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Home My Public Portal About5938 TEMPLE CITY BLVD_Building__ i WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING yc� ❑ Certified copy is hereby furnished. FOR�A/PPLICANT TO FILL IN ADDRESS �`1�W El �fi�• �G� _ Certified copy is filed with the county building inspec- BUILDING 3 b 7�wv WoTSTinn tion department. ADD RES Date Applicant CITY t IE P (A5 i!-( ZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. 417 COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) TEL. / OWNER �[ZA4 Ilk �EtADSU►�1 NO. IOZ-�'i Qa�j USE ZONE MAP 1 certify that in the performance of the work for which this NO. permit is issued, I shall not employ any person in any manner ADDRESS SPECIAL n}. CONDITIONS so as to become subject to the Workers'Compensatio Laws. O CITY ZIP Date-Applicant ARCHITECT OR TEL. ix NOTICE TO APPLICANT: If, after m this Certificate of ENGINEER NO. DISTRICT ;GROUP TYPE FIRE PROCESSED BY O g CONST. ZONE Exemption, you should become subject to the Workers' p w Compensation provisions of the Labor Code, youlmust forth- ADDRESS ��a �, a with comply with such provisions or this pernlit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR DII:c�r k—'91V 4(11 ►2 NO. 41`1g� Z LICENSED CONTRACTORS DECLARATION t� LIC. CLASS NO� DWELL. UNITS - I hereby affirm that I am licensed under provisionslof Chapter 9 ADDRESS I 7 L4 V`5 NO. (ol 3F1� (commencing with Section 7000)of Division 3 of the Business LIC, SEWER MAP and Professions Code,and my license is in full force and effect. CITY Uf r„7 oe V► I I or- CLASS G-3`1T BK PG VALIDATION SQ. FT. df NO. OF NO. OF CHECK License Number b«52'7Lic. Class V'3 of SIZE �� STORIES FAMILIES ONE VALUATION Contractor 17G1�� <<CCX Date /Ol / DESCRIPTION OF WORK fc POI tU 40 NEW 1:1 $ Elam exempt under Sec. D 2g 2C ADD ❑ ALTER ❑ B.&P.C. for this reason I REPAIR ❑ $ Date: 1 Q/ I USE OF EXISTING BLDG. DEMOL F1 Signature APPLICANT TEL. FINAL OWNW-BUILDER DECLARATION (PRINT) NO. D DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS °I' wages as their sole compensation,will do the work and / the structure is not intended or offered for sale(Section LOCALITY Poo �n�I _�_•r :+3°'�_ 7044, Business and Professions Code.) MOVING TEL. ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. h t= with licensed contractors to construct the project (Sec- ADDRESS =:y:- Ls:�r tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPpLIINEFROM 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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name P.C. Fee$ Permit Fee ��0 6 LDMA Ref. # Lender's Address - •t - I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee 2 d ordinances and State laws relating to building construction, Total Fee J LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. r �' o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date r • COUNTY OF LOS.ANGELES TEMPLE CITY # 0508 BUILDING PERMIT ' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0806180034 PHONE: (626) 285-0488 EXT: LEGAL ID: I N0. OF CONST NEW I BUILDING ADDRESS: [ ITR: 6561 IT: 196 BL: .001 I SQ. FT STORIES TYPE OCCUP GROUP 5938 TEMPLE CITY BL [ I ISTRUCTURE: 420 1 V—B B I TEMP CA 917802010 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-019-029 I I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: COMME USE ZONE: (ISSUED ON: PROCESSED BY: I [EXIST OCC GRP: B 112/17/08 SR (OWNER: TEL N0: ]BLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: ] IPIAO, MEI HUA (626) 378-7909— 1 33,800 1 ] 15938 TEMPLE CITY BL ITEMP 917800000 I FEES PAID IDESCRIPTIO OF WORK I I ITENANT IMPROVEMENT STORE FRONT RENOVATION AND RESTROOM I ]FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IRENOVATION I (APPLICANT: TEL. NO: I I 1 ]PIAO (626) 378-7909— ]Al PLANCHECK W/EN—HC 33800.00 VAL 575.63 1 1 15939 TEMPLE CITY BL IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: ITEMPLE CITY CA 91780 IAE STRONG MOTION OTHER 33800.00 VAL 7.10 ] ] IA2 PERMIT W/ENERGY—HC 33800.00 VAL 677.24 I I 1 TOTAL FEES 1,287.72 ] 1 [CONTRACTOR: TEL. NO: I ]APPROVALS DATE INSPECTOR SIGNATURE IJ C Y CO. (626) 452-8895— 1 1 1 112012 LOWER AZUSA RD. LIC. NO I ILOCATION AND SETBACKS 1 I 1 IEL MONTE, CA 91732 582921 B I I I I 1 ISOILS ENGINEER APPROVAL I 1 I (ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I I I ITENG LI (626) 797-0531— 1 1 1 I I 11070 N. ALTADENA DR. LIC. NO: I 1SLAB/UNDER FLOOR I I I PASADENA, CA 91107 NONE I I I 1 I I I IRAISED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-1 IUP'i)ERFLOOR INSULATION I ] 3 041 4 I I I �_ �d!r+ ` , IFLOOR SHEATHING I NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I l,. \ I I I I NO 22 ] IROOF SHEATHING I I I I I I [ SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I [AIR QUALITY: 1000 FEET