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Home My Public Portal About5031 SANTA ANITA AVE_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY ' WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDI G ADDRESS I hereby affirm that I have a certificate of consent to self insure, ` BUILDING ADDRESSI or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab CITY ZIP LOCALITY Policy No. Comps _ SIZE OF LOT NO.OF BLDGS.NOW ON LOT lsgidH ❑ Certified copy Is hereby furnished. , + NEAR CROSS S. ❑ Certified copy is filed with the county bui�m_ TRACT Lo K LOT NO. apartment. I USE ZONE MAP NO. /I G�� , – Ap ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER (N – 7/ WITHIN 1000 FT OF SCHOOL? YES NO COMPENSATION INSURANCE ADD R , (This section need not be completed if the permit is for one hundred I DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CI ZIP 1 certify that in the performance of the work for which this permit WL a L \ is issued, I shall not employ any person in any manner so as t ARCHITECT OR ENGINEER TEL NO. \` become subject to the Workers'Compensation Laws. _ STATISTICAL CLASSIFICATION APT CO Data?q qb Applicant � ADDRESS CLASS NO. 0 1 DWELL UNITS NOTICE TO APPLICANT. If, iter mading this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' ONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH o'CCompensation provisions of the Labor Code,you must forthwith ow weAl__ comply with such provisions or this permit shall be deemed-revoked. ADDRESS LIC.NO. FR ONT LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PIL nom. I hereby affirm that I am licensed under provisions of Chapter 9 SO.FT SIZE NO.O STORES NO. FAMILIES SEWER MAP � (commencing with Section 7000)of Division 3 of the Business and NEW ❑ BK PG' �� Professions Code,and my license is in full force and effect. � DES IPTI OF WORK ❑ License Number Lic.Class I ADD VALUATION CO)poll- ntractor Date I ALTER ❑ c EV.- a c,wi 5 REPAIR ❑ 7 1 9.4 A $ ❑ 1 am exempt under Sec. I DEMOL # 0 0 0 0 0 1 B.BP.C.for this reason LDMA P/C k USE OF EXISTING LDG. Date: I kits 1ck ov,. URM 4 o e 8800 Signature A 'CANT(PRINT) TEL NO. LDMA Perm N Z 06088.00X0 1, as owner of the ro p party,or my employees with wages O their sole compensation,will do the work and the structure is ADDREW not intended or offered for sale (Section 7044, Business and a[ . 'e— FINAL A C Professions Code.) WI�LTHEAPPLICANT OR FUTUR BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL j as owner of the property, am exclusive) contracting with ORIA MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q P P Y Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL �j I contractors to construct the project.(Section 7044, YES'❑ NO❑ Business and Professions Code.) WI IL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY copsr AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FORT GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ the performance of the work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 2D.100THROUGH 22M140 CONCERNING LendeesName COUNTYNameSOMATERIALS EPORTINGAN,TITLE 2.CHAPTER 2.2D DFOROONS BTAAINNGAPERMIT FROM THE SCAOMD. Lender's Address owr'moRAeQCr 0 1 certify that I have read this application and state that the above Information is correct. I agree to comply with all county PC.FEE PERMIT FEE `7 ordinances and State laws relating to building construction,and I �'W hereby authorize representatives of this County to enter upon ISSUANCE FEE th ove-mentioned property to inspection purposes. 3-a-(� INVEISTIGATION FEE TOTAL FEE Q� O SEE REVERSE FOR EXPLANATORY LANGUAGE t APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY " WORKER'S COMPENSATION DECLARATIONBUILDING ADDRESS FOR APPLICANT TO FILL IN FSUIL—DING ADDRESS 1 I hereby affirm that I have a certificate of consent to self insure, 7 S Q. v� I /� or a certificate of Workers'Compensation Insurance,or a certified ZIP C Lt. copy thereof(Sec.3M,Lab.C.) LOCAL] Policy No. Company SIZE OF NO. BLDGS.NOW ON LOT NEAREST CROSS ST c , � Certified copy is hereby furnished. 