The URL can be used to link to this page

Home My Public Portal About5945 TEMPLE CITY BLVD_Building__ WORKERS'COMPENSATION DECLARATION ` I hereby affirm that I have certificate of consent to self APPLICATION pPLICATI®N F®R BUILDING PERMIT •insure.' �a certificate of Workers'Compensation Insurance, Z a carded copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND JAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDR SS &1241 LL9 X6' Certified copy is filed with the county building inspec- BUILDING G tion department. ADDRESS�� 1 l ,1 I L Date Applicant CITY E �� ZIP °LOCALITY 71. '•r CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST 0 COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS IT. U (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. ASSESSOR hundred dollars($100)or less.) /� p MAP BOOK PAGE PARCEL OWNER RO N M L•LIE TAUS 1 , USE ZONE MAP I certify that in the performance of the work for which this p p ' (� NO. permit is issued, I shall not employ any person in any manner ADDRESS O�8 •IBJ(•I S 1� SPECIAL iz so as to become subject to the Workers'Compensation La s. CONDITIONS U Date �9 oC f-47 Aplicant S CITY l 115 ZIP 9 Q I I OR NOTICE TO APPLICANT:pIf, offer making this C ARCHITECT TEL.rfificate of ENGINEER NO i- DISTRICT GROUP TYPE FIRE PROCESSED BY O Exemption, you should become subject to the Workers' / / If / ZONE - Compensation provisions of the Labor Code, you must forth- ADDRESS L a XO N V ZO W ILI with comply with such provisions or this permit shall be deemed revoked. TEL. STATISTICAL CLASSIFICATION AP CONDO. (A CONTRACTOR NO. �r / Z LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. 16 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. Professions Code, and my license is in full force and effect. CITY CLASS BK PG VA&IM994Q A SQ.FT. NO.OF NO.OF CHECK SIZE STORIES FAMILIES ONE License Number Lic.Class �y # 0 0 0 0 0 DESCRIPTION OF WORK ` I NEW DD C] VALUATI•✓N, (/�� Contractor Date 1 0 0 3 3 0 0 A ❑I am exempt under Sec. ALTER 0 0 - 33,00,9 B.BP.C. for this reason 1ZlC Gl( � ___Tp Z111 EPAIR ❑ $ Date: U E OFw t IEMOL ❑ I Q26-87 EXISTING BLDG. CL�1�N 1 1V Signature APPLICANT 7' nv,/ TEL.P f jl _/ 7/ FINAL OWNER-BUILDER DECLARATION PRINT SPIn41 G /C l V ; NO. 9v 7� / /� w� y (� /�► DATE/O ^ j I hereby affirm that I am exempt from the Contractor's License ADDRESS l!%��/►'r ��•� N�2� r` 7 f/2c Law for the following reason (Section 7031.5, Business and • FINA r Prpfessions Code): RE By 114Q`11 BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 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). REQUIRED TOTAL SETBACK IR ROW"'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. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # P.C.Fee$ Permit Fee r• (/ Lender's Address I certify that I have read this application and state that the Issuance Fee I L/ LDMA P/C# Poo 3 above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, g Total Fee, and hereby authorize representatives of this County to enter .(� LDMA Perm. # $ upon the above enti property for inspection purposes. sQin a-/01 /cam oSEE REVERSE FOR EXPLANATORY LANGUAGE Signature MApplicant or Agent Date WORKERS'COMPENSATION DECLARATION Y sure, affirm that I have r certificate of consent to self APPLICATION P L I A I FOR BUILDING I T jasure, or a certificate of Workers'Compensation Insurance, ® L1U or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company I Jn ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDR SS ❑ Certified copy is filed with the county building inspec- BUILDING F ,(� ��' tion department. ADDRESS �T4`:a /T�4` /� ft Date Applicant CITY A`` ,a ZIP LOCALITY < - c ^= CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. NEAREST J COMPENSATION INSURANCE SIZE OF LOT 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. Q ,.