HomeMy Public PortalAbout9810 RICHMOND WAY_Building__ WORKERS' COMPENSATION DECLARATION
insure,oraafcertif cafirm tharte of Workers' Compensation eInsuran eve a certificate of consnt to lf APPLICATION F®R BUILWNG PERMIT
or a certified copy thereo, (Sec 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
CrS`z2.7rJr..7 P�iTSF&G
Polic�o.— om an •:. t:
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 G ch 11 (4
Dat&— —ft Appl is n �' cITY Temple City ZIP 917 8 0 LocALITY
NO. OF BLDGS. NEAREST -
CERTIFICATE OF EXEMPTIO WO S' SIZE OF LOTS 7 0 0 0 NOW ON LOT Q CROSS ST.
COMPENSATION URANCE M'
4 313 6 < 7 1. :y ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO, MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) TEL• '•:`
''OWNER Westco land Inc. No.286-3636 USE ZONE MAPNO. j `r
I certify that in the performance of the work for which this (/�} SPECIAL -
permit is issued, I shall not employ any person in any manner ADDRESS 1425 e -a i e Lane A CONDITIONS a
so as to become subject to the Workers'Compensation Laws. CI Ar C a d] a ZIP 910 0 6 0U
Date Applicant ARCHITECT OR TEL. _ CZ
NOTICE TO APPLICANT:, If, after making this Certificate of ENGINEER Same NO °� • DISTRICT POUP� CONST
FZlR E PROCESSED BY
Exemption, you should become subject to the Workers' w
Compensation provisions of the Labor Code, you must forth- ADDRESS Y• p.
with comply with such,provisions or this permit shall be CONTRACTOR Same NO STATISTICAL CL45SIFICATION•••- APT. CONDO. y °�WZ
deemed revoked. / —
UdNSED•CONTRACTORS DECLARATION LIC. ! CLASS NO. DWELL. UNITS—�
ADDRESS NO. 2 6 5 8 6 4 ;+
I hereby affirm that'l am licensed under provisions of-Chapter 9 or
MAP
(commencing with Section 7000)of Division 3 of the Business LIC. ■a
and Professions Code,and my license is in full force and effect. CITY CLASS $ BK PG � � ALIDATION ;U9e5
License Number� �
��� 'Lic. Class g ZE Fr2 0 5 0 STORIOES 2 FAMILIES 1 ONE
K
// VALUATION •2 ITEMS
Contract&a:� r/y/F� ate DESCRIPTION OF WORK S i ri g 1 e family NEW ISL J ,. t TOTAL .y 0 i90
5.
El I am exempt under Sec. attache 2 c g ADD Elt 3 V
ALTER EJ _ CHECK 1015.911
BAP.C. for this reason Garage. REPAIR ❑ $ ��` fay p OCA CHANGE ■00
Date: USE OF
: EXISTING BLDG.
Single family Res dEMOL ❑ .r' �:
Signature y APPLICANT TEL.
FINAL 8/ 1/89
OWNER:BUILDER DECLARATION i (PRINT) George Wiegand NO. 28-6-3636 DATE
I hereby affirm that I am exempt from the Contractor's License `� 4805 1 AM $0-07
Law for the following reason (Section 7031'.5, Business and ADDRESS FINAL
Professions Code): r PRESENT By
BUILDING -
❑ 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. +, —
❑ I,as owner of the property,am exclusively contracting I CONTRACTOR NO.with licensed contractors to construct the project.(Sec- ADDRESS '
tion 7044,,Business and Professions Code.) ..
REQUIRED YARD HWY TOTAL SETBACK FROM• EXIST.
CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH
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. V
(Sec. 3097, Civ. C.). s -SIDE 11
F.L.
Lender's NameB B H 'M 0 r t g a g a
LDMA Ref. #
8383 WIIshire* Beverly Hil P.C. Feea � Permit Fee T99s
� Lender's Address .. •J� � � ® - • -
1 certify that I have read this application and state that the _ Issuance Fee f Ct}SQ LDMA P/C#
3 above information is correct.I agree to comply with all County Investigaq�tr
Z ordinances and State laws relating to building construction, Total Fee , LDMA Perm. #
2 and hereby authorize representatives of this County to enter " >.
° upon the above-mentioned pr pe ty for insp ction p p es. Y
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign/n a of Olica/or4
dent to
I f
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 1008120005
PHONE: (626) 285-0488 EXT:
LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: 1
ITR: 43136 LT: 1 UN: 7 I SQ. FT STORIES TYPE 1 9810 RICHMOND WY 1
I ISTRUCTURE: V-B I TEMP CA 917803966 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GOLDEN WEST
8589-020-085 I I THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, Cl
I I
TEST: EXIST BLDG USE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY:
1 (EXIST OCC GRP: 108/16/10 SR 1
TOWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IF DATE FINAL BY: CODE: 1
ILIU, YANG(DAVID) (626) 297-7001- 1 1,500 11
19810 RICHMOND WA
ITEMP 917803966 1 FEES PAID [DESCRIPTION OF WORK 1
I I IBUILD INTERIOR WALL IN LIVING ROOM TO CREATE AN OFFICE 1
I 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1
APPLICANT: TEL. N0:
SAME AS OWNER - ID1 PLANCHECK W/O EN-HC 500.00 VAL 82.10 1 I
IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: 1
AB STATE GREEN BLDG FEE 1500.00 VAL 1.00 1 I
AC STRONG MOTION RESID 1500.00 VAL 0.50 I I
D2 PERMIT W/O EN-HC 1500.00 VAL 82.20 I I
CONTRACTOR: TEL. NO: IFS INV WORK W/O PERMIT 257.00 DOL 257.00 (APPROVALS DATE INSPECTOR SIGNATURE 1
SAME AS OWNER - I TOTAL FEES 450.60 1 1
LIC. NO 1 ILOCATION AND SETBACKS I I
1 ISOILS ENGINEER APPROVAL 1 I I
1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS 1 1 1
1 LIC. NO: 1 •1SLAB/UNDER FLOOR 1 1
1 I IRAISED FLOOR FRAMING 1
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I (UNDERFLOOR INSULATION I I 1
1144-269 3 001 1 [ I 1
I I IFLOOR SHEATHING I 1
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 I 1 I I
NO 21
IROOF SHEATHING
SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I
AIR QUALITY: 1000 FEET MATERIALS
1 NO NO NO1 1FRAME INSPECTION
T 1 1FIRE SPRINKLER HANGERS
1 1 INSULATION/WEATHER STRIP(
[ I [INTERIOR LATH/DRYWALL 1
1 (EXTERIOR LATH I
I 1 IRATED FLOOR/CEIL ASSEM. I I I
IRATED WALL ASSEMBLIES I 1 [
1 1
IRATED SHAFTS/OPENINGS I I I
IT-BAR CEILINGS [ I 1
I 1 1LOT DRAINAGE I I I
1REPORT ID: DPR261 ROUTE TO: BS0508 I I I 1