HomeMy Public PortalAbout6206 RENO AVE_Building__ WORKERSyCOMPENSATION DECLARATION
unsurebor affcertif cairm fe of Wo ke s'tCompensation ificate of eInsurance,nt to self ? Q F �� 1 ERMIT
hereI I
or a certified copy thereof(Sec. 3800, Lob. C.) � COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.R Company k A/1 ��.✓�fL�� BUILDING
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
Certified copy is filed with.the county building inspec- BUILDING
tion department. ADDRESS 2)0
Date �U Applicant CITY E�� �i� ZIP LOCALITY
ERTIF ATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST ! w�
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST. ,A44
(4
(This section need not be completed if the permit is for one n (p (p ' R
hundred dollars($100)or less.) TRACT BLOCK LOT N MAP BOOK PAGE PARCEL
TEL. USE ONEMAP
/S� oZ(off
I certify that in the performance of the work for which this OWNER NO. >_SPE
permit is issued, I shall not employ any person in any manner SPECIAL
ADDRESS
so as to become subject to the Workers'Compensation Laws.. L8p71�i CONDITIONS
CITY ZIP @S
Date Applicant ARCHITECT OR TEL.
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER N0. DISTRICT GROUP TYPE FIRE PROCESSED BY
Exemption, you should become subject to the Workers' �j `x/ ® CONST. ZONE
Compensatioprovisions of the am
Labor Code, you must forth- gDDRE55 ) 70�
with comply with such provisions or this permit shall be �p ,
deemed revoked. CONTRACTOR LC
CLASSIFICATION APT. NDO. g
LICENSED CONTRACTORS DECLARATION LIC:' p� `a,ass NO. DWELL. UNITS
�
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS `LAS � NO. ��t/(Z ^ SEWER MAP
(commencing with Section 7TIW)of Division 3 of the Business andl LIC:
Professions Code, and my license is in full force and effect. CITY !rte CLASS BK s�J PG VALIDATION
+r/�cJ Lic.Class_ SQ. NO.OF CHECK
License Number SIZE STORIES
� STORIEIE S FAMILIES ONE ,.
^^����1 //������r VAJDESCRIPTION OF WORK L NEW
❑ VALUATION .
Contractor V9�� A.ru�..L7TAl ate ADD $_ "—
❑I am exempt under Sec. It ' '6`� ' ALTER ❑ 5 0 0.2 A
B.BP.C. for this reason
�7 u � tl REPAIR ❑ $ {
USE OF pp ❑ # 0 0 0 0 2 3
Date: EXISTINGBLDG. S f [. DEMOL k
Signature APPLICANT TEL. FINAL . I ° 3 5 7.0 0
OWNER-BUILDER DECLARATION (PRINT) NO. DATE ?j2 ° - 357006)'
I hereby affirm that I am exempt from the Contractor's License ADDRESS / 7" `8 b
Law for the following reason (Section 7031.5, Business and :-. ,
Professions Code): PR E •
El1,
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and LOCALITY
the structure is not intended or offered for sale(Section _
7044, Business and Professions Code). MOVING TEL. e5 3 Q 2 A
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- ADDRESS # o a o 0 0 1
tion 7044, Business and Professions Code). r: ::.:
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP.LINE CK R WIDTH I ° 4 3 Q 5 0
1 hereby affirm that there is a construction lending agency for FRONT _
the performance of the work for which this permit is issued P.L. ° °��3 Q 5 0 v
(Sec. 3097,Civ. C.). r SIDE
a Lender's Name 6 dT �e�'i Gdl P.L. `" 0 8 2 6'`8 6
f:P.C.Fee iDNA Ref. #
F
Lender's Address :0 awxlk a.,'i'�1/ $ ®p Permit Fee a d
x I certify that I have read this application and state that the Issuance Fee . -�—v LDMA P/C#
x above information is correct. 1 agree to comply with all County ' Investigation Fee
ordinances and State laws relating to building construction, Total Fee. +. LDMA Perm.#
and hereby authorize representatives of this County to enter . .: ..:.. .........:. F
upon the above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature 0 Applicant or Agent Date
WORKERS'COMPENSATION DECLARATION I �.
I' hereby affirm f I have certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, A P P L p CATION FOR BUILDING P E RM I T
or a certified copy thereof(Sec. 3800 LLab`. C.) COUNTY OF LOS ANGELES - BUILDING AND SAFETY
Po' No. � � Company4U71d"
BUILDING / ,
Certified copy is hereby furnished. FOR ^"APPLICANT TO F IN ;..ADDRESS �v� 6 [� . al'ivt a V
❑ Certified copy is filed with the county building inspec- BUILDING /•
tion epa22/App
ent. ADDRESS v,[ / e>� �lv`. (f-A
Date .El Iica CITY 040. OF BLDGS. .4ZIP LOCALITY
CERTIFICATE OF-EXEMPTION FROM WORKERS' SIZE OF .T NOW ON LOT NEAREST
LO
'COMPENSATION INSURANCE CROSS ST.
