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HomeMy Public PortalAbout4505 TEMPLE CITY BLVD_Building__ WORKERS COMPENSATION DECLARATION Thereby affirm that I have r certificate Come of tion in, to ,elf APPLICATION. FOR BUILDING PERMIT upure, or a certificate of Workers' Compensation Insurance, or a cenified copy thereof (Sec 3800, Lob C) r - COUNTY OF LOS ANG6lE5 - BUILDING AND ISAFE" Polity No llurn D-�Compony AJURIC_ EJ 'Certified copy Is hereby furnished ///`/�� -FOR APPLICANT TO FILL IN BUILDING )te` ADDIrEss r Certified copy is filed with the county building Inspec- BUILDING RI T i hon department n/ 2 �-c}Z CITY T ZIP I O LOCALm R' Date Applicant NO OF BLDG ST , CERTIFICATE OF EXEMPTION'FROM W SIZE OF LOT NOW ON LOT ' ' CROSS ST 'COMPENSATION INSURANCE - ASSESSOR (This section need not be completed If the permit Is foi one TRACT BLOCK LOT NO - - MAP BOOK ,)-r Z PAGE ( pgRCFI Q3 hundred dollars ($100) or less ) OWNER TEL -702`] 115E ZONE t MAP a-lv I certify that in the performance of the work for which this _ /J _ permit is Issued, I shall not employ any person In any manner ADDRESS rq E /�. / y GOND TIONS 0. so as to become subject to the Workers Compensation Lava0 CITY rti ZIP' SA—/ _ _ ._ Date ' Applicant ARCHITECT OR TEL OC NOTICE TO APPLICANT If, after making this Certificate of ENGINEER NO _ _DISTRICT GROUP NIST _ ,ZONE PROl�SSED BY rO~ Exemption, you should become subject to the WorkersQ' // V Compensation provisions of the Labor Code you must forth- ADDRESS 1% n --� -•' `3 �L� with comply with such provlslom or this permit shall be TEL7r4 STATISTICAL CLASSIFICATIAPT CONDO Z deemed revoked CONTRACTOR M E NO /O 1 - LICENSED CONTRACTORS DECLARATION LIC CLASS NO DON WELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO Z SEWER MAP (commencing with Section 7000)of Division 3 of the Business _ LIC , and Professions Code,and my license is in full force and effect Cin CLAS' BK /-- PG �O�s VALIDATION License Number A')2?Q4 Z.` Llc Class a SIZE STORIES FAMILIES I ONE NEW ❑ VALUATION QC Contractor ,n _Date Jr- 2"'7-ci Z DESCRIPTION OF WORK ,v L $ ❑1 am exempt under Sec - ALTER ADD- ELI pop.� _ � _ _ B 8P C for this reason E REPAIR ❑ $ Date USE OF ," _ _ EXISTING BLDG -DEMOL ❑ 23 Signature APPLICANT TEL FINAL • , OWNER43UILDER DECLARATION (PRIM) -rt.L NO' -0Ip DATE ACCT.AT I hereby affirm that I am exempt from the Contractor s License _ _ _ `� Law for the following reason (Section 7031 5, Business and ADDRESS FINAL 3307 b2...1 Professions Code) _ _ t4T _ , t - By _ 1 ❑ I, as owner of the property, or my employees withDINADDRESS ACCT a T .r wogesas their sole compensation willdothewarkand LOCALITY 7 LL�.bJ the structure is not Intended or offered for sole(Section , 3303 7044, Business and Professions Code ) MOVING TEL ._ , _ - ❑ 1, as owner of the property,am exclusively contracting CONTRACTOR NO 2 ITEMS with licensed contractors to construct the project (Sec hon 7044, Business and Professions Code) ADDRESSTOTAL 175.84 CONSTRUCTION LENDING AGENCYSET BACK IRED TOTYARD Ifsvv AL SE pB L(� FROM' Eel - I NE WIDTH L .84 hereby affirm that there Is o construction lending agency for FRONT ry4Ays� the performance of the work for which this permit is Issued P IL - - - bFlfg .130 (Sec 3097 Civ C ) SIDE - r PL Lender's Name �p OfY L)MA Ref N 8/27/9r:"0001 $727� PC Fee o2_1 Permit FeePilo. Lender s Address y 5234 1 AM 9;41 o I certify that I have read this application and state that the Nuance Fes LDMA PTC N above Information is correct 1 agree to comply with all County Investigation Fee _ p - - ordinances and State jaws relating to building construction Total Fee /✓� '� LDMA Perm N < and hereby authorize representatives of this County to enter y - Y$ upoqAhp above-m�fft)nttigneddp property for Inspection purposes SEE REVERSE