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Home My Public Portal About5945 PRIMROSE AVE_Building__ WORKF,,-S'COMPENSATION DECLARATION here b affirm tical I havecertificate of consent to self �ftisusuAPPLICATION PPLICATI®N F WILDING P E MI Tre, r a certificate of Workers'Compensation Insurance, hl F! or r certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING SAFETY Policy No. Company 1:1Certified copy is hereby furnished. FOR APPLIC NT TO FILL IN BUILDING ADDRESS /6 Certified copy is filed with the county building inspec- [OWNER LDING 5j' 5 /1 ,?,� A�t S — tion department. DRESS �/ GG /r/KJ Date Applicant Y ZIP ✓ LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE OF LOT NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one r� ASSESSOR hundred dollars($100)or less.) CT BLOCK LOT NO. / MAP BOOK PAGE PARCEL TEL. —l9 z USE ZONE MAP I certify that in the performance of the work for which this NO. NO. permit is issued, I shall not employ any person in any manner S"' r3 SPECIALS ADDRESS CONDITIONS so as to be omee subject to the Workers' ompensation Laws. V 7 go Date � / " 91 Applican CITY ZIP �l NOTICE TO APPLICANT: If, after eking, this Certific a of ARCHITECT OR y7 ! TEL. DISTRICT 7-D UP TYPE FIRE PROCESSED BY O ENGINEER 6l-•" 1L NO. CONST. ZONE I"' Exemption, you should become subject to the Workers' U ? (, Compensation provisions of the Labor Code, you must forth- ADDRESS �' V, 0. with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CON . N deemed revoked. CONTRACTOR 15f;�c-r 6 NO. z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 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 L PG 5 VALIDATION SQ. FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES I FAMILIES ONE VALUATION DESCRIPTION OF WORK NEW 13 Contractor Date $ I am exempt under Sec. Z ADD � 91 5.1 A 0 0 0 0 0 1 B.&P.C. for this reason Date: USE REPAIR ALTER EMOL O $ ( o - 60,50 EXISTING BLDG. Signature APPLICANT TEL. FINAL �`ljrf o 0 0 6 Q 5 0 6 OWNER-BUILDER DECLARATION PRINT NO. DAT ✓ I hereby affirm that I am exempt from the Contractor's License 3. 1 1 -88 Law for the following reason (Section 7031.5, Business and ADDRESS FI Professions Code): PRESENT BUILDING ` I, as owner of the property, or my employees with ADDRESS r wages as their sole compensation,will do the work and 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- ADDRESS tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTAPROPL NEER 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 Q o LDMA Ref. # P.C.Fee$ Permit Fee Lender's Address f I certify that I have read this application and state that the Issuance Fee iv EA P/C# above information is correct. I agree to comply with all County Investigation Fee �J C ordinances and State laws relating to building construction, Total Fee 4f/ J LDMA Perm. q and hereby authorize representatives of this County to enter upon the above- ntioned property for inspection purposes. ogrc�� /l 'SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Applicant or Agent Date 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 BL 0508 1203290077 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 6561 LT: 271 SQ. FT STORIES TYPE 5945 PRIMROSE AV IASSfiSSOR INFORMATION NUMBER: STRUCTURE: 800 V-B TEMP CA 917802064 NEAREST CROSS STREET: LAS TUNAS 18587-013-004 I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl (TENANT: JEXIST BLDG USE: RESID USE ZONE: R-3 JISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 103/29/12 SR OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FI CODE: IRR LIVE OAK LLD (626) 285-4466- I 3,000 1150 N. SANTA ANITA IARCADIA, CA 91006 FEES PAID ILYESCIdPTIO14 OF WORK TEAR OFF REROOF 30 YR COMPOSITION REPLACE FASCIA BOARD TRIM IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: AROUND WINDOW AND EXTERIOR PAINT DO TO CITY TREE DAMAGE APPLICANT: TEL. NO: I IO'LEARY, TOM - IAA BLDG PERMIT ISSUANCE 27.80 1 IAB STATE GREEN BLDG FEE 3000.00 VAL 1.00 SPECIAL CONDITIONS: IAC STRONG MOTION RESID 3000.00 VAL 0.50 ID2 PERMIT W/O EN-HC 3000.00 VAL 99.00 IFR INV WORK W/O PERMIT 342.20 DOL 342.20 CONTRACTOR: TEL. NO: TOTAL FEES 470.50 JAPPROVALS DATE INSPECTOR SIGNATURE ITOM O'LEARY CONSTRUCTION (626) 287-0927- I 15823 AGNES AVENUE LIC. NO ILOCATION AND SETBACKS TEMPLE CITY, CA 91780 489354 * I- SOILS ENGINEER APPROVAL 1ARCHITECT OR ENGINEER: TEL. NO: - 1 IFOUNDATION/TRENCH FORMS LIC. NO: ISLAB/UNDER FLOOR RAISED FLOOR FRAMING [MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I15OH265 3 001 I I IFLOOR SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I 0 NO 21-1 IROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS I NO NO NO IFRAME INSPECTION I I I (FIRE SPRINKLER HANGERS IINSIILATION/WEATHER STRIP( I 1 I 11NTERIOR LATH/DRYWALL 1 I 1 1 (EXTERIOR LATH 1 1 IRATED FLOOR/CEIL ASSEM. I IRATED WALL ASSEMBLIES I 1 IRATED SHAFTS/OPENINGS I I IT-BAR CEILINGS I I* ADDITIONAL DATA ON FILE II 1 ILOT DRAINAGE I 1 I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I