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Home My Public Portal About5744 PRIMROSE AVE_Building__ WORKERS'COMPENSATION DECLARATIONS ' I �h / of consent to sf insurebor a certificate of Worke s'iificate Compensation Insurance, ` A 00 L I CAT I O N FOR R U I L D-I N G PERMIT or O certified copy thereof(Sec. 3800, Lab. C.)• F O ' —�✓ n COUNTY OF LOS ANGELES BUILDING AND SAFETY Pollcy No.�Company BUILDING / t- Certified copy is hereby furnished: FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building ins ec- PADDRE ^ tion department. LOCALITY , .�<•.r 4, NEAREST r` Date/ Z �' Applicant- 7� ZIP �� CROSS ST. _ ,r /i^iC-�G ERT KATE.OF EXEMPTI N FROM W RKE NO.OF BLDGS. 'ASSESSOR COMPENSATION INSURANCE '- , Z� N01(V ON LOT MAP BOOK PAGE PARCEL (This section need no)be completed,if.the-permit is for one•• USE ZONE. MAP hundred daliars ($100).or less.) TRACT'/,74 BLOCK `'. LOT NO. NO. ..". � L� " L S TEL. �. 'SPECIAL.I certify that in the•performance of the•work-for which this NO! '7 CONDITIONS CL permit is issued, I shall not employ'any person in any manner DISTRICT. GROUP TYPE FIRE PROCESSED BY C)' -�3 CONST.. ONE so as to become subject to the Workers'Compensation Laws. Date Applicant CITY ZIP• STATISTICAL CLASSIFICATION L-/ - NET. CONDO. ARCHITECT O TEL. S 3 NOTICE TO APPLICANT: If, after making this'Certificate'Of ENGINEER I NO. ✓ %� CLASS NO. DWELL.UNITS LU Exemption, you should become 'subject to the Workers' y� CIL .- Compensation provisions of the Labor Code, you must forth- ADDRESS 45^ ,10Aod. iA SEWER MAP with comply with such provisions or this permit shall be deemed revoked. CONTRALTO ` TELi� VALIDATION. .i� NO. X-2 3 BK. IPG, �s� / LICENSED CONTRACTORS DECLARATION LIC./ q _ I hereby affirm that I am licensed under provisions of Chapt .9 ADDRE 4- d00/ti' NC b/7 •Z- VALUATION (commencing with Section 7000)of Division 3 of the Business nd LIC• ,r Professions Code,and my license is in full force and effect. CITY CLASS $ !1 ) 29�2 SQ. NO.OF NO.OF CHECK License Numb r 7 J Lic.Class /5 SIZE ��1� STORIES FAMILIES ONE r,., s. Contract0 f Date! DESCRIPTION OF WORK 'D/Z f'IEW ❑ $ I am exempt 4der Sec. ADD ALTER ❑ FINAL "-7�• B.BP.C. for this reason D REPAIR E] DATE? - ,e) „y Date: USE OF DEMOL ❑ FINAL { EXISTING BLDG. A/� 8y Signature APPLICANT TEL.I) OWNER-BUILDER DECLARATION PRINT /Q. NO. Q -� I-hereby off irm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5,-Business and ADDRE Professions Code): PRESENT BUILDING I, as owner of the property, or my employees. with ADDRESS wages as their sole compensation,will do the work and O G, p1 the structure is not intended or offered for sale(Section LOCALITY' -'�' 7044, Business and Professions Code). MOVING TEL. , I,as owner of the property,am exclusively contracting CONTRACTOR NO. ± with licensed contractors to construct the project (Sec- r. r 'tion 7044, Business and Professions Code). ADDRESS e.' C. I G•. REQUIRED TOTAL SETBACK FROM EXIST. r CONSTRUCTION is N-LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH ® ° C. G 2 I hereby affirm that there is a'constrtiction lending agency for FRONT the performance of the work for which this permit is•issued P.L. j %,-0 2—8 2 iSec. 3097, Civ. C.). SIDE - 6 P.L. Lender's Name Lender's Address P.C.Fee$ Permit Fee L { r I certify that I have read this application and state that the Issuance Fee �)G I above information is correct. I agree to comply with.all County Investigation Fee Aan ances and State laws relating to building construction, Total Fee C! Jy authorize repre a atives of this County to enter bove-me 'Cfje erty fo inspection Pur oses. oy' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f App scant or Agent Abate 7. es -A APPLICATION FOR BUILDING PERMIT 1 COUNTY OF LOS ANGELES � BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN 71BUILD61NG ADDRESS � . 