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Home My Public Portal About6210 SULTANA AVE_Building__ •� WORKERS'COMPENSATION DECLARATION L •I hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS O Certified copy is filed with the county building inspec- BUILDING I - /► tion department. ADDRESS (� LOCALITY !iL NEAREST p� / Date Applicant CIN ZIP CROSS ST. i �:✓(� CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE { SIZE OF LOT }(J NOW ON LOT 3 MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one G G��` USI ONE hundred dollars($100)or less.) TRACT �� BLOCK LOT NO. ./ / /j�� NO. TEL. /4f S �/ SPECIAL } I certify that in the performance of the work for which this OWNER -1 / NO. CONDITIONS 1L permit is issued, I shall not employ any person in any manner DISTRICT GROUP TYPE FIRE PR SED BY O ADDRESS / / CONST. ZONE U so as to become subject to the Workers'Compensation Laws. o, p d D O ^3 •CITY L Cl'� ZIP /17�T 0 Date Applicant STATISTICAL CLASSIFICATION APT. CONDO. V NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT O TEL. all Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO.�DWELL.UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be J72 A TEL. [I01 vN_ deemed revoked. CONTRACTOR NO. BKJf PG, V a o 0 0 3 LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION 1 - 357.00 (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 $ �� (rf/(J , 0 0 357.0050 SQ.FT. INO.OF NO OF CHECK License Number Lic.Class SIZE [STORIES 1 FAMILIES ONE 0625-87 i-e 44-c a'u L T. NEW $ Contractor Date J . DESCRIPTION OF WORK /G [ ` ADD FiI am exempt under Sec. "7A"-, ALTER ❑ FINAL B.BP.C. for this reason .t REPAIR DATE USE OF // DEMOL f Date: EXISTING BLDG.M 00--e- E] FINAL I APPLICANT TEL. Y Signature PRINT -'ay �,. u N0.2/'; �-7 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License ^ ,L.L rfl /QST Law for the following reason (Section 7031.5, Business and ADDRESS�2/Lt/vl u Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS t wages as their sole compensation,will do the work and / the structure is not intended or offered for sale(Section LOCALITY 1 7044, Business and Professions Code). MOVING TEL. I,as owner of the property,am exclusively contracting I CONTRACTOR NO. V with licensed contractors to construct the project (Sec- ADDRESS tion 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. / a Lender's Name P.C.Fee$ —3 6-7,A6 Permit Fee Lender's Address _ W I certifythat I have read this application and state that the PP Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee fl and hereby authorize representatives of this County to enter upon the above- t* d property for inspection purposes. 0 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or;0,Aewt Date ®s s �• e,s,WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers' Compensation Insurance, ores savrtified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ElBUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS O' ❑ Certified copy is filed with the county building inspec- BUILDING a -"o tJ4-- --W 14 tion department. ADDRESS Date Applicant CITY IGWPLc C?Y ZIP LOCALITY C NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK ..�s % PAGE e907 PARCEL*pA hundred dollars ($100)or less.) TEL U OWNER / Tp NO,�8SS3 CSi7 USE ZONE MOP r� I certify that in the performance of the work for which this _ SPECIAL permit is issued, I shall not employ person in any manner ADDRESS C'1�F C CONDITIONS or so as to com subject to the r e s'Compensation ws. O CIN ZIP U Date Applicant �C ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY ty NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE 0 Exemption, you should become subject to the Workers' ��(/ .2 w Compensation provisions of the Labor Code, you must forth- ADDRESS O J Lu with comply with such provisions or this permit shall be e n n� TEL. I"P3_!S STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR L0A,2+r= NO.7-TT J"' — LICENSED CONTRACTORS DECLARATION � ( LIC. CLASS NO.�DWELL. UNITS ADDR 60116/�• `�OK AO N0.3Q�<3 I hereby affirm that I am licensed under provisions of Chapter 9 .�• SEWER MAP (commencing with Section 7000)of Division 3 of the Business CITY � [T'• CLASS and Professions Code,and my license is in full fort and effect. OB BK `G PG �� VALIDATION a, ,�Y SQ. FT. NO. OF NO. OF CHECK License Nu •'-��"`��,/ Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractors �- a/L� e 3 QI DESC PTION OF WORK NEW ❑ $ .� J 700 �0 ❑I am exempt under Sec. ! �"1r<r�-• ��G �{ ADD ❑ O�� ► B.&P.C. for this reason .,� �� .-- ALTER l�sl REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMO' ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE I hereby affirm that I am exempt from the Contractor's License ✓�L Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT BY Q BUILDING ❑ I, as owner of the property, or my employees with ADDRESS -�� wages as their sole compensation,will do the work and a3_1 r ry!u"r 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-exclusive) contracting CONTRACTOR NO. P P y. Y 9 .