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Home My Public Portal About5919 ROWLAND AVE_Building__ . WORKERS'that DECLARATION 4ersifk�06ffirm that I have a certificate of consent to self i4re;or-6 certificate of Workers'Compensation Insurance, APPLIC"A790M POPRUMMY` PER"RIT wor a.certified coey thereof(Sec. 3800, Lob. C.) %F M Policy No. Company COUNTY OF LOS ANGELES BUILDING AND SAF - Certified copy is hereby furnished. BUILDING ��miiiilllil FOR APPLIC7AT TO F LIN_&� I ADDRESS Certified copy is filed with the county building inspec- flan department. BUILDING �� 1 -1 V/0 LO LITY ADDRESS Date Applicant 12.�Iel_pl CITY ile! Ir ZIP eII' 0 CROSSNEAREST ST. CERTIFICATE OF EXEMPTION fROM WORKERS' 10.OF BLDG;S. R IS ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT g MAP BOOK IPAGE PARCEL (This section need not be completed if the permit is for one TRACT LOT NO. USE AONE hundred dollars($100)or less.) JBLOCK J At 960 4&- SPECIAL .6- TEL. -7 1 certify that in the performance of the work for which this OWNER `,J�1_—,3 NO. KCONDITIONS :0- permit is issued, I shall not employ any person in any manner DISTRICT Grp TYPEV FIRE PROCESSED BY 0. 0 so as to become subject to the Workers'Compensation Laws. ADDRESS CONST. ZONE Date Applicant CITY `LJ e��&� NOTICE TO APPLICANT: this Certificate 7f ARCHITECT OR [STATISTICAL CLAS§YICATION APT. CO 0 f, after making Z 11- DO. Exemption, you should become subject to the Workers' ENGINEER • CLASS NO, :W1 DWELL UNITS-n Compensation provisions of the Labor Code, you must forth- 1.9. 9L with comply with such provisions or this permit shall be ADDRESS Alle,4117ald. Adx SEWER MAP deemed revoked. CONTRACTOR '470'All-Al 0 -W, TEL_' _6$743 BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. 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 "401 1 VALLIATIONI Professions Code,and my license Is in full force and effect. CITY LIC. e"Iej CLASS AO SQ. FT, 0 NO TORIES CHECK JES NO.OF e License Number 3!a 6e, Lic.Clo-_,6) SIZE__VS IFAMILIES ONE Contractor -z'-, DESCRIPTION OF NEW $ ❑ '3�V,Date WORK &A-Alszvlle7_ V, ADD 0 I am exempt under Sec. &TER Al� B.&P.C. for this reason TE` REPAIR 0 Date: USE OF I EXISTING BLDG. DEMOL ❑ By y Signature APPLICANT TEL, OWNER-BUILDER DECLARATION PRINT) NO, 93229A I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and # a 0 0 0 23 Professions Code): '1 - 26585 PRESENT BUILDING 13 1, as owner of the property, or my employees with i, ADDRESS a - 2 6 5 8 5 C wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). Q 8 5 MOVING TEL. ❑ 1,as owner of the property,am exclusively contracting -CO-NTRACTOR NO. with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). ADDRESS ADDRESS P R E P ADDRESS REQUIRED ii SET CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. I hereby affirm that there is a construction lending agency for 0 T PROP LINE WIDTH FRONT the performance of the work for which this permit is issued P.L tsec. 3097, Civ. C.). SIDE P P.L. ;23467A A. Lender's Name MT..7mwx IM # 0 a a 0 a 7S- Lender's Address P.C.Fee$ Permit Fee o32a25 I certify that I have read this application and state that the 3 2 3.2 5 above information is correct. I agree to comply with all County Issuance Fee Investigation Fee ordinances and State laws relating to building construction, A 14 —01_;z and hereby authorize representatives of this County to enter PIZIB-5-WO -7 Total Fee upon.t abov man �0, roperty for Inspection purposes. 7,5 1 man SEE REVERSE FOR EXPLANATORY LANGUAGE Signature;f Applicant or Agent 10 0 to I. • 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 1112140063 • PHONE: (626) 285-0488 EXT: LEGAL ID: N0. OF CONST BUILDING ADDRESS: ITR: 6561 IT: 37 SQ. FT STORIES TYPE 5919 ROWLAND AV I ISTRUCTURE: V-B TEMP CA 917802241 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 18587-031-008 1 I THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl TENANT: 1EXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: (EXIST OCC GRP: 112/14/11 SR 1 (OWNER: TEL NO: [BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: 1 IDLCC CORP. (626) 575-8880- 1 5,000 19531 GIDLEY AVE. I ITEMP 917802241 1 FEES PAID DESCRIPTION OF WORK 1 I I [KITCHEN REMODEL AND RE STUCCO ENTIRE HOUSE 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( [ [APPLICANT: TEL. NO: I I [ 1WU, JACK (626) 523-5819- IAA BLDG PERMIT ISSUANCE 27.80 1 I 19531 GIDLEY AVE. IAB STATE GREEN BLDG FEE 5000.00 VAL 1.00 ISPECIAL CONDITIONS: [ ITEMPLE CITY CA 91780 IAC STRONG MOTION RESID 5000.00 VAL 0.50 [ 1 JB2 PERMIT W/ENERGY 5000.00 VAL 146.10 [ 1 1 TOTAL FEES 175.40 [ ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE [ IT C PAINTING, INC. (626) 282-5095- 1 1-- 1514 1514 S HIDALGO AVENUE LIC. NO [ ILOCATION AND SETBACKS [ I I JALHA6MRA CA 91801 803169 B [ I I I I [ [ ISOILS ENGINEER APPROVAL I [ 1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS I [ 1 LIC. NO: [ 1SLAB/UNDER FLOOR I I I I 1 1 IRAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP.j 1UNDERFLOOR INSULATION [ [ [ 115OH269 3 001 [ J I I 1FLOOR SHEATHING I 1 [ INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS. I I 0 NO 21 1 IROOF SHEATHING [ [ 1 SCHOOL WITHIN HAZARDOUS 1 SHEAR PANELS I [ [ JAIR QUALITY: 1000 FEET MATERIALS [ I J I [ NO NO NO [ IFRAME INSPECTION [ [ I [ I 1FIRE SPRINKLER HANGERS J J I I J I I 11NSULATION/WEATHER STRIP( I I I I [INTERIOR LATH/DRYWALL [ I [ I I (EXTERIOR LATH I J J I � I I I IRATED FLOOR/CEIL ASSEM. I I I I IRATED WALL ASSEMBLIES I [ I I I I IRATED SHAFTS/OPENINGS I I I I I I IT-BAR CEILINGS I I I I 1 I I I ILOT DRAINAGE I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I [ I [ I I I I I I 76A66 ' +i+Or,; that k lgavNS cerci DECLARATION CE-806 1081 APPLICATION FOR ELECTRICAL PERMIT I h�rpby'affirm that L nave a certificate of consent to self CE-806G insuru, or a certifi'eate of Workers'Compensation Insurance, COUNTY OF LOS ANGELES BUILDING AND SAFETY or a certifieA copy thereof (Sec. 3800, Lab. C.) Policy No. ' yCompany FOR APPLICANT TO FILL IN JOB Certified copy is hereby furnished. New Residential Bldgs. 8 Poo s EACH NO FEE ADDRESS LOCALITY J = Certified copy is filed with the county building m 1 8 2-Family, Sq. Ft. $ S spec- �, , hon d a enc. Multi-family Sq. Ft. NEAREST / CROSS ST. f-;o J Date Applicantr--�1yP � .��_�� Residential Swimming Pools OWNER OR FIRM NAME r G 7 CE TIFICATE OF EXEMPTION FROM WORKERS' Outlets: Rec Light Sw._ MAIL ��S COMPENSATION INSURANCE First 20 ADDRESS (This section need not be completed If the work involved by Total No. Additional CITY��i, Tel. No. the permit is for one hundred dollars($100)or less.) I certify that in the performance of the work for which this PLAN CHEC`,9y• , 7 permit is issued, I shall not employ any person in any manner APPLICANT G'Go so as to become subject to the Workers'Compensation Laws. Lighting Fixtures First 20 ADDRESS _ Total No. Additional T Date Applicant CITY _Cilli Tel. No 7�� NOTICE TO APPLICANT: If, after making this Certificate of Fixed Appliances Not Over 1 HP PERMIT Exemption, you should become subject to the Workers' Range_ Heater—D.W. _ APPLICANT 4 , Compensation provisions of the Labor Code, you must forth- Oven —Dryer _W.M.— ADDRESS with comply with such provisions or this permit shall be Top FAU —W.H. — deemed revoked. CITY Tel. No. LICENSED CONTRACTORS DECLARATION Hood _ Fan _Other_ p' Dis _ Room Air Cond. LICENSE OR I hereby affirm that I am licensed under provisions of Chapter 9 REG. NUMBER Class. >_ (commencing with Section 7000) of Division 3 of the Business DISTRICT NO. PROCESS p- Power Apparatus 8 Large Appliances and Professions Code,and my license is in full force and effect. pp° g Pp �S( O Size&Type HP, KW, KVA, or KVAR 6/ V License Number s Lic. Class Size Up to 1 Incl. FINAL 0: o y >g (' Over 1 to 10 Incl. DATE C+ r(� VALUD ION V Contract 0A Date Over 10 to 50 Incl. _�J ❑ I am exempt under Sec. Over 50 to 100 Inc. BYAL Z B.BP.C. for this reason Over 100 Date: Services, Swbd., MCC 8 Ponelboards 0 -200 Amp. Under 600 V Signature 201 - 1000 Amp. Under 600 V ❑ Exemption for Reg. Maint. Elect. Over 1000 Amp. or Over 600 V SINGLE FAMILY Temp. Power Pole&Appurtenances HOME OWNER-BUILDER DECLARATION Sign with One Branch Circuit I hereby affirm that I am exempt from the Contractor's License Additional Sign Branch Circuits 3(Z f, /, Low for the following reason (Section 7031.5, Business and Professions Code): o o a o o ❑ I, as owner of the property, will do the work and the Misc. Conduits 8 Conductors structure is not intended or offered for sale (Section Other(See Complete Fee Schedule)_ o o [ Q 7044, Business and Professions Code). ® o o o (; 0"/ t' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for { L G9—,' the performance of the work for which this permit is issued PERMIT FEE (Sub-Total) (Sec. 3097, Civ. C.). PLAN CHECKING FEE Lender's Name PERMIT ISSUING FEE U 1576' Lender's Address I certify that I have read this application and state that the TOTAL FEE above information is correct. I agree to comply with all County ordinances and State laws regulating Electrical wiring, and hereby authorize re.resentatives of this County to enter upon the above a property for inspection purpos S. SEE REVERSE FOR EXPLANATORY LANGUAGE / ✓ �' d Sig ature of Permittee Oate