HomeMy Public PortalAbout5753 ROWLAND AVE_Building__ r CORKERS'COME ENSATION;DECLARATION
�i cEr°lifi-ott,, Worke s',Compensot on Insuranceent to f A" F ��CAU�� ��" �U��O I PERMIT
. Il
F,t1 copy thereof(Sec. 3800, Lab. C.)
1 COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company .... ......:......,..:.,..,;•... .... .: .,.. ..-.:-.....-•..., D
Certified copy is hereby furnished. FOR APPLICAN TO FILL IN ADDRESS v
❑
F Certified copy is filed with the c my building inspec- BUILDING T—^ 1,
ly' � LOCALITY
tion department. ADDRESS ` v ((al
NEAREST
Date Applicant CITY t ZIP CROSS ST.
CER IFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. / ASSESSOR
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL
(This section need not be completed if the permit is for one U ZO E MAP
hundred dollars($100)or less.) TRACT BLOCK LOT NO. NO.
TEL. SPECIAL
I certify that in the performance of the work for which this OWNER NO._ ^� CONDITIONS CL
permit is issued, I shall not employ an person in an manner 7 DISTRICT GROUP TYPE FIRE PROCESS D BY
P P Y Y P i ADDRESS S 7 3 /1 W CA NL CONST. ZONE V
so as to become subject to the Workers'Compensation Laws. rI, A5r�� �.� �
Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CON
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT O TEL. S PU
Exemption, you should become subject to the Workers'
A ENGINEER L NO. CLASS NO. DWELL.UNITS
Com
Compensation provisions of the Labor Code, you must forth- ,.
P P Y ADDRESS� ,5 V a CA� � SE3PG
�
with comply with such provisions or this permit shall be f o _
deemed revoked. 6 l0[e TACO. ,�� BK. PG, VALID'ATtON-•
;'CONTRACTOR ((J' e.T^ f)t �t o 0 0 0 '
LICENSED CONTRACTORS DECLARATION (( LIC, "• '
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS L NCAf/1a NO. FVALUATION ;
(commencing with Section 7000)of Division 3 of the Business and LIC
Professions Code,and my license is in full force and effect. CITY CLASS SQ. FT NO.OF NO.OF CHECKLicense Number Lic.Class SIZE STORIES FAMILIES ONE $Contractor Dafe DESCRIPTION OF WORK (moo G( 5j( NEW ❑I am exempt under Sec. G e - � S ADDALTER ❑ FINA
B.&P.C. for this reason ❑ DAT
REPAIR
F DEMOL
USE OpI
Date: EXISTING BLDG. bnC� ❑
Signature APPLICANT TEL.
OWNER-BUILDER DECLARATION PRINT lY 1Z 13 ./fj NO.
1 hereby affirm that I am exempt from the Contractor's License ADDRESS S 753 W �dL V� e O �2 48:9 A
Low for the following reason (Section 7031.5, Business and _ # 0 0 0 o a 1
Professions Code): PRE ENT
BUILDING I o 3 4 &0 0
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work and a a 3 4 a G 0 ::s
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code). MOVING TEL. 7, 18-65
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. '
with licensed contractors to construct the project (Sec- ADDRESS 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
the performance of the Work for which this permit is issued P.L.
tSec. 3097, Civ. C.). SIDE
P.L.
QLender's Name : ....,, ..,..:..:. .. .,._.,.�,. :.......;...
Lender's Address P.C. Fee$ q2 V V Permit Fee 3 /rL) I
I certify that I have read this application and state that the Issuance Fee O
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee I00
and hereby authorize representatives of this County to enter
upon bove-me t ed property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE ®s
Signature of Applicant or Agent C618
J
v COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF Fr(JBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0101290048
PHONE: (626) 285-0488 EXT:
GA ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 6561 LT: 406 SQ. FT STORIES TYPE OCCUP GROUP 5753 ROWLAND AV
STRUCTURE: 192 1 VN R3 TEMP CA 917802617
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: WORKMAN
8587-029-011 OTHER: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: USE ONE: SSUED 0 : PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 01/29/01 UT 07/28/01
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL PAJE FINAL CODE:
BROWN GLENN R;ELAINE M (626) 286-8224- 1 14,400 2-312
d
5753 ROWLAND AV `"!'
TEMP 917802617 FES PAID DESCR PT 0 OFR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ADD 19 SF TO EX�I(S�I�TI� EN
APPLICANT: TEL. NO.- 4! to &
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 _
AC STRONG MOTION RESID 14400.00 VAL 1.44 SPECIAL CONDITIONS:
AX BUILDING REV-IEW`FEE---' 54.70
82 PERMIT W%EN.EFfGY.-_I =r,- 14400:.00 VAL 330.66
rxF���F_--E1OTAC,-FEES•- 414.55
CONTRACTOR: TEL. NO: :4�f/ ` '�'� '�^ APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - ;�.�� ���,"'p. N1
LIC. NO LOCATIONAND SETBACKS
6 r! (� ��i � • \` ``,.�` SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER:
TEL. NO: - j' yf= I. ' \ FOI�NDAFIO /TRE CH FORMS
LIC. NOi++ _�� I i_ �I -- - --1 1,�+G,H SLAB/UNDER FLOOR
__ _ JJ II 1 �
�+ L ' _- _-l- J ' -_� __,_LJ �,_ . 'q RAISED,F OOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP r,„ -- - r . ; - I UNDERFLOOR INSULATION
ST LEVEL FLOW SHEATH
0. OF FAMILIES: DWELLING S: A T/COND: STT CLA S:- ----------- ------ -- ----------- -a
NO 21'0,; -----'f ,/ -, ---=-_ - — -- ND LEVEL FLOOR SHEATH
\\
SCHOOL WITHIN HA ARDOUS % � ,••` t1
ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO
7�
FIRE DEPT. FRAME INSPECT
REQUIRED c- TOTAL SETBACK FROM EXISTfi1BLDG DEPT. FRAME INSP
EC
SET BACK ARD: HWY: PROP LINE: WIDTH:
FRONT PL- SHEAR A
I-/Z
Z
D
Z �&•"v ^C rSIDE PL- I S ATO / AT ERSRIP
INTERIOR LATH/DRYWALL
EXTERIOR H
1
LOT DRAINAGE
SMOKE DETECTION DE ICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BSO5O8
0