`CI�•�� 3il�•�a•• � �-�r with licensed contractors to construct the project (Sec- ADDRESS --, tion 7044, Business and Professions Code.) �I4�; REQUIRED TOTAL SETBACK FROM EXIST. F . CONSTRUCTION LENDING AGENCY SET.BACK YARD HWY PROP. LINE WIDTH (,rltiii�t 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. (Sec. 3097, Civ. C.). SIDE P.L: A '9:�?s Lender's Name z 'l A 25 $ P.C. Fee$ Permit Fee 7� LDMA Ref.# 1L. tij j Lender's Address , ,;ifykthat I have read this application and state that the Issuance Fee � LDMA P/C#Investion is correct. I agree to comply with all County gation Fee State laws relating to building construction, Fee LDMA Perm. #iie representatives of this County to enter - a ed property for inspectio purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant o`f111- Date 76A638A CE 9803 3-69 C%Jc f1' APPLICATION FOP BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING 6210 North tigna +3� DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY Temple City JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. GAA 1'6141Cll F014 APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE CONST. PROCESSED BY (PRINT OR TYPE ONLY) tqCLASS BUILDING ISTICAL CLASSIFICATION SEWER MAP ADDRESS J NO. DWELL.UNITS BK � PGSSLOT N0. BLOCK ZONE 'MAP NO. -zoo 3 TRACT - J SPECIAL NO. OF BLDGS. COND TIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG. SETBACK FROM TEL. FRONT PROP. LINE OF (STREET) OWNER L NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS 6210 North Sultana HIGHWAY WIDTH FROM L.L. CITY p lAv� $Ab + 2 0=20 ARCHITECT OR TEL. FIR (STREET) ENGINEER N0. SIDE PROP. LINE OF TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM L.L. TEL + CONTRACTORVir 'n Of CO N0. 287-0507 1 ADDRESS 6 0 S. San Gabriel Bl No* 160650CORNER CUTOFF YES ❑ NO [L}/ LIC. CITY San Gabriel CLASS .C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS CONSTRUCTION LENDER ' NAME AND BRANCH ADDRESS ' SQ. FT. N0. OF NO. OF ❑ SIZE STORIES 1. FAMILIES NEW USE OF STRUCTURE Rero6f With 235#' ADD ❑ ALTER ❑ Composition Shingles REPAIR iJ SIGNATURE OF DEMOL ❑ APPLICANT VALUATION$ 600.00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE $ FEE $ 9.00 FORMS MATERIALS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME , STOPS, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY. BRACING BOLTS WITH ALL ORDINANCES AND LAWS REGULATING BUILDINGCONSTRUC- FURNACE: LOCATION, TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 4 GAS VENT DUCTS •WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE. OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER CORRECT PERMITTEE �ti �� AND POSTED ADDRESS FINAL z/ / JOHN F. LEWIS, PRI CIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH - PERMIT VALIDATION cK. M.O: CASH .Arc 7 0.0 IR SEP 3 0 1 D 9.00- 1 -.1auNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS I ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT l TEMPLE CITY CA 91780 BL 0508 9810200057 I PHONE: (818) 285-0488 EXT: I LEGAL ID: NO. OF CONST IBUILDING ADDRESS: TR: 5904 LT: 199 i SQ. FT STORIES TYPE 6210 SULTANA AV STRUCTURE: 0 VN TEMP CA 917801553 ASSESSOR INFORMATION M ER: NEAREST CROSS STREET: LONGDEN 5384-007-002 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: 'EXIST BLDG USE: RESID USEZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/20/98 UT 10/20/99 OWNER: TEL. NO: ,BLDGS. NOW ON LOT: VALUATION: FIN L DATE FINAL BY: CODE: LAUPPE EARL M;ANNETT M (818) 285-5388- 1 5,000 Z 6210 SULTANA TEMP 917801553V FEES PAID DESCRAPTION OF WURK - REMOVE AND APPLY 1/2" CDX PLYWOOD, GAF 25 YR. COMP. SHINGLE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. O: IST CHOICE ROOFING (909) 590-1842- AA BLDG PERMIT ISSUANCE 27.75 11987 ROSWELL AVE. 'AC STRONG MOTION RES 000.00 VAL 0.50 SPECIAL CONDITIONS: CHINO, CA 91710 D2 PERMIT W/0 N= C-50`0000 VAL 132.60 �4,GELET-Ol E 160.85 CONTRAC ICE ROOFING TEL. N590-1842- 0� ��,'� APPRO ALS DATE INSPECTOR SIGNATURE 11987 ROSWELL AVENUE LIC. NO LOCATION AND SETBACKS CHINO, CA 91710 548382 SOILSiENGINEER APPRO AL ARCHITECT OR ENGINEER: TEL. 0: - / FO D.TIO TRE CH FORMS LIC. NO: 1111111 SLAB/UNDER FLOOR RAISED FLOOR FRAMING 153H265EWMAP SER K: PAGE: FIRE ZON3: 01 CMQ USSUCC ��1�I UNDERFLOOR INSULATION OR"KS LOOR'S EA G 0. OF FAMILIES: DWELLING UN TS: APT CO D: STAT CLASS: j 12 NO 21 /� , I ROOF SHEATHING SCHOOL TNIN AISHEARPANELS AIR QUALITY: 1000 FEETHAZARDOUS . ,fn NO NO NO FRAME INSPECTION TION r REQUIRED —TOTAL SETBACK FROM EXIST 4�j� 11 JO�� FIRE SPRINKLER HANGERS SET BACK FRONT PL- YARD: HWY: PROP LINE: WIDTH: �C Service.th�t� INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH ATED,FLOOR/CEIL ASSEM. RATEDIWALL ASSEMBLIES A iS A SOP NGS -BAR CEILINGS OT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 i