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Home My Public Portal About5753 TEMPLE CITY BLVD_Building__ WORKERS'COMPENSATION DECLARATION tp hereby affirm that I haWor certCom a'of'consent to self, , "APIR L.I CATION FOR. BUILDING P E RM I T Insure, or a certificate of Workers'Compensation InsJrance, or a certified copy thereof(Sec: 3800, Lob. C. ., COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL-IN. ADDRESS �3 ❑ Certified copy is filed with the county building inspec- BUILDING 'tion department. ADDRESS A-7 Si N. `�� C ed-I';- - LOCALITY rn c 4 C C� NEAREST . Date Applicant CITY• £C1j/9L CCT C aq .ZIP `!7 CROSS ST. /t i M st/ CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE - I SIZE OF LOT ,�d' X•!I� NOW ON LOT MAP BOOK . PAGE PARCEL (This section need not 6e completed if the permit is for one USE ZONE MAP hundred dollars($100)or lei's.) TRACT BLOCK LOT NO. / NO: c�/�O TEL. s L! SPECIAL, >- I certify that in the performance of the-work for which this OWNER /�� /1�lkg' NO..� , S 734c, 7 CONDITIONS 0. is issued,I'shall not employ any person in any manner DISTRICT .GROUP TYPE 'FIRE PRO ED BY O0 so as fo become subject to the Workers'Compensation Laws. ADDRESS• �s m/IGE C.O- �'• T CONST. ZONE U,permit I�- P4j CITY £olt L E C/T ZIP P V (,C/ 1-7 O Date Applicant STATISTICAL IFICATION APT. CONDO. u r ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making thisCertificate of ENGINEER S 2� NO. °,J-b�S�73<G CLASS NO. DWELL. UNITS 'Exemption, you should become subject. to the Workers' IL Compensation provisions of the Labor Code, you must forth- `-ADDRESS S. SEWER MAP 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 3.6f the Business and LIC. Professions Code,and my license is in.'full force and effect. CITY" CLASS $ �(,®. SQ.FT; NO.OF 1 NO:OF CHECK ' Poo.Number Lic..Class SIZE. •7 76o STORIES / FAMILIES ONE DESCRIPTION OF WORK 5%/ � NEW Contractor Date ❑ �, O St 7 ® • ❑I am exempt under Sec: "tJ a< % die' 4MeK')rA.W ADD ALTER ❑` FINAL -7 TC B.BP.C. for this-reason REPAIR DAT • - ❑�' 'o 28 ::U Date: USE OF EXISTING BLDG. $/yt t DEMOL. ❑ B," r C Signature APPLICANTNO./� TEL. /12IRfL .' OWNER-BUILDER DECLARATION PRINT .#ERt)p �f/ I.hereby affirm that I am exempt from the'Contractor's License Law•for the following reason (Section 7031:5; Business and ADDRESS 7 3 Il!•. !i7ft f. C 'Professions Code): PRESENT ❑ I, as owner of the property, or .my employees with BUILD RIESSSG ��; �r/�C < <7 / C- wages as their sole compensation,will do"the work and the structure isnot intended or offered for sale(Section - LOCALITY 7044, Business and Professions Code). MOVING TEL. . ❑ 1,as owner of the property,'am exclusively.contracfing CONTRACTOR NO. with licensed contractors to construct the project (Sec- Y ADDRESS• 'tion 7044, Business and Professions Code). REQUIRED, TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. ' tSec.•3097; Civ..C.). SIPE' ii Q Lender's Name P.C.'Fee$ Permit Fee Lender's Address I cerfify that I have read this application and.state-that the Issuance Fee �. s above information is correct. I agree to comply with.all County Investigation Fee y 3 ordinances and State laws relating to building construction, Total Fee 0 f �Q 9 and hereby authorize represeritatives of this County to enter - 5 up is above--mentioned operty for inspection purposes. !l_�7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applico t or Agent= Date 1 ®s WORKERS'CC(AAPENSATION DECLARATION +t v er irm rhat I haver certificate of consent to self g p p L l CA O N FOR Bid I L D I� - G P E RM I T � Insure, or a ce�;j�.ieafe Zf Workers'Compensation Insurance, or a certified copy thereof(Sec. 38W:Lab. C.) •s COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING r er 1 ADDRESS e' ❑ Certified copy is filed with the county building irispec- BUILDING 3 7 tion department.. ADDRESS s Date