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HomeMy Public PortalAbout5128 ROSEMEAD BLVD_Building__ WORKERS' COMPENSATION DECLARATION hereby.affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance;or ' a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND•.SAFETY . Policy No. Company Certified co is hereb furnished. BUILDING ❑ Pv v FOR APPLICANT TO FILL IN ADDRESSd ❑ Certified copy is filed with the county building inspec- BUILDING ��� /� tion department.. ADDRESS I�r�+�.7G��6'V �✓0 LOCALITYNEARE .1�Y Date Applicant CITY �c+�1 4C47 ( ZIP CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' Zr?S NO. OF'BLDGS. }+_ ,` ASSESSOR /t�"D 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 �,� , hundred dollars ($100)or less.) TRACT ��� BLOCK LOT NO. NO. TEL. .�+� Q SPECIAL la, certify that in the performance of the work for which this OWNER0446 S, 4414 dSSOG NO.Z=-24®p CONDITIONS '01 permit is issued, I shall not employ any person in any manner DISTRIC"T� GROUP TYPE FIRE ESSE lJ so as to become subject to the Workers'Compensation Laws. ADDRESS SJ Lr7 04VAM�ITwV bA- �V CONST. ZONE CITY 4r• ZIP 47M 36 zo Date Applicant STATISTICAL CLASSIFICATION APT. JC0NDO. 6J ARCHITECT R TEL LU NOTICE' TO APPLICANT: If,, after making this Certificate of �[/�(� S. GaA�i .aS5�GN0.�ZZ� 3 @, Exemption, you' should become subject to. the Workers' +_ ' ENGINEER CLASS IN L. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS VSZS "0%W1'144S'r6AV Dzi AJ, SEWER MAR ,/ with comply with such provisions or this permit shall be CONTRACTOR /JJ� deemed revoked. TEL. BK PG VALIDATION NO.' LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. .► r��'" �' Professions Code, and my license is in full.force and effect. CITY CLASS $ `,�O A00 SQ. FT. NO. OF INC. OF CHECK License Number Lic.Class SIZE Dio ISTORIES 2 FAMILIES ONE NEW Contractor Date DESCRIPTIO<�WORK JJAJ 4)J=. $ ❑ ! t TbwAJ#1" ADD ❑ I ce exempt from the licensing profremenal e I am a 3 u�.t" � licensed architect or a registered professiondl engineer � � ALTER ❑ DATEFINA ' z 2 3-�I,J A acting in my professional capacity (Section 7051, P/Q��/� REPAIR Business and Professions Code). USE OF ❑ FINAL # 0 0 0 0 2 3 - Il DEMOL f EXISTING BLDG. NG ❑ id�.,,/ Lit, or Reg. No. —Date APPLICANT `c SEL.a ,. ,,e BY �� 2 0 1 20.60 (PRINT)xa//VG' Sr `v� A6S4 p �(iT� OWNER-BUILDER DECLARATION z I hereby affirm that am exempt from the Contractor's License ADDRESS5S'ZS �1t 41fA &r-0A) O&- A)# 3 �� o a 120,600 s ,Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT -2-3 I,2, 1 6:-8 1 ❑ BUILDING 51-m-^4 ' D ,�d0- I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY �EMO� the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING ` TEL. �^ I, as owner of theproperty, am exclusive) contractingCONTRACTOR ��Np NO. with licensed contractors to construct the project (Sec- kADDRE tion 7044, Business and Professions Code). - D TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY K YARD HWY PROP. LINE WIDTH. -9234 6A I hereby affirm that there is a,construction lending agency for / �f� the performance of the work for which this permit is issued ! / 0 0 0' o 0 1 (Sec. 3097, Civ. C.). ' ` I G RI�I�� ��G 0&41t21,40 50 Lender.'s Name , ./.,Q/ // �jLender's Addres4�C2*4e/ IAV4,, �� //4�� Permii Fee -( - o �,�(. ( ,rjQw I certify that have read this application and state that the wr �(GIssuance Fee � 12, 16-81 above information is correct. I agree to comply with all County on Feel ,p (�- V F�' ordinances and State laws relating to building construction, Total Fee and hereb authorize representat'ves of this County to enter a upo g�ove- oned erty for inspection purposes. ` Z v