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Home My Public Portal About5760 PRIMROSE AVE_Building__ WORKERS'COMPENSATION DECLARATION V. -07 rre`= rd m that 1 have certificate of consent to self APPLICATION FOBUILDING PERMIT titr , or-a certificate of Workers'Compensation Insurance, R or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING Q ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 3�7'a I AJsrr'� Date Applicant CITY e.,I" ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT S D JIT- ' Zk NOW ON LOT CROSS ST. GG (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER TEL' O: USE ZONE MAP '.fDr �/6 Z I certify that in the performance of the work for which this NNO* permit is issued, I shall not employ any person in any manner ! SPECIAL so as to become subject to the Workers'Compe ation Laws ADDRESS 3��b f� - CONDITIONS 0 CITY / i ZIP Date Applic TEL. V NOTICE TO APPLICANT: If, r making this Certificate of ARCHITECT OR DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER ANO. Exemption, you should become subject to the Worker CONST ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS �v� :� A. with comply with such provisions or this permit shall be t/s deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. am DWELL. 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 and LIC. Professions Code, and my license is in full force and effect. CITY CLASS BK VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE you ISTORIES FAMILIES ONE Contractor Date VALUATION ' DESCRIPTION OF WORK NEW $ �/ /� V b V ADD ,❑I am exempt under Sec. S ALTER ❑ B.&P.C. for this reason — REPAIR ❑ $ Date: USE OF EXISTIING BLDG. DEMOL ❑ 7 6 9 81 Signature APPLICANT �1 TEL. FINAL # 0 0 0 0 PRINT TOr' _ �/ "2 NO. Z � OWNER-BUILDER DECLARATION DATE 4t/ UU ( -.o87,38 I hereby affirm that I am exempt from the.Contractor's License0 0 0 = Law for the following reason (Section 7031.5, Business and ADDRESS J� a /V. r FI 0 1 ?g 9� Professions Code): PRESENT I, as owner of the property, or my employees with ADDRESS i wages as their sole compensation,will do the work and ® I the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING - TEL. l ❑ I,as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM T. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY 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 o P.L. Lender's Name LDMA Ref. # P.C. Fee$ Permit Fee ' Lender's Address p I certify that I have read this application and state that the Issuance Fee Q.S� LDMA P/C# r above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee5-7 ,38- LDMA Perm. # J and hereby authorize representatives of this County to enter I on th bove ntioned property for inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Age -�+- Date •� � t ' I WORKER�COMPE"JSATION DECLARATION� here��trm that I hcLe a certrficute of Fonsent to self ., APPLICATION P P L I CAT I®N FOR BUILDING PERMIT insur or a certificate of Workers'Compensation Insur-once, . ; or certified copy thereof (Sec. 3800, Lab. C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. (company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS /+ ��f e e Date Applicant CITY , ZIP /,gx(/ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST j• COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. ASSESSOR hundred dollars($100)or less.) MAP BOOK PAGE PARCEL + / TEL. 7NEI certify that in the performance of the work for which this OWNER t ? 6 % NO. permit is issued, I shall not employ any p n in any manner 1 /y SPECIAL �+ so as to become subject to the Worker' mpensation ADDRESS //l / / e . CONDITIONS O. .