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HomeMy Public PortalAbout9937 OLIVE ST_Building__ • APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN .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.) y� ZIP Q Policy No,��'���� Company lra.G ewTY 4 J Z$d LOCALITY [SIZEiiLOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. 167. NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACT - G BLOCK LOT NO. department. r�' 1q TS L-0T■ —7 USE ZONE MAP NO. Dated pplicant �i1 0" G1►�.l� ASSESSOR$S$ AP 8 BOOK PAGEl y `SPARCEL Z� ■ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �`' �+ TEL NO. COMPENSATION INSURANCE O W�'+ 3 ® �� E�Lj�•d?�' WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS r��� .., 7 w/Av A-11� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) 423rd OA/ P I certify that in the performance of the work for which this permit CITY ,j rwoA)lr ZIP a ' , `'�� - 73 is issued, I shall not employ any person in any manner so as t0 ARCHITECT OR ENGINEER ITEC NO. c■ VZ9 become subject to the Workers'Compensation Laws. AR`McH cvmyn peg IPJ).60.03, STATISTICAL CLASSIFICATION CONDO194.59 Bt Date 194 Applicant ADDRESS CLASS NO. 99 O DWELL UNITS ,} 0 5 7p NOTICE TO APPLICANT.• If, after making this Certificate of PL's• ®7< <O �1Z•V�p► C� q T©� REQUIRED TOTAL s BACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY P WIDTH Compensation provisions of the Labor Code, you must forthwith /4111{E AS p%"AJ FRONT R v comply with such provisions or this permit shall be deemed revoked. ;p ADDRESS LIC.NO. PL ��--+ Q 31 LICENSED CONTRACTORS DECLARATION V SIDE - CITY LIC.CLASS PL �} UP I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT SIZE y NO.OF STORIES NO.of FAMILIES TOTAL 2101.90 Professions Code,an m li ense is in full force and effect. ?.D 50 t t NEW BK PG ® p >- e"25r"Number Lic.Class DESCRIPTION OF WORK ADD ❑ VALUATION CHECK 2101°70(L License Contractor Date '�y 9L� N FEW •�•�• ALTER ❑ a— CHANGE - °00 U cc ❑ I am exempt under Sec. REPAIR 11Geo - USE OF EXISTING BLDG. BAP.C.for this reason DEMOL El `` � � 0000-0001 2/14!95 W Date: URM ❑ LDMA P/C# 48.2 1 AM10a00a- Signature APPLICANT(PRINT) TEL NO. LDMA perm# z ❑ I, as owner of the property, or my employees with wages as qS A&O VIE) ZO their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE. dr Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL !(/1Q-� ORA MIXTURE CONTAININ A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED O E HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL j YES El NO licensed contractors to construct the project (Section 7044, B Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR DUALITY MAMA ENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR + a GUIDELINES .�•! I hereby affirm that there is a construction lending agency for YES❑ NO C11 the performance of the work for which this permit is issued(Sec. ACCT v � IHAVE READ THE HAZARDOUS TERULLSINFORMATION GUIDE AND THE SCAOMD PERMITTING ry�1L 3097,CIV.C.) CHECKLIST I UNDERSTAND MY E)UIR ENTS UNDER Ty GELES COUNTY CODE, •- �I 1-' 1025.93 N TITLE 2.CHAPTER 2 E NS 2 2 00 THggO0 .14 ONCERNING HAZARDOUS �'-J�J Lender's Name MATERIALS REPO F ER E SCAOMD. C3 Lender's Address �� l 1 ITEMS E 10" 0MEF7 OR AGENT,,' ,�.-.., o I certify that I have read this application and state under penalt 1�I I AL 1025.93 O of perjury that the above information is correct.I agree to com ��/j P.C.FEE :S PERMIT FEE Q /� O N with all county ordinances and laws relating to buil ' �•- �a� J O �v ' / CHECK 1025.93 construction,and hereby But r sentatives of this County j �[ r� ISSUANCE FEE 7. D CHANGE .00 m to enter upon the above- perty for inspection purposes. / 7• a a INVESTIGATION FEE TOTAL FEE ,V 3 , m u oy■ SEE REVERSE FOR EXPLANATORY LANGUAGE 00011--0001 5/22/95 6 , 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 1301100057 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ON FILE I SQ. FT STORIES TYPE I 9937 OLIVE CT I ISTRUCTURE: V-B I TEMP CA 917803239 1 [ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: BALDWIN I 18588-019-014 [ THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY CAI I I I I ITENANT: EXIST BLDG USE: RESID USE ZONE: RPD (ISSUED ON: PROCESSED BY: [ EXIST OCC GRP: 101/10/13 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IF NAL DATE FI BY: CODE: [ IPAN, SHU (626) 280-9317- 1 15,000 1 19937 OLIVE COURT ITEMPLE CITY CA 91780 J FEES PAID I 3CRI TI OF WORK I I [ IKITCHEN AND TWO BATHROOMS REMODEL 1 I _IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:[ 1 [APPLICANT: TEL. NO: I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 [ IAB STATE GREEN BLDG FEE 15000.00 VAL 1.00 ISPECIAL CONDITIONS: [ IAC STRONG MOTION REBID 15000.00 VAL 1.50 [ JB2 PERMIT W/ENERGY 15000.00 VAL 330.70 [ J IFR INV WORK W/O PERMIT 339.60 DOL 339.60 J- [ ICONTRACTOR: TEL. NO: I TOTAL FEES 700.60 [APPROVALS DATE INSPECTOR SIGNATURE J ISAME AS OWNER - I I_ I LIC. NO I ILOCATION AND SETBACKS I I I ISOILS ENGINEER APPROVAL] I I ARCHITECT OR ENGINEER: TEL. NO: - i (FOUNDATION/TRENCH FORMS I I I LIC. NO: I JSLAB/UNDER FLOOR [ I I I [RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J [UNDERFLOOR INSULATION 1 I I 1147H269 3 001 1 I I I I I IFLOOR SHEATHING J I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I IJ I I 1 0 NO 21 1 IROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I JAIR QUALITY: 1000 FEET MATERIALS 1 I- I I I J NO NO NO J [FRAME INSPECTION J 1 1 I IFIR3 SPRINKLER HANGERS J I JINSVLATION/WEATHER STRIP[ I I I i [INTERIOR LATH/DRYWALL 1 I I EXTERIOR LATH IRATED FLOOR/CEIL ASSEM. J I I IRATED WALL ASSEMBLIES I I I JRATED SHAFTS/OPENINGS I J IT-BAR CEILINGS I I I I I ILOT DRAINAGE [ I I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I I