HomeMy Public PortalAbout6229 RENO AVE_Building__ ^- - WORKERS' COMPENSATION DECLARATION ;
hetdby affirm that I have a certificate Of consent,to self APPLICATION S B lJ I L�Il PERMIT
insure, or a certificate of Workers' Compensation Insurance,
or a certified copy thereof(Sec. 3800, Lab. C.) . .6 a
COUNTY OF LOS ANGELES I BUILDING AND SAFETY
Policy No. Company I BUILDING
El. Certified copy is'hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING A
tion department. ADDRESS
Date gpplicant CITY C.1 ZIP -- LOCALITY
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 'L L NOW ON LOT rL CROSS ST.
COMPENSATION INSURANCE' ASSESSOR p ,/ v
(This section need not be completed if the permit is for one TRACT BLOCK L07 NO t�� MAP BOOK ✓ ,]3Q PAGE PARCEL O
hundred dollars ($100)or less.) OWNER R66 - NO. USE ZONE MP
o;
I certify that in the performance of the work for which this ,/may SPECIAL >
permit is issued, I shall not employVnersan in an mann r ADDRESS F�C1/ / CONDITIONS o-
so as to becomesubject to the WorCop sati aw CITY - O
Date �"�'� t� ZApplicantC. ARCHITECT O s ZIP TEL.
NOTICE TO APPLICANT: If, after makin this Certific ENGINEER 'Y�
F NO.��p DISTRICT GROUP TYPE FIRE' PROCESSED BY" O
i 9 CONST. ZONE
Exemption, you should become -subject to the Workers' w
Compensation provisions of the Labor Code, you must forth- ADDRESS ai () -L/rcl�c.+ '�-/P• �r �•�� V Q'��m a
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. to
deemed revoked. CONTRACTOR . NO. z
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 021 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 LIC.
and Pfofessions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION
SQ. FT. NO. OF NO.OF CHECK
License Number Lic. Class SIZE, STORIES FAMILIES ONE
VALUATION
Contractor Date DESCRIPTION OF WORK NEW ❑ $ 000
ADD ❑ i'%
❑I am exempt under Sec. Illy PJ�QeCQM hz ALTER ❑
B.&P.C. for this reasonREPAIR ❑ $
Date: USE OI FG BLDG. 100-ATI+Af L DEMOL ❑
Signature. APPLICANT i TEL.
OWNER-BUILDER DECLARATION (PRINT), (�F4ND a M,uc�a, NO. FINAL . g2
• DATE 7'"7-- /
I hereby affirm that I am exempt from the Contractor's License gDDRESS �!'• _ I FINA4 `&/ ,
Law for the following reason (Section 7031.5, Business and �1� ;GL�
Professions Code): PRESENT By
BUILDING 6r.:'- s1, as owner of the property, or my employees with
ADDRESSgea:�Qn•ti•L•; ��-
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY Poo -
7044, Business and Professions Code.) MOVING TEL.
❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. i
with licensed contractors to construct the project (Sec- ADDRESS _
tion 7044, Business and Professions Code.) • ry''�'• 's
REQUIRED TOTAL SETBACK FROM EXIST. :-
YARD HWY
CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH _._,L./ .
I hereby affirm that there is a construction lending agency for FRONT _ _ '
the performance of the work for which this _ -!-1
p permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE . .,�_,_ _
P.L. I!�I i HL, r" !�i z r s
Lender's Name � �.;J
, •O LDMA Ref. #
-'HEP' 1 7..4.
P.C. Fee$ Permit Fee
Lender's Address , ;;r
I certify that I have read this application and state that the Issuance Fee el LDMA P/C tY `�`
above information is correct.'I agree to comply with all County Investigation'Fee / ?
ordinances and State laws relatingto buildingconstruction, Total Fee (�/ a / LDMA Perm. # s
7-!I.Ji iI k�!liiwF
and her authorizer rese tatives of this County to enter
g upon the ve-rtt'n(io pr pertly for inspection purposes. -a;.r;
:rpt; i r=-.et_
o SEE-REVERSE FOR EXPLANATORY LANGUAGE Fti;
Signal re of Applica 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 1201170104
PHONE: (626) 285-0488 EXT:
ILEGAL ID: NO. OF CONST
BUILDING ADDRESS:
ITR: 5904 IT: 54 UN: .002 II TEMP CA 9AV
17788
01535
SQ. FT STORIES TYPE I
(STRUCTURE: 500 V—B I 6229 RENO
(ASSESSOR INFORMATION NUMBER: I I
15384-001-018 1 i NEAREST
PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
1TENANT: (EXIST BLDG USE: PATIO USE ZONE: R-1 ISSUED ON: PROCESSED BY:
(EXIST OCC GRP: 101/17/12 SR 1
I �
(OWNER: TEL. NO: ' IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1
IHE, PEARL (626) 235-3567— 1 2,500 I I
16229 RENO AV I
ITEMP 917801535 1 FEES PAID IDE$CRIPTION OF WORK I
I I 1PAiI0 ROOF + OVERLAY 500 SQ.FT. 30 YRS SHINGLES I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1
APPLICANT: TEL. NO: I I
IRHEE, JAY (323) 864-7388— IAA BLDG PERMIT ISSUANCE 27.80 I
11200 DEWEY AVE IAB STATE GREEN BLDG FEE 2500.00 VAL 1.00 [SPECIAL CONDITIONS: [
ILOS ANGELES CA 90006 1AC STRONG MOTION RESID 2500.00 VAL 0.50
ID2 PERMIT W/O EN—HC 2500.00 VAL 99.10 1 1
I TOTAL FEES 128.40 1
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
IK Y DEVELOPMENT, INC. (323) 864-7388— 1 I
11200 DEWEY AVENUE LIC. NO 1 (LOCATION AND SETBACKS I I I
ILOS ANGELES CA 90006 940437BC39 1 I I I
I I ISOILS ENGINEER APPROVAL 1 I I
1ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUTTDATION/TRENCH FORMS I I I
1 LIC. NO: 1 ISLAB/UNDER FLOOR 1
I I
1 1 RAISED FLOOR FRAMING 1 I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:'J 1UNDERFLOOR INSULATION I I I
1153H265 3 001 I_ I
I 'I IFLOOR SHEATHING
1
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I I 0 NO 21 1 IROOF SHEATHING
I I I
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I
AIR QUALITY: 1000 FEET MATERIALS
1 NO NO NO 1 S R E D IFRAME INSPECTION I I 1
(FIRE SPRINKLER HANGERS I I I
1 / (INSULATION/WEATHER STRIP( I I
1 j (INTERIOR LATH/DRYWALL 1 1 1
1 1
1 EXT RIOR LATH 1 I
1 IRATED FLOOR/CEIL ASSEM. I I
1 1 1RATED WALL ASSEMBLIES 1 I I
IRATE SHAFTS/OPENINGS I 1 1
1 C 1T—BAR CEILINGS I I
II ILOT DRAINAGE I I
IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I