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Home My Public Portal About5120 ROSEVALE DR_Building__ I WORKERS COMPENSATION DECLARATION sure, affirm that IofW r ce' Come of consent to raself APPLICATION FOR BUILDING PERMIT insure, aria certificate of Workers' Compensation Insurance or a rt fi copy thereof(Sec 38DO L%b C ) �� //1{ " COUNTY OF LOS ANGELES BUILDING AND SA Po No mpan Certified copy is hereby furnished FOR APPLICANT TO FILL IN eu NG �{ Certified copy is hiedJunty building inspec BUILDING J �� L. hon department ADDRESS / Doro �ApphCITY ZIP LOCALITY Q CERTIFICATE OF EXEMM WORKERS W3 OF BLDGS � NEAREST COMPENSATINCE SIZE OF LO7 NOW ON LOT CROSS ST j (This section need not be completed if the permit is for one �� ASSESSOR hundred dollars ($100)or leas ) TRACT BLOCK LOT IJO MAP BOOK PAGE I PARCEL TEL 115E Z E IMAP I certify that in the performance of the work for which this L NO12i NO l l permit is issued I shall not employ any person in any manner l — I SPECIAL d so as to become subject to the Workers Compensation Lows ADDRE CONDITIONS O Date Applicant Cm' ZIP {� O NOTICE TO APPLICANT if after making this Certificate of ARCIiI i No; 06[� DISTRICTq GROUP TYPE FIRE BY Exemption you should become subject to the Workers' QO y�J CONST ZONE Compensation provisions of the Labor Code you must forth- ADDRESS (` IL with comply with such provisions or this permit shall be TEL ^ ' STATISTICAL CLASSIFICATION T_ APT CONDO deemed revoked CONTRACT NO s-f 4; ,, LICENSED CONTRACTORS DECLARATION UC CLASS NO DWELL UNI I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS v IVO —[ r (commencing with Section 7000)of Division 3 of the Business and LIC SEWER MAP Professions Code and my license is in full face and effect CITY t, - CLASS BK PG VALIDATION 50 FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAAUUES ONE �,s., , VAIUATIO Contrac9W �-•e�S�patrI",�.f b 7 IPr woR� ADD f QO`J, ' —9634.8A F11 am exempt under Sec ALTER , # • • e • 23 B BP C for this reasonf USE OF REPAIR I • 64452 Date EXISTING BDG DEMOI Signature OWNER-BUILDER DECLARATION NTf71.FTJ�o dYNp 41 FINAL e - 6116, 526 1 hereby affirm that I am exempt from the Controctor's License � �ii � � � TE Law for the following reason (Section 7031 5 Business and d G 01 1 5—8 7 Professions Code) � ❑ BUILDING I as owner of the property or my employees with ADDRESS wages as their sole compensation will do the work and lop 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 contractor to construct the project (Sec- ADDRESS tion 70/4 Business and Professions Code) CONSTRUCTION LENDING AGENCY REQUIRED L SETBACK FROM EXIST SET BACK YARD HWY TDTAPROP LINE WIDTH �P 6 4 Q 7 A I hereby affirm that there iso construction lending agency fon FRONT the performance of the work for which this permit is issued P L • • • • •,, (Sec 3097 Civ C ) SIDE a PL I * 76975 Lender s Name cartFae F S �`ARefs • • 769756 PC Fomes Lender's Address " 01,27 -87 I certify that have read thr application and state that the Issuance I" Us LON P/C s above mf ion a coned I ogres to comply with all County Invengoeon Fee ordinanc to jaws relating to building construction, b s d and her ut ize representatives of this County to enter Told Fee LAMA perm upon ve tioned property for inspection purposes ^ ( sRE REVERSE FOR EXPLANATOEy LANGUAGE & e of Applicem or Agent Dob O i L COUNTY OF LOS ANGELES TEMPLE CITY I L # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9807130068 PHONE (818) 285-0488 EXT LEGAL ID. NO OF---EMgT BUILDING ADDRESS BK 60 PG 55 PC 2 SQ FT STORIES TYPE 5120 ROSEVALE DR STRUCTURE 0 VN TEMP CA 917803300 ,{) _ ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET. /4&0, _ 8585-007-065 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY TENANT EXIST BLDG USE RESID USE 769r-W--F— ISSUED ON PROCESSED BY EXPIRES-ON EXIST OCC GRP 07/13/98 UT 07/13/99 OWNER: --Tn--No BLDGS ROW ON LOT VALUATION FINAL DATE -rw 8 CODE ARJOMANDI ABDOLLRAHMAN 000 - 1 2,400 5120 ROSEVALE DR TEMP 917803300 _ REPAIR WATER DAMAGE TO UPSTAIRS BAI OM (STUDS, PLATE AND APPLICANT itL. NO FEE DESCRIPTION QUANTITY UOM AMOUNT SUB FLOOR) REPLACE BATH TUB AND SH ER VALVE ERIC TELLESON CONST (626) 441-6388- AA BLDG PERMIT ISSUANCE 27 75 611 FAIRVIEW AL STRONG MOTION,RESID-- 2400 00 VAL 0 50 SPECIAL CONDITIONS SO PASADENA, CA D2 PERMIT W/O'EN-HC- X2400 00 VAL 99 00 �R1GEL C.TOTAL-FEES 127 25 CONTRACTOR TEL NO: DATE INSPECTOR SIGNATafF-- APPROVALS ERIC TELLESON 4 611 FAIRVIEW AVE LIC NO LOCATION AND stikim;K5Ar- SO PASADENA CA 91030 603508 B \ LIL NO 1�� ' �� - I �_-� RAISED FLOOR FRAMING MAP NO SEWER MAP BOOK PAGE: FIRE ZONE �,itSLAB/UNDER FLOOR 147H273 3 '01 -�i�il I -- FLOOR SHEATHIN9-- NO 21 6/ - r ROOF SHEATHING SCHOOL WITHIN KAZAKULUS AIR AW $HEAR PANELS OL ITY 1000 EET MANEORIALS �� 1��, ��,J A / e� FIRE SPRINKLER HANGERS SET BACK YARD• HWY PROP LINE WIDTH r =1 Y� 42 FRAME INSPECTION REQUIRED TOTAL SETBACK FROM �< F''Cv1 FRONT PL- � _ce_?haINSULATION/WEATHER STM SIDE PL- INTERIOR LATH/DRYWALL - - - �_ EXTERIOR LATH RATED SHAFTS/OPENING§— T-BAR CEILINGS LOT DRAINAGE REPORT ID DPR261 ROUTE TO BS0508