42— J ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date—Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER r TEL O. YES NO COMPENSATION INSURANCE �' �f 4 36 WITHIN 1000 FT.OF SCHOOL? ADDRES (This section need not be completed if the permit is for one hundred Q p JL w DISTRICT GROUP TYPE CONST.' FIRE ZONE OC ED BY dollars($100)or less.) ^ CI ZIPof �d� ✓, OY 9.3 � ✓{ I certify that in the performance of the work for which this permit � eCSL�' GZ —` /f1b Is Issued, I shall not employ any person in any manner so as to CHIT f'OR ENGINEER r /� TEL NO. become subject to the Workers!Compensation Laws. A( f r'•p I�Q V STATISTICAL CLASSIFICATION APT CO q Date Applicant ADDRESS Ess n s �r Ane QO _/ II�V CLASS NO. DWELL UNITS NOTICE TO APPLICANT., If, after making this Certificate of CONTRACTOR Ut`r +v` +u ` TEL NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers• SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith FRONT, comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS SIDE P L r•r•T a CC3 I hereby affirm that I am licensed under provisions of Chapter 9 SQ FT SIZE NO.OF STORES NO. FAMILIES SEWER MAP :s 1� 7f 7—= (commencing with Section 7000)of Division 3 of the Business and �,sl�! a n�S:I rp Professions Code,and my license is in full force and effect. Z ea NEW BK PG �, D CRIPTION F ADD ❑ VALII TION ) j TI EMS W License Number at Class JL �, 5 � fLI(gJ 1 TOTAL 88a5 - �:,_ Contractor Date _ ALTER ❑ __� ❑ I am exempt under Sec. �' REPAIR ❑ $ 11Y 11CHECK_ sL"�° B.&RC.for this reason DEMOL ❑ ID CHANGE USE OF EXISTING BLDG. URM ❑ LDMA P/C 11 Date: Signature 1J% 6Fq1CANT(PRINT) Ir TEL O. LDMA Perm f7 ❑ 1, as owner of the property, or my employees with es as Z their sole compensation,will do the work and the structure is M . AD Ess rn:` °a t 9'-112 not intended or offered for sale (Section 7044, Business and �, FIN7/0-7 E < (1�'fl Professions Code. 3307 �_{` WILLTHEAPPLICANTOR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL o ITEMS< ❑ 1, as owner of the property, am exclusive) contractin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN1 Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY TOTAL i�.) lBusiness and Professions Code.) 7C�°,�_ icensed contractors to construct the project (Section 7044, YES❑ No❑ ��: .lei WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING •t '7 OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTHHE�•�:U i1,:7 °st+1. CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. .• •'�i I`"' °('?ii 1 hereby affirm that there is a construction lending agency for FO 11 No El `tG the performance Of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD o� 3097,Civ.C.)• '; PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �•+ COUNTY CODE.TITLEZ CHAPTER 220SEanONS Z20.10DTHROUGH 220.140 CONCERNING �' 000 °t 0-01004 5/ 4/90 Lenders Name ^` HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. q Lenders Address `V OMER O„G� ;; � i AIS 8 0.1115 o I certify that I have read this application and state that the above RC,FEE Q� PERMIT FEE Information is correct. I agree to comply with all county C)(/ ordinances and State laws relating to building construction,and f•�d. hereby authorize representatives of this County to enter upon r ISSUANCE FEE 7 1 the eb mentioned props for i Ion pure s. 0,00 112 ' hD INVESTIGATION FEE TOTAL FEE S%.8ft 04App0.M. DW "SEE REVERSE FOR EXPLANATORY LANGUAGE f- f 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 0412100029 PHONE: 0626) 285-0488 EXT: EGA ID: NO. OF CONST 3UILDING ADDRESS: TR: 13363 LT: 15 SQ. FT STORIES TYPE 5031 SANTA ANITA AV STRUCTURE: VN TEMP CA 917803618 ASSESSOR INFORMATION NUB : NEAREST CROSS STREET: 8574-009-016 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY, C NANT: EXIST BLD USE: R SID USE ZONE: R-3 ISSUED ON: PROCESSED-B XPIRES ON: EXIST OCC GRP: - 12/10/04 JK 12/05/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: TSANG, CHIU (626) 450-5089- 1,200 1108 W. VALLEY BLVD. ALHAMBRA, CA 91803 FEES PAID OF WORK REPAIR DRY WALL. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 1200.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 1200.00 VAL 82.20 FR INV WORK W/0 PERMIT 257.00 DOL 257.00 TOTAL FEES 367.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATUR SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: OUNDATIO R NCH FOR S LIC. NO: SLAB/UNDER FLOOR S D FLOOR A NG MAPXX . SEWER MAP BOOK: PAGE: FIRE ZONE: CMP01 NDERFLOOR INSULATION FLOOR SEAH G NO. OF FAMILIES: DWELLING UNITS: APT CO D: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQ IRED JOTAL SETBACK FROM EXIS FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INS LATION/WEATHER STRIP SIDE PL- INTERIOR- LATH/DRYWALL L- TERIORL T / R ALL EXTERIOR LATH RATED FLOOR CEI ASSEM. RATED WALL ASSEMB IES RA ED SHAM-7-0-PEM-9-GS T-BAR CEILINGS LOT DRAI G REPORT ID: DPR261 ROUTE TO: BS05O8