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HomeMy Public PortalAbout6038 ROSEMEAD BLVD_Building__ WORKERS;C04APENSATION DECLARATION ( �� N FOR l certificate elfinsureora certifcaeof Wo kes'Compensaton Insurance, APa BUILDING PE have a RMIT or a certified copy thereof(Sec. 3800,, Lab. C.) COUNTY OF LOS ANGELES BUILDINGAND SAFETY Policy No.12a-0320compony Ca1AP9* AW �s� Qr Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS tY t(ro3 iJ Rosev­,ecd Certified copy is filed with the county building inspec- BUILDING �ro Q tion department. ADDRESS 03 90 aq 8/•Vp/7- 2-2�`•Q ! 780 r LOCALITY Date Applicant CITY •� �� ZIP CERTIFICATE OF EXEMPT104 FROM W RKERS' / t NO.OF BLDGS. /� ::NEAREST COMPENSATION INSURANCE SIZE OF L�OTT 6'O 4'l.9ia NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one TRACT t7 /�`f' /�[.�(7 // ASSESSOR hundred dollars($100)or less.) BLOCK a LOT NO. /tO MAP BOOK PAGE PARCEL TEL. I certify that in the performance of the work for which this OWNER s S �l►( NO. -�8 ,USE ZONE OP permit is issued, I shall not employ any person in any mannerr� f ^ i. . SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS 2 — e-L -S� / CONDITIONS Date Applicant CITY D. 0i.L 1000© ZIP /pA OS NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY Exemption,' you should become subject to the Workers' ENGINEER NO. CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS R-3-1 . v with comply with such provisions or this permit shall' be ���p TEL. STATISTICAL CLASSIFICATION APT. Y deemed revoked. CONTRACTOR OWNER NO. LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (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 BK VALIDATION > SQ.FT. NO.OF / NO.OF CHECK IL License Number Lit.Class SIZE STORIES / FAMILIES ONE O VALUATION 0 ' Contractor Date .DESCRIPTION OF WORK �7r`CO NEW ❑❑ S �v Q ❑I am exempt under Sec. RX1ST/J!C r40C&e a ALTER ❑ B.BP.C. for this reason D TT/4C` � tUSE OF / REPAIR• $ 0. Date: EXISTING BLDG.S ff, LC F14 41 � DEMO;- ❑ Z APPLICANT TEL. �.rt•.� _ Signature FINAL PRINT / •s.s L�/I✓� 1/ NO. $2 �[� -.-.�- =C -t= OWNER-BUILDER DECLARATIO t y- d 7+ ,/ �/,'``. ,DATE I hereby affirm that I am exempt rom the ontractorrs License ADDRESS F 20�J ( L�t� S/o IYOr �Q�C�+��Y/ Law for the fallowing reason (Section 7031.5, Business and • .••..• FINA - �Professions Code): PRE E T gY _ ... BUILDING '•'i l i:jr "=�+ .�--- b ', as owner of the property, or my employees with ADDRESS r`�" wages as,their sole compensation,will do the work and LOCALITY "}' 59.225 SK the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. I_ll, I, as owner of the property,am exclusively contracting CONTRACTOR NO. ❑ with licensed contractors to construct the project (Sec- ADDRESS tiori 7044, Business and Professions Code): REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.-LINE WIDTH I hereby affirm that-there is a construction lending agency for FRONT ` ' M '- i the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name " " •►� o P.C.Fee$ Permit fee 4 {S LDMA Ref. # Lender's Address I certify that I have read this application and state that the /•� i Y PP I Issuance Fee lJ• U LDMA P/C it 2 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, n and hereby authorize representatives of this County to enter Total Fee S L`� LDMA Perm.N li upon t e above- a ned property or inspection purposes. `r 'GG (� SEE REVERSE FOR EXPLANATORY LANGUAGE Signat a Applicant or Agett Date r 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 0806020006 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BIIILDING ADDRESS: JTR: 5904 IT: 161 SQ. FT STORIES TYPE 1 6038 ROSEMEAD BL STRUCTURE: 1159 VN TEMP CA 917801538 1 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5384-016-003 1 