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Home My Public Portal About6234 SULTANA AVE_Building__ WORKERS'COMPENSAT16N DEELkRATIONN ti, t_ +I hereby affirm that I o have a certificate of consent.to self I AP P L I CAT1 Of4 FOR I L D I N G PERMIT r insure, or a certificate of Workers'Compenstion Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS AJE BUILDING AND SAFETY -Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL INBU DING �,,,�// ADDRESS �� ; j,O � ❑ Certified copy is filed with the county building inspec- BUILDING / -� /� tion department.. ADDRESS /F1.34 SU LNI nPJ A ALOCALITY Oz AREST Date Applicant CITY 1 Ci PLG- C• l f ZIP NE CROSS ST. TT CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 13 v NO.OF BLDGS.NOW ON LOT ASSESSOR COMPENSATION INSURANCE MAP BOOK PAGE PARCEL (This section need not be completed if the permit.is for one SowUSE ZONE MAP hundred dollars ($100)or less.) TRACT � 9 ' BLOCK LOT NONOTEL. + SPECIAL 1 certify that in the performance of the work for which this OWNER�� C l NO.� e--/ CONDITIONSpermit is issued, I shall not employ any person in any manner T /� DISTRICT GROUP TYPE FIRE PRO SD BY Uso as to become subject to the Workers'Compensation Laws. ADDRESS 6 1 - t t 1n V C� ,r1� CONST. ZONE Date —� Applican /\ CITY 1 L rl L- C (1-1r, ZIP I / STATISTLI/CAL CLASSIFICATION I APT. CONDO. V CL NOTICE TOA LICANT: If, aft r ma ing this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO DWELL.UNITS Compensation provisions of the Labor Code, you must forth- I 11A ADDRESS SEWER MAP � with comply with such provisions or this permit shall be TEL. . 'deemed revoked: CONTRACTOR Q t� �' � BK. VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION ,(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 SQ. FJ-1 FJ-1NO.OF I NO.OF CHECK License Number Lic.Class SIZ - STORIES FAMILIES I ONE - $ Contractor Date DESCRIPTION OF WORK f NEW ❑. ❑ 1 am exempt from thedicensing requirements as I am a �� _. S ADD licensed architect or a registered professional engineer ALTER -Q FINAL acting in my professional capacity (Section 7051, dzei REPAIR ❑ DATE Business and Professions Code). FINAL USE OF EXISTING BLDG. Q(Y� � DEMOL ❑ � By •�_`� Lic.or Reg.No. _Date APPLICANT o.. pjJ TEL. �c OWNER-BUILDER DECLARATION (PRINT), ® (� �o�U NO. q�r O,J� v ' +�+�• /� I hereby affirm)hat I am exempt from the Contractor's License ADDRESS�� L'1 f 7 ° 1 V Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT - 42 Q$7, BUILDING / �_ I, as-owner of the property, or my employees with ADDRESS r 0 0 0 0 0 wages as their sole compensation,will do the work and `�1 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). i MOVING TEL. ✓J 7 2 0 3 3 8.5 0 ❑ CONTRACTOR NO. I / , as owner of the property,am exclusively contracting -7 ^ rl o c with licensed contractors to construct the project (Sec- 3 tion 7044, Business and Professions Code). ADDRESS REQUIRED TOTAL SETBACK FROM EXIST. 0 8.2 4—c 1 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work-for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name a Lender's Address P.C. Fee$ .S O Permit Fee' � . I certify-that I have read this application and state that the I 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 Q /•'o and hereby outtiorize representatives of this County to enter. _ upon t. a above-me boned property for inspection purposes. D [ j%27 SEE REVERSE FOR EXPLANATORY LANGUAGE o ®s Signaturf Appl e oica t or Agent Dote i - • APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION BUILD[ FOR AePLICANT TO FILL IN BUILDING A4,ORESS 2 3 ti I hereby affirm that I have a certificate of consent to self insure, NG ADDRESS or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Y ZIP ,eyvGf LOCALITY Policy No. Company [SIZEOF UJIT NO.OF BLDGS.NOW ON LOT ��• / ❑ Certified copy is hereby furnished. ® 136 NEAREST CROSS ❑ Certified copy is filed with the county building inspection TRAC,L—0 BLOCK LOT NO2 0.'), L vs department. 7r' USE ZONE rICNI, Date Applicant ASSESSOR_MW BOOK •. PAGE_® PARCEL 3 L�! k0 f6 EIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS OWNER '� TEL NO. COMPENgATION I/NSURANCE "� WITHIN 1000 FT OF SCHOOL? Yes NO (This section need not be omplete /f the permit is for one hundred ADD E3,S� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100) or less.) a4 I certify that in the perfor ance of the work for which this permit CITY ZIP79 ,D V is issued, I shall not emplloy an person in any manner so as to ARCHITE OR ENGI EER TEL NO. become subject to the W rke Compensation Laws. V_ Q`�2 Ali t STATISTICAL CLASSIFICATION APT CONDO Date Appl' an AD RE c� �1 CLASS NO. DWELL UNITS N077CE TO APPLICA T If, after making this Certificate of ru ' F-s-m-1 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Sh0 become subject t0 the Workers' CONTRACTOR w ^ TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisio of the Labor Code, you must forthwith V �` a 5—� FRONT comply with such provi Ions or this permit shall be deemed revoked. 6DDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION `^U SIDE CI 1LIC.CLASS PL I hereby affirm that I am licensed underprovjsions of Chapter 9 � SEWER NJAB- (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE r NO.OF STORIE NO.OF FAMILIES NEW BK �j PG Professions Code,and my license is in full force and effect. 11 r r t o ESCRIPTION OF WORK ADD j] VALUATIO polo. License Number Lic.Class 1 l . Contractor Date !V ALTER ❑ I am-exempt under Sec. REPAIR El � �.`t as BAP.C.for this reason DEMOL ❑ aC LDMA P/C# Date: USE OF EXISTING B . O J=LI ' URM -airtm 427-P �y n 5919— IgnatUreAP LICANT(PRIN ) TE O. LDMA Perm# �I as owner of the property, or my employees with wages as � �� Z TOTAL 420 a 85 their sole compensation, will do the work and the structure is A RES - C-14 E CK i6210 85 not intended or offered for sale (Section 7044, Business and FINAL DATE /� ' Q CHANGE ProfeSSIOfIS COde.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 2� _�( � ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE P Y Y g AMOUNTS SPECIFIED qNTHE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, YES❑ NO !' { Business and Professions Code.) i ! �,�. WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING r`r� �— �� p; COASOCCUPANT R QUQUIRE A PERMIT NAGEMENT DISTRRCONSTRUCTION C OMDRSEEDIFICATION PERMRT PEROM THE MITTING CHECKUTH 0 LIST - LI{50 1 P 1 1°e S CONSTRUCTION LENDING AGENCY GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO CM the performance of the work for which this permit is issued(Sec. a 3097,CIV.C.) I HAVE READ THE HAZARDOUSMATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CHECKUSTMNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, TITLE 2, R 2.20$ CTI NS 2.20.100 THROUGH 2.20,140 CONCERNING HAZARDOUS Lender's Name MATERI EP RTING AND F R OBT PERMIT FRO THE SCAQMD. o Lender's Address R NT c 1 certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE " �-0 PERMIT FEE �q,3 N with all county ordinances and State laws relating to building •7 ` J econstruion, and hereby authorize representatives of this County ISSUANCE FEE 2 j_Ipon the ve- perty for inspectio purp es. �/m INVESTIGATION FEE TOTAL FEE /O � 3Ikanl a � SEE REVERSE FOR EXPLANATORY LANGUAGE 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 1210250068 PHONE: (626) 285-0488 EXT: [LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: [ [TR: 5904 LT: 202 UN: .002 I SQ. FT STORIES TYPE [ 6234 SULTANA AV [ _ISTRUCTURE: V-B [ TEMP CA 917801553 [ASSESSOR INFORMATION NUMBER: [ I NEAREST CROSS STREET: LONGDEN 15384-007-006 [ THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl [TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 TISSUED ON: PROCESSED BY: [ IRXIST OCC GRP: 110/25/12 SR I [[OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFI FI BY: CODE: [ IVUONG, LE (818) 285-3863- 1 4,900 IIa I 6234 SULTANA AV [TEMP 917801553 [ FEES PAID [DESCRIPTION OF WORK I [ [ [BATHROOM REMODEL [ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ [ [APPLICANT: TEL. NO: I [ ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 I I [ IAB STATE GREEN BLDG FEE 4900.00 VAL 1.00 [SPECIAL CONDITIONS: IAC STRONG MOTION RESID 4900.00 VAL 0.50 [ [ [ IB2 PERMIT W/ENERGY 4900.00 VAL 145.90 [ IFR INV WORK W/O PERMIT 342.20 DOL 342.20 I I CONTRACTOR: TEL. NO: I TOTAL FEES 517.40 [APPROVALS DATE INSPECTOR SIGNATURE [ [SAME AS OWNER - I I I I LIC. NO [ [LOCATION AND SETBACKS I I I [ [ ISOILS ENGINEER APPROVAL [ I I I I I I I I [ARCHITECT OR ENGINEER: TEL. NO: [ [FOUNDATION/TRENCH FORMS I [ [ LIC. NO: I [SLAB/UNDER FLOOR I I [ RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: cmP:[ [UNDERFLOOR INSULATION [ I [ 1153H265 3 001 I I I I I [FLOOR SHEATHING [ I INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I [ I [ [ 0 NO 21 I ROOF SHEATHING [ I [ [ SCHOOL WITHIN HAZARDOUS [ [SHEAR PANELS I I [AIR QUALITY: 1000 FEET MATERIALS [ [ I [ [ NO NO NO I [FRAME INSPECTION I (FIRE SPRINKLER HANGERS [ I I I I I I [ [ [INSULATION/WEATHER STRIP[ [ / [ [INTERIOR LATH/DRYWALL I I I I [EXTERIOR LATH I I I I I I I I I [ [ [RATED FLOOR/CEIL ASSEM. I I I I I [ [ IRPTED WALL ASSEMBLIES [ [ [ I IRATfiD SHAFTS/OPENINGS 1 T I I [ IT-BAR CEILINGS I I I I I I I I ILOT DRAINAGE I I [ IREPORT ID: DPR261 ROUTE TO: BS0508 [ I [ I I I I I I I