HomeMy Public PortalAbout6037 PRIMROSE AVE_Building__ lkbRKERS"COMPENSATION DECLARATION
.1 hereby'offirrn that I have a,certificate of consent to self
insure, ar b certificate of Workert',Compensation Insurance, APPLICATION F®R BUILDING P E RM I T
or a cer ifie�py�t rgof Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Na � /�CCoompany BUILDING 603 -
.Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS e&C
❑ Certified copy is filed with the county building inspec- BUILDING / (�Ia���Gl� ry
tion department. 1pe,&__
ADDRESS v ! S J✓
CV
Date 3 Applicant_ZL _J CCITY ♦ G ZIP 7* LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' p.� NO.OF BLDGS. .NEAREST ,
COMPENSATION INSURANCE SIZE OF LOT 6,y OD NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one �, L ASSESSOR
hundred dollars($100)or less.) TRACT 6��6p BLOCK LOT NO. !►p� MAP BOOK PAGE PARCEL
pv r y®V T L 7^ p s'USE 7,pNE MAP
I certify that in the performance of the work for which this OWNER 1/!l//_J NO. S�. y.
permit is issued, I shall not employ any per on in any manner, E (�oQ p 2J SPECIAL 0
so as to become subject to the Workers' mpensationnla�s. ADDRESS17/3 a 1 CONDITIONS UO
�i 3/ �A li n 14or' ' ♦��'f 01 -+ CITY % C/. ZIP 1 7�V t !19
Dat pp ca t ARCHITECT O TEL. R O
NOTICE TO APPLICANT: If, after makin this Certificate of i/� `� y� DISTRICT GROUP TYPE FIRE PR D BY
g ENGINEER 0151MOK NO. c7—0" ^ CONST. ZONE
Exemption, you should become subject to the Workers' /�( j
Compensation provisions of the Labor Code, you must forth- ADDRESS3�j �. M . S'`�O ✓ � �
Cn
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. I NDO.
deemed revoked. CONTRACTOR NO. y 1
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. � DWELL UNITS NOW
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 BKPG VALIDATION
SQ. NO.OF NO OF CHECK I
License Number 0 Lic.Class SIZE STORIES Z FAMILIES ONE
VALUATION
Contractor ate f`
�� —� DESCRIPTION OF WORK NEW $
❑ I am exempt nder Sec. V 0' r D W o AD ER ❑ 000. 4 3 4,8 A
B.&P.C.for this reason 5 REPAIR ❑ $ # 0 0 0 0 2 3
USE OF L
Date: EXISTING BLDG. 5r ®Usk DEMOL ❑ °
<_; r '�_���� APPLICANT TEL.,.p FINAL 6 04.3 5
Signature -�� "'��/�� 7YO v NO.L� O�
OWNER-BUILDER DECLARATION PRINTQ� DATE17
J ° ° b O 4,3 5
I hereby affirm that I am exempt from the Contractor's License ADDRESS / "tom/�� FINAL
Law for the following reason (Section 7031.5, Business and 0 Ll.0 1 —86
Professions Code): PRESENT 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
7044, Business and Professions Code). MOVING TEL. ;�6 2 aJ A
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. # a 0 0 0 0 1
with licensed contractors to construct the project (Sec-
ADDRESS
tion 7044, Business and Professions Code).
REQCONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK
LINE FROM WIDTH ( - 721.50
I hereby affirm that there is a construction lending agency for FRONT o o 7 2 1.5 0
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L. 12 Z i —86
allow.MEN
Lender's Name
3 LDMA Ref.#
P.C.Fee$ p(J r 45♦3 Permit Fee
Lender's Address //,,.. �
I certify that I have read this application and state that the Issuance Fee 6 5V
LDMA P/C# polo
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee LDMA Perm.#
9 and hereby authorize representatives of this County to enter
upon the abtione property for=X-3
D
SEE REVERSE FOR EXPLANATORY LANGUAGE n 1
Signature of Applicant or Agent Date
n . ,
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 1208220012
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST 1
I I BUILDING ADDRESS:
ITR: 44381 IT: 1 UN: D I SQ. FT STORIES TYPE I 6037 PRIMROSE AV ]
I ISTRUCTURE: V-B 1 TEMP CA 917802006
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: LAS TUNAS 1
15385-007-034 1 1 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
ITENANT: (EXIST BLDG USE: REBID USE ZONE: R-2 [ISSUED ON: PROCESSED BY: 1
[EXIST OCC GRP: 108/22/12 SR
[OWNER: TEL NO: JBLDGS. NOW ON LOT: VALUATION: IF DATE FINAL BY: CODE:
IFUNG KAI TAK;STELLA W (626) 823-7505- 1 2,300
16037 PRIMROSE AV
ITEMP 917802006 1 FEES PAID 1DESCR PTION OF WORK
I [ IRE-TROFIT ALL 9 WINDOWS LOW E 1
IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:1 I
APPLICANT: TEL. NO: I I I
IX-TREME BUILDERS INC. (626) 786-2347- IAA BLDG PERMIT ISSUANCE 27.80 1
2509 EIICLID CRESENT JAB STATE GREEN BLDG FEE 2300.00 VAL 1.00 SPECIAL CONDITIONS:
UPLAND, CA 91784 JAC STRONG MOTION RESID 2300.00 VAL 0.50 J
ID2 PERMIT W/O EN-HC 2300.00 VAL 99.00
[ 1 TOTAL FEES 128.30 1
(CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
JX-TREME BUILDERS INC. (909) 931-4464- J 1 I
12509 EIICLID CRESCENT EAST LIC. NO ILOCATION AND SETBACKS ]
JUPLAND, CA 91784 627142B ] I I I
I I ISOILS ENGINEER APPROVAL 1 I I
[ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I
I - I
LIC. NO: 1 ]SLAB/UNDER FLOOR I I
� I �
IRAISED FLOOR FRAMING I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J JUNDERFLOOR INSULATION I I I
I ] I
1150H265 3 001 1 1 1 I
I IFLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
[ 0 NO 21 1 ]ROOF SHEATHING I I I
1 SCHOOL WITHIN HA9.ARDOUS (SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS I I
1 NO NO NO 1 IFRAME INSPECTION I I
I 1 ]FIRE SPRINKLER HANGERS 1 1 1
I ] JINSULATION/WEATHER STRIPI I I
] I INTERIOR LATH/DRYWALL 1I-
I1
I 1 JEXTERIOR LATH I [
] kNT-ED FLOOR/CEIL ASSEM. ] [ [
RATED WALL ASSEMBLIES I 1 I
1 RATED SHAFTS/OPENINGS I I
I I IT-BAR CEILINGS
LOT DRAINAGE 1 I
1 [
I (REPORT ID: DPR261 ROUTE TO: BS0508 I I [