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Home My Public Portal About5307 PAL MAL AVE_Building__ WORKERS COMPENSATION DECLARATION W �F hereby off car that I hove r certificate Come of consent Incur fol, fi PPLICATION FOR BUILDING PERMIT JIS' Insure, w a certificate of Workers' Compensation Insurance ' or 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 APPLI NT TO FILL IN ADDRESS 5 3,0q L M q L Q J E . Certlion department s bled with the county building Inspec- BUILDING ^/1 O 9L ��,/ vG —r r— qI � C I T- tion mens ADDRESS 4+ V `q c,. �'f LOCALITY L. Dara Applicant Cm' E L C 1..�17 ZIP // 7 8 C/ C NEARESST F2 E � 12 CERTIFICATE OF EXEMPTION FROM WORKERS '( 9 OF&DGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit Is fat one USE P hundred dollars({100)or less ) TRACT LOT NO / NO ��,,N7EL / SPECIAL > I certify that in the performance of the work fa which the OWNER M E O S Nr10 CONDITIONS d permit is issued, I shall not employ any Parton in any manner STRZF P TYPE FIRE BY O s ,as to become subject to the Workers'Compensation Laws ADDRESS M S DLJ� CONST Z E U -7- 27-R��Date .m,licant CITvZIP ST TISTIGALP APF O NOTICE TO APPLICANT If, offer making this Certificate of ARCHITECT OR TEL V Exemption you should become subject to the Workers' ENGINEER NO CLASS NO DWELL UNITS_ R Compensation provisions of the Lobar Cade, you must forth- ADDRESS SEWER MAP to with comply with wch provisions or this permit shall be Z deemed revoked CONTRACTOR I p jRL K, VAUDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 7000)of Divlt on 3 of the Bigness and tic r�� /Jn 2� Professions Code, and my license Is in full force and effect CRY r p CLASS i> SO CKCK License Number Lic Class SIZE NJ 7 STORIES FAMILIES ONE ► Contractor Date DESCRIFfION OF WORK A D b S Ef)20om �' ❑ = O� El I am exempt under Sec Is I of N G eook'k'L 15T-IEU i ADD B 8P C fat this reasons AL1ER ❑ FINAL REPAIR ❑ DATE Date USF OF Cs � 'p ❑ FINAL OOSnNG BLDG t) \ B Signature y OWNER-BUILDER DECLARATION A�PR�IM PAM F RoI3)Al p/Ot I hereby affirm that I am exempt from the Contractor's License ► Low fat the following reason (Section 7031 S Business and SS S ✓� r Professions Code) BUILD13 1, as owner of the y employees ADDRESS property, or m em b with ADDRESS wages as their sole compensation,will do the work and ,')9 3 7 A the structure is not intended or offered fat sale(Section L 70", Business and Professions Code) MOVING TEL T o s s s s 1 1, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project(Sec- ADDRESS 2 e 26550 tion 7011 Business and Professions Code) REou� CONSTRUCTION(ENDING AGENCY SET BAp� YARD Hwv 707 PROP LISETBACK FROM EXIST ► 2 5 S 1 hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is Issued P L! 27- 23 5 Rec 3077, Civ C ) SIDE — PL Lender's Name LZ � Lender s Address P C F«S Permit Fee I certify that I have read this application and vote that the tnuonce Fee above infornatan Is correct I agree to comply with all County Invnegulion Fee ordinances and State lows relating to building construction Tool Fee sv and hereby authorize representatives of this County to enter upon the above-m'enEtionm �ed property for Inspection purpo V /f I/V 1Q �x '7- 9-7-43Z) E@ RN9EE FOR EXPLANATORY LANGUAGE �/�l Spmtwe of Applicant or Agent Dote AF WORKERS COMPENSATION DECLARATION T, � �I \ hereby affirm that I have a certificate of consent to self t , - AP'PLICA'TION FOR BUILDING PERMIT 71ST Insure or a certificate of Workers Compensation Insurance r i or 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 S- Certified copy is filed with the county building inspec BUILDING MQ 11e r 1 tion department ADDRESS LOCALITY T NEAREST Date Applicant CITY L ZIP 80 CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS OF BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 1 MAP BOOK PAGE PARCEL (This faction need not be completed if the permit Is for one USE ZONE MAP (J O hundred dollars($100)or less ) TRACT BLOCK LOT NO NO TEL �i SPECIAL 1- I certify that in the performance of the work for which this OWNER /�10 CONDITIONS d •� DISTRICT GROUP TYPE FIRE SSED BY O permit is Iswed I Shall not employ rsan In n manner � � 5 30 7 Pic CONST ZONE V to m to become w6lect to the Work Comps I Lows - �U 3 , / 3 XDote '�U (3 AppIIcan CITY ZIP STATISTICAL CLASSIFICATION '/ APT CONDO F- NOTICE TO APPLICANT If, after making this Certificate of ANG NEER OR NO �-TEL W Exemption you should become subject to the Workers' CLASS NO DWELL ITS W Compensation provisions of the Labor Code you must forth- Is. ADDRESS SEWERVp N with comply with such provisions or this permit shall be TEL Z deemed revoked CONTRACTOR hiOBK PG VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO VALUATION (commencing with Section 700D)of Division 3 of the Business and LICO(] Professions Code, and my license is in full force and effect CITY CLASS f pop. FTrs NO OF NO OF CHECKLicense Number Lic Class SIZE e.0 Q STORIES FAMILIES ONE Contractor Date DESCRIVIION OF WORK Nom, ❑ S ADD E]n I am exempt under Sec '�� ALTER E] FINAL ❑ 2 B 8P'C for this reason REPAIR DATE Dote USE OF EXISTING BLDG oFMOL FINAL Signature APPLICANT TEL By L .' U 3 9 7 A OWNER-BUILDER DECLARATION PRINT NO If 1 hereby affirm that I am exempt from the Contractor s License Low for the following reason (Section 7031 5 Business and ADDRESS 2 • - 6a63 Professions Code) PRESENT a O 3 E] 1, e o I, as owner of the property or my employees with ADDRESS i wages as their sale compensation,will do the work and LOCALITY J (1 8 o-83 the structure is not intended o,offered for sale(Section _ 7041 Business and Professions Code) MOVING TEL ElI as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Businem and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there iso construction lending agency for FROM the performance of the work for which this permit Is issued PL (Sec 3097, Civ C ) SIDE PL Lenders Name 6 Lender s Address PC Fee f Permit Fes 7 1t I certify that I have read this application and state that the Issuance Fee O ., 0 above information is correct I agree to comply with all County Investigation Fee ordua avid State laws relating to building construction, Toal Fee 3 and here outhouse r esentahves of this County to nter rrpo th above-mens operty for Inspection purposes 9-J0-e3 4' SH REV9tfE FOR E%PIANATORy�IANGUA6! Signature of Applicant or Agent Dab WORKERS COMPENSATION DECLARVION - �' I hereby affirm that I hove a certificate of tensent ts•self insure or a certificate of WorkersCompensation Insurance APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished B UILDING FOR APPLICANT TO FILL IN Certified copy Is filed with the county building inspec BUILDING C hon department ADDRESS Date Applicant CITY—TemplZIP CERTIFICATE OF E%EMPTION FROM WORKERS Nq OF COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT(This section need not be completed If the permit is for one hundred dollars($100)or less ) TRAIL BLOCK LOT NOK PAGE PARCEL OWNER rk TEL USE ZONE 1 certify that In the performance of the work for which this NO NO V )• permit is Issued I shall not employ any person In any manner ADDRESS7 k- I SPECIAL ONS IL O so as to become subject to the Workers Compensation Laws 0 Date Applicant CITY ZIP K NOTICE TO APPLICANT If after making this Certificate of RCHI a OR NO DISTRICT GROUP TYPE FIRE BV o Exemption you should become subject to the Workers' ENGI7�Ly 0 MT ZONE ISULE Compensation provivons of the Labor Code, you must forth- ADDRESS LDV /�—31 V d with comply with