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HomeMy Public PortalAbout9708 RICHMOND WAY_Building__ "WORKERS'COMPENSATION DECLARATION •h �Ay affirm that I have r certificate of consent to self P L I CA`s 1 ��� � PERMIT I T "^�ure, or-.certificate of Workers'Compensation Insurance, V� �a or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NW28014 982 Company Pi romans Fund BuuDING ' Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUDDING l CF�392U/IlC1 j-j Ction department. ADDREI&MOAd 0 Lot 16 Plan E r Eley B ertified copy is filed with th county buil g inspec- % BUILDING6 LL AAJJ I nd, GS b Date6 PP •licant CITY Temple Cit- ZIP 91780 s LOCALITY SW corner Golden West & • CERTIFICATE OF EXEMPTIO ROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT Ir r 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 43189 BLOCK LOT NO. MAP BOOK PAGE PARCEL TEL. USE ZONE MAP �z 6 I certify that in the performance of the work for which this OWNER NO. — NO. G >. permit is issued, I shall not employ any person in any manner SPECIAL I& so as to become subject to the Workers'Compensation Laws. ADDRESS 4275 Baldwin Ave. CONDITIONS 0 CITY El Monte zip 91731 ®s Date Applicant O NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROC SED BY ENGINEER Courtne NO. 331-3060 CONST. ZONE I b Exemption, you should become subject to the Workerss '/ Ley Compensation provisions of the Labor Code, you must forth- ADDRESS 529 S H011enbeck ° y with comply with such provisions or this permit shall be TEL "'STATISTICAL CLAS IFI TION APT. JO)NDO. g deemed revoked. CONTRACTOR Owen Construction NO. 575-0503 LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 i.ADDRESS NO. 444758 (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 B BK. PG. VALIDATION SQ.FT. NO.OF NO.OF CHECK License Nu er Lic.Class R SIZE 2352 STORIES 2 1 FAMILIES 1 ONE VALUATION DESCRIPTION Contracto /Date �ll+� ' DESCRIPTION OF WORK AD �j $ 4s.ro '" a 4 5 4 2 A d arae `r ❑ I am exempt under Sec. ALTER ❑ # ­ 023 B.BP.C. for this reason REPAIR ❑' $ Date: USEEXIOF F BLDG. DEMOL ❑ 1 - 48329 Signature 4 APPLICANT TEL FINAL �� o 0 4 8 3,2 9 6 OWNER-BUILDER DECLARATION PRINT Owen Construction NO. 575-0503 DATE I hereby offirm that I am'exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FI L 4 L -86 Professions Code): PRESENT B ❑ BUILDING {• , I, as owner of the property, or my employees with ADDRESS-7 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- '. r. ADDRESS tion 7044, Business and Professions Code). 0 5 7 7.6 A SETBACK CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROP. LINEFRUM ]WIDTA I hereby affirm that there is a construction lending agency for FRONT # 0 0 0 0 0 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 1 - 82275 a o Lender's Name o -, 8227556 ,� , LDMA Ref. NP.C.Fee$ - Permit FeeLender's Address :' I (],G$-86 GI certify that I have read this application and state that the 031� Issuance Fee /OLDMA P/C#abo inform 'on is correct. I agree to comply with all County Investigation Feerd nces n State laws relating to building construction, Total Fee LDMA�Perm.a an reb au horize representatives of this County to enter up he bov -mentioned property for inspection purpose';. o � SEE REVERSE FOR EXPLANATORY LANGUAGE O t ignatur Applicant or Agent Date COUNTY OF LOS ANGEEES. TEMPLE CITY # 0508 I BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS ' 9701 LAS TUNAS ` ALTERAT-ION/REPAIR' BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 b"508-0008160032 PHONE: (626) 285-0488 EXT: LEGAL D: N0. F CONST BUILDING ADDRESS: TR: 43189 LT: 16 SQ. FT STORIES TYPE 74.9708 RICHMOND WY STRUCTURE: 0 VN ',TEMP CA 917803930 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GOLDEN WEST 8589-019-050 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITYQ TENANT: EXIST BLDG USE: RESID USE ZONE: RPD ISSUED 0PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/16/00 UT 02/13/01 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MORE 9708 RICHMONDTHUR ;HAMANO EMIKO - 1 7,780 WA TEMP 917803930 FEES PAID DESCRIPTION OF WORK REMOVE AND RE-INSTALL EXISTING CEMENT TILES-HOUSE & GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: 0: RANDOL ROOFING CO (626) 288-4040- AA BLDG PERMIT ISSUANCE 27.75 2304 TROY AAVE. AC STRONG MOTION RES D 7780.00 VAL 0.78 SPECIAL CONDITIONS: SO EL MONTE, CA ID2 PERMIT W/0 0.00 VAL 183.00 �OGELES0' F 211.53 CONTRACTOR: TEL. NO: �O� V�Ay APPROVALS DATE INSPECTOR SIGNATURE RANDOL ROOFING AND CONSTRUCTION (626) 288-4040- 2304 N. TROY AVE.D LIC. NO LOCATION AND SETBACKS SOUTH EL MONTE, CA 91733 451937C39 SOILS ENGINEER APPROVAL i ARC TECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO / 1111111 SLAB/UNDER FLOOR L RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP U UNDERFLOOR INSULATION 144H269 3 10�1(� p L C W0�RS FLOOR SHEATHING 0. OFF ILIES: DWELLING UNITS. AP COND: STAT CLAS u NO 21 I i ROOF SHEATHING SCHOOL WITHIN HAZARDOUS El �glSHEAR—PANELS 3�U AIR QUALITY: 1000 FEET MATERIALS Q ❑ , NO NO NO El ©�'�®� FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIS 4� _�1 Dim FIRE SPRINKLER HANGERS SET FRONTPL- YARD: HWY: PROP LINE: WIDTH: ,�C Serlic a khat vv INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSE . RATED WALL ASSEMBLIES R TED,'SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE_ :REPORT ID: DPR261 ROUTE TO: BS05O8 t