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HomeMy Public PortalAbout5703 ROWLAND AVE_Building__ WORKERS'CL•MPENSATION OCLARATION hereby affirm that I have a certificate of consent to self APPLICATION F O BUILDING PERMIT ~insure, or a certificate of Workers'Compenstion Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELE BUILDING AND SAFETY Policy No9,'" 33-2- CompanyW_4S_1r--z0 `os 1 F1 Certified copy is hereby furnished. _ FOR APPLICANT TO FILL INJA RESS 5­7 a"3 �'wLA Wo 8 f= ® Certified copy is filed with the co ty b ' ng ins BUILDING tion department. ADDRESS 5�d'3 11:i-XIA— )WO �)\J MLITY 1 'r1 QLD C 1T/'�/ 'g Date SSuWC_ Applica CITY• 1��'MPLf CIT'' ZIP NE CROSSNEAREST.T. L�v c)Au- A V� CERTIFICA PTIO FROM R NO.OF BLDGS. SSOR COMPENSATION INSURANCE • SIZE OF LOT NOW ON LOT BOOK PAGE PARCEL (This section need not be completed if the permit is for one ON EIAL hundred dollars ($100)or less.) TRACT BLOCK LOT NO. / > OWNER $ �TV I b IL I certify that in the performance of the work for which this N CONDITIONS O permit is issued, I shall not employ any person in any manner T CT GROUP TYPE FIRE P OCES D BYso as to become subject.fo the Workers'Compensation Laws. ADDRESSqq�, Q� �vw�u'D R�1T= � ,y CONST.' �I ZONE � CdCITY L0P`lE CITq 1 IJ•V !l Date Applicant ZIP -STATISTICAL CLASS ICATION PT. CONDO. ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CLASS NO. DWELL. UNITS � Exemption, you should become subject to the Workers' 9L Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP 4A with comply with such provisions or this permit shall be TEL �j /RLMA JA deemed revoked. CONTRACTO• \ �� VR NO. ) � � Byr—�GJv VALIDATION LICENSED CONTRACTORS DECLARATION // � t.. LIC.uu�� J I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES 'Ol7 � � � � NO.ovT3 T I VALUATION (commencing with Section 7000)of Division 3 of the Business and 1' LIC. (� i Professions Code, and my license is in full force and effect. CITY F�����LF CLASS "d` r $ �8 Z CJ NO.OF NO.OF CHECK L)c nse Numberci` s�/p��f.��,' Lic.Class _ STORIES FAMILIES d ONE 1CHI� F GJ W-ew �o�UN , t DESCRIPTION OF WORK NEW ❑ $ Contractor `3.Date ❑ I am exempt from the licensing requirements as I am a E '•MOD CyISTI 0 �fc ADD ' licensed architect or a registered professional engineer ALTER ❑ FINAL acting in my professional capacity (Section 7051, REPAIR ❑ DATE ` ( :20 1 3.2 P Business and Professions Code). USE OF v FINAL 0 0 0 0 0 EXISTING BLDG es Daw DEMOL ❑ By # 1 Lic.or Reg.No. Date APPLICANT TEL, ff``', t 2 - 106.00 (PRINT) � "�+ . \)C-FLI-(I�rlO. �IrJ�+ Irl OWNER-BUILDER DECLARATION nn /� �' I hereby affirm that I am exempt from the Contractor's License I�O��ID (1 ��t,�► �G� 1 0 6 Law for the following reason (Section 7031.5, Business and ..0 a►"" ��16�1p 0 0 ADDRESS Professions Code): 'PRESENT ❑ BUILDING -���0 3 QD VI-14 1D AVP- 0 6 10-8 1 I, as owner of the property, or my employees with ADDRESS_ /� /� wages as their sole compensation,will do the work and LOCALITY 1 �ti/� 4 i'� l_;�1�-I I" 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 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 PRO INE WIDFH 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. (Sec. 3097, Civ. C.). SIDE P.L.' Lender's Name t IIIIIIIIN 3 Lender's Address P.C.Fee$ Permit Fee _ r I certify that I have read this application and state that the Issuance Fee above informati is correct. I agree to comply with all County Investigation Fee a ordinances a relatin building construction, Total Fee and here au tze rese iv of this oun to enter I on abo d pe or-ins ecti urpose SEE REVERSE FOR EXPLANATORY LANGUAGE �igwawr Ap i nt o gent Dote W WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION, FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ��703 PY Y ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS• AW1_,+-00 e CITY E7Y//0Ge / Q zip q! p V LOCALITY �o(•G Date Applicant ! NO.OF BLDGS. CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT NEAREST CROSS ST. COMPENSATION INSURANCEASSESSOR �i �j' (This section need not be completed if the permit is for one TRACT BLOCK LOT NO, MAP BOOK g:a _7 PAGE PARCEC�� hundred dollars ($100)or less.) TEL. /y p NO. ��^ f� 8 USE ZONE MAP