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Home My Public Portal About5503 SANTA ANITA AVE_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have cemte of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' CCompensation Insurance, or a certified copy thereof(Sec. 3800, Lob. C.) f' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No._rCompany I VAaAo ❑ Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING PY Y ADDRESS _J `,J 3 Ck —aftitIc Certified copy is filed with the county building inspec- rAD7DRESS /J `+ tion department.Date__4 , _Applicant / Y ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEM FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. Q COMPENSAT N INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) I TEL. USE ZONE MAP�� NO. NO. d — o�7 I certify that in the performance of the work for which this OWNER.AWK permit is issued, I shall not employ any person in any manner ADDRESS _ SPECIAL CL CONDITIONS so as to become subject to the War ion aws. .I O CITY ZIP Dat Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY W NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. C'I CONST. ZONE U Exemption, you should become subject to the Workers' 9� w Compensation provisions of the Labor Code, you must forth- ADDRESS a- with comply with such provisions or this permit shall be I TEL. _ STATISTICAL CL4,SIFIC#4TION APT. CONDO. N deemed revoked. CONTRACTOR NO. r Z LICENSED CONTRACTORS.DECLARATION ��g LIC. CLASS NO. DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS T/ _ri /L/ NO. (commencing with Section 7000)of Division 3 of the Business LIC. : SEWER P and Professions Code,and my license is in full force and effect. CITY S G?�� CLASS _ BK ` VALIDATION License Number-&2—fl ( Lic. Class SIZE STORINO. IEES FAMILLIIES ONEK VALUATION Contractor/ , Date— DESCRIPTION OF WORK C �/ t NEW ❑ADD 1:1 �`L/$ •/%y _ ^+ � J � El am exempt under Sec. • J /' ALTER 1:1 B.&P.C. for this reason S G d d REPAIR $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signatu APPLICANT TE..iFINAL OWNER-BUILDER DECLARATION (PRINT) /j$ NO �t DAT I hereby affirm that I am exempt from the Contractor's License ADDRESS r y /s�- Law for the following reason (Section 7031.5, Business and FIN �� t[ tt' Professions Code): PRESENT By 685.63 NG ❑ I, as owner of the property, or m _"s—with ADDRBUILDESS mP� Y ADDRESS wages as their sole compensat' ill do the work and Poo TOTAL 68.63 the structure is not inte or offered for sale(Section LOCALITY 7044, Business rofessions Code.) MOVING TEL. 1 CHECK t t� ❑ I,as ow the property,am exclusively contracting CONTRACTOR NO. � v °Q wi censed contractors-to construct the project (Sec- ADDRESS CHA%E 00 on 7044, Business and Professions Code.) ° CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPALINE FROM WIDTH I hereby affirm that there is a construction lending agency for FRONT (� � �� 6/19/89 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE 40'47 1 AM 8950 P.L. Lender's Name LDMA Ref. # P.C. Fee$ Permit Fee CJ Lender's A ss TT { I I certif that I have read this application and state that the Issuance Fee V .`� LDMA P/C# S above information is correct. I agree to comply with all County InvesPilo tigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter upon lthe bpve-me d00erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Ageint Date ,d APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) FDDRE NG COUNTY OF LOS ANGELES SS ' r DEPARTMENT OF COUNTY ENGINEER [ L ZIPBUILDING AND SAF DIVISION NO.OF BLDGS. BUILDINLOT NOW ON LOT ADDRESS U� TRACT BLOCK LOT NO. \\ LOCALITYTEL. - NEAREST.NO. ¢SJWCSSST14 kp�_. r'7 yl -Alit* -04 0OWNER e ASSESSOR ADDRESS//go W 44<- (,j /��/ MAP BOOK PAGE PARCEL -CITY /r�`� (� ZIP"7( ee DISTRICT GROUP TYPE FIRE CESSED BY p � CONST. ARCHITECT OR TEL. d G (L ENGINEER NO. STATISTICAL CLASSI//FIC>>ATIONSEW,ERMAP ADDRESS / CLASS NO. DWELL.UNITS BK PG CONTRACTOR E N2. /,t� ^ZONE NMOAP LIC. ,//)`/� ADDRESS NO. SPECIAL LIC. Aso CONDITIONS CITY II�Ci I CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRO PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK HI HWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } DESCRI ION OF WORK / _ E. + - O ADD ❑ BLDG.SETBACK