HomeMy Public PortalAbout9944 OLIVE ST_Building__ j YORKER& COMPE44TION DECLARATION 5
i sure o C certificate
that I haver certificate of consent to self APPLICATION FOR �C�!I QLD IAV G P E RM I T
insure—or a certificate of Workers' Compensation Insurance,
ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
BUILDING
Certified copy is hereby furnished. 11rrF,,O``R APPLICANT TO FILL IN ADDR
ElCertified
❑ Certified copy is filed with the county building inspec- BUILDING PRESS T7 v` V E 5
tion department. p /�
Date Applicant CITY 7EM LFE C' 1 Y ZIP /Jhfo LOCALITY
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCE [y� ASSESSOR
(This section need not be completed if the permit is for one TRACT 0 1�J BLOCK LOT NO. MAP BOOK �O�I KAGE-/ eP�^ ARCEL
hundred dollars ($100)or less.) TEL.
OWNER kJ O NIk Z k W G NO. USE ZONE MAP L1 -2
I certify that in the performance of the work for which this G'�ff /� ! SPE 7
permit is issued, I shall not employ any person in any manner ADDRESS I'c OLIVE 7% —I SPECIAL a-
CONDITIONS
so as to become subject to the Workers'Compensati.9i Laws. O
< 3 z
CITY �°7N`� CITY ZIP 917d'd
Date Applicant ARCHITECT OR t 1 TEL. Y( DISTRICT GROUP TYPE FIRE PROCESSED BY Ix
NOTICE TO APPLICANT: If, after aking this Certif�' ate of ENGINEER KEA/ E I DE NNI NO. — u 3 ( CONST. ZgNE U
Exemption, you should become subject to the Workers' e etf' ,�aa/ - 3 U
Compensation provisions of the Labor Code, you must forth- ADDRESS �S 0 �lar� �raN to ti w
a
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION �CONDO. v7
deemed revoked. CONTRACTOR NO. ?f
Z
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. D L. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP
(commencing with Section 7000)of Division.3 of the Business LIC.
and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION
SQ. FT, ii``,, NO OF NO. OF i CHECK
License Number Lic. Class SIZE T Y V STORIES FAMILIES 1 ONE
VALUATION '*
Contractor Date DESCRIPTION OF WORK-/ NEW $ 2 4 13 !D0
El am exempt under Sec. if tof
46,it C — ADD 1:1O ►
ALTER ❑
BAP.C. for this reason REPAIR ❑ $
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT �/ 'TEL. j-1y_3626 FINAL '
(PRINT) `oklj D RNVe-t2a W ci NO.
OWNER-BUILDER DECLARATION --� DATE
I hereby affirm that I am exempt from the Contractor's License ADDRESS • VL�V� 7F�yME I
Law for the following reason (Section 7031.5, Business and — FINAL.
Professions Code): PRESENT By .
® I, as owner of theproperty, or m em to ees with BUILDING z
Y P Y ADDRESS
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY •--t_-.
7044, Business and Professions Code.) MOVING TEL.
CONTRACTOR NO.
I,as owner of the property,am exclusively contracting s s j i.I•a
with licensed contractors to construct the project (Sec- ADDRESS �;;� a
tion 7044, Business and Professions Code.)
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH r.C!_E:
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. t:�ll-1!'GE
(Sec. 3097, Civ. C.). SIDE +
P.L.
g Lender's Name 9a o �-S•_— ;j
iLDMA Ref. # I
P.C. Fee$ Permit Feed
Lender's Address �) .�_!J 5 1 rij :�
I certify that I have read this application and state that the Issuance Fee .2 LDMA P/C#
3 above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee ;-,r/j d.A, LDMA Perm. #
and hereby authorize representatives of this County to enter
upon the bove- entioned roperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of Applicant r Agent Date
R
COUNTY OF LOS ANGELES TEMPLE CITY * 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9708210002
PHONE: (818) 285-0488 EXT:
'rMAL ID: NO. OF CONS G SS:
TR: 6755 LT: 10 BL: .001 SQ. FT STORIES TYPE 19944 OLIVE ST
STRUCTURE: 0 VN 'TEMP CA 917803238
ASSESSOR IN0 R: NEAREST CROSS STREET:
8589-005-005 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