ASSESSOR
(This section need not be'completed if the permit is for one TRACE BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL USE ZONE MAP
OWNER !�'�r�M rJ d NO�'D J �� NO
I certify that in-the performance of the work for which this SPECIAL a
permit is issued,'hsholl not employ any person in any manner ADDRESS ��f� r�„ U L Rh L /�i CONDITIONS
so as to-become subjec a Workers'Compensation,Laws. O
CITY Q/W� fig' ZIP U
Date Applicant ARCHITECT OR r TEL. W
NOTICE TO APPLICANT: If, after maki this•Certificate of ENGINEER NO. DISTRICT. GROUP TYPE FIRE P OCESSED BY Q
Exemption, .you should become subject to the Workers' p' CONST. Z NE U
LU
Compensation provisions of the Labor Code; you must forth- ADDRESS ,�O -3 a
with comply with, such,provisions or this permit..shall be TEL. yqr STATISTICAL CLASSIFICATION APT. CONDO. N
.deemed revoked. CONTRACTOR V1f CiV)r Y�v6 �1 NO.�� y 7 %� ' Z
LICENSED CONTRACTORS DECLARATION.• LIC. . r. CLASS NO. DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter'9 ADDRESS /01�•- /�.)y GZ+ NO.�y7��
LIC. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business �• ,
and Professions Code,and my license is in full force and effect. CITY Jam, cs Pr�n'G CLASS G� B� PG. VALIDATION
Y� �.�, SQ. FT. � NO.OF NO.OF / CH CK
License Number ~7��d'�3 Lic. Class SIZE STORIES FAMILIES I ONE
/,/�� ff '7 W VALUATION
Contractor_C -+ -1yir • y es lih DESCRIPTION OF WORK �C tyy d?�� h NEW. ❑
ADD ❑ Clr li ,
❑I am exempt under Sec, f YG U dl 1../l
BAP.C.for this reason �� (/_ � r4 `Pt gG�r ; ALTER $
vY I ` REPAIR ❑
USE OF
Date: EXISTING BLDG.• v4 R DEMOL ❑
J
Signature APPLICANT - TEL. p
(PRINT) � 1= �N/1/gl- NO. 76 �"7�7 FINAL i
OWNER-BUILDER.DECLARATION. DATE �'!�•�
I hereby affirm that I'am exempt from the Contractor's License 'x[ Q 4 G A.-'%:1 u s
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL
Professions Code): RESENT By
- '-
BUILDING y
❑ •I, as owner of the property, or my employees with ADDRESS v • *-'r-�_
I ,
wages as their sole- tion,will do the work and � �/L� � �(L76�K." - .
the structure is not intended or offered for sale(Section LOCALITY _
7044, Business and Professions Code.) MOVING TEL. �- -"
AL
:.
I, as owner of the property,am CONTRACTOR NO. .t exclusively contracting ty%ECK ,141,3.`_
with licensed contractors to construct the project (Sec- LADDRE
tion 7044, Business and Professions Code.) r i f E "I
CONSTRU N LENDING AGENCY
REQUIRED
YARD HWY TOTAPROPALINEFROM WIDTH
I hereby affirm that there i construction lending agency for
the performance of the war for"which this permit is issued P.L. t"'l f l�_tU. ;(J.- +;; -+
(Sec. 3097, Civ. C.).
;"tJ �+F y'lfn9+?r.:t
I
'Lender's Name LDMA Ref. #
3 Permit Fee 05Lender's Address� 1 certify that I have read this application andstate that the Issuance'Feeabove information is correct. I agree to comply with all County ee /
ordinances aState laws relating to building construction,. Total Fee .lO ' LDMA Perm. #
= and her thorize representatives of this County to enter
9 upon ve-me ned property for inspection urpose
o /l vSf SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature-of Applicant or Agent Date
WORKERS'COMPENSATION DECLARATION �i '�
I hereby affirm that I have a certificate of consent to self ® P L I CAT ® R p W61P-IG PERMIT
insur$ or a certificate of Workers'Compenstion Insurance,or ® �!
a cerfified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS,ANGELES BUILDING AND SAFETY
Policy No. Company
LDING
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN
ADDRESS (7
L'i
❑ Certified copy is filed with the county building inspec- [ADDRESS
ILDING ter}
tion department. DRESS (� 1°7 fi LOCALITY
• NEAREST
Date Applicant Y �Y' G/ ZIP CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE E OF LOT �f)C U NOW ON LOT MAP BOOK PAGE PARCEL
` (This section need not be completed if the permit is for one ACT ,Sl f a 5� BLOCK LOT N / , USE ZONE OP �.���
I hundred dollars($100)or less.)
TEL. �y �' SPECIAL
I certify that in the performance of the work for which this NER f�/� NO.�,C ,J' CONDITIONS
permit is issued, I shall not employ any person in any manner DI TRICT GROUP TYPE FIRE PRO ESSED`BY (�
so as to become subject to the Workers'Compensation Laws. n (/ � CONST. ZONE
Date C5��WApplicant W —U`,L CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. U
NOTICE TO APPLICANT: If, after making this Cefilficate of ARCHITECT OR TEL.
