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Home My Public Portal About4947 TEMPLE CITY BLVD_Building__ ,*i 'WORKERS COMPENSATION DECLARATION r� 1 hereby affirm that I have a certificate of consent to ,elf -APPLICATION FOR BUILDING PERMIT insure or a certificate of Workers Compensation Insurance or a certibedc py t of (Sec 399 lab C ) - COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company J Certified copy Is hereby furnished FOR APPLICANT TO FILL IN ADDRESS BUILDING /� Certified copy is filed with the county budding inspec BURDING I non do an 1 ADDRESS '` F r Da19 Applicant �. { �, CITY i.� G/ ZIP LOCALITY CERTIFICATE EXEMPTION FROM WORKERS' / L NO OF BLDGS NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON T ST L '(This section need not be completed If the permit Is for o e - TRACT BLOCK "' LOT NO -- ASSESSOR hundred dollars (SIOD)or leu ) MAP BOOK PAGE PARCEL ' lEl USE Z E I comfy that In the performance of the work for which this OWNER - - NO 3' (]g' 3NO _ I MAP permit Is Issued I shall not employ any person In any manner �� p, y, / SPECIAL so as to become sub a to the Workers Compensation ADDRESS •LawCONDITIONS Date Applicant v A�ITECT ZIP hL a, NOTICE TO APPLICA If offer making this Cenrficab, f LK NO 24 DISTRICT TYPE FIRE BY O Exemption, you should become subject to the Work ItvEEROR 7 MT / OZ�ONE CF7- Compensation provisions of the Labor Code you must fes h . 16Wi. ✓ J LLJ with comply with such provisions or this permit shall be Ll deemed revoked STAnSncAL CLASSIFICA ION CONDO Z CONRRACTOR NO LICENSED CONTRACTORS DECLARATION UC CLASS NO y DWELL UNITS_ I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO mmmili (commencing with Section 7000)of Mvrsion 3 of the Business and LIC SEWER PG Professions Code, and my license Is In full force and effect Cm CUBK SS 3' 3 v�Q§&9 A 5O FT NO OF NO OF CHECK 1 License Number Uc CI SIZE STORIES fAMI ES ' ONE # • • is • 2 3 VALUATION lOS 2Sb Contractor Data F �� DESCRIPTION OF YAW "' . NEw Utz , 1 - 70,190 A00 f � I ism exempt under Sec ALTER , e e 7 o 1,9 0 5 B 8P C for this reason vl G/✓r °'" E { USE OF EPAIR I G06-88 Date EXISTING BIDG / DEA40L Signature - APPLICANT �s TEL RNAL OWNER-BUILDER DECLARATION PRINT iq/ NO L I hereby affirm that I am exempt from the Contractor s License / S Law for the following reason (Section 7031 5 Business and ADDRESS ZEE1 Professions Code) 13 I as owner of the property, or my employees with ADDRESS ACCT.4 wages as their sole compensation,will do the work and the structure Is not Intended a offered for sale(Section LOCALITY ' J7 336.25 PRE 70" Business and Professions Code) MOVING TEL �. 1 ITQM7 tub( I as owner of the property am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sac- ADDRESS - TOTAL s.36 2 non 7014, Business and Professions Code) ` CHECK II IRED AL . `\�1 1l I '' CTTCCf� D'Oe`S CONSTRUCTION LENDING AGENCY SET ao YARD HWY PROP LINE WIDTH v` y ' ' �" .� I hereby affirm that there Is a construction lending agency for FRONT ( {� the performance of the work for which this permit is Issued P _ (Sec 3D97 Civ C ) SIDE - lender s Name Pl. L 000M�11 �J s IDA1A Ret R Lender s Address PC Fee E G . Permit Fee p4 I 0742 1 AM 10:49 I certify that I have rood this application and stab that the issuance I" LDMA P/C• L 1 ''" . I s1 S! above Information is correct I agree to comply with all County Investigation Fee ordinances and State laws relating to budding construction, _ Tole1 Fee LOMA perm ♦ " - , and hereby authorize representatives of this County to antm �3Y7 upon the above-m/em property far I speUlon purposes o t^ • I fq REVERE FOR EXPLANATORY LANWAGE Signature of Applicant or Agent Dole 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 1108110010 PHONE (626) 2B5-0488 EXT LEGAL ID NO OF CONST BUILDING ADDRESS TR 14647 LT 51 SQ FT STORIES TYPE 4947 TEMPLE CITY BL (STRUCTURE 3500 V-B TEMP CA 917803869 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 18590-015-006 THOMAS PAGE 597 _ GRID AS LOCALITY TEMPLE CITY CAI � I ITENAN'T EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY (EXIST OCC GRP 08/11/11 - SR TOWNER TEL NO BLDGS NOW ON LOT VALUATION AFI FI Y CODE TING LAN HUA (626) 309-9991- 1 6,500 14947 TEMPLE CITY BL TEMP 917803869 FEES PAID CRIPTION OF WORK IRE-ROOF 30LB UNDER LAYMENT, 30 YEAR LIFE SHINGLES 1FEE DESCRIPTION QUANTITY UOM AMOUNT (APPLICANT TEL NO IQI YUN CONSTRUCTION - AA BLDG PERMIT ISSUANCE 27 80 IAB STATE GREEN BLDG FEE 6500 00 VAL 1 00 (SPECIAL CONDITIONS IAC STRONG MOTION REBID 6500 00 VAL 0 70 ID2 PERMIT W/O EN-HC 6500 00 VAL 166 60 TOTAL FEES 196 10 I CONTRACTOR TEL NO 1APPROVALS DATE - INSPECTOR SIGNATURE IQI YON CONSTRUCTION (626) 780-2806- 119627 MESCAL ST LIC NO LOCATION AND SETBACKS ROWLAND REIG14TS CA 91748 856012 I ISOILS ENGINEER APPROVAL 1ARCHITECT OR ENGINEER TEL NO POUNDATION/TRENCH FORMS I LIC NO (SLAB/UNDER FLOOR I I RAISED FLOOR FRAMING IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I UNDERFLOOR INSULATION 1194X269 3 001 I I FLOOR SHEATHING , IND OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I ROOF SHEATHING (yl I I 0 NO 21 Vim` I I 1 i I SCHOOL WITHIN HAZARDOUS SHEAR PANELS 1AIR QUALITY 1000 FEET MATERIALS NO NO NO FRAME INSPECTION FIRE SPRINKLER HANGERS I (INSULATION/WEATHER STRIP( INTERIOR LATH/DRYWALL EXTERIOR LATH I I I IRATED FLOOR/CEIL ASSEM I I I (RATED WALL ASSEMBLIES (RATED SHAFTS/OPENINGS I T-BAA CEILINGS I I I _ I LOT DRAINAGE I I I (REPORT ID DPR261 ROUTE TO BS0508 I I I I I I