j/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Applicant or Agent Date _ ©s COUNTY OF LOSS ANGELES TEMPLE CITY „ #•0533 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9801140083 PHONE: (818) 285-0488 EXT: LEGAL ID• NO. OF CONST_ BUILDING ADDRESS: TR: 38313 UN: 13 SQ. FT STORIES TYPE 5128 A-D ROSEMEAD BL STRUCTURE: 0 VN SGAB CA 917762267 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5388-019-050 THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R- ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/14/98 UT 01/14/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINA CODE: RICHTOWN REALTY MANAGEMENT (626) 288-3330- 1 4,200 Iv VALLEY BLVD. 19 ORK ROSEMEAD, CA FEES PAID DESCRIPTION OF W TEAR OFF/HOT MOP FLAT ROOF, 4VILT UP WITH CLASS A FIBERGLASS FEE DESCRIPTION: R QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: C & A ROOFING (626) 285-7107- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 4200.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 4200:00 VAL 133.05 TOTAL FEES 161.30 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE C & A ROOFING (818) 285-7107- 4927 FIESTA AVE LIC. NO LOCATION AND SETBACKS TEMPLE CITY CA 91780 536091 C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: -- -" SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 140265 3 01 FLOOR SHEATHING N0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: YES 21 ROOF SHEATHING WAS- 144 SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: /�� G✓�� �(J�( FRONT PL- INSULATION/WEATHER STRIP SIDE PL- ( � G INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 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 1202090060 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 38313 UN: 13 SQ. FT STORIES TYPE 1 5128 A-D ROSEMEAD BL 1 I ISTRUCTURE: 22 V-B I SGAB CA 917762267 1 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 15388-019-050 1 1 - THOMAS PAGE: 596 GRID: H5 LOCALITY: TEMPLE CITY, Cl I I I (TENANT: 1EXIST BLDG USE: RESID USE ZONE: R-3 11SSUED ON: PROCESSED BY: 1 I IEXIST OCC GRP: 102/09/12 SR 1 - I I I I OWNER: .TEL. NO: jBLDGS. NOW ON LOT: VALUATION: FINAL ATE FI Y: CODE: IZHANG, MIKE (626) 255-7888- I 4 7,000 1 I FEES PAID ID SCRIPTION OF WORK I I ITEAR OFF EXISTING ROOFING MATERIAL INSTALL 04 PLY BUILT UP (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ISYSTEM ON 4 UNITS & INSTALL WHITE COATING (APPLICANT: TEL. NO: ISUNSHINE ROOFING (909) 598-8988- IAA BLDG PERMIT ISSUANCE 27.80 1 I IAB STATE GREEN BLDG FEE 7000.00 VAL 1.00 ISPECIAL CONDITIONS: IAC STRONG MOTION RESID 7000.00 VAL 0.70 ID2 PERMIT W/O EN-HC 7000.00 VAL 166.60 I I TOTAL FEES 196.10 I 1 (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 (SUNSHINE ROOFING (909) 598-8988- I I 1 1516 N DIAMOND BAR BLVD #183 LIC. NO I ILOCATIOWAND SETBACKS I I IDIAMOND BAR CA 91765 755126 C39 I I I I I I ISOILS ENGINEER APPROVAL I I I (ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I I LIC. NO: I ISLAB/UNDER FLOOR I I I I IRAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:; IUNDBRFLOOR INSULATION I 1144H265 3 001 1_ I I I IFLOOR SHEATHING ' INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I 1 0 NO 21 j 1ROOP SHEATHING 1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I 1AIR QUALITY: 1000 FEET MATERIALS I I I I I 1 NO NO NO I IFRAME INSPECTION I I I I I I I I I IFIRE SPRINKLER HANGERS I I I I I I I I I I (INSULATION/WEATHER STRIPI I I I I I 11NTERIOR LATH/DRYWALL I I IEXTERIOR LATH I I I I I I I I I IRATED FLOOR/CEIL ASSEM. ( 1 I I I I I I I IRATED WALL ASSEMBLIES I I I I I I I IRATED SHAFTS/OPENINGS IT-BAR CEILINGS I I I I I I I I - ILOT DRAINAGE I I I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508