Applicant CITY Zfzzy RLf C 17V ZIP / 78 0 LOCALITY CERTIFICATE OF•EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST ,� ' COMPENSATION INSURANCE SIZE OF LOT Sv X NOW ON LOT CROSS ST. UJ v �-49n (This section need not be completed if the permit is for one ASSESSOR hundred dollars($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL �s TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER !7J 1✓" J�Yh 1/�f•4N0. �i= fin( NO. permit is issued, IFE AL .shall not employ any person in any IL manner ADDRESS 17y ,`� CONDITIONS O so as to become subject to the Workers'Compensation Laws. W } an ZIP � Date &��BG Applicant �'� - "'� NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. G ENGINEER . . NO• DISTRICT G OUP TYPE FIRE PROC SED BY Exemption, you should become subject to the Workers' �`/'(� �2 CONST. , / ZONE W Compensation provisions of the Labor Code, you must forth-. AD.DRESS v 0 J V p with comply with such provisions or this permit .shall be - TEL, STATISTICAL CLASSIFICATION APT. CMNDO. y deemed revoked.. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION - LIC: CLASS NO.Z 1 _DWELL. UNITS - I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (commencing with Section 7000)of Division 3•of the Business and LIC. j Professions Code,and my license is in full force and effect. CITY CLASS BK L- PG 5?/ VALIDATION SQ.FT NO.OF NO.OF CHECK License Number Lic.Class SIZE 2 STORIES FAMILIES ONE VALU�T QN� Contractor Date DESCRIPTION OF WORK' 7'/ /2S NEW D O $ 17/ I I am exempt under Sec. -77 0.,- e) 7- Gam'ff 13 ALTER ❑ pill. 2 4.8 b 0 A B.&P.C. for this reason m- REPAIR ❑ $ # o 'o 0 0 2 3 Date: USE OF BLDG. O f�7'£ DEMOL ❑ 'I o357.00 EXIAPPLICANT EL. 0 .357. 0 0 Si n FINAL $b � 2 Q Signature PRINT nature OWNER-BUILDER DECLARATION - _ DATE •• (� ,� I hereby affirm that I am exempt from.the Contractor's License ADDRESS 7 J C BC dD FINAL Law for the following reason (Section 7031.5, Business and Professions Code): PRESEN BY. BUILDING �� I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and oil, 1Rnsd• uW J o the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). 6 8 1. REQUIRED TOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY' PROP.LINE WIDTH. . I 1 hereby affirm that there is a construction lending agency for FRONT # o o the performance of the work for which this permit is issued P.L. ; (Sec. 3097, Civ. C.). SIDE ( ° N2 . I g P.L. Q Lender's Name LDMA Ref. # ° ° 4 3 P.C.Fee$ 3,5-71104 Permit Fee O p B Lender's Address _nn 1 certify that I have read this application and state that the Issuance Fee I✓ LDMA.P. C# ' # o,0 0 0 0.1 above information is correct. I agree to comply with all County Investigation Fee ["' LDMA Perm.# ordinances and State laws relating to building construction, Total Fee .7 U and hereby authorize representatives of this County to enter 1 - 43.(150 i UPQD the above-mentioned property for inspection purposes. t SEE REVERSE FOR EXPLANATORY LANGUAGE ° ° 4 3 Q 5 0 C R Signature of Applicant oAg r ent Date O 1IK WORKER°"COMPENSATION DECLARATION ' i hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT 11i.g &sure, a certificate of Workers'Compensation Insurance, 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 tLEA r ❑ Certified copy is filed with the county building inspec- BUILDING �,_ _ C ` tion department. ADDRESS Q Date Applicant CITY C r ZIP -/, a LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT S G NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. A MAP BOOK PAGE PARCEL OWNER j ��,i'+/ n f� Z NO.ac 8s 3�G USE ZONE MAP I certify that in the performance of the work for which this SPECIAL permit is issued, I shall not employ any person in any manner IL ADDRESS-5 P/ Z NJ ry CONDITIONS V so as to become subject to the Workers'Compensation Laws. J R CITY ZIP ad Date 4 Applicant ARCHITECT OR TEL. 0 NOTICE TO APPLICANT: If, after making