such provisions or this permit shall be 7L' deemed revokedCONTRACTOR TEL STATISTICAL CIASSIF CATgN APT N29 ftp LICENSED CONTRACTORS DECLARATION LK CLASS NO DWELL UNITS_ 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code and my license Is in full force and effect CITY CLASS VALIDATION SO FT l NO OF AM NO OF CHECK PGLicense Number Uc ClassSIZE 3lQ STORIES FILIES ONE VALUATION A DEsatlPnoN of watK r NEW $ 150011,10D # 1 2 1 9 1 Contractor pate ADD ElI am exempt under Sec ALTER S&P C far this reason REPAIR $ - - 49.88 Dote USE OF BLDG D6NOL • • 4 9.8 8EXISc=i Signature APPLICANT TEL FINAL , 1 2 1 3—8 4 OWNER-BUILDER DECLARATION INT NO DATE ILS g/ I hereby affirm that I am exempt from the Contractors License Law for the following reason (Section 7031 5 Business and ADDRESS FINAL / Professions Code) PRESENT BY ® I as owner of the property or my employees with BUILDING wages as their sole compensation will do the work and ' the structure Is not Intended or offered for sale(Section LOCALITY 70" Business and Professions Code) MOVING TEL I as owner of the property, am exclusively contracting CONTRACTOR NO with licensed controctors to construct the project (Sec- ADDRESS hon 7041 Business and Professions Code) CONSTRUCTION LENDING AGENCY REOUIRSET BACK Y'ED TOTAL SETBACK FROM I,XIbI 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 (Sec 3097, Civ C ) SIDE PL Lender's Name 8 LDMA Ref 0 >-> Lender s Address PC F"$ Permit Fee Au 317 K I certify that I have read this application and state that the Issuance Fee O P. P/C F above information is correct I agree to comply with all County Invastlgotwn Fee ordinances and State jaws relating to building construction Total 41? v and hereby authorize representatives of this County to enter Fee LDAL4 Farm upon the above-mentioned property for inspection purposes ^ yUon:cm L c i_G_ SEE BEVERU FOR ULPLANATOBY LANGUAGE Signor ss of Applic t or Agent Duro O I 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 9608150005 PHONE (818) 285-0488 EXT LEGAL ID NO OF -CURgr BUILDING ADDRns TR 11290 LT 20 BL. B SQ FT STORIES TYPE 5307 PAL MAL AV STRUCTURE V TEMP CA 917802845 NEAREST CROSS STREET FREER 8585-021-029 THOMAS PAGE 597 GRID C4 LOCALITY: TEMPLE CITY TENANT EXIST BLDG USE REBID ISSUED ON PROCESSED BY B(PIRES ON EXIST OCC GRP 08/15/96 , TC 08/15/97 OWNER TEL NO BLDGS NOW ON LOT VALUATION fTwAr-mk MARTIN MARK J,PAMEY K (818) 579-4108- 1 4,000 �O 5307 PAL MAL AV TEMP 917802845 CONVERTING PA OF GARAGE TO DEN 209 SQ FT -STORAGE 132 FT APPLICANT FEE DESCRIPTION QUANTITY UOM AMOUNT SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27 75 AC STRONG MOTION RESID 4000 00 VAL 0 50 SPECIAL CONDITIONS- AX BUILDING REVIEW'FEE (� (1 54 70 82 PERMIT W/ENERGYG L-C L 4000'00 VAL 127 71 CONTRACTORTOTAL FEES---I& � 210 66 SAME AS OWNER - `�' LIC NO LOCATION AND SETBACKS :lA SOILS ENGINEER APPRWAr- ARCHITECT OR ENGINEER TEL NOITMrTmu ® / LIC NO SLAB/UNDER FLOOR MAP NO: SEWER NAP BOOK. PAGE FIRE ZONE CKPUNDERFLOOR INSULATIOW- 6+ GG �o WORKS 147H273 3 01 P` B U C tl O R KS ry NO OF FAMILIES S0 -- NO 21 �CoROOF SHEATHING SCHOOL W THIN HAZARDOUS fj OSHEAR PANELS AIR WAIITY 1000 FEET MATERIALS / NO NO FRAME INSPECTION WI /'1 n FIRE SPRINKLER HANGER3-- SET BACK YARD HWY PROP LINE WIDTH l•- �� FRONT PLINSULATION/WEATHER p - SIDE PL- REPORT ID OPR261 ROUTE TO BS0508 M COUNTY OF LOS ANGELES TEMPLE CITY 0 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPmEttr TEMPLE CITY CA 91780 BL 0508 1107120048 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ITR 11290 LT 20 BL B SQ PI STORIES TYPE I 5307 PAL MAI. AV ISTRUC99RE 3900 V-B TEMP CA 917802845 (ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET FREER 18585-021-0291 THOMAS PAGE 597 GRID C9 LOCALITY TEMPLE