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl TENANT: EXIST BLDG USE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY: EXPIRES ON: (EXIST OCC GRP: 106/02/08 SR 11/29/08 1 OWNER: TEL NO: JBLDGS. NOW ON LOT: VALUATION: IF DATE FINAL Y: CODE: IYAN, J JIANG (626) 757-9262- 1 40,000 6038 ROSEMEAD BLVD. i ` V TEMPLE CITY CA 91780 FEES PAID ID CRIPTION OF WORK REFRAME EXISTING ROOF AND REFINISH WITH CONCRETE TILE LARR 1 FEE DESCRIPTION: QUANTITY: DOM: AMOUNT:123700 1 APPLICANT: TEL. NO: I I TAI (626) 823-5048- JAA BLDG PERMIT ISSUANCE 27.75 9552 WENDON ST. JAC STRONG MOTION REBID 40000.00 VAL 4.00 ISPECIAL CONDITIONS- TEMPLE CITY CA 91780 1D2 PERMIT W/O EN-HC 40000.00 VAL 667.20 TOTAL FEES 698.95 1 CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE 1H088 CONSTRUCTION (626) 202-3730- 1 5836 SULTANA ST LIC. NO ILOCATION AND SETBACKS TEMPLE CITY CA 91780 852362 B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS IKALIR DESIGN ASSOCIATES (626) 391-3248- I o 2033 MONTERA DR LIC. NO: (SLAB/UNDER FLOOR HACIENDA HEIGHTS, CA 91745 24845 1 RAISED FLOOR FRAMING 1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:l JUNDERFLOOR INSULATION 1150H265 3 Oil FLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS 1SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO IFRA14E INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: MY: PROP LINE: WIDTH: FRONT PL- 1 JINSUTATION/WEATHER STRIP SIDE PL- 1 INTERIOR LATH/DRYWALL EXTERIOR LATH O/ 1 RATED FLOOR/CEIL ASSEM. 1 1 1 1 RATED WALL ASSEMBLIES 1 1RATED SHAFTS/OPENINGS � 1 �T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: HS0508 1 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 0909280007 PHONE: (626) 285-0488 EXT: ILEGAL ID: N0. OF CONST I BUILDING ADDRESS: ITR: 5904 LT: 161 SQ. FT STORIES TYPE 1 6038 ROSEMEAD BL I ISTRUCTURE: 1159 V-B I TEMP CA 917801538 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: GARIBALDI 15384-016-003 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-2 11SSUED ON: PROCESSED BY: I [ [EXIST OCC GRP: 109/28/09 SR I 1OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 IYAN, J JIANG (626) 757-6280- 1 40,000 1 I 16038 ROSEMEAD BLVD. I I 1 ITEMPLE CITY CA 91780 1 FEES PAID IDENCRIPTION OF WORK I IRE-STUCCO ENTIRE HOUSE AND INSULATION I [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT-.1 1 (APPLICANT: TEL. NO: I I I IBMS SERVICES INC. (909) 419-9089- IAA BLDG PERMIT ISSUANCE 27.75 1 I IPO BOX 388 IAB STATE GREEN BLDG FEE 40000.00 VAL 2.00 ISPECIAL CONDITIONS: 1 WALNUT, CA 91780 AC STRONG MOTION RESID 40000.00 VAL 4.00 I 1D2 PERMIT W/O EN-HC 40000.00 VAL 667.20 I I 1 TOTAL FEES 700.95 I I [CONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE 1 ISMS SERVICES, INC. (909) 419-9089- I 1 I IP.O. BOX 388 LIC. NO ILOCATION AND SETBACKS 1 I 628 BARNES WAY 655563 B WALNUT, CA 91788 ISOILS ENGINEER APPROVAL 1 I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I I 1 LIC. NO: I (SLAB/UNDER FLOOR 1 I I IRAISED FLOOR FRAMING 1 1 (MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I 1150H265 3 001 1 1- I I I I IFLOOR SHEATHING 1 I I [NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I NO 21 1 IROOF SHEATHING 1 I 1 1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I 1 1AIR QUALITY: 1000 FEET MATERIALS 1 I I I I 1 NO NO NO 1 1FRAME INSPECTION I 1 1 REQUIRED TOTAL SETBACK FROM EXIST 1 IFIRE SPRINKLER HANGERS I I I SET BACK YARD: HWY: PROP LINE: WIDTH: I I I I I IFRONT PL- I 11NSULATION/WEATHER STRIPI 1 I I SIDE PL- I I I 1 I I [INTERIOR LATH/DRYWALL 1 I I 1EXTERIOR LATH I I 1 [ [RATED FLOOR/CEIL ASSEM. 1 1 I RATED WALL ASSEMBLIES [ I I [RATED SHAFTS/OPENINGS � � I I [ IT-BAR CEILINGS1-1 I I I 1 (LOT DRAINAGE1-1 I I 1 [REPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I I I I