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Home My Public Portal About5466 TEMPLE CITY BLVD_Building__ WORKERS COMPENSATION DECLARATION insure, that I have r cs' Come of consent r ,elf' APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance r- or a certified copy thereof (Sec 3800, L,obb�C) BUILDING �//�'�',/ _ _ COUNTY OF LOS ANGELES AND SAFETY_ Policy No Company. /� /'�e'CT BUILDING ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN / I ADDREss C 1 VD ❑ Certified copy is filed with the county building irupec- - AADIDRESSSS Cb - tion department , I �}- Date Applicant , CITY 4— NOTICE ZIP LOCALITY ) L .: NO OF BL NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE CF LOT Z-L NOW ON LOT CROSS ST COMPENSATION INSURANCE' ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LO7 NO Mqp BOOS' C,J PAGE O PARCEL O�� hundred dollars ($100) or less )' - t OWNER NO _TEL 115E ZONE MAP .I certify that d the performance a the work for which this �^V SPECIAL }a ' lug permit is issued, I shall not employ arty person m any manner ADDRESS �,Z 7 6 6 �� CONDITIONS so as to become subject to the Workers'Compensation Laws O ` ' CITU ZIP - U Date Applicant ARCHITECT OR TEL IY NOTICE TO APPLICANT If, after making this Certificate of ENGINEER - NO _ _ I ,�DIISTRIC(T/ �QROJF TYPE �{' FIRE PROC�E�SSSSE�D BY 0 Exemption you should become subject to the Workeri hL o7 K '1 � I/ ZONE � 0 Compensation provisions of the Labor Code, you must forth- ADDRESS cl ((illi J ...J� with comply with such provisions or this permit shall be TEL 7 STATISTICAL CLASSIFICATION , CONDO Z deemed revoked CONTRACTOR NO �3/ '7 LICENSED CONTRACTORS DECLARATION ADDRESS C / rU•sCo 0 CLASS NO DWELL UNITS.111 I hereby affirm that I am licensed under provisions of Chapter 9 L (commencing with Section 7000)of Div son 3 of the Business ee UIQ SEWER AVP 7 and Professions Code,and my license n in full face and effect CIN /Ifs YALI- D_ATIONN 97 L/ SO FT 00 OF NO OF CHECK BK PG T j_' License Number `(0�1 V 0 Lic Clan SIZE ✓ STORIES FAMIUES ONE Contract rl//44- Date /Z� DESCRIPTION OF WORK NEW ❑ VALUATION , t TOTAL 335. 97 ❑I am exempt under Sec $ ADD : ► MCK n5.97 _ ALTER ❑ - WMIGE DO B 8P C for this reason _ USE�- 6C - f REPAIR ❑ S �� Signature —Date EXISTING TEL oEMa ❑ ' gg00��0770-0001. \ 1�2,/,[� E_/89 (PRINT) NO FINAL Ys9f? 1 OWNER-BUILDER Dram the ON DATE I hereby affirm that I g r exempt from the Contractor's License - 3 Law for the following reason (Section 7031 5, Business and '��u FINAL 1 ITER' Professions Code) - _ By - 583 ❑ I, m owner of the or m em to ees with BUILDING '1 TOTAL 67 . ,.f a..E property Y P Y ADD I 67.J.• wages W their sole compensation,will do the work and - -- - * ,CHEM . the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code ) MOVING TEL ( I _ ❑ 00 1, os owner of the property, am exclusively contracting CONTRACTOR NO , with licensed contractors to construct the project (Sec- _ tion 7044, Business and Profession Code ) ADDRESS CONSTRUCTION LENDINGAGENCY "' SET REQUIRED TOTYARD FILVY AL PAONFROM I \.