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Home My Public Portal About5702 RIO HONDO AVE_Building__ �aWORKERS' COMPENSATION-DECLARATION "" X � APPLICATION FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to self ins,�re, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) �� Q ��/� ! COUNTY OF LOS ANGELES BUILDING AND SAFETY �. Policy No. Companys °j'r v BUILDING s- 7 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDINNDDRES �� I d �� tion department. Date o8?1 Applicant , ' CITY / NO. OF BLDGS. EARZIP LO EST, , CERTIFICATE F EXEMPTION FROM WORKER SIZE OF LOT 620 NOW ON LOT ®)I�,Ge� CROSS ST. COMPENSATION INSURANCE 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.) ll TEL OWNER d. `�� NO. C USE ZONE OP I certify that in the performance of the work for which this n permit is issued, I shall not employ any person in any manner ADDRESS1 SPECIAL so as to become subject to the Workers'Compensation Laws. 1 CONDITIONS Q CITY ZIP L) Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Q NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. .� Exemption, you should become subject to the Workers' �� CONST. w Compensation provisions of the Labor Code, you must forth- ADDRESS a with comply with such provisions or this permit shall be S TEL• STATISTICAL CLASSIFICATION APT. CONDO. to deemed revoked. CONTRACTOR 4 NOSSLOBS� Z LICENSED CONTRACTORS DECLARATION Gs LIC. CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS o � �� No�1� S ,pp�p�� (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP CITY IP ZRJ.`' CLASS and Professions Code,and my license is in full force and effect. BK. PG. VALIDATION License Number 40S Lic. Class SIIZE� L! STORIIEES FAMILIESOF O EK Contractor Date — DESCRIPTION OF WORK NEW VALUATION ElI am exempt under Sec. IjV IAAXWG ADD ❑ ; " +� ALTER ❑ BAP.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ;ADDRESS FINALZ*. 1 �° Professions Code): PRESENT By ElBUILDING I, as owner of the property, or my employees with ADDRESS /a wages as their sole compensation,will do the work and v� the structure is not intended or offered for sale(Section LOCALITY ® a - 7044, Business and Professions Code.) MOVING TEL. v ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. CHEC► 92°75 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAL SETBACK FROM 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. frJ (Sec. 3097, Civ. C.). SIDE Z.J n P.L. f1 75 Lender's Name .✓ tVa Q ll ty ° $ LDMA Ref. # . -t-. bk' Lender's Address P.C. Fee$ Permit Fee � ,I certify that I have read this application and state that the Issuance Fee LDMA P/C# O 3 above information is correct. I agree to comply with all County Investigation Fee Cr7 ordinances and State laws relating to building construction, Total Fee LDMA Perm. # i and hereby authorize representatives of this County to enter Ind ° up o he above- ntioned& perty for inspection purposes. r.11 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or ent Date (A- � , t WORKERS'COMPENSATION DECLARATION / C' /J-- D / — 4, I hereby affirm that I have certificate of consent to self APPLICATION Z P P L I CAT I®N 1`®E WILDING PERMIT insure, or a certificate of Workers' Compensation ensation Insurance, �a�" or a certified copy thereof(Sec. 3800, Lob. C.) Policy NW 975585 Compan�epubli.c Indemnity COUNTY ®F LOS ANGELES BUILDING AND SA ILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADBUDRESS LD ® Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 5702 N. Rio Hondo LOCALITY Temple Cit 91780 NEAREST `- Date 11-1-87 Applicant Randol Roofing CITY y ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ".ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL USE ZONE MAP (This section need not be completed if the permit is for one [ _ _ 2 hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO. TEL-2 EL. SPECIAL I certify that in the performance of the work for which this OWNER Vera Bomser No286-6013 CONDITIONS permit is issued,I shall not employ any person in any manner 5702 N. Rio Hondo DISTRICT PTYPE FIRE ROC ED BY 0 ADDRESS CON ZONE so as to become subject to the Workers'Compensation Laws. �D p r3 ( r ,� Date 11-12-86 Applicant Raridnl Rnnf i nq CITY ZIP STATISTICAL CLASSIFICATION APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS DWELL.UNITS LU Exemption, you should become subject to the Workers' ®„ Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be deemed revoked. TEL' BK. L PG �3, VALIDATION CONTRACTOR NO. _ _ LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 529 E. Valley Blvd NO 451937 VALUATION (commencing with Section 7000)of Division 3 of the Business and San Gabriel, Ca. LIC. C-39 1900.00 Professions Code, and my license is in full force and effect. CITY CLASS $ 451937 C-39 SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE d f h R DESCRIPTION OF WORK Re–roof anNEW $ Contractor Mandol Roofing pate 11-12-86 �: .ADD I am exempt under Sec. garagp with 3 tabfiberalas ALTER FINAL B.&P.C, for this reason shingles, Class A. Roofing. IREPAIR DATE `� 2 USE OF Sfd FINAL Date' EXISTING BLDG. DEMOL ❑' BY APPLICANT TEL. Signature OWNER-BUILDER DECLARATION PRINT NO.188-4040 I hereby affirm that I am exempt from the Contractor's License ADDRESS 529 E. Valley Blvd, S.G. Law for the following reason (Section 7031.5, Business and Professions Code): PRESEN ❑ (3UILDING I, as owner of the property, or my employees with J,ADDRESS 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). 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 for FRONT ;2 6 0 Q 8 A the performance of the work for which this permit is issued Pa La tSec. 3097, Civ. C.). SIDE # 0 0 0 0 0,1 P.L. I a o49.88 Q Lender's Name Lender's Address P.C.Fee$ Permit Fee S3CJ o a 0 4 q,8 8 53 r I certify that I have read this application and state that the Issuance Fee $10.50 I 1,21 -86 above information is correct. I agree to comply with all County ;.Investigation Fee ordinances and State laws relating to building construction, Total Fee 9 and hereby authoriz res tatives of this Count to enter p the abov t' ne pe y r inspeJctio aura. es. T 0 // SEE REVERSE FOR EXPLANATORY LANGUAGE ` Signature of Appt cant or Agent to ®s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT ti DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1105170067 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I ITR: 6561 LT: 1 UN: .006 I SQ. FT STORIES TYPE OCCUP GROUPI 5702 RIO HONDO AV I ISTRUCTURE: 40 1 V-B U I TEMP CA 917802432 I (ASSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET: [ 18587-004-002 I OTHER: I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl 1TENANT: 1EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: 1EXIST OCC GRP: 05/17/11 SR (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL- BY: CODE: IGUSTAFSON JAMES B;MARY A (818) 399-4301- 1 1,841 [ 15702 RIO HONDO AV I 1 ITEMP 917802432 FEES PAID ESCRIPTIO OF WORK I I I ILEGALIZE 40 SQFT ADDITION TO STORAGE ROOM ] IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I (APPLICANT: TEL. NO: I I I IGEORGINO THOMAS (626) 390-3814- IAA BLDG PERMIT ISSUANCE 27.80 1 I 1215 E. LAS TUNAS DR IAB STATE GREEN BLDG FEE 1841.00 VAL 1.00 (SPECIAL CONDITIONS: I ISAN GABRIEL CA 91776 AC STRONG MOTION RESID 1841.00 VAL 0.50 ID2 PERMIT W/O EN-HC 1841.00 VAL 82.20 I 1 TOTAL FEES 111.50 I I [CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 ITHOMAS, GEORGINO (626) 390-3814- 1 1 I 1215 E. LAS TUNAS DRIVE LIC. NO I ILOCATION AND SETBACKS I [ [ ISAN GABRIEL, CA 91776 NONE I I 1--1 [ [ I [SOILS ENGINEER APPROVAL 1 1 (ARCHITECT OR ENGINEER: TEL. NO: [ IFOUNDATION/TRENCH FORMS I I I LIC. NO: 1 ]SLAB/UNDER FLOOR [ I [ I I IRAISED FLOOR FRAMING [ ] [ I I I ] IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-( 1UNDE"R L00R INSULATION ] 1 3 001 1- I I I I1ST LEVEL FLOOR SHEATH I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I 1 0 NO 21 1 12ND LEVEL FLOOR SHEATH I I I ] SCHOOL WITHIN HAZARDOUS [ IROOF SHEATHING [ I ]AIR QUALITY: 1000 FEET MATERIALS I I I [ NO NO NO IFIRE DEPT. FRAME INSPECTI I I I [BLDG DEPT. FRAME INSPECTI [ [ I [ ISHEAR PANELS ` I I I I [ (INSULATION/WEATHER STRIP( I I I I [INTERIOR LATH/DRYWALL I ] I I I (EXTERIOR LATH I I I I 1LOT DRAINAGE I I I I [ ISMOKE DETECTION DEVICES I I 1FIRE DEPARTMENT APPROVAL( I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I [ ] I I I I I I COUNTY OF IAS 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 