�CRIPTION OF WORK 1 I I ILEGALIZE PATIO COVERED 1 IFEE DESCRIPTION: QIIANTITY- DOM: AMOUNT:( I (APPLICANT: TEL. NO: I I I ISAME AS OWNER - ID1 PLANCHECK W/O EN-HC 4780.00 VAL 112.90 1 I I IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: 1 I IAB STATE GREEN BLDG FEE 4780.00 VAL 1.00 I IAC STRONG MOTION RESID 4780.00 VAL 0.50 I ID2 PERMIT W/0 EN-HC 4780.00 VAL 132.80 1 (CONTRACTOR: TEL. NO: I TOTAL FEES 275.00 (APPROVALS DATE INSPECTOR SIGNATURE 1 ISAME AS OWNER - 1 I LIC. NO I ILOCATION AND SETBACKS I I I II ISOILS ENGINEER APPROVAL 1 1 1 1ARCHITECT OR ENGINEER: TEL. NO: 1 (FOUNDATION/TRENCH FORMS I - I 1 LIC. NO: I (SLAB/UNDER FLOOR I I I 1 I (RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I I 3 OOI 1-1 11ST LEVEL FLOOR SHEATH I I I I 1N0. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I I I 1 0 NO 21 1 12ND LEVEL FLOOR SHEATH i 1 I SCHOOL WITHIN HAZARDOUS I IROOF SHEATHING I I 1AIR QUALITY: 1000 FEET MATERIALS I I I I INO NO NO 1 (FIRE DEPT. FRAME INSPECT( 1 1 I 1 (BLDG DEPT. FRAME INSPECT( i 1 I I ISHEAR PANELS I I I I I (INSULATION/WEATHER STRIP( I I (INTERIOR LATH/DRYWALL 1 I 1EXTERIOR LATH I I 1 1 ILOT DRAINAGE 1 I [SMOKE DETECTION DEVICES 1 (FIRE DEPARTMENT APPROVAL[ 1 1 I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I 1 [ I I I I I I I