HomeMy Public PortalAbout5853 SULTANA AVE_Building__ Y+ W DRKF.RS'COMPENSATION DECLARATION
re I reo r that I have certificate of consent to self
1 in?ure,' r a certificate of Workers'Compensation Insurance, APPLICATION FOR U I L®I N G PERMIT
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No-W,= Company Lanz BUILDING
Certified copy is hereby furnished. FO PPLICA T TO FILL IN ADDRESS
Certified copy is filed with the it Ze BUILDING u
tion depa tment. ADDRESS
Date O Applicant ��JJ7' _ ' /f3�f CITY ZIP LOCALITY LZ C1T�
E T FICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST
COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST.
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars($100)or less.) TRACE BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL. USE ZONE MAP
I certify that in the performance of the work for which this OWNS NO. NO.
permit is issued, I shall not employ to p y an y person in any manner SPECIAL,�,C/
so as to become subject to the Workers'Compensation Laws. 1ADDRESS CONDITIONS 0
CITY ZIP 1S
Date Applicant ARCHITECT OR TEL.
NOTICE TO APPLICANT: If, after making this Certificate of DISTRICT GROUP CTMOPNST. ZONE gSED BY 0
Exemption, you should become subject fo the Workers' ENGINEER NO :ti J
Compensation provisions of the Labor Code, you must forth- 1 {U( II// ?,
with comply with such provisions or this permit shall be ,ADDRESS t
deemed revoked. � h'!�� H TEL. iZ � y STATISTICAL CLASSIFICATION APT. NDO. �
CONTRACTOR LLef y' NO. '•'7 nn ,,
LICENSED CONTRACTORS DECLARATION ? IC. CLASS NO. DWELL. UNITS
-
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS / O SEWER MAP
(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 '5 BK.,E PGSZ VALIDATION
SQ.FT. NO.OF NO.OF CHECK .
License Number f 1r 25 Lic.Class "/ SIZE STORIES FAMILIES ` ONE VALUATION
r _,
r4s/!/ �er ��^ ;' DESCRIPTION OF WORK i/' NEW
Contractor •'
� 1.���'1'�.fC^�/�i�ate $ V
❑ e � tQ S'�i jl ADD �•�,
I am exempt under Sec. ILTER
❑ poll,
;226Q3A
B.&P.C. for this reason REPAIR ❑; a
USE OF # 0 0 0 0 23
Date:
EXISTING BLDG. & DEMOL ❑;liiimiiiniiiii
,.
APPLICANT TEL. a I
Signature FINAL
PRINT a1s717X_ NO 1 - 321.30
OWNER-BUILDER DECLARATION DATE X13 %{�
1 hereby affirm that I am exempt from the Contractor's License1:� FINAL 0 o321.303
Law for the following reason (Section 7031.5, Business and ADDRESS/� / i �/�
Professions Code): PRESENT By /c
❑ BUILDING 08,07-85
1, as owner of the property, or my employees with ADDRESS
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). MOVING TEL.
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO.
with licensed contractors to construct the project (Sec- FADDRE
tion 7044, Business and Professions Code). 2 8 IL 2 A
TOTAL SETBACK FROM T.
CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH # a a o a o 1
1 hereby affirm that there is a construction lending agency for I o 3 8 a 5 0
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.). z oo38a505Lender's Name7p.5lJi�/LoftmazzmM n �.J LDMA Ref.# 04 -85
ei Permit Fee V 1 9,Lender's AddressIcertify that I have read this application and state that the Issuance Fee v rJLDMA
LDMA P/C#
above information is correct. I agree to comply with all County on Fee
ordinances and State laws relating to building construction, Total Fee Perm.#
and here uthorize representatives of this County to enter
upon ove-m tioned property for inspection purposes.
SCh 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 RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0202200075
PHONE: (626) 285-0488 EXT:
LEL ID: NO. FTR:5905 LT: 110 SQ. FT STORIES TYPET OCCUP GROUP NEWLD GAD SS:6B9-13) A
STRUCTURE: 155 1 VN R3 TEMP CA 917801841
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: ROSEMEAD
5387-014-007 OTHER: THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
EN IS BL SE: USE ZONE: ISSUED 0 PROCESSED Y: EXPIRES ON:
EXIST OCC GRP: 02/25/02 JK 08/24/02
OWNER: TEL. NO: BLDGS. NOW ON LOT: VA T ON: FINAL DATE FIN 8 CODE:
WALKER WILLIAM R;MARTHA J - 11,625
9044 HERMOSA DR C� R�2-
TEMP 917801841 S PAI DESCRIPTION OF WORK
ADD BATH AND EXTEND BEDRM
APPLI TEL. N0: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
WILLIAM LEONG (562) 698-0571- AA BLDG PERMIT ISSUANCE 27.75
11713 E WASHINGTON AC STRONG MOTION RESID 11625.00 VAL 1.16 SPECIAL CONDITIONS:
WHITTIER 90606 AX BUILDING REVIEW FEE 54.70
B2 PERMIT W/ENERGY 11625.00 VAL 275.22
TOTAL FEES 358.83
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
HAMMERFORD CONSTRUCTION (562) 698-0571-
11713 E WASHINGTON BLVD LIC. NO LOCATION AND SETBACKS
WHITTIER CA 195413 B
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TE 0: FOUNDATION/TRENCHFOR S
LIC.
NO-SLAB/UNDER FLOOR
D FLOOR FRAMING
AP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: NDERFLOOR NSULATIO
3 01
N0. OF FAMILIES: DWELLING UNTS: APT/CO D: S AT 5
C A : IST LEVEL LOOR SHEAT
NO 21 2ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS 00 HEA NG
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL 5 T C FROM EX S BLDG DEPT. FRAME INSP C 7 A
SET BACK YARD: HWY: PROP LINE: WIDTH: -OL v
FRONT PL-SIDE PL- SHEAR PANELS Z? N, --�
INSULATION/WEATHERS P
INTERIOR LATH/DRYWALL j EXTERIOR LATH
LOT DRAINATE-
SMOKE-DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508