� ,�.\_ _ _ Q,340 1 AM 8:41 1 hereby affirm that there is a construction lending agency for FRONT `I L the performance of the work for which this permit is issued, P L (Sec 3D97, Civ C) SIDE O D f,. r foil PL Lenders Name ID Ref N P C Fee S 5. PermitFee • 2 Lenders Address _ �s ; y g I certify that I have read this application and state that the ' 5(y Issuance Fee-- 13 ._o L7 TAA P/C Y ► L o_ above information is correct I agree to comply with all County Inveategatwn Fee _ Q ordinances and State lova relating to building construction, Total Fee V LDMA Perm 0 and hereby authorize representatives of this County to enter upon the abo erten oned property for inspection purposes (y �O . p �ti r AVL n Y UZ/1'� en TEE RiVB6!FOR EXPLANATORY LANGUAGE N6LANGUAGECCIO t -G C� r_rj V I •J1 S,�Apphmnt or Agent Dole � _ � .,-. COUNTY OF LOS ANGELES TEMPLE CITY q 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS-TUNAS ALTERATION/REPAIR BUILDING AND SAFELY / LAND DEVEWPMENT TEMPLE CITY CA 91780 BL 0508 0902240018 PHONE (626) 285-0488 EXT LEGAL IO NO OF CONST BUILDING ADDRESS ON FILE SQ FT STORIES TYPE 5466 TEMPLE CITY BL STRUCTURE V-B TEMP CA 917803150 ASSESSOR1INFORMATION NUMBER - NEAREST CROSS STREET OLIVE 8588-023-022 - THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY Cl TENANT EXIST BLDG USE RE9ID USE ZONE R-1 JISSUED ON PROCESSED BY EXIST OCC GRP 102/24/09 _ _._ SR__________ ____c JOWNER TEL NO BLOCS NOW ON LOT VALUATIONF E VV r FIM ( BY CODE I ALVARADO SOPTEMHIA (626) 512-6473- I 4 800 �I 1 15466 TEMPLE CITY BL �I ITEMP 917803150 PEES PAID DESCRIPTION OF PARK CHANGE 16 WINDOWS ALUMINUM TO VINYL RETROFIT AND 1 SLIDING PEE DESCRIPTION QUANTITY 00M AMOUNT IPATIO DOOR APPLICANT TEL NO GUERRERO (562) 318-7641- AA BLDG PERMIT ISSUANCE 27 75 [ 1 - 1844 E BONDS ST JAB STATE GREEN BLDG FEE 4800 00 VAL 1 00 SPECIAL CONDITIONS 1 ICARSON, CA 90745 JAC STRONG MOTION REBID 4800 00 VAL' 0 50 1 D2 PERMIT W/0 EN-HC 4800 00 VAL 132 60 I JFR INV WORK W/O PERMIT 257 00 DOL 257 00 CHITE7CTURAL CREATIONS Tj E 310) 505-4255- NOTOTAL FEES 418 85 APPROVALS DATE INSPECTOR SIGNATURE I AR 1917 N BAY VIEW AVENUE LIC NO 1 (LOCATION AND SETRACKS 1 WILMINGTON CA 90744 759571 S f SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER TEL NO IFOGN0.ATION/1RENCH FORMS 1 1 I LIC NO SLAB/UNDER FLOOR _ RAI BED FLOOR FRAMING _ _ I I I I [MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP (UNDERFLOOR INSULATION 1147H269 3 00 1 1 (FLOOR SHEATHING INO OF FAMILIES DWELLING UNITS AFT/COND STAT CLASS NO 21 (ROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS 15HFAR PANELS I I I JAIR QUALITY 1000 FEET MATERIALS I NO NO NO _ IFRAME INSPECTION I I REQUIRID 1OTAL SETBACK FROM IXIST PIRE SPAINRi.AR HANGERS ISET BACK YARD HWY PROP LINE WIDTH 1 1 1 1 1 IFRONT PL- INSULATION/WEATHER STRIPI I I I SIDE PL- I 1 INTERIOR LATH/DRYWALL 1 EXTERIOR LATH [ 1 1 I I I I I I IRATED FLOOR/CEIL ASSEM RATED WA L ASSEMBLIES ' RATED SHAFTS/OPENINGS IT-BAR CEILINGS (LOT DRAINAGE I I REPORT ID DPR261 ROUTE TO BS0508 I I I I I I