// y MAP BOOK PAGE PARCEL OWNER I L /L ' NO��+� % `/ 'USE ZONE MAP I certify that in the performance of the work for which this Q /�� / h /nI NOSF . (� permit is issued, I shall not employ any person in any manner ADDRESS �/ /� "'" u��n �/ �� `,�� CONDITIONS 1 IAL so as to become subject to the Workers'Compensation Laws. O s2 U Date Applicant CITY !� ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PRq�CESSED BY O ENGINEER NO. r. CONST. ZO E Exemption, you should become subject to the Workers' y �,C /)k Compensation provisions of the Labor Code, you must forth- ADDRESS /�� //Wow A 4K �tv(J V with comply with such provisions or this permit shall be V TEL. STATISTICAL CLASS APT. DO. Z deemed revoked. CONTRACTOR NO. LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. � DWELL. UNITS — 1 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 �L/ VALIDATION SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES—" LUATION ONE � VAI/ Contractor Date DESCRIPTION OF WORK �� •NEW 0. $_ /}�� ADD E]:. (l � �J ❑ I am exempt under Sec. 14 ALTER 7 B.BP.C. for this reason REPAIR ❑ $ USE OF Date: EXISTING BLDG. DEMOL ❑� ��r//� /�n Signature APPLICANTTEL. FINAL OWNER-BUILDER DECLARATION (PRINT) RINT NO. DATE r Z w I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business and ADDRESS FIN J� PPrfessions Code): PRE EN B .00 BUILDING I, as owner of the property, ormy employees with ADDRESS wages as their sole compensation,will do the work and LOCALITY the structure is not intended or offered for sale(Section 7044, Business and Professions Code). MOVING TEL. 8 2 A ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. # 0 0 0 0 0 1 with licensed contractors to construct the project (Sec- ADDRESS0 0 7 8 Q Q tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK o 0 0 7 a Q Q v 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. I (Sec. 3097, Civ. C.). SIDE G28-87 P.L. Lender's Name 2 LDMA Ref. # P.C.Fee$ - ) Permit Fee f Lender's Address I certify that I have read this application and state that the Issuance Fee C (/ f LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee iordinances and State laws relating to building construction, Total Fee r(,/ LDMA Perm.# and hereby authorize representatives of this County to enter S upon the above-mentione prop or inspection purposes. �7 V 'J SEE REVERSE FOR EXPLANATORY LANGUAGE 0 Signature of Applicant Agent Date ' COUNTY OF LOS ANGELES 5 TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT i TEMPLE CITY CA 91780 BL 0508 0911230035 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I I ON FILE I SQ. FT STORIES TYPE OCCUP GROUPI 5945 #1 TEMPLE CITY BL I ISTRUCTURE: 1200 1 V-B B I TEMP CA 91780 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: T 18587-014-007 'i 1 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl ITENANT: ` (EXIST BLDG USE: COMMS USE ZONE: ISSUED ON: PROCESSED BY: 1 I (EXIST OCC GRP: B 111/23/09 SR I TOWNER: TEL. N0: IBLDGS. NOW ON LOT: VALUATION: IF TE FINAL BY: CODE: ITONG, LUCITA C (626) 512-1274- 1 8,900 1 I 15945 TEMPLE CITY BL. T T I D ITEMPLE CITY CA 91780 I FEES PAID 1seRIPTION OF WORK itT I I (TENANT IMPROVEMENT NEW INTERIOR PARTITIONS FOR OFFICES 1 [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I (APPLICANT: TEL. NO: I I 1 ILAI (626) 288-2651- IAA BLDG PERMIT ISSUANCE 27.75 1 I 8748 VALLEY BLVD. #K IAB STATE GREEN BLDG FEE 8900.00 VAL 1.00 ISPECIAL CONDITIONS: ROSEMEAD, CA 91770 1AE STRONG MOTION OTHER 8900.00 VAL 1.87 1 AX BUILDING REVIEW FEE 54.70 _1A2 PERMIT W/ENERGY-HC 8900.00 VAL 229.77 1 CONTRACTOR: TEL. NO: I TOTAL FEES 315.09 1APPROVALS DATE INSPECTOR SIGNATURE IBEYOND CHOICE CONSTRUCTION (909) 463-9995- I 1 I 17615 ETIWANDA AVENUE #201 LIC. NO I ILOCATION AND SETBACKS I 1 I IRANCHO CUCAMONGA, CA 91739 916375 B I I I I I I SOILS ENGINEER APPROVAL I 1 I (ARCHITECT OR ENGINEER: TEL. NO: I FOUNDATION/TRENCH FORMS I 1 LIC. NO: - I (SLAB/UNDER FLOOR I I I 1 1 I_I I I 1(RAI ED FLOOR FRAMING I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( UNDERFLOOR INSULATION I I 1 3 041 _ p 1 I I 1 I i J C( �� 1 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: f t I NO 22 1IROOF SHEATHING I I I 1 I r - �a 6:3�� 1 " I I I I SCHOOL WITHIN HAZARDOUS I 1 ISHE)LR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS I I 1 NO NO NO i TFRAME INSPECTION I 1FIRE SPRINKLER HANGERS I I I I I I I I I IINSbLATION/WEATHER STRIPI I [ I I I I I I I NTPRIOR LATH/DRYWALL I 1EXT�RIOR LATH I I 1 I I I (RATED FLOOR/CEIL ASSEM. I I I I I 1 IRATED WALL ASSEMBLIES I I 1 (RATED SHAFTS/OPENINGS 1 1 I T-BCEILINGS I I 1 I I I I 1LOT DRAINAGE I 1 I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY g 0508 , BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS TENANT IMPROVEMENT BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1210170023 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEWBIIILDING ADDRESS: I ON FILE SQ. FT STORIES TYPE OCCUP GROUP 5945 TEMPLE CITY BL (STRUCTURE: 1200 1 V-B B TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: WOODRUFF 8587-014-007 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI ((TENANT: JEXIST BLDG USE: COMMS USE ZONE: ]ISSUED ON: PROCESSED BY: VISTA IT CONSULTING/TRAINING JEXIST OCC GRP: B 110/24/12 SR [OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IF NAL DATE FI AL BY: CODE: TEMPLE CITY PLAZA (626) 289-4088- 1 3,500 (' 1238 S. ATLANTIC BLVD I IALHAMBRA, CA 91801 FEES PAID IDESC IPTION OF WORK IT/I INTERIOR NONBEARING PARTITION FOR PROFESSIONAL OFFICE I [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 APPLICANT: TEL. NO: I I IYUNG, BRIAN (626) 579-6053- IA1 PLANCHECK W/EN-HC 3500.00 VAL 113.20 1 15945 TEMPLE CITY BL IAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: TEMPLE CITY CA 91780 IAB STATE GREEN BLDG FEE 3500.00 VAL 1.00 IAE STRONG MOTION OTHER 3500.00 VAL 0.70 IA2 PERMIT W/ENERGY-HC 3500.00 VAL 133.20 ]CONTRACTOR: TEL. NO: TOTAL FEES 275.90 JAPPROVALS DATE INSPECTOR SIGNATURE IS B L CONSTRUCTION INC (626) 512-5748- 1 19173 SOUTHVIEW ROAD LIC. NO ILOCATION AND SETBACKS I ISAN GABRIEL CA 91775 754301 I SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I LIC. NO: (SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:] JUNDERFLOOR INSULATION 1 3 001 1- I I IFLOOR SHEATHING [NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: I I I 0 NO 22 I (ROOF SHlEATHING SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS 1 (AIR QUALITY: 1000 FEET MATERIALS I I I NO NO NO I IFRAblE INSPECTION 1 (FIRE SPRINKLER HANGERS I (INSULATION/WEATHER STRIP( IINTERIOR LATH/DRYWALL I EXTERIOR LATH IRATED FLOOR/CEIL ASSEM. I I I IRATED WALL ASSEMBLIES IRATED SHAFTS/OPENINGS I IT-BAR CEILINGS I I 1 [LOT DRAINAGE I 1 I IREPORT ID: DPR261 ROUTE TO: BS0508 1 [ I 1 I I I I I I