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Home My Public Portal About9707 RICHMOND WAY_Building__ L -WORKERS'COMPENSATION DECLARATION Q her0y ctffifrh that I have a certificate of consent to self N HO" a' insure, or a certificate of Workers'Compensation Insurance, L TH� am LJ U I L 0 Uff"I I'No C OF;` P"ERMIT IL or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Ndn12801A3-(MCompany Fi remant; Fund + . Certified coy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING P Y ,:ADDRESS Certified copy is filed with the county buil Ing inspec- BUILDING tion department. ADDRESS v IG0"'V,0 Plan F, Eley A -v �7�� CITY a Cit zip 91780 LOCALITY SW corner Golden West & Date a .- Or'Applicant T CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. '• NEAREST COMPENSATION INSURANCE SIZE OF LOT Irre NOW ON LOT CROSS ST.Lower AZuSA (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 TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER Owen Construction NO- 575-0503 No. -� permit is issued, I shall not employ any person in any mannerSPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS 4275 Baldwin Ave. i R' CONDITIONS CITY El Monte zip 91731 Dare Applicant NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY ENGINEER Courtney No. 331-3060 CONST" ZONE Exemption, you should become subject to the Workers' ,( Compensation provisions of the Labor Code, you must forth- ADDRESS 529 S Hollenbeck with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C DO. deemed revoked. CONTRACTOR QjLen Co 'tructon No. 575-0503g LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 444758SEWER MAP 4 Q $ v A (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 PG V, ILL DATIO,3 FT LICHECK License Number 444758 Lic.Class B SIZE 2216 STORIES 2 FAMILIES 1 ONE �F u 'may Z VALUATION I o463,21 Contract Date -- DESCRIPTION OF WORK New Sin' la .FaMil AD � $ /7 0 - 463," l ' I am exempt under Sec. ": ALTER 0 IL 2 1 -86 B.BP.C. for this reason REPAIR Di $ Date: USE OF DEMOL EXISTING BLDG. .: Signature APPLICANT TEL. (PRINT) Owen Construction NO.575-0503 FINAL OWNER-BUILDER DECLARATION DATE r I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and a'ADDRESS FI ,1 igProfessions Code): RESE ❑ BUILDING 1, as owner of the property, or my employees with ADDRESS f 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). 5 7 7, A REQUIREDTOTAL SETBACK k0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH # 0 0 0 0 o 1 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. ( 0 7 8 9,r'0 (Sec. 3097, Civ. C.). SIDE P.L. 0 G 7 r. Lender's Name ,. .:...-..:..:,•..:,..,.. ... ., ".. C c s 15 D LDMA Ref. # R-8 L Lender's Address P.C.Foe$ Permit Fee V ( V 6 3.z : .: ;r I c fy th have read this application and state that the Issuance Fee gU LDMA P/C# abo inf m tion is correct. I agree to comply with all County Investigation Fee 3 ordi 17k 9 nc a d State laws relating to building construction, Total Fee LDMA Perm. # .i and h re y o thorize representatives of this County to enter ._... 3 up he bore-mentioned property for inspection purposes. x SEE REVERSE FOR EXPLANATORY LANGUAGE E Signatu V of Applicant or Agent Dat O 1 COUNTY OF IAS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAPID DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1110030020 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 43189 IT: 17 I SQ. FT STORIES TYPE I [ ISTRUCTURE: V-B I 9707 RICHMOND WY J TEMP CA 917803932 I (ASSESSOR INFORMATION NUMBER: 1 NEAREST CROSS STREET: 18589-019-051 1 1 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, Cl ITT: EXIST BLDG USE: RESID USE ZONE: R-3 ISSUED ON: PROCESSED BY: I 1 EXIST OCC GRP: 110/04/11 SR (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FIN Y: CODE: IKERSHAW, ALLAN - [ 50,000 _ 1 9707 RICHMOND WA ITEMP 917803932 I FEES PAID D S�I�OF WORK J I 1 IFIRE DAMAGE REPAIR HOLES IN ROOF CUT BY FIRE DEPARTMENT & I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:JREROOF WITH LIGHT TILES, KITCHEN REMODEL, 3 BATHROOMS REMODEI (APPLICANT: TEL. NO: I IL REPLACE (5) WINDOWS (1) PATIO SLIDER AND INSULATION AND * J JHYLTON, DONALD (626) 938-1595- IBI PLANCHECK W/ENERGY 5000.00 VAL 124.20 I 1 1228 E. BADILLO ST. IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: I ICOVINA, CA 91723 IAB STATE GREEN BLDG FEE 50000.00 VAL 2.00 1 1 IAC STRONG MOTION REBID 50000.00 VAL 5.00 1 I JB2 PERMIT W/ENERGY 50000.00 VAL 875.60 I I ICONTRACTOR: TEL. NO: I TOTAL FEES 1,034.60 JAPPROVALS DATE INSPECTOR SIGNATURE [ IPROTECH CONSTRUCTION (626) 359-8283- 1 1 1 111626 GOLDRING ROAD LIC. NO 1 ILOCATION AND SETBACKS 1 I 1 IARCADIA, CA 91006 452024 B * I I 1 1 1 1 I ISOILS ENGINEER APPROVAL I I I JARCHITECT OR ENGINEER: TEL. NO: J IFOUNDATION/TRENCH FORMS I I I JANDERSON, BRUCE (626) 938-1595- [ I -1-1 I 1228 E. BADILLO ST. LIC. NO: 1 [SLAB/UNDER FLOOR 1COVINA, CA 91723 3341 1 1 [RAISED FLOOR FRAMING 1 I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ JUNDERFLOOR INSULATION I I I 1144H269 3 001 1 1 1 1 I I IFLOOR SHEATHING 1 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I 1 0 NO 21 1 [ROOF SHEATHING I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS J I I AIR QUALITY: 1000 FEET MATERIALB 1 NO NO NO 1 1FRAME INSPECTION IFIRE SPRINKLER HANGERS [ J [ I I 1 1 JINSULATION/WEATHER STRIPI 1 1 1 1 ]INTERIOR LATH/DRYWALL 1 1 ] 1 1 (EXTERIOR LATH J [ [ I I (RATED FLOOR/CEIL ASSEM.. 1 I 1 1 I IRATED WALL ASSEMBLIES [ [ 1 I IRATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS [ I I I* ADDITIONAL DATA ON FILE [LOT DRAINAGE i 1 I [REPORT ID: DPR261 ROUTE TO: BS0508 b�s I 1 I