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Home My Public Portal About5216-5218-5220-5222-5224 VILLAGE CIRCLE DR_Building__ WORKERS' COMPENSATION DECLARATION hereby affirm that I have b certificate of consent self APPLICATION FOR BUILDING PERMIT .insure, or certificate of Workers' Compensation Insurance, or a certified copy the eof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SftfETY PVD1*r.X No. Company E7' BUILDING Certified copy is hereby furnished. FOR APFILICANT TO fdLL IN ADDRESS Certified copy is filed with the county building ins BUILDING q do department. ADDRESS/ 8 CI ZIP LOCALITY Date Applican NO OF BLDGS. NEAREST ERTIFICATE OF EXEMPTION FROM W KERS' SIZE OF LOT N ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACE 11 BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) f TEL I 1 USE ZONE NO. Z'73 OWNER O. 1 certify that inLthepe?note nc the work for which this SPECIAL permit is issuedall oy any person in any manner ADDRESS 1� r r �J.V t )] CONDITIONS so as to becomjeWorkers'Compensation Laws. r�q!l O IN L ful ZIP LLVDate Appt ARCHITECT OR TEL. a! NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE P CESSED BY O Exemption, you should become subject to the Workers' CONST. ZONE w Compensation provisions of the Labor Code, you must forth- ADDRESS 5�a3 1e-3 �LL� � a_ with comply with such provisions or this permit shall beTELT /_r�,�qq STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTO a NOL PL� Z LICENSED CONTRACTORS DECLARATION n LIC. CLASS NO. Z( DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS j b f I�NO. (commencing with Section 7000)of Division 3 of the Business LIC. A 24 SEWER MAP and Professions Code,an y lic se is in full for a ffect. cl1Y C "— ' BK. PG. VALIDATION /.��71 SQ. FT. NO. OF NO. OF CHECK License Numb 0 Lic. Class SIZE STORIES FAMILIES . ONE /' G NEW ❑ VALUATION w�f� / Contracto Date DESCRIPTION OF WORK T r0W -n $ � 2-J ❑ h. I am exempt under Sec. CTER 1:1 BAP.C. for this reason ` � 1 6*E L REPAIR $ Date: USE OF EXISTING BLDG. r DEMOL ❑ Signature APPLICANT(PRINT) - TEL. FINAL NO ER-BUILDER DECLARATION r'O,tJCt� . DATE ®- I hereby affirm that I am exempt from the Contractor's LicenseADDRESS Q�J Z 9�1' -'Yi-( pil Law for the following reason (Section 7031.5, Business and FINAL S Professions Code): PRESENT Dy ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and -;r; the structure is not intended or offered for sale(Section LOCALITY pop -=`.._,,j y4 tip: 7044, Business and Professions Code.) MOVING TEL.❑ CONTRACTOR NO.I, as owner of the property,am exclusively contracting with licensed contractors to construct the project (Sec- ADDRESS �l�s AL ° y-t}T a 68 tion 7044, Business and Professions Code.) i.";"•Ir REQUIRED TOTAL SETBACK FROM EXIST. :;)�•,,.T., '`%�:7 :+^ CONSTRUCTION LENDING SET BACK YARD HWY PROP. LINE WIDTH ' ='- I herebyaffirm that there is a const ion lendin agency for FRONT �" g 9 Y 1.•!i GE �{.:• the performance of the work which this permit is issued FSIDE o: (Sec. 3097, Civ. C.Lender's Name j , 0 0-11.'+7/� LDMA Ref. #Permit Fee A ` -I i H[t,4 S L Lender's I certify that I have read this appli •tion and state that the Issuance Fee �7 �c� LDMA P/C# above information is correct. I agree mply with all County Investigation Fee 9 ordinances and State laws rel g o uilding construction, Total Fee A� /, 6 LDMA Perm.# and hereby author1 repretient 'v this County to enter J upon e p ove m n n pro r jgispect' n p r as il-- � SEE REVERSE FOR EXPLANATORY LANGUAGE Slgnatur Applicant r gent Da e _. ,yrrrL1f,,A I IUN I-UN tiU I LUI NU I- EHM I I FOR APPLICANT TO FILL IN (Print or type only) Blr'_EI'.G COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER g.ITY ZIP BUILDING AND SAFETY DIVISION NO.OF BLOGS. BUILDINGS, SIZE OF LOT NOW ON LOT ADDRESS 2- TRACT BLOCK LOT NO LOCALITY,_ " TEL. NEAREST OWNER NO. CROSS ST. .•,;-.�,�^' ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICTGROUP TYPE FIRE PRACESSED BY CITY ZIP [' CONST�,.r:' ZONE" ARCHITECTOR TEL. �:'� T "•" j I { .� ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP TEL. ADDRESS CLASS NO_&_:—__DWELL.UNITS BK PG CONTRACTOR NO � USE ZONE NAOP 7J / LIC. ADDRESS NO. SPECIAL CITY LIC. CONDITIONS CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER C NAME AND BRANCH BLDG.SETBACK FROM c FRONTPROP.LINEOF ISTREETI LA ADDRESS CIN HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING N SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH 7 SIZE STORIES - FAMILIES ONE p e + DESCRIPTION OF WORK NEW ❑ C BLDG,SETBACK FROM s •,.,,,�R,�_ ADD SIDE PROP. LINE OF ISTREETI �... ALTER ❑ = TOTAL SETBACK FROM TYPE OF EXISTING H �/ :%,.y:.4-`a-.