�iH� ✓� CITY P.P7 (,i,n ZIP 2?d Date Applican ARCHITECT OR TEL. NOTI TO A PLICANT: if, afte eking�this Certificate ENGINEER NO. DISTRICT GROUP TYPE FIRE PROC ED BY O Exemption, you should become subject to the Work rs' �f CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS i r/ ` y W ` with comply with such provisions or this permit shall be a' L STATISTICAL CLASSIFICATION APT. NDO. fn deemed revoked. CONTRACTOR I / Z LICENSED CONTRACTORS DECLARATION LIC, CLASS V6. DWELL. UNITS I 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 BK VALIDATION SD FT. h O.OF NO.OF CHECK License Number Lic.Class SI G STORIES FAMILIES ONE ❑ VAI,{J�►T ON Contractor Date DESCRIPTION OF WORK NEW p(/`/ / ADD $ F1 , I am exempt under Sec. �D/!1� /I ❑ ALTER oil B.BP.C. for this reason 7 f v.,9 REPAIR ❑ $ USE OF Date: DEMOL ❑ z 9 7 Q 5 A EXISTING BLDG. o Signature APPLICANT I % j TEL. FINAL OWNER-BUILDER DECLARATION PRINT �• f7 f G y' NO. DATE # 0 0 0 0 0 1 1 hereby affirm that I am exempt from the Contractor's License 7 /I i"< < /� Law for the following reason (Section 7031.5, Business and ADDRESS r t� FINAL w .( o 2 q(12 5 Prof sions Code): PRE EN BY BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 0 o290,255 7044, Business and Professions Code). MOVING TEL. 2 6 8 8 ❑ CONTRACTOR NO. I, as owner of the property, am exclusively contracting O with licensed contractors to construct the project (Sec- ADDRESS % tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK AL NE FROM 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 P.L. Lender's Name o P.C.Fee$ Permit Fee t LDMA Ref. # Lender's Address E I certify that I have read this application and state that the Issuance Fee 5-0 LDMA P/C# above information Is correct. I agree to comply with all County Investigation Fee 'o ordinance;,and State laws relating to building construction, Total Fee LDMA perm.# v and hera thorize representatives of this County to enter upon t ve-mentioned for inspection pur oses. / j SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or A Dafe 1 • " 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 1003110068 PHONE: (626) 285-0488 EXT: ILEGAL ID: I N0. OF CONST I BUILDING ADDRESS: I ITR: 6561 LT: 651 UN: .003 I SQ. FT STORIES TYPE 1 5760 PRIMROSE AV 1 I ]STRUCTURE: 1160 V-B I TEMP CA 917802507 I ASSESSOR1INFORMATION NUMBER: I I NEAREST CROSS STREET: I 8587-016-015. I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl ITENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 IISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: ]03/15/10 SR ]OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FI Y: CODE: I ]CHAVEZ, JOSE L (626) 641-6188- 6,000 1 15760 PRIMROSE AV I 1 1 1TEMP 917802507 I FEES PAID 115ESCRIPTION OF WORK REMOVE EXISTING COMPOSITION SHINGLE ROOF ON HOUSE & GARAGE I 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: REPLACE WITH NEW COMPOSITION SHINGLE ] ]APPLICANT: TEL. NO: I I 1 IGUERRA (818) 438-8009- IAA BLDG PERMIT ISSUANCE 27.75 1 ] 1 IAB STATE GREEN BLDG FEE 6000.00 VAL 1.00 [SPECIAL CONDITIONS: IAC STRONG MOTION RESID 6000.00 VAL 0.60 D2 PERMIT W/O EN HC 6000.00 VAL 149.40 TOTAL FEES 178.75 I I ICONTRACTOR: TEL. NO: 1 APPROVALS DATE INSPECTOR SIGNATURE 1 IA-1 ALL AMERICAN ROOFING (626) 303-3737- 1 1 ] (1705 S. MOUNTAIN AV. LIC. NO ] ILOCATION AND SETBACKS I I ] MONROVIA, CA 91016 699115-C39 ] I 1 1 I ISOILS ENGINEER APPROVAL 1 1 I (ARCHITECT OR ENGINEER: TEL. NO: I 1FOUNDATION/TRENCH FORMS I I I 1 LIC. NO: [ (SLAB/UNDER FLOOR I I I (RAISED FLOOR FRAMING [ I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:] (UNDERFLOOR INSULATION [ I ] 115OH269 3 00 (FLOOR SHEATHING i [ [NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: Joel"' ] NO 21 I ��e q IROOF SHEATHING F1 1 [ SCHOOL WITHIN HAZARDOUS 1 1SHEAR PANELS1 I LAIR QUALITY: 1000 FEET MATERIALS 1 I 1 NO NO NO 1 IFRAME INSPECTION IREQUIRED TOTAL SETBACK FROM EXIST I ]FIRE SPRINKLER HANGERS I 1 ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I I 1 IFRONT PL- 1 ]INSULATION/WEATHER STRIPI I I 1 SIDE PL- 1 I( ] 1 1 INTERIOR LATH/DRYWALL ] I I 1 1 1EXTERIOR LATH ] ] I 1 I IRATED FLOOR/CEIL ASSEM. I 1 1 IRATED WALL ASSEMBLIES [ I I 1RATED SHAFTS/OPENINGS I I I �T-BAR CEILINGS 1 I I I 1LOT DRAINAGE 1 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I [ I I I I I I