this Certificate ENGINEER NO. DISTRICT GR111P TYPE FIRE PR ESSED BY Exemption, you should become subject to the Workers' +UZ CONST ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS s , '5 CL W with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION e�dn�� APT. rNDO. Z deemed revoked. CONTRACTOR KV NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO.1 �, QWEIk..UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. SEWER MAP (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 BK PG VALIDATION SQ. FT INO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION d DESCRIPTION OF WORK e' t NEW ❑ I /1� G �� Contractor Date ADD ® $) V ` ❑ I am exempt under Sec. 't tygxk S �� ALTER ❑ B.&P.C. for this reason I /S—/W A_ /y REPAIR ❑ $ USE OF ❑ Date' EXISTING BLDG. G tsz DEMOL Signature I APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) I7 vr/ /K NO. l-73a DATE I hereby affirm that I am exempt from the Contractor's License ADDRE55� t'g'3 [E C/ r�� FI Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT 21 I, as owner of the property, or my employees with BUILDING A 4 8 a,4 A wages as their sole compensation,will do the work and LOCALITY # 0 0 0 0 0 1 the structure is not intended or offered for sale(Section ' 7044, Business and Professions Code). I MOVING 'TEL. ❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. ° 1 1550 with licensed contractors to construct the project (Sec- ADDRESS ° ° 1 1 S 5 0 5 tion 7044, Business and Professions Code). REQUIRED YARD HWY TOTAL SETBACK FR M '061 9_8 6 CONSTRUCTION LENDING AGENCY SET BACK PROP.LINE WIDTH 1 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.). I rInvestigation e Lender's Name LDMA Ref. # : Lender's Address Permit Fee [f/� (Jf� ' I certify that I have read this application and state that the Issuance Fee / r/ a s LDMA P/C# a above information is correct. I agree to comply with all County \ /� ordinances and State laws relating to building construction, Total Fee J s�V LDMA•Perm. # d and hereby authorize representatives of this County to enter 41 upon the above-mentioned property for inspection purposes. ti Q / �l� _ SEE REVERSE FOR EXPLANATORY LANGUAGE n n Signature of Applicant or Agent Date l i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMBNT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0608110036 PHONE: (626) 285-0488 ERT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 IT: 609 UN: .002 SQ. FT STORIES TYPE 5753 TEMPLE CITY BL STRUCTURE: 403 VN TEMP CA 917802510 ' ASSESSOR INFORMATION NUMBER: 'NEAREST CROSS STREET: 8587-016-011 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-3 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/11/06 JK 08/06/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUBTION: FINAL DATE FINAL BY: CODE: RAMIREZ HERMAN H;SUZANNA L (626) 285-7366- 5,240 y/1/ y� 5753 TEMPLE CITY BL (✓ /o aP TEMP 917802510a `%YEES PAID DESCRIPT ON OF WORK e`er PATIO COVER OPEN SOLID-AND LATTICE 403 S.F. FEE DESCRIPTION: QUANTSTY: UOM: AMOUNT: APPLICANT: TEL. NO: ALBERTO (909) 594-7547- AA BLDG PERMIT ISSUANCE 27.75 786 PINEFALLS AVE AC STRONG MOTION REBID 5240.00 VAL 0.52 SPECIAL CONDITIONS: WALNUT, CA 91789 AX BUILDING REVIEW FEE 54.70 D2 PERMIT W/O EN-HC 5240.00 VAL 149.40 TOTAL FEES 232.37 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE WEST COAST CUSTOM ROOMS (909) 594-7547- 786 PINE FALLS AVENUE LIC. NO _ ti LOCATION AND SETBACKS WALNUT, CA 91789 4716198 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO. SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 150X269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SR'3AR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: RWY: PROP LINE, WIDTH: FRONT PL- INSULATION WEATHER STRIP SIDE PL- INTERIOR LATH DRYNALL EXTERIOR LATH I RATED FLOOR CEIL ASSEM. i RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 i I