Exemption, you should become subject to the Workers' ENGINEER NO. CLASS No.-=PV DWELL. UNITS H
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER 4MAP
with comply with such provisions or this permit shall be TEL
NO. Ja VALIDATION
deemed revoked. CONTRACTOR Qq — BK. PG,
LICENSED CONTRACTORS DECLARATION /�` 41 ,• C LIC. t "
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS V J NO. VALUATION
(commencing with Section 7000)of Division 3 of the Business and LIC. f
Professions Code, and my license is in full force and effect. CITY /'(,A 44
CLASS $
G SIZ LICHECK
License Number �� g �
iy � Lic.Classp J� /� �STORIES
FAMILIESONE
0^ Date NEW
Contractor $
DESCRIPTION OF WORK
❑ I am exempt from the icensing requirements as I am a a'L/!O ADD ❑;::.�
licensed architect or a registered professional engineer ,/��� ALTER ❑ FINAL
acting in my professional capacity (Section 7051, t/.e.pr ✓.�G�.. DATE
Business and Professions Code). USE OF REPAIR ❑ FINAL � 1 7 7.7 A
EXISTING BLDG. 5 �� DEMOL ❑ \ G
' # a a a a 21
B>;,Lic.or Reg.No. Date APPLICANT TEL.
�J
OWNER-BUILDER DECLARATION PRINT) NO. \ J� 2 0 a 1 2
1 hereby affirm that I am exempt from the Contractor's License _
Law for the following reason (Section 7031.5, Business and ADDRESS O O O 1 5 1 2=
U
Professions Code): PRESENT
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS 0 8 1 8-80
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY 1 7 7.8 A
7044, Business and Professions Code). MOVING TEL.
CONTRACTOR NO.
I, as*owner of the property,am exclusively contracting NO
?
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). 2 ° 0 34.00
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency forFRONT ° 3 4 0 0 5
the performance of the work-for which this permit is issued P.L
(Sec. 3097, Civ. C.). SIDE 0 8 1 8-80
P.L.
Lender's Name ,•_....•. ., :..,
P.C. Fee$ 4--Z— Permit Fee
Lender's Address
I certify that I have read this application and state that the Issuance Fee
above information is correct. I agree to comply with all County Investigation Fee 2
ordinances and State laws relating to building construction, Total Fee J
and hereby authorize representatives of this County to enter
upon the above-mentioned pro rty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatur Applicant or Agent Date ®s
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 1403120051
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
ITR: 5904 LT: 66 UN: .002 I SQ. FT STORIES TYPE 6206 RENO AV 1
ISTRUCTURE: V-B I TEMP CA 917801534 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1
15384-004-001 1 1 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI
ITENANT: EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY:
(EXIST OCC GRP: 103/12/14 SR
(OWNER: TEL. NO: IBLDGS. NOW ON IAT: VALUATION: IFINAL DATE FI AL BY: CODE: I
ICANOY, EDDIE/LOURFIMA (626) 285-0438- 1 6,000 1 /! I
16206 RENO AVENUE I 1� \ I
ITEMPLE CITY CA 91780 I FEES PAID IZESLRIPTIOS OF WORK
I I (BATHROOM REMODEL CHANGE BATHROOM DOOR, WATER CLOSET AND
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IBATHTUB I
APPLICANT: TEL. NO:
SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 I
IAB STATE GREEN BLDG FEE 6000.00 VAL 1.00 ISPEdIAL CONDITIONS: 1
I 1AC STRONG MOTION RESID 6000.00 VAL 0.60 I I
I IB2 PERMIT W/ENERGY 6000.00 VAL 164.30 I I
I IFR INV WORK W/O PERMIT 344.00 DOL 344.00 I I
]CONTRACTOR: TEL. NO: 1 TOTAL FEES 537.70 1APPROVALS DATE INSPECTOR SIGNATURE ]
ISAME AS OWNER - I I- 1
ILIC. NO 1 (LOCATION AND SETBACKS I I I
ISOILS ENGINEER APPROVAL I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUFDATION%TRENCH FORMS I I I
LIC. NO: I ISLAB/UNDER FLOOR I ] I
I ] RA_ RA
SED FLOOR FMING
I 1--i
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 1UNDFRFLOOR INSULATION
I I
1 3 001 IFLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS- I I I I I
] NO 21 1 IROOF SHEATHING
I I I
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I
1AIR QUALITY: 1000 FEET MATERIALS I I I I
NO NO NO 1 1FRkME INSPECTION I I I
I I IFIRE SPRINKLER HANGERS ] I I
I I I
] I INSULATION/WEATHER STRIP
( I I I
I I (INTERIOR LATH/DRYWALL
I I I
I IEXTERIOR LATH
]
I I IRATF.D FLOOR/CEIL ASSEM. ]
I
I IRATED WALL ASSEMBLIES I 1 ]
I I IRATED SHAFTS/OPENINGS
IT-BAR CEILINGS
ILOT DRAINAGE 1 I 1
I ]REPORT ID: DPR261 ROUTE To: 880508 I I
I I I I I I