1105120043 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I ITR: 6561 LT: 1 UN: .006 I SQ. FT STORIES TYPE 1 5702 RIO HONDO AV [ ISTRUCTURE: V-B I TEMP CA 917802432 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 18587-004-002 1 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl 1TENANT: (EXIST BLDG USE: STORA USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 -1EXIST OCC GRP: 105/12/11 SR 1 I (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFI)ML DATE FI Y: CODE: 1 IGUSTAFSON JAMES B;MARY A (818) 399-4301- 1 18,410 15702 RIO HONDO AV 1 I ITEMP 917802432 1 FEES PAID IDE_ IPTIO WORK [ I 1 IREAPPLYING FOR FINAL PERMIT FOR PERMIT ISSUED IN 1989 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IFOR STORAGE ROOM 1 [APPLICANT: TEL. NO: 1 IGEORGINO THOMAS (626) 390-3814- 1AA BLDG PERMIT ISSUANCE 27.80 1 1 1215 E. LAS TUNAS DR IAB STATE GREEN BLDG FEE 18410.00 VAL 1.00 ISPECIAL CONDITIONS: 1 ISAN GABRIEL CA 91776 AC STRONG MOTION RESID 18410.00 VAL 1.80 [ 1 I 1D2 PERMIT W/O EN-HC 18410.00 VAL 36.89 1 I [ TOTAL FEES 67.49 1 1 ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 ITHOMAS, GEORGINO (626) 390-3814- 1 1215 E. LAS TUNAS DRIVE LIC. NO 1 ILOCATION AND SETBACKS I I I [SAN GABRIEL, CA 91776 NONE 1 I I I [ 1 ISOILS ENGINEER APPROVAL I [ I 1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS I I I 1 LIC. NO: 1 ISLAB/UNDER FLOOR I I I I 1RAISED FLOOR FRAMING [ 1 I I I I I I ]MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( 1UNDERFLOOR INSULATION 1 [ I 1147H265 3 001 1 I I IFLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: 1 1 1 NO 21 -1 IROOF SHEATHING 1 1 I I SCHOOL WITHIN HAZARDOUS 1 [SHEAR PANELS I I I I I I 1AIR QUALITY: 1000 FEET MATERIALS 1 1 NO NO NO 1 IFRAME INSPECTION [ I I I I I I 1 [FIRE SPRINKLER HANGERS 1 1 I I I I 1 (INSULATION/WEATHER STRIP[ 1 I (INTERIOR LATH/DRYWALL I I [ I I I I [ IEXTERIOR LATH I [ I I I I IRATED FLOOR/CEIL ASSEM. I I I 1 I 1RATED WALL ASSEMBLIES I I I I I I (RATED SHAFTS/OPENINGS 1 1 IT-BAR CEILINGS 1 I I I LOT DRAINAGE I II I I 1 1REPORT ID: DPR261 ROUTE TO: BS0508 1 I I I 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 1108010072 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST SIIILDING ADDRESS: 1 ITR: 6561 IT: 1 UN: .006 I SQ. FT STORIES TYPE 1 5702 RIO HONDO AV 1 ISTRUCTURE: V-B I TEMP CA 917802432 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LIVE OAK 18587-004-002 1 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl ]TEST: IEXIST BLDG USE. RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 1 IEXIST OCC GRP: 108/01/11 SR I (OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IF AL DATE FINAL BY: CODE: J ILIU, TRACI (626) 203-5767- 1 8,000 15702 RIO HONDO AV 1 1 --�{�V I (TEMP 917802432 J FEES PAID 1D SCRIPTIOF WORK v �` 1 I I IREMODEL KITCHEN, BATHROOM, REPLACE 10 WINDOWS AND CLOSED 7 J I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IWINDOWS 1 (APPLICANT: TEL. NO: J ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 I IAB STATE GREEN BLDG FEE 8000.00 VAL 1.00 ISPECTAL CONDITIONS: J IAC STRONG MOTION RESID 8000.00 VAL 0.80 1 I JB2 PERMIT W/ENERGY 8000.00 VAL 201.80 1 J I JFR INV WORK W/O PERMIT 257.00 DOL 257.00 J i (CONTRACTOR: TEL. NO: 1 TOTAL FEES 488.40 1APPROVALS DATE INSPECTOR SIGNATURE I [SAME AS OWNER 1 I LIC. NO 1 JLOCAI'ION AND SETBACKS I I I ISOILS ENGINEER APPROVAL I 1 1 1ARCHITECT OR ENGINEER: TEL. N0: - 1 IFOUND4TION/TRENCH FORMS J I I 1 LIC. NO: I JSLAB/UNDER FLOOR J J I 1 I IRAISED FLOOR FRAMING 1 I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 JUNDERTTAOR INSULATION I 1 1147H265 3 001 1 I _I 1FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: [ 1 0 NO 21 1 IROOF SHEATHING I I I J SCHOOL WITHIN HAZARDOUS J ISHEAR PANELS I I I JAIR QUALITY: 1000 FEET MATERIALS J I I I 1 NO NO NO J (FRAME INSPECTION I I I I I ti V• � � 1FIRE SPRINKLER HANGERS I [ J � I 1 1 I JINSULATION/WEATHER STRIP) I I I I I I INTERIOR LATH/DRYWALL I I I I I JEXTERIOR LATH [ I I 1 r1 1 IRATED FLOOR/CEIL ASSEM. I I I 1 1 IRATED WALL ASSEMBLIES 1 I I 1 1 IRATED SHAFTS/OPENINGS I [ I 1 1 IT-BAR CEILINGS 1 I I ]LOT DRAINAGE I I I I I I 1REPORT ID: DPR261 ROUTE TO: BS0508 1 1 1 I