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HomeMy Public PortalAbout6335 SULTANA AVE_Building__ W.RKERS'COMPENSATION DECLARATION r• affirm'that.l have a certificate of consent to self a c6rtificate of Workers'Compensation Insurance, APPLICATION FOR U I L D I N G P E RI�VrI T "�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 3.S Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESSW1.3 5 0 LOCALITY NEAREST Date Applicant CITY /-. C ZIP / 2CP0 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSES! fr COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT -C=7— NEAP BOOK 1 PAGE PARCEL (This section need not be completed if the permit is for one WSPEC /1� � hundred dollars($100)or less.) TRACT BLOCK LOT NO. G�TEL. IALI certify that In the performance of the work for which this OWNER N L "ill NO. O07 + DITIONS p} permit is issued,I shall not employ any person in any manner V _ DISTRICT GROUP TYPE FIRE P ESSED BY O so as to become subject to the Workers,',Compensation Laws. ADDRESS 6:5-.2/ AIWVR U � /(�/ ! CONST. v ZME U Date /�� ' Fs Applicant P-r-' "sv 2, O',�S, CITY /IJ CF � L ZIP �/ U STATISTICCAJL CLASSIFICATION APT. JC0JDO. ��tt e NOTICE TO APPLICANT: If, after making this ARCHITECT OR TEL.Certificate of ENGINEER CAP-/J S 40i NO. 7y� 7��� CLASS NO. ©B DWELL. UNITS L i Exemption, you should become subject to the Workers' g- Compensation provisions of the Labor Code, you must forth- ADDRESS3 SEWER MAP U with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR 'NO. BK. PG, 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. Ff. NO.OF / NO.OF ` CHECK , License Number Lic.Class SIZE J/ STORIES IFAMILIES / ONE Contractor Date DESCRIPTION OF WORK IJ C.4 C NEW ] ;2 2 3 a 8 A I am exempt under Sec. 5 FAM It Or11 ADD i ALTER E] FINAL ..) # 0 0 0 0 2 3 B.&P.C. for this reason REPAIR DATE „ 1 -, 541.25 USE OF FINALd Date: EXISTING BLDG. DEMOL By o 0 5 4 1.2 5 Signature APPLICANT TEL. 1 i OWNER-BUILDER DECLARATION PRINT O W AL W L Ill NO.7113 OOYr " 1 hereby affirm that I am exempt from the Contractor's License ADDRESS 5 52 1�., A ® O 7'O r 8 5 Law for the following reason (Section 7031.5, Business and Professions Code): PRE ENT BUILDING El I, as owner of the property, or my employees with ADDRESS A9 2 8 a 2 A wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section # 0 0 0 0 0 1 7044, Business and Professions Code). MOVING TEL. 1 - 647.25 I,as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS a a 647,256 'tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. l O 9. 1 Q-85 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH ; J'' 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. Lender's Q Lender's Name I�»Ek�1L f�/j (3(�Ai l� S ' P.C.Fee$ It Permit Fee ✓ ` /S Lender's Address 05 1,04 AP efJL/t I certify that I have read this application and state that the t Issuance Fee S� above information is correct. I agree to comply with all County Investigation Fee �I^ ordinances and State laws relating to building construction, `, Total Fee ..2 J and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. I; SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date es 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 1204200019 PHONE: (626) 285-0488 EXT: ILEGAL ID: I N0. OF CONST I BUILDING ADDRESS: 1BK: 180 PG: 91 PC: 1 I SQ. FT STORIES TYPE 1 6335 SULTANA AV 1 I ISTRUCTURE: 29 V-B I SGAB CA 917752031 1 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15382-021-042 1 i THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1EXIST OCC GRP: 104/20/12 SR i (OWNER: TEL. NO: [BLDGS. NOW ON LOT: VALUATION: IFI �L TE FINAL BY: CODE: IPENA ROBERT R;ELLA (626) 285-5180- 1 1 8,200 I I 6335 SULTANA AV [ [ y 1 ISGAB 917752031 1 FEES PAID D SCRIPTION OF WORK I 1 �REM,CVE EXISTING ASPHALT SHINGLES AND REPLACE WITH 30 YEAR I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: COMPOSITION SHINGLES I (APPLICANT: TEL NO: I I j I IMETRO, RYAN (626) 463-7049- [AA BLDG PERMIT ISSUANCE 27.80 1 I 170 SOUTH LAKE IAB STATE GREEN BLDG FEE 8200.00 VAL 1.00 ISPECIAL CONDITIONS: 1 PASADENA CA AC STRONG MOTION RESID 8200.00 VAL 0.80 1 ! ID2 PERMIT W/O EN-HC 8200.00 VAL 199.80 444J I I TOTAL FEES 229.40 [CONTRACTOR: TEL. NO: 1 ]APPROVALS DATE INSPECTOR SIGNATURE [BEACH CITIES ROOFING (626) 463-7049- 1 1 r 125775 AVENIDA PEDREGAL LIC. NO 1 ILOCATION AND SETBACKS I ] [ ISAN JUAN CAPISTRANO, CA 92675 697489039 1 II I I I [SOIL+S ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUtDATION/TRENCH FORMS 1 [ LIC. NO: 1 IS /UNDER FLOOR I I ] I RAISED FLOOR FRAMING IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( UND RFLOOR INSULATION [ I 1153H265 3 001 I I I I I FLOOR SHEATHING I [ [ INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I [ 0 NO 21 I (ROOF SHEATHING 1 1 [ SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS 1AIR QUALITY: 1000 FEET MATERIALS NO NO NO ( 1FRAME INSPECTION [ [ 1I I ] I 1FIR$'SPRINKLER HANGERS ] I [ I [ ]INSU TION/WEATHER STRIP( [ [ I I (INTERIOR LATH/DRYWALL I [ [ I I � I 1 (EXTERIOR LATH I [ I 1RATED FLOOR/CEIL ASSEM. I I 1 1 IRATED WALL ASSEMBLIES I I I I (RATED SHAFTS/OPENINGS I I IT-BAR CEILINGS 1 I 1 ILOT DRAINAGE I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 I