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Home My Public Portal About9849 VAL ST_Building__ > VORKERS' COMPENSATION DECLARATION ergo affvm that I have certificate of consent to self b APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or.o i a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ol fLJ� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING��jj ,..` - /l, �-->- _ tion department. ADDRESS ` E r, ?�/'T �, I C•/�� E= cQ J CITY 6 ?7L C f / , /� z I P 1 lJ G LOCALITY Date Applicant / NO. F BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE / ASSESSOR (This section need not be completed if the permit is for one TRACT .a fG ' BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) Y ^, j� TEL. �(/ OWNER 1 I /Vr I� �JJ CT/O NO. ,%v' (73> ' USE ZONE NO I certify that in the performance of the work for which this r 1 SPECIAL a permit is issued, I shall not employ any person in any manner ADDRESS G CONDITIONS so as to become subject to the Work s'Compensation Laws. /� O 6 CITY Tamp!& f;//? ZIP �0 V Date Applicant �`G'�L'" e`" v �'A ARCHITECT OR TEL. J � tP DISTRICT GROUP TYPE FIRE PR SED BY NOTICE TO APPLICANT: If, after king this Certificate of ENGINEER - C NO. 6-0 O Exemption, you should become subject to the Workers' Q,y T T O CONST ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS /0 &. ! . ! LE CIT .DO 3 �r a with comply with such provisions or this permit shall be TEL. f STATISTICAL CLASSIFICATION APT. CONDO. Z deemed revoked. CONTRACTOR NO. CLASS NO. DWELL. UNITS LICENSED CONTRACTORS DECLARATION IC' I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �flf�f NO. (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP f and Professions Code,and my license is in full force and effect. CITY CLASS BK b VALIDATION SQ. F� NO. OF NO.OF CHECK License Number Lic. Class SIZE>F STORIES FAMILIES ONE VALUATION Contractor Date - DESCRIPTION OF WORK o IS5 NEW ❑ $ 0 b ► t ADD - ❑1 am exempt under Sec. 0 1 � ALTER B.BP.C. for this reason fAM11,yBELL lU REPAIR ❑ $ Date: USE OF I , EXISTING BLDG. DEMOL ❑ Signature APPLICANT Ow _TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) p NO. _� DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS O �. � L �j L�i r Law for the following reason (Section 7031.5, Business and FINAL i Professions Code): PRESENT By EJ 1, as owner of the property, or my employees with ADDRESSS kccTm•a wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY , 3307 TCFi M4.50 7044, Business and Professions Code.) MOVING CONTIN RACTOR NO. i I 1 G11 I, as owner of the property,am exclusively contracting TOTAL with licensed contractors to construct the project (Sec- ADDRESS 1O1AL :3464-50 tion 7044, Business and Professions Code.) t 364e�C1 CONSTRUCTION LENDING AGENCY SETBACK YARD HWY TOTAPROPALINEFROM WIDTH �� I hereby affirm that there is a construction lending agency for FRONT 4+ � o� the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name --UMI 5/26/99 8 h LDMA Ref. # CM P.C. Fee$ 001- 6 Permit Fee ��+JL �i;01 Lender's Address 3W4 1 I certify that I have read this application and state that the Issuance Fee JA• S LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee +-C� /��y/ ordinances and State laws relating to building construction, Total Fee J to / LDMA Perm. # and h.reb authorize representatives of this County to enter upon the bove-ment'oned grope ty for inspection purposes. gGLN- (��r , - G " 4'` SEE REVERSE FOR EXPLANATORY LANGUAGE 'Stature of Applicant or gent Date 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 0505230056 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 12368 LT- 13 SQ. FT STORIES TYPE 9849 VAL ST STRUCTURE: 3147 VN TEMP CA 91780 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5383-025-013 THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/23/05 JK 05/18/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FIN AT F AL CODE: CHOU, Y. W (626) 446-0326- 9,580 - 9849 VAL TEMPLE CITY, CA FEES PAID amscppl OF WORK REMOVE EXISTING SHINGLE ROOF, INSTALL CLASS A 30 YR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: COMPOSITION SHINGLES ROOF HOUSE 6 GARAGE APPLICANT- TEL. NO: SOUTH COAST ROOF, INC. (714) 744-5996- AA BLDG PERMIT ISSUANCE 27.75 P.O. BOX 7305 AC STRONG MOTION REBID 9580.00 VAL 0.96 SPECIAL CONDITIONS: ORANGE, CA 92863 D2 PERMIT W/O EN-HC 9580.00 VAL 216.60 TOTAL FEES 245.31 CONTRACTOR: TEL. NO- APPROVALS DATE INSPECTOR SIGNATURE SOUTH COAST ROOF, INC. (714) 744-5996- P.O. BOX 7305 LIC. NO LOCATION AND SETBACKS ORANGE, CA 92863-7305 365271 HIC 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 153H269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: NO 21 ROOF SHEATHING Ls 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: Im. PROP LINE: WIDTH: FRONT PL- INSULATION WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATE RATE(? FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508