E S G S ESI S SS 0 ROC ED B : R S O :
EXIST OCC GRP: 08/21/97 RF /21/98
OWNER: L. NO: BLDGS. OW ON LOT: A DATION: FINAL DATE FINAL BY: CODE:
FUKUZAWA YUKIO (626) 448-2026- 1 2,000 ��
9944 OLIVE ST
TEMP 917803238 FEES ffl�__ - NOWNTFONOF WORK
TEAR OFF AND INSTALL 1/2" COX PLYWOOD AND COVER WITH OWNENS
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: COMP. SHINGLE 25 YR. GUARANTEE - HOUSE ONLY
APPLICANT: TEL0:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 2000.00 VAL 0.50 SPECIAL CONDITIONS:
D2 PERMIT W/O EN-HC 2000.00 VAL 82.20
TOTAL FEES 110.45
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: 0 TR NCHFORMSLIC. NO: SLAB/UNDER FLOOR
ISD FLOOR FRAMING
P NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CNP: UNDERFLOOR INSULATION
144H269 3 01
FLOOR SHEATHING. 0 F S: C C ASS:
NO 21 ROOF SHEATHING �Z f
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED -TOTALS EXIST SP AGRS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
EBLATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CVIL ASSE14.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
CEILINGS
0
REPORT ID: DPR261 ROUTE TO: BS0508 LDRAINAGE
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 1104200010
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1
ITR: 6755 IT: 10 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUPI I 9944 OLIVE ST 1
STRUCTURE: 140 1 V-B U I I TEMP CA 917803238 I
ASSESSOR INFORMATION NUMBER: IGARAGE: I I NEAREST CROSS STREET: BALDWIN
18589-005-005 1 OTHER: I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
ITENANT: (EXIST BLDG USE: USE ZONE: (ISS ' D ON: PROCESSED BY: I
EXIST OCC GRP: 104/28/11 SR 1
I I I I
[OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFI DATE FINAL BY: CODE:
-
FUKUZAWA, VERONIKA 2,800 II
19944 OLIVE ST I I I
ITEMP 917803238 1 FEES PAID ID SCRI TI N OF WORK [
I I IPAT1O COVER ON GUEST HOUS [
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I
(APPLICANT: TEL. NO: I I II
IVICTOR FELIX (323) 215-9783- ID1 PLANCHECK W/O EN-HC 2800.00 VAL 84.20 1 I
1 JAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: 1
I JAB STATE GREEN BLDG FEE 2800.00 VAL 1.00 I I
IAC STRONG MOTION RESID 2800.00 VAL 0.50 I I
1 ID2 PERMIT W/O EN-HC 2800.00 VAL 99.10 I I
ICONTRACTOR: TEL. NO: ITOTAL FEES 212.60 [APPROVALS DATE INSPECTOR SIGNATURE I
ICEM CONSTRUCTION INC. (760) 792-6523- 1pr- 1
18207 BROOKGREEN RD LIC. NO 1 [LOCATION AND SETBACKS 1 J
IDOWNEY, CA 90240 941346 B [ I-
I ISOILS ENGINEER APPROVAL
I I I I I
1ARCHITECT OR ENGINEER: TEL. NO: - I IFOUNDATION/TRENCH FORMS I I I
1 LIC. NO: 1 [SLAB/UNDER FLOOR
1 IRAISED FLOOR FRAMING I
1
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ - 1UNDERFLOOR INSULATION [ I I
3 001 I1STILEVEL FLOOR SHEATH [ I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I [ [ I
[ NO 21 1 12ND,LEVEL FLOOR SHEATH [ I I
[ SCHOOL WITHIN HAZARDOUS IROOV SHEATHING I I I
[AIR QUALITY: 1000 FEET MATERIALS I I
1 NO NO NO i [FIRE DEPT. FRAME INSPECTI I 1
I I (BLDG DEPT. FRAME INSPECTI I [
I. ISHEAR PANELS I I I
I I 1-1
I
1 INSULATION/WEATHER STRIP( I I
I (INTERIOR LATH/DRYWALL 1 I
I I [EXTERIOR LATH I I
J I J LOT;DRAINAGE I I J
I I I
I 1 SMOKE DETECTION DEVICES J I I
I IF RE DEPARTMENT APPROVALI I 1
i
1 REPORT ID: DPR261 ROUTE TO: BS0508
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 1404090026
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
ITR: 6755 LT: 10 BL: .001 I SQ. FT STORIES TYPE I 9944 OLIVE ST 1
ISTRUCTURE: V-B I TEMP CA 917803238 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BALDWIN I
8589-005-005 [ I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI
I I
ITENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 TISSUED ON: PROCESSED BY: 1
1 (EXIST OCC GRP: 104/09/14 SR