�.z. -:.,. _ HIGHWAY f YARD _ _ EPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OF } _ EXISTING BLDG. DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ Q IN COASTAL ZONE YES ❑ NO ❑ �'AL UA T I ON$ CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S CO MPENSAT;ON INSURANCE. SIGNATURE OF "l PERMITTEE ' ADDRESS FINAL BY TEL. CITY NO. DATE 11.Af�f ( ll(-( K� N ll.l l;l_I 10. P,C, $ FEE �P PMT.C FEE HARVEY T. SRANDT. COUNTY ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION CK M O CASH p..Ao1 c v 344.7 -A 76A6380C 0480) 7/T3 _AJ �✓iv i• j �i�..,�iR w V - . t �. 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 0707250053 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: 1 ITR: 29602 IT: 1 UN: 29 I SQ. FT STORIES TYPE I 5224 VILLAGE CIRCLE DR ISTRUCTURE: 130 VN I TEMP CA 917803355 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: BALDWIN AVE 18585-001-096 I I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl 1 TENANT: ( (EXIST BLDG USE: RESID USE ZONE: R-2 TISSUED ON: PROCESSED BY: EXPIRES ON: I (EXIST OCC GRP: 107/25/07 SR 01/21/08 (OWNER: TEL. NO: JEWS. NOW ON IAT: VALUATION: IF T FIN CODE: IPORTEOUS IRENE R;SIEGEL JACK H - I 4,000 I I 15224 VILLAGE CIRCLE I I I ITEMP 917803355 I FEES PAID IDEACRIIPTION OF WORK I I I IREPLACE ALL TERMITE INFEST& /DAMAGED OR DRY ROTTED TIMBER ONI I IFEE DESCRIPTION: QUANTITY: QOM: AMOUNT:IEXISTING LATTICE PATIO COVER AT REAR OF HOME I (APPLICANT: TEL. NO: I I I IRUTHERFORD (626) 858-5300- IAA BLDG PERMIT ISSUANCE 27.75 1 I 11139 W SAN BERNADINO IAC STRONG MOTION RESID 4000.00 VAL 0.50 ISPECIAL CONDITIONS: 1 COVINA CA 91722 ID2 PERMIT W/O EN-HC 4000.00 VAL 115.80 I TOTAL FEES 144.05 I [CONTRACTOR: TEL. NO: T APPROVALS DATE INSPECTOR SIGNATURE I MERCURY TERMITE & PEST CONTROL (626) 858-5300- 1139 W. SAN BERNARDINO RD. LIC. NO I [LOCATION AND SETBACKS I I I ICOVINA, CA 91722 PR1373 * I I I I ISOILS ENGINEER APPROVAL I 1 (ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS I I I LIC. NO: 1 1SLAH/UNDER FLOOR I I I 1 I IRAISED FLOOR FRAMING I 1 I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP.I [UNDERFLOOR INSULATION I I I 1147H273 3 Oil I I I I I I IFLOOR SHEATHING I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I 1 NO 21 I IROOF SHEATHING I I 1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I I I I NO NO NO 1 IFRAME INSPECTION T I I 1REQUIRED TOTAL SETBACK FROM EXIST 1 1FIRE SPRINKLER HANGERS I I I ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I I I IFRONT PL- I 11NSULATION/WEATHER STRIP( I I 1 SIDE PL- I I I I I IINTERIOR LATH/DRYWALL I I I I I (EXTERIOR LATH 1 1RATED FLOOR/CEIL ASSEM. 1 I 1 RATED WALL ASSEMBLIES I I I 1 RATED SHAFTS/OPENINGS 1 I I IT-BAR CEILINGS I I I 1 1* ADDITIONAL DATA ON FILE II I 1 I ILOT DRAINAGE 1 1REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I I 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 0705160039 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST 1 BUILDING ADDRESS: 1 ITR: 29544 LT: 2 UN: 55 SQ. FT STORIES TYPE 5224 VILLAGE GR STRUCTURE: VN LOSA CA 900165208 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5025-011-055 THOMAS PAGE: 673 GRID: B1 LOCALITY: TEMPLE CITY, Cl TENANT: JEXIST BLDG USE: RESID USE ZONE: R-3 (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 1EXIST OCC GRP: 105/16/07 JK 05/10/08 1 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: DA FIN BY: CODE: 1POSTEOUS, IRENE (626) 444-0961- 1 6,000 15224 VILLAGE GR TEMPLE CITY CA 91780 FEES PAID IDLISCAIPTibN OF WORK CHANGING (4) WINDOWS LIKE FOR LIKE AND (2) PATIO DOORS LIKE FEE DESCRIPTION: QIIANTITY: UOM: AMOUNT:IFOR LIKE APPLICANT: TEL. NO: JALI HOSSEINZADELI (714) 373-8545- IAA BLDG PERMIT ISSUANCE 27.75 15261 CONNECTOR LN. AC STRONG MOTION RESID 6000.00 VAL 0.60 ISPECIAL CONDITIONS: HUNTINGTON BEACH D2 PERMIT W/O EN-HC 6000.00 VAL 149.40 1 TOTAL FEES 177.75 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE IGALKOS CONSTRUCTION, INC. (800) 763-4000- 115261 CONNECTOR LANE LIC. NO ILOCATION AND SETBACKS 1HUNTINGTON BEACH CA 92649 492715 HIC SOILS ENGINEER APPROVAL 1ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS 1 LIC. NO: 1SLAB/UNDER FLOOR 1RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMPmI JUNDERFLOOR INSULATION 1147H273 3 011 I I FLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 NO 21 1 1ROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NOFRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST 1 1FIRE SPRINKLER HANGERS 1 SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- iINSULATION/WEATHER STRIP SIDE PL INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. 1RATED WALL ASSEMBLIES 1 RATED SHAFTS/OPENINGS 1 1 IT-BAR CEILINGS 1 1* ADDITIONAL DATA ON FILE 1LOT DRAINAGE 1REPORT ID: DPR261 ROUTE TO: BS0508