MATERIALS I I ] I I NO NO NO I 1FRAME INSPECTION I I I I IFIRE SPRINKLER HANGERS 1 I (INSULATION/WEATHER STRIP( I ] (INTERIOR LATH/DRYWALL I (EXTERIOR LATH I 1 1 I I (RATED FLOOR/CEIL ASSEM. I I I [RATED WALL ASSEMBLIES I ] I I 1 IRATED SHAFTS/OPENINGS 1 1 I IT—BAR CEILINGS I I I [LOT DRAINAGE I I I I I I I I I [REPORT ID: DPR261 ROUTE TO: BS0508 1 1 I [ I I I I I I r / 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 0508250012 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 196 BL: .001 SQ. FT STORIES TYPE 5938 TEMPLE CITY BL STRUCTURE: VN TEMP CA 917802010 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-019-029 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: COMME USE ZONE: C-1 ISSUED ON: PROCESSED BY: EXPIRES ON: PIAO MEI HUA EXIST OCC GRP: 08/25/05 JK 08/20/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAT FINAL BY: CODE: BROOKS, RENDELL (626) 294-0292- 200 5950 TEMPLE CITY BL TEMP 917600000 FEES PAID DESC N OF WORK REPLACE DRYWALL FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: JIAN (626) 236-6726- AA BLDG PERMIT ISSUANCE 27.75 1003 BENITO AVE AE STRONG MOTION OTHER 200.00 VAL 0.50 SPECIAL CONDITIONS: ALHAMBRA, CA 91803 D2 PERMIT W/O EN-HC 200.00 VAL 43.65 TOTAL FEES 71.90 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE JIAN, WANG (626) 236-6726- 1003 BENITO AVENUE LIC. NO LOCATION AND SETBACKS ALHAMBRA, CA 91803 853450B 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 XX 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATE DRYWALL ( EXTERIOR LATE / I RATED FLOOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT XD: DPR261 ROUTE TO: BS0508 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 0510060015 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 196 BL: .001 SQ. FT STORIES TYPE 5938 TEMPLE CITY BL STRUCTURE: VN TEMP CA 917802010 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-019-029 ' THOMAS PAGE: 596 GRID: 73 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: COMMS USE ZONE: C-1 ISSUED ON: PROCESSED BY: EXPIRES ON: PIAO MEI HUA EXIST OCC GRP: 10/06/05 JK 10/01/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D E FINA CODE: BROOKS, RENDELL (626) 294-0292- 200 �- 5950 TEMPLE CITY BL TEMP 917800000 FEES PAID DES RI ION OF WORK OPENING A WINDOW FOR BATHROOM FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: APPLICANT: TEL. NO: JIAN (626) 236-6726- AA BLDG PERMIT ISSUANCE 27.75 1003 BENITO AVE AC STRONG MOTION RESID 200.00 VAL 0.50 SPECIAL CONDITIONS: ALHAMBRA, CA 91803 D2 PERMIT W/O EN-HC 200.00 VAL 43.65 TOTAL FEES 71.90 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE JIAN, WANG (626) 236-6726- 1003 BENITO AVENUE LIC. NO LOCATION AND SETBACKS ALHAMBRA, CA 91803 853450B i 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 XX 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 22 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAMs INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BSO508 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 0205070015 PHONE: (626) 285-0488 EXT: LEGAL ID: 0. OF CONST G ADDRESS: TR: 6561 LT: 196 BL: .001 SQ. FT STORIES TYPE 5938 TEMPLE CITY BL STRUCTURE: VN TEMP CA 917802010 ASSESSORINFORMATION NUMBE : NEAREST CROSS STREET: LAS TUNAS 8587-019-029 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY TENANT: EX S LDG USE: COMME USE ZONE: C- ISSUED ON: PROCESSED B EXPIRES ON: EXIST OCC GRP: 05/07;/02 JK 11/03/02 OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINAL D TE FINAL BY: CODE: HUDSON DONALD E (626) 286-8579- 1,900 ., Z 922 W. DUARTE RD TEMP 91780 E SI ESC 7 0�K OF WORK T/O;I.NSTALL 3PLY HOT MOP ROOF:NAIL 1-28#BASE,HOT MOP2-11#PLY PPLICL. 0• FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: HOT MOP 1-72# FIBERGLASS CAP J N DAVIS�ROOFING (626) 821-4665- AA BLDG PERMIT ISSUANCE 27.75 235 E COLORADO #202 AC STRONG MOTION. RESID 1900.00 VAL 0.50 SPECIAL CONDITIONS: PASADENA 91101 D2 PERMIT W/O EN-HC 1900.00 VAL 82.20 TOTAL FEES 110.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE J N DAVIS ROOFING (626) 821-4665- ' 235 E COLORADO BLVD #202 LIC. NO �LrAT SETBACKS PASADENA, CA 91101 572125039 SOILS ENGINEER A PRO AL ARCHITECT-OR ENG : FOUNDA IONPRENCHOR LIC. N0: ISLAS/UNDER FLOOR RAISED FLOOR FRAMING P N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CM : UNDERFLOOR INSULATION 150H269 3 04 0. OF f S: E 6 UNITS: T O : STAT F�5T1- G SSCLA : - NO 21 R0-OF SHEATHING S 00 HAZARDOUS S A PAN '7 AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAM; INSPECTION EQ R D 0 AL SE AC FROM X R P L M90EIRS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- I SULATION/WEA HER STRI SIDE PL- LATH/DRYWALL EXTERIOR LATH - RATED 0 CE SS RATED WALL ASSEMBLIES I S /0 S CEILINGS * ADDITIONAL DATA ON FILE -BA� 0 I REPORT ID: DPR261 ROUTE TO: BS0508