CJS' SIDE PROP.LINE OF (STREET) O TOTAL SETBACK FROM OF EXISTING w 4.0 ALTER El REPAIR ❑ HIGHWAY + YARD = SIDE PROP.LINE HIGHWAZY WIDTH N USE C F ' I Z EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) /9- 01471410 NOIj �pCv IN OPEN SPACE YES ❑ NO ❑ BY)SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ 6-C�-6 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �7 ✓�1' THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN R TING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF PERMITTEE— Lw ADDRESS � FINACITY IJ �llT" (Bf' T L DATE L �yBY MAKE CHECKS PAYABLE TO: FP. EE $ vG S �rf F ET.s HARVEY T.BRANDT,COUNTY ENGINEER r 7� PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 30 2 TR. 13 1 2 1 .7 5 A;;o ®s 76A63BA CE#803 3.75' (J v c t' APPLICATION FOR R BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS, _�v� DEPARTMENT OF COUNTY ENGINEER CITY 40 y i & zIP BUILDING AND SAFETY)DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS �� U TRACT BLOCK LOT NO. LOCALITY ^ TEL. NEAREST NOT#�OWNER �,�yy CROSS ST. ASSESSOR ADDRESS G!N S MAP BOOK PAGE PARCEL -CITY �[r ZIP /�r1� DISTRICT GROUP TYPE FIRE RO ED BY l e £ CON!I/:r ARCHITECT OR TEL. J, Q ENGINEER NO. STATISTICAL CLASSIFICATION SEWER4AP ADDRESS TEL. CLASS NO. S DWELL.UNIT — BK PG CONTRACTOR NO USE ZONE MOAP J —� ADDRESS NO. SPECIAL LIC. CONDITIONS CITY �C-/'i� CLASS_ e�� CONSTRUCTION LENDER ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ NAME AND BRANCH Q fLDG.SETBACK FROM RONT PROP.LINE OF ISTREETI ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK IGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK - NEW ❑ + - O rBLDG.SETBACK oe e 7 G DD ❑ SIDE PROP.LINE OF (STREET) O `Z ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM F EXISTING Lu USE OF REPAIR ❑ SIDE PROP.LINE HIGH WIDTH Z EXISTING BLDG. DEMOL + APPLICANT 1. /� �W I�'� TEL �j CORNER CUTOFF YES ❑ NO ❑ IPRINTI /�' NO IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF PERMITTEE n ADDRESS TELJ�'_ FINAL �+ �` ry` BY � CITY �/y NO?K DATE JS f J`�'r/fVn C/�J MAKE CHECKS PAYABLE TO: P.C.EFEET'$ HARVEY T.BRANDT.COUNTY ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATIONK. M.O. CASH (�: 3 0 .3 EI-O RPR 13 1 D 6.00. Abd ®s 76A63BA CE#803 3.75' e 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 1304240113 PHONE: (626) 285-0488 EXT: [LEGAL ID: NO. OF CONST BUILDING ADDRESS: 1BK: 67 PG: 49 PC: 2 I SQ. FT STORIES TYPE I 5503 SANTA ANITA AV I ISTRUCTURE: V-B I TEMP CA 917802905 [ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: DAINES 18573-020-039 ] THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY CAI (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1 (EXIST OCC GRP: 104/25/13 SR 1 (OWNER: TEL. NO: ]BLDGS. NOW ON LOT: VALUATION: IF DATE FI Y: CODE: 1 1SHAH, MEHUL (626) 279-6424- I 800 I �3 15503 SANTA ANITA AVE 1 I 1 I ITEMPLE CITY CA 91780 I FEES PAID IDESCRIPTION OF WORK V [ I I [CONVERT BATHTUB TO SHOWER STALL I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ I [APPLICANT: TEL. NO: I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1_ IAB STATE GREEN BLDG FEE 800.00 VAL 1.00 [SPECIAL CONDITIONS: 1 1 AC STRONG MOTION RESID 800.00 VAL 0.50 I I B2 PERMIT GY 800.00 VM 71.90 [ /IFR INV WORKW/ORPERMIT 166.70 DOL 166.70 I I ICONTRACTOR: TEL. NO: I TOTAL FEES 267.90 ]APPROVALS DATE INSPECTOR SIGNATURE 1 [SAME AS OWNER - I I- I I LIC. NO I ILOCATION AND SETBACKS I I SOILS ENGINEER APPROVAL I I II I I [ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUVDATION/TRENCH FORMS I I I I - I I I I I I LIC. NO: 1 ]SLAB/UNDER FLOOR I I ]RAISED FLOOR FRAMING 1 I I I I I I [MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ (UNDERFLOOR INSULATION I I I 3 ODI IFLOOR SHEATHING I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I INO 21 I IROOF SHEATHING [ I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS [AIR QUALITY: 1000 FEET MATERIALS I I__ I NO NO NO 1 (FRAME INSPECTION 1 I I IFIRE SPRINKLER HANGERS I I II I I IINSULATION/WEATHER STRIPI I I I 1 IINTERIOR LATH/D L [ I I 1 (EXTERIOR LATH I ] I I (RATED FLOOR/CEIL ASSEM. ] I I [ I IRATED WALL ASSEMBLIES ] I IRATED SHAFTS/OPENINGS I I IT-BAR CEILINGS I I I ILOT DRAINAGE I I I I [REPORT ID: DPR261 ROUTE TO: BS0508 I