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: I F117AL DATE FIN Y: CODE: ]
IFUKUZAWA YUKIO - 1 2,200
19944 OLIVE ST ]
(TEMP 917803238 1 FEES PAID 1 CR PTION'F WORK [
I IREMOVAL OF EXISTING CHIMNEY, FRAME OUT AND PATCH STUCCO 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[
(APPLICANT: TEL. NO: I I
[HERNANDEZ, FRANCISCO . (626) 232-9865- IAA BLDG PERMIT ISSUANCE 27.80 I__
112700 ELLIOTT AVE IAB STATE GREEN BLDG FEE 2200.00 VAL 1.00 ISPECIAL CONDITIONS: 1
JEL MONTE CA 91732 IAC STRONG MOTION RESID 2200.00 VAL 0.50 ] 1
ID2 PERMIT 'W/O EN-HC 2200.00 VAL 99.00 1 I I
] IFR INV WORK W/O PERMIT 344.00 DOL 344.00 1 I
ICONTRACTOR: TEL. NO: I TOTAL FEES 472.30 ]APPROVALS DATE INSPECTOR SIGNATURE ]
IFH CONSTRUCTION (626) 232-9865-
112700 ELLIOTT AVE SP 25 LIC. NO I ILOCATION AND SETBACKS I I I
TEL MONTE CA 91732 968550 1 1- I I I
I I ISOILS ENGINEER APPROVAL I I I
[ARCHITECT OR ENGINEER: TEL. NO: I IFOUNOATION/TRENCH FORMS I I I
LIC. NO: I (SLAB/UNDER FLOOR I I I
1 I IRAISED FLOOR FRAMING
11 1
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( UNDERFLOOR INSULATION I I I
3 OOI IFLOOC SHEATHING I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: [ I [ [ I
NO 21 1IROOFISHEATHING
AI I
1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I I
(AIR QUALITY: 1000 FEET MATERIALS
I
INO NO NO 1 (FRAME INSPECTION 1
I ] IFIRE SPRINKLER HANGERS I 1
I I (INSULATION/WEATHER STRIP( I I
I 1 (INTERIOR LATH/DRYWALL I I
I ]EXTERIOR LATH 1
(RATED FLOOR/CEIL ASSEM. I I I
] I IRATED WALL ASSEMBLIES I ]
] IRATED SHAFTS/OPENINGS
I I 1 I
I I I
T-BA4 CEILINGS I 1 I
ILOT DRAINAGE I I
I (REPORT ID: DPR261 ROUTE TO: BS0508
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 1007140014
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
1TR: 6755 LT: 10 BL: .001 SQ. FT STORIES TYPE OCCUP GROUP 9944 OLIVE ST
(STRUCTURE: 320 1 V-B R3 TEMP CA 917803238
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: BALDWIN
18589-005-005 OTHER: 126 1 V-B U THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
TENANT: !EXIST BLDG USE: USE ZONE: JISSUED ON: PROCESSED BY: 1
1EXIST OCC GRP: 109/28/10 SR
[OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: [FI DATE FI BY: CODE:
[FUKUZAWA, VERONIKA - 49,950 1
19944 OLIVE ST
TEMP 917803238 FEES PAID IDE CRIPTION bF WORK
1 NEW REC ROOM, BATHROOM AND PORCH
[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. N0: I I
VICTOR FELIX (323) 215-9783- 1B1 PLANCHECK W/ENERGY 49950.00 VAL 744.30 1
1AA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS:
IAB STATE GREEN BLDG FEE 49950.00 VAL 2.00
AC STRONG MOTION RESID 49950.00 VAL 5.00
[B2 PERMIT W/ENERGY 49950.00 VAL 875.60
CONTRACTOR: TEL. NO: TOTAL FEES 1,654.70 JAPPROVALS DATE INSPE R SIGNATURE
ICEM CONSTRUCTION INC. (760) 792-6523- 1
18207 BROOKGREEN RD LIC. NO ]LOCATION AND SETBACKS
IDOWNEY, CA 90240 941346 B I lU[
SOILS ENGINEER APPROVAL
(ARCHITECT OR ENGINEER: TEL. NO: I F9i'RIDATION NCH FORMS [ I I
IMENDOZA, RAMON (323) 724-8333- I [ [
12161 S. EASTERN AVE. LIC. NO: 1 /UNDER FLOOR [ [
ICOMMERCE C25255
I 1 /V j�IRAISED FLOOR FRAMING
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: L (UNDERFLOOR INSULATION 1
3 OOI [1ST LEVEL FLOOR SHEATH [ 1 1
[NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: [ I I I I
[ NO 21 [ 12ND LEVEL FLOOR SHEATH 1 1
[ SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING 1 1
]AIR QUALITY: 1000 FEET MATERIALS 1 I 1
NO NO NO 1 IFIRE DEPT. FRAME INSPEC 1 I
I (BLDG DEPT. FRAME INSPEFV1 [ [
I I ISHEAR PANELS ! 1
1 1 [INSULATION/WEATHER STRIP [ 1
1 [INTERIOR LATH/DRYWALL I 1 [
1 I� Ll 1 [
[ 1 1EXTERIOR LATH I [
1 [ [LOT DRAINAGE I I
[ ISMOKE DETECTION DEVICES [ [
[FIRE DEPARTMENT APPROVAL[ [
[ [ [ I I
[REPORT ID: DPR261 ROUTE TO: BS0508 1 1 1 [
I I [ I I [