HomeMy Public PortalAbout5451 PARMERTON AVE_Building__ WORKERS COMPENSATION DECLARATION '
hereby affirm that I have a certificate of consent to self APPLICATION- FOR- BUILDING PERMIT Il
insure, or a certificate of Workers Compensation Insurance, '
or a certified copy thereof (Sec 3800 Lab C ) I
Policy No Company
COUNTY OF LOS ANGELES BOLDING AND SAF TY
Certified copy is hereby furnished FOR APPLICANT TO FILL IN. ADDDDRESSRESS _
A
Certified copy is filed with the county building iospec BUILDING .O
hon department ADDRESS cJ / r�/Zmpc LOCALITY
" T �j/ �r NEAREST
X Date�-5-Lr 3 Applicant t (� CITY / ZIP // [/ CROSS ST
/ o
CERTIFICATE OF EXEMPTION FROM WORKERS NO OF BLDGS r 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 - sO
hundred dollars ($100)or less') TRACT wsyr BLOCK LOT NO '` NO
I certify that in the Performance of the work for which this OWNER /N iLd bI QS v TEL
7'36 �/ CONDITIONS ' IS•
permit is issued, I shall not employ any person in any manner r/`t 'DISTRICT GROUP TYPE FIRE PROCESSED BY « O
so as to become subject to the Workers Compenwt,on Laws' ADDRESS./ 7J� f CONST Z E V
/.7 - ✓ro Di OU
Date_ Applicant '' ARCHCify—Ff,ITECT /� ZIP -/TEL / STATISTICAL C1A551FICA)T'1ION - ONDO t
NOTICE TO APPLICANT If after making this Certificate of ENGINEER - "NO 6 CLASS NO DWELL UNITS_ 'r W
Exemption you should become sublet to the Workers' IS.
Compensation provisions of the Labor Code, you must forth ADDRESS - SEWER MAP N
with comply with such provisions or this permit shall be Z
deemed revoked ' CONTRACTOR 49 •ND , _BK PG -VALIDATION ..• -
_ LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1,gJ4A LNO 36 00-;1-7 VALUATION
(commencing with Section 7000)of Division 3 of the Business and LIC
P.55 -`
Professions Code, and m license is in full force and effect CITY ►
36or�27 d�- NO OF NO OF CHECK
(Con'tracto6i
License Number LK Class SIZ STORIES FAMILIES ONE
//NO 9 -fl.v pR to -5^- 3 DESCRIPTION OF WORK NEW ❑ ro v/�•�Q��'+`
I am exempt under Sec y ADD ® Y'✓� -
❑ DATE I I-IO
B 8P C for this reason I FINAL
'y- REPAIR ALTER R ❑ < 0 9 a 8,A'
Date
USE OF Br AL
f
EXISTING BLDG DEMOL ❑ #i. . . ..2 3•
Signature ^ APPLICANT TEL ` '
OWNER BUILDER DECLARATION PRINT NO 2 -,1'4 Q 2 5
1 hereby affirm that I am exempt from the Contractor's License s
Law for the following reason (Section 7031 5, Business and ADDREui Oo7 .� "^ e • • 1 4 Q 2
Professions Code) BPRESENT
UILDING `' #y Jx , , 0405-83
I, as owner of the property or my employees with ADDRESS _ ` _ s
wages as their sole compensation,will do the work and LOCALITY _ ,$p 9 8.O A'
the structure is not intended or offered for sale(Section
7044 Business and Professions Code) MOVING�� TEL ! Zi<O. /�, �. ,# • •r• • • .�
I, as owner of the property am exclusively contracting
with licensed contractors to-construct the project (Sec ADDRESS �3 ^
b 44 0 3 2(• 430 5 0
on 70Business and Professions Code) _
REQUIRED TOTAL SETBACK FROM EXIST
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH , •'• 4-30 5 0 v
hereby affirm that there is o construction lending agency for FROM
'
perfoimonce of the work for which this Permit is issued P L' ' 0 4 0 5-8,3 ;
(Sec 3097 Cry C ) SIDE , _ _
Lender z Name
P C Fee$
Permit Fee
- lender sAddress -
I certify that I have read this application and,stote that the Issuance Fee 4
above information is correct I agree to comply with all County Investipot, n Fee - .f
ordinances and State laws relating to building construction
lY and hereby authorize representatives of this County to enter Total Fee i
upon t above`me tion property for IInspecttiioon purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
1
Signomre of ppI¢ t or Agent, Dale Qj 0s
I! _
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 8L 0508 0209110003
PHONE (626) 285-0488 EXT
LEGAL ID- NO OF CONST BUILDING ADDRESS
TR 13613 LT 72 SO FT STORIES TYPE 5451 PARMERTON AV
STRUCTURE VN ' TEMP CA 917803506
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET MCCLINTOCK
8573-005-033 1 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY
TENANT EXIST BLDG USE RESIff-- USE ZONE R-1 ISSUED ON PROCESSED BY EXPIRES ON
EXIST OCC GRP 09/11/02 JK 03/10/03
OWNERL OT VALUATIONZ CODE
CLEMAN JOHN,DONNA (626) 443-8633- - 6,400
5451 PARMERTON AV J lid
'---
TEMP 917803506 _ FEES 1'TDN—(SF WKK
EMOVE.EXISTING CEDAR SHAKES,APPLY GAF TIMBERLINE SHINGLES
FEE DESCRIPTION QUANTITY UOM AMOUNT
EAGLE ROOFING (626) 291-5700- AA BLDG PERMIT ISSUANCE - 27 75
6327 LIVIA AVENUE AC STRONG MOTION RESID 6400 00 VAL 0 64 tTaIAL CONDITIONS
TEMPLE CITY 91780 D2 PERMIT W/O EN-HC—--�6400 00 VAL 166 20
7 5 P�GELESTCAOL�FEES 194 59
CONTRACTOR TEL NOEAGLE ROOFING (626) 291-5700- ��
APPR OVALS DATE INSPECTOR SIGWATUR5
6327 N LIVIA AVE LIC NO 1 LOCATION AND SETBACKS
TEMPLE CITY CA 91780' 698529 C391
/ NAPPROVAL
ARCHITECT OR ENGINLTW— TEL NO FOUNDATION/TRENGH FORMS
' LIC N0,(Y(
SLAB/UNDER FLOOR
iRATSMAP NO SEWER MAP BOOK1
UNDER
147H277 AGE rm 3 ' o
N1 (� (� O L J V 1:! u U ON
NO OF FAMILIES DWELLING UNITS APT/
No 21\SCHOOL WITHIN HAZARDOUSy19
R 6
AIR QUALITY 1000 FEET MATERIALS \ Q S 7
No NO NOREQUIRED TOTAL SETBACK PKum tx"lFIRE SPRINKLER HANGER-9--
SET BACK YARD HWY PROP LINE WIDTH AGb/ U �0t�4
FSDT PL-E PL- t �� Servlee Shat r /
INTERIOR LATH/DRYWALEr
EXTERIOR
WALL AS
r -
CEILINGS
LOT DRAINAGE
REPORT ID DPR261 ROUTE TO BS0508