FOR EXPLANATORY joss" Sigriorore dKApplicant or Agent Date f WORKERS COMPENSATION DECLARATION tinsure affirm certificate that I have r certificate of tionconsent to ,elf APPLICATION FOR. BUILDING PERMIT insure ,or a certifirats of Workers' Compensation Insurance, or a certified copy thereof (Sec 3800, Lob C ) 1lslicy No Company COUNTY OF LOS ANGELES - - BUILDING AND SAFETY ' ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN ppm 5'p ❑ Certified copy Is filed with the county building inspec- ti on department ESS swP1C alD Date Applicant Ta"P\Cr r- GA ZIP g\'l'9'�' LOCALITY NO OF NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' OF LOT \d C NOW ON LOT \- - CROSS ST COMPENSATION INSURANCE ,{ M p (This section need not be completed if the permit is for one T \`Z��{$ BLOCK LOT NO 'Za{ MAPS BOOK' .J pgGP"'� pqQ hundred dollars ($100)or less ) I comfy that in the performance of the work for which this :R Q 1110 a USE ZOO I NO MAP permit s Issued,I shall not employ any Persian in any manner ESS 44 T C 'g�LVD - �' CONSPECDITIONS a W as to become subject to the Workers Compensation Laws O - CITY ZIP X1'7�1� - - - Date Applicant IIECi OR TEL NOTICE TO APPLICANT If, after making this Certificate of NEER L,LA\6 NO DISTRICT GROUP �N$T ZONE PROCESSED BY OO Exemption, you should become wblect to the Workers' 1/ G Compensation provisions of the Labor Code, you must forth- ESS 3 y 9 t with comply with such provisions or this permit shall be STATISTICAL CIASSIFKATION AP7 CONDO Z deemed revoked _ TRACTOR Or'1�1 vsi\DV4 NO LICENSED CONTRACTORS DECLARATION LIC CLASS N0'.�DWEII UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ESS _ NOSDNER Map(commencing with Section 7000)of Division 3 of the Business �j qG nG A�(r7a and Professions Code,and my license is In full force and effect gl( PG g tlAL1BATION SW 4- OF NO OF6IEIXLicense NumberLic Clap STORIES FAMILIES \ ONE RIPTION OF WORK 1 V . %ii NEW ❑ VALUATION r 1 ITEM_ Contractor Date _ _ ❑I am exempt under Sec ,;- oZ SpA ADD ® 4ioPilo. T(E K ��'fi _ d� B 8P C for this reason a'L- � � N7FR ❑ ��/SODO �� c�I�C��t�� REPAIR ❑ L 1-O.UI Date USE OF t - CHAWIG ,11Q EXISTING BLDG "ewv q , DEMOL ❑ Signature APPLICANT TEL FINAL (PRINT) Ada\F- NO YY4S' DATE OWNER-BUILDER DECLARATION I(1 O I here affirm that I am exempt from the Contractor i License 4'�J�s �6`..4rs C MII.11 Law for the following reason Section 7031 5 Business and aaVD FINAL4 i F Professions Code)' _ B BUILDNG ING L\6pS 'j'� '�JZI Y - ® I, m owner of the property, or my employees with ADDRESS - wages as their sole compensation will do the work and LOCALITY - \\ •- a the structure is not intended or offered for sole(Sectionv' ' ' ► t 7044, Business and Professions Code ) MOVING 1 .• - J"" TFL - ❑ I os owner of the property am exclusively contracting CONTRACTOR 'i NO ` -�+ , -- with licensed controctoni to construct the prolect (Sec- i !•- tion 7044, Business and Professions Code ) ADDRESS t, CONSTRUCTION LENDING AGENCY IRED - YARD H1VY AL IXNE FROM. - . ` I 4 I {Yi/ '�.• O -� f S hereby affirm that there s BA a construction lending agency for T t -�--- f, the performance of the work for which this permit is issued PL ' Cly .- i.t F h.• (Sec 3097 Civ C ) IDE M ? M. •�.: T.`5 Lend _P Lender's Name = F+3 LDMA Ref E "1 N41,PC Fee •� Per $Fee f"/e 667 ► Lenders Address - .�/- p - - o I certify that I have read this application and state that the / 6 ce Fee �3'L TDMA P/C 0 t above info mation is correct I agree to comply with all County Investigation Fee / ordinances and State laws relating to building construction, Total Fee /Q !O D LDMA Perm It Q and hereby authorize representatives of this County to enter $ 8$ upon 1pe above- ennoned property fes inspection purposes i-• -rc.