CITY CI (TENANT EXIST BLDG USE RESID USE ZONE R-1 (ISSUED ON PROCESSED BY EXIST OCC GRP I07/12/11 SR OWNER TEL NO BLDGS NOW ON IAT VALUATION FIBAL DATE FINAL BY CODE IWUYL MAG (626) 443-]125- 3 000 153 1530] PALAL MAL AV (TEMP 917802845I FEES PAID JDIESCRIPTION OF WORK ki I I RE-ROOFING ONE LAYER OF 30 LB PAPER IS PUT ON THE TOP OF (E) I I IFEE DESCRIPTION QUANTITY UOM AMOUNT [SHINGLE ROOF FOLLOWED BY ONE LAYER OF SHINGLE ROOFING MATERII (APPLICANT TEL NO IAL IS PUT ON TOP OF FELT PAPER ALL OR THEM ARE COVERED THE WI ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 80 1 1 I IAB STATE GREEN BLDG FEE 3000 00 VAL 1 00 ISPECIAL CONDITIONS I IAC STRONG MOTION REBID 3000 00 VAL o 50 1 1 ID2 PERMIT W/0 EN-HC 3000 00 VAL 99 10 1 I FR INV WORK W/O PERMIT 257 00 DOL 257 00 1 1 ICONTRACTOR TEL NO I TOTAL FEES 385 40 (APPROVALS DATE INSPECTOR SIGNATURE I (SAME AS OWNER - I I I LIC NO i iIOCATION AND SETBACKS i I I (SOILS ENGINEER APPROVAL I I ARCHITECT OR ENGINEER TEL NO i (FOUNDATION/TRENCH FORMS I LIC NO I SLAB/UNDER FLOOR (RAISED FLOOR FOAMING MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION 114]H2]3 3 001 [ 1 I I FLOOR SHEATHING NO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 NO 21 IROOF SHEATHING I SCHOOL WITHIN HAZARDOUS SHEAR PANELS (AIR QUALITY 1000 FEET MATERIALS NO NO NO IFRAM2 INSPECTION FIRE SPRINKLER HANGERS (INSULATION/WEATHER STRIP( (INTERIOR LATH/DRYWALL IEXTERIOR LATH I I 11 1 (RATED FLOOR/CEIL ASSEM I IRATED WALL ASSEMBLIES (RATED SHAFTS/OPENINGS I I I IT BAR CEILINGS I• ADDITIONAL DATA ON FILE ILOT DRAINAGE REPORT ID DPR261 ROUTE TO 13SO508 I COUNTY OF LOS ANGELES TEMPLE CITY R 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVEI/OPMENT TEMPLE CITY CA 91780 BL 0508 1110110089 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS ITR 11290 LT 20 BL B I SO FT STORIES TYPE 5307 PAL MAL AV ISTRUCTURE V B I TEMP CA 917802845 I (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET FREER 18585-021-029 1 1 THOMAS PAGE 597 GRID C4 LOCALITY TEMPLE CITY Cl I I I I ITENANT EXIST BLDG USE RESID USE ZONE R-1 TISSUED ON PROCESSED BY I (EXIST OCC GRP 110/11/11 SR I I I TOWNER TEL NO IBLDGS NOW ON LOT VALUATIONIFI{'NAL DATE FIN�AL/�Y CODE 1 1REBECCA Y (626) 443-7125- i 1 300 I t`�1+�� 15753 07 PAL MAL AV J ✓t� 17'EMP 917802845 I FEES PAID 10 SCRIPTION OF WORK 1 I I IWINDOW REPLACEMENT A TOTAL OF 5 WINDOWS IN THE FRONT OF THE 1 I IFEE DESCRIPTION QUANTITY DOM AMOUNT (HOUSE WILL BE CHANGED TO VINYL REPLACEMENT 1APPLICANT TEL NO I I I ISAME AS OWNER IAA BLDG PERMIT ISSUANCE 27 80 1 1 IAB STATE GREEN BLDG FEE 1300 00 VAL 1 00 ISPECIAL CONDITIONS I IAC STRONG MOTION RESID 1300 00 VAL 0 50 1 1 ID2 PERMIT W/O EN-HC 1300 00 VAL 82 20 1 1 I TOTAL FEES 111 50 I_ I CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1 ISAME AS OWNER - I I I I LIC NO ILOCATION AND SETBACKS I I I I I I 150ILS ENGINEER APPROVAL I I I I I I I I 1ARCHITECT OR ENGINEER TEL NO 1 IFOONOATION/TRENCH FORMS I I I 1 LIC NO I ISLAB/UNDER FLOOR I I I I IRAISED FLOOR FRAMING I I I I I I I (MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP 1 Il1NDERFL00R INSU[ATION I I I I147H273 3 001 1_ 1 I I I FLOOT SHEATHING I IND OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I 1 NO 21 (ROOF SHEATHING I I I SCHOOL WITTiIN HAZARDOUS I (SHEAR PANELS I I I LAIR QUALITY 1000 FEET MATERIALS I I I I NO NO NO 1FRAME INSPECTION I I I I I I I I I I (FIRE SPRINKLER HANGERS I I I I I I I I I IINBLLATIDN/WEATHER STRIP( 1 1 I I I I I (INTERIOR LATH/DRYWALL I I 1 I I I IE%TERIOR (.ATH I 1 1 I 1 I (RATED FLOOR/CEIL ASSEM I I 1 I I 1 1 (RATED WALL ASSEMBLIES I I I I I I (RATED SHAFTS/OPENINGS I_ I I I IT-BAR CEILINGS I I 1 I I I I I (LOT DRAINAGE 1 1 1 I I IRE WORT IO DPR261 ROUTE TO BSO508 I 1 I I I I I 1 I I