OWNER L I certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner SPECIAL a ADDRESS `� Lr CONDITIONS so as to become subject to the Workers'Compensation Laws. / O CITY /dG� G! ZIP L ��� ��/ U Date Applicant ARCHITECT OR TEL. � NOTICE TO APPLICANT: If, after makingthis Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE OCESSED BY CONST. ZONE Exemption, you should become subject to the Workers' t� -2 -� w Compensation provisions of the Labor Code, you must forth- ADDRESS �O J 9 �2 -G�z as with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. u7 deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 50�1 DWELL UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION Y SQ. FT. NO. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date ` DESCRIPTION OF WORK �G.t�L/�f F NEW ❑ $ /10D` ❑1 am exempt under Sec. _ /F� N� O • b ADD ❑ T ► ��yy ALTER c❑7I BAP.C. for this reason c WIR, 1 / N REPAIR 0 $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature : APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE O�?'3 ^�!O I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By vL� � BUILDING AC•�T ACCT.11r 1, as owner of the property, or my employees with ADDRESS -+ wages as their sole compensation,will do the work and , 3303 72.00 the structure is not intended or offered for sale(Section LOCALITY ITEMS 7044, Business and Professions Code.) MOVING TEL. ❑ 1,as owner of the property,am exclusively contracting CONTRACTOR NO. TOTAL 72 .00 2 e,��!+0 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code.) CHECK 77°l0 REQUIRED TOTAL SETBACK FROM EXIST. �•�t CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHANGE .00 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. (Sec. 3097, Civ. C.). SIDE Lender's Name P L 0000-0001 8/ 5/96 a P.C. Fee$ permit Fee S-- LDMA Ref. # 7813 1 AM 11 a 39 , Lender's Address I certify that I have read this application and state that the Issuance Fee a 7.S LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, ITotal Fee LDMA Perm. # = and hereby authorize representatives of this County to enter upon the above-m coned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ��Signature of Applicant or Agent Date 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 0011130005 , i PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING AD R SS: TR: 6561 LT: 50 SQ. FT STORIES TYPE 5703 ROWLAND AV STRUCTURE: 0 VN TEMP CA 917802617 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-029-001 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: E WIRST B DG USE: RESID USE ZONE: R- SS ED ON: PROCESSED BY: EXPIRES N: EXIST OCC GRP: 11/13'/00 UT 05/13/01 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL. DATE FINAL BY: CODE: ANTONIO LAWRENCE M (818) 285-6985- 1 4,000 5703 ROWLAND AV . TEMP 917802617 FEES PAID DESCRIPTION OtWORK REMOVE & RE CE BROKEN CLAY TILE, INSTALL MODIFIED APPLICANT: TEL. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: MEMBRANE ON PART OF HOUSE ONLY 0: LEACH & ASSO. ROOFING - AA BLDG PERMIT ISSUANCE 27.75 1627 N. HUMBOLDT AC STRONG MOTION RES-LD- VAL 0.50 SPECIAL CONDITIONS: ONTARIO, CA D2 PERMIT W/0 P 4000.00 VAL 115.80 ��GELE§TOI --FE 144.05 CONTRACTOR: TEL. NO: �®S APPROVALS DATE INSPECTOR SIGNATURE LEACH AND ASSOCIATES ROOFING SYSTEM (626) 851-1427- 1627 N. HUMBOLDT AVE. LIC. NO LOCATION AND SETBACKS ONTARIO, CA 91764 691152039 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER. T 0: FOUNDATION/TRENCH FORMS LIC. NO / 1111111 SLAB/UNDER FLOOR L RAISED FLOOR FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: C P�� n n D n �C ��O rl�/J � UNDERFLOOR INSULATION 150H269 3 0 - U IIh Il1�lC��u�(w FLOOR SHEA I G NO. OF FAMILIES: DWELLING U ITS: APT CO D: ISTAT CLAS NO 21 O 0 ice;, ROOF SHEATHING SC 00 WITHIN -HAZARDOUS i \ a ' ,lAr:� SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS Q ❑ ti � �i NO NO NO A ❑ ©i �5 FRAME INSPECTION REQUIRED TOTA SETBACK FR EXIS !�6 ElFIRE SPRINKLER HANGERS SET BACK FRONT PL- YARD: HWY: PROP LINE: WIDTH: 'gyp -UerviC a That�tl INSULATION/WEATHER STRIP SIDE PL- NTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASS M. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DR GE REPORT ID: DPR261 ROUTE TO: BS0508