$ [, uv Q p r0 7Y1 �•-'i L a-y-9� NERS E REVERSE FOR EXIT VkNATORY LA0gUfW'F, F r,_ ;. Sig es re of Applior Agent Dote t ' r - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0506 1207120026 PHONE (626) 285-0488 EXT DUPLICATE )LEGAL ID NO OF CONST BUILDING ADDRESS ITR 12998 LT 24 BL 001 SQ FT STORIES TYPE 4505 TEMPLE CITY BY, )STRUCTURE 2300 V-B. TEMP CA 917804234 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 18592-001-038 THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY C TENANT IEXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY IE%IST OCC GRP 07/16/12 SR OWNER TEL NO IBLDGS NOW ON LOT VALUATION IF D E F1+nr BY CODE LEE, BRIAN (626) 215-6870- 1 15,000 14505 TEMPLE CITY BL TEMP 917809239I FEES PAID IDffcktPTlkON OF WORK I I R VE ALL LAYERS AND INSTALL COMPOSITION SHINGLE TO BE FEE DESCRIPTION QUANTITY COM AMOUNT (CHANGED TO LITE WEIGHT TILE EL ICANT PROLROO IF NG CO (213) 663--- 8812- AA BLDG PERMIT ISSUANCE 27 60 I 14219 S ALAMEDA ST AS STATE GREEN BLDG FEE 7500 00 VAL 1 00 (SPECIAL CONDITIONS 1LOS ANGELES CA 90058 IAC STRONG MOTION RESID 7500 00 VAL 0 BO D2 PERMIT W/O FN-HC 7500 00 VAL 183 00 D2 PERMIT W/O EN-HC 15000 00 VAL 117 60 ICONTRACTOR TEL NO TOTAL FEES 330 20 APP-OVALS DATE INSPECTOR SIGNATURE IPRO ROOFING CO (213) 663-8812- I 4219 S ALSMEDA ST LIC NO LOCATION AND SETBACKS )LOS ANGELES, CA 90058 956975C39- SOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER TEL NO 1F0 R9DATION/TRENCH FORMS I I LIC NO ISLAB/UNDER FLOOR I IRAISED FLOOR FRAMING IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP IUI."CERFLOOR INSULATION I144H269 3 001 FLOOR SHEATHING IND OF FAMILIES DWELLING UNITS APT/COND STAT CLASS 1 0 NO 21 I_ I I )ROOF SHEATHING I I I SCHOOL WITHIN HAZARDOUS ISHEAR PANELS AIR QUALITY 1000 FEET MATERIALS I NO NO NO FRAVF INSPECTION FIRE SPRINKLERHANGERS I I )INSULATION/WEATHER STRIP) I INTLRIOR LATH/DRYWALL . E%TEPIOR LATH (RATED FLOOR/CEIL ASSEM I � (RATED WALL ASSEMBLIES IRATFD SHAFTS/OPENINGS II T-BAA CEILINp9 ' )LOT DRAINAGE (REPORT ID DPR261 ROUTE TO BS0508 I 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 1207120026 PHONE (626) 285-0488 EXT r LEGAL ID NO OF CONSTBUILDING D ITR 12998 LT 24 BL 001 SQ FT STORIES TYPE 450TEMPLECITY SL ]STRUCTURE 2300 V-B TEMP CA 917804234 A956550R INFORMATION NUMBER NEAREST CROSS STREET 18592-001-038 i THOMAS PAGE 597 GRID AS LOCALITY TEMPLE CITY, Cl ]TENANT IXIST BLDG DSE RESID USE 20NE R-1 ISSUED ON PROCESSED BY EXIST OCC GRP 07/12/12 SR OM`6R TEL NO �BLDQS NOW ON LOT VALUATION )LEE, BRIAN (626) 215-6870- 7,500 1FINAI. (]ATE FINAL BY CODE 14505 TEMPLE CITY BL ]TEMP 917809239I FEES PAID (DESCRIPTION OF WORK (REMOVE ALL LAYERS AND INSTALL COMPOSITION SHINGLE 1 FEE DESCRIPTION QUANTITY DOM AMOUNT (APPLICANT TEL NO I IPRO ROOFING CO (213) 663-8812- AA BLDG PERMIT ISSUANCE 27 80 1 14219 S ALAMEDA ST AB STATE GREEN BLDG FEE 7500 00 VAL 1 00 (SPECIAL CONDITIONS 1 ILOS ANGELES CA 90058 1AC STRONG MOTION RESID 7500 00 VAL 0 BO 1 1 D2 PERMIT W/O EN-HC 7500 00 VAL 183 00 TOTAL FEES 212 60 ONTRACICR TEL NO IAPPROVALS,, DATE INSPECTOR SIGNATURE IPRO ROOFING CO (213) 663-8812- I 14219 S ALAMEDA ST LIC NO (LOCATION AND SETBACKS ]LOS ANGELES CA 90058 956975C39- )SOILS ENGINEER APPROVAL - )ARCHITECT OR ENGINEER TEL NO t/UNUER DATION/TRENCH FORMS LIC NO ] FLOOR 1 1 I - ]RAISED FLOOR FRAMING M1AP NO SEWER MAP BOOR PAGE FIRE 7AHE CMP UNDEAFLOOR INSULATION 144H269 3 00 1ND OF MANICIES DWELLING UNITS APT/GOND STAT CLASS ]FLOOR SHEATHING 1 0 NO 21 ]ROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I ]AIR QUALITY 1000 FEET MATERIALS ( I I NO NO NO i FRAME INSPECTION FIRE SPRINKLER HANGERS INSULATION/WEATHER STRIP ' - I INTERIOR LATH/DRYWAr.*. - I EXTERIOR LATH RATED FLOOR/CEIL ASSEM I _ ] RATED � ASSEMBLIES I( RATED SHAFTS OPENINGS T-BAR CEILINGS I ]LOT DRAINAGE I 1 ]REPORT ID DPR261 ROUTE TO BS0508 1 I I I