1 hereby affirm that I have a certificate of consent to self insure, MSIZEOFU LDING ADDRESS /,m tZ �£ �y or a certificate of Workers'Compensation Insurance,or a certified /�1 /1 copy thereof(Sec.3800,Lab.C.) I„ •�— ZIP `7 I `lALITY - �-CJr IPolicy No. Company J NO.OF BLDGS.NOW ON LOT G� ❑ Certified copy is hereby furnished. � — /,�Oyn� �p�R '� NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. [® USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE, PARC L/i I 01SPECIAL CONDITIONS O/ CERTIFICATE OF EXEMPTION FROM WORKERS' ER /� O TEL NO. YES NO COMPENSATION INSURANCE CrA ��ZJf�I vY�J"� �1� �7�Sl'o WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred DISTRICT {� p. mv-, DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars($100)or less.) I certify that in the performance of the work for which this permit Cf e m e- n� ZIP,, ( 7, is issued, I Shall not employ any person in any manner so as t0 ARC ITE OR ENGINEER (� TEL NO. become subject to the Workers'Compensation Laws. rA STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS YV CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL 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 NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW _BK PG ® a License Number Lic.Class DESCRIPTION O WORK ADD ❑ VALUATION Contractor Date ALTER EDs"e,°ego Q ❑ I am exempt under Sec. , !^ REPAIR ❑ 0 $ F- B.BP.C.for this reason DEMOL ❑ W LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ 17. 14 .9fsnII 5(0 e ii I �• Signature A CO PLI ANT( NT) i TE N0. LDMA Perm# 141tn a z IK1as owner of the property, or my employees with wages as u�' ^- S z 1, e{ air sole compensation, will do the work and the structure is ADDRESS l ` F 330 not intended or offered for sale (Section 7044, Business and 1`�• Jai eltrne t _ FINAL DATE a 2 ITEMS Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ` ,{� ❑ I, as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE y O J JQ TOTAL IL59 a •�•(,-:L„y AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES licensed contractors to construct the project (Section 7044, FINAL BY > t � Business and Professions Code.) YES❑ No❑ CHECK 159.40 WILL THE INTENDED USE OF THE BUMUNG BY THE APPLICANT OR FUTURE BUILDING n 1 13 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ No❑ i_ {�(+(} /j _ _ cm the performance Of the Work for which this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING LIUoQ-0oo1 ?f 131 95 CM 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. �� 1 AM O n y TITLE 2.CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS 51 9 l � Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. o Lender's Addres O OWNER OR AGENT c I certify that ave read this application and state under penalty C of perju t the a4 a informat• is correct.I agree to comply P.C.FEE �, `Q PERMIT FEE q N with my o nances a State ws relating to building V con n, an ereby au a re sentatives of th• County ISSUANCE FEEm toe pn t ve- arty for inspectio p s. m INVESTIGATION FEE TOTAL FEE /' 59NIuro al cnl a AJ-- 0.:1 v SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERM-I-T { DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS -ATERATION/REPAI�j BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL\0508 9809�24UOT4 PHONE: (818) 285-0488 EXT: GA D: OF CONST B 1LAISrr-ADDRf S# TR: 6561 LT: 652 SQ. FT STORIES TYPE 5744 PRIMROSE W STRUCTURE: 0 VN TEKP-CA-9780 507 ASSESSOR INFORMATION NUMB : NEAREST CROSS STREET: LAS TUNAS 8587-016-019 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: S 0 E: R-1 ISSUED 0 : PROCESSED B EXPIRES N: EXIST OCC GRP: 09/24/98 UT 09/24/99 OWNER: TEL. 0: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: OVERLEASE CHARLES E;CATHERINE A - 1 5,600 /� 5744 PRIMROSE AV fVJ�I262 TEMP 917802507 FEES PAID TEAR OFF AND INSTALL 4D YR_ FIK COM2a SHINGLE 'f APPLICANT-- TEL.-NO: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:' -' --" - SUNSET ROOFING (626) 357-3556- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID-=== - 5600.00 VAL 0.56 SPECIAL CONDITIONS: D2 PERMIT W/0 EN-HC- _-:- 5600.00 VAL 149.40 - .---,`TOTAL-'FEES 177.71 CONTRACTOR: TEL. N0: ��` �;��' " APPROVALS DTE INSPECTOR SIGNATURE SUNSET ROOFING :',� �; �.��'''•: (626) 357-3996- 5660 GARY PARK AVE. LIC. NO ": / ' 7 `� �'� �•'+� LOCATION AND SETBACKS ARCADIA, CA. 91006 603218/C39 /. SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. 0: FOUNDATION/TRENCH-]FORMS - LIC. 'y , {- , + 0 0 / RENC OR SLIC. NO: i SLAB/UNDER FLOOR RAISED FLOOR R G P NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP• I, ! `+�, i' �,� ;� r`,%} I_ !"' UNDERFLOOR INSULATION 150H269 3 01' ' iJ i ',; FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 OOF SHEATHING SCHOOL WITHIN HAZARDO S f` _ 1 ,,r , �� :`sa SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME-INSPECTION fl REQUIRED TOTAL SETBACK R XIST •��u3,/�- i•• b; =� R S E AGE S SET BACK YARD: HWY: PROP LINE: WIDTH: ?j;,�� ;�/r FRONT PL- JL se's INSULATION/WEATHER STRIP SIDE PL- INTERIOR ;_