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Home My Public Portal About5521 WELLAND AVE_Building__ 76A638A CE;;803 6-62 APPLICATION FOR BUILDING PER COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY �s JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUP'T OF BUILDING CROSS ST. f FOR APPLICANT TO FILL IN DISTRICT NO. ROUP TYPE Z ESSED BY . ,} CONST 71/ BUILDING STATISTICAL CLASSIFICATION EWER MAP ADDRESS BK G CLASS. NO. DWELL. UNITS LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED ❑ CERTIFICATE: TRACT MAP HIGHWAY NO.OF BLDG$. N�.. . (CIRCLE) STATE MAJOR SECOND, L CAL SIZE OF LOT , NOW ON LOT- USE ZONE/ SPECIAL / USE OF CONDITIONS EXISTING BLDG. TEL. Qe OWNER S c " NO J] BUILDING EXIST. AA / SETBACK YARD HWY STREET ME WIDTH ADDRESS 'V�9 ICS J . FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P. L. a ADDRESS C i TEL. �' CONTRACTORk/ '� ff J' NO. �! ♦ v ADDRESS /O.S,� (/S`j a DESCRIPTION OF WORK ` '`'A ' L LL a NE 40 ALTER REPAIR DEMOLISH �• ^.� ` - v' T. J NO. OF NO. OF ` r SIZE / STORIES 1 FAMILIES USE OF ^n �� ` STRUCTURE �S/ A /,9 f r s r Ae SIGNATURE OF '- Ao APPLICANT VALUATIONS , APPROVALS IDATE INSPHCT SIGNATURE P.C. PMT. �J FOUNDATION: LOCATION 7 FEE S FEE FORMS, MATERIALS k FRAME: FIRE STOPS, /) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS �J AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY i WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. Q-'Y , TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. LATH. EXT. G �t SIGNATURE OF HOUSE NUMBER COR- PERMITTEE PERMITTEE_ RECT AND POSTED ADDRESSFINAL - ' JOHN F. LEWIS. PRINCIPAL ST TU RAL ENGINEER PLAN CHECK VALIDATION,/ C .KM.O. CASH _ PERMIT VALIDATION �K. ' M.O. CASH LI A60 1 1 5 J FEB 2 0 2 3 D 2 3 5 a �.;iLO 1 7 7 1 D 4 6.5 0— �/ WORKERS'COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compenstion Insurance,or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS 5521 Welland Avenue ElCertified copy is filed with the county building inspec- BUILDING tion department. ADDRESS LOCALITY Tem le t NEAREST Date Applicant CITY Temple CitV zip 91780 CROSS ST. Daines CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 50415 r NO.OF BLDGS. ASSESSOR NOW ON LOT MAP BOOK PAGE PARCEL COMPENSATION INSURANCE (This section need not be completed if the permit is for one J USE ZONE MAP �c� TRACT a�t✓r� BLOCK LOT NO. No. rte`�^ .! !- hundred dollars ($100)or less.) >_TEL. a SPECIAL IL I certify that in the performance of the work for which this OWNER Mr & Mrs. Monaco NO- 443 5045 NDITIONS DISTRICT GROUP TYPE FIRE PROC ED BY U permit is issued, I shall not employ any person in any manner CONS ZONE ADDREss5521 Welland Ave. `/so as to/�become ((SSsubject to the Workers'Compensation Laws. S<<' P -� 7J Y Date g 16`d� Applicant Q,� CITY Temple City ZIP 9L. STATISTICAL CLASSIFICATION APT. CONDO. '\NOTICE TO APPLICANT: If, after makin This Certificate of ARCHITECT OR TEL. -� LU Exemption, you should become subject to the Workers' ENGINEER 1 NO. CLASS NO. DWELL. UNITS i9. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. BK. - PG,�� VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS r NO. VALUATION (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 $ 5000.00 SQ. FT.r NO.OF NO.OF CHECK License Number Lic.Class SIZE tJ-� STORIES FAMILIES ONE $ Contractor Date DESCRIPTION OF WORK NEW All I am exempt from the licensing requirements as I am a garage (340Sgr) & convert (180 4) licensed architect or a registered professional engineer ALTER ® FINAL acting in my professional capacity (Section 7051, to family room REPAIR DATE Business and Professions Code). USE OF EXISTING BLDG. DEMOL :, FINAL i Lic.or Reg.No. Date APPLICANT TEL. By yy OWNER-BUILDER DECLARATION (PRINT) Robert G. Monaco NO.443 5045 I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 5521 Welland Ave Temple Cit Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS o8 ,] r wages as their sole compensation,will do the work and the structure is not intended or offered for sale(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- 6 1,r 0 tion 7044, Business and Professions Code). ADDRESS REQUIRED BACK TOTAL SETBACK FROM EXIST. ° c .' I,I r CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT U h ;,— the performance of the work for which this permit is issued P L (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name Lender's Address P.C. Fee$ Permit Fee W I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee 0 ordinances and State laws relating to building construction, Total Fee i W and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. ' ax i mtm ac J SEE REVERSE FOR EXPLANATORY LANGUAGE Signaturloof Applicant or Agent Date ®s i j WORKERS' COMPENSATION DECLARATION t t.a '1 hcreby1Off%rm that I have a certificate of consent to self APPLICATION F O�''' "'I L D'NG P E.RM I T 'insufre, or a certificate of Workers' Compensation Insurance, or a certified cSpy 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 _j e �� d, o. ❑ Certified copy is filed with the county building inspec- BUILDING ` CAC4ak[Avg �1 tion department. ADDRESS 1 —1 rm Date Applicant CITY ? Lt, ZIP 1784 LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST SIZE OF LOT NOW ON LOT CROSS ST. v,� eow COMPENSATION INSURANCE ASSESSOR14aa (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK GEC PARCEL033 hundred dollars ($100)or less.) TEL. / OWNER e, NO S USE ZONE MAP NO. �D r I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS k N W pe-6;7- SPECIAL a- CONDITIONS so as to become subject to the Workers'Compensation Laws. O CITY ZIP v Date Applicant ARCHITECT OR I TEL. DISTRICT GROUP TYPE FIRE PRO SSED BY W_ NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- ADDRESS aa- e73 1 with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. C O. N deemed revoked. CONTRACTOR NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. aZ DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. (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 CLASS BK PG VALIDATION SQ. FT. NO. OF r NO.OF J CHECK License Number Lic. Class SIZE QQ I STORIES 1 FAMILIES ( ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW Eln ��Q ADD $,J0, ,Ja -IL•':. ° ❑1 am exempt under Sec. J111 ► --� - ALTER BAP.C. for this reason REPAIR ❑ $ - USE OF -' Date- EXISTING BLDG. DEMOL ❑ ^- APPLICANT TEL. Signature OWNER-BUILDER DECLARATION (PRINT) N S FINAL =$-r+ - 94 t+' 1 hereby affirm that I am exempt from the Contractor's License DATE .�,Z Law for the following reason (Section 7031.5, Business and ADDRESS FINAL ~:��•I. -1° °t Professions Code): PRESENT By BUILDING �l- ❑ I, as owner of the property, or my employees with ADDRESS ' wages as their sole compensation,will do the work and = the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. :i_i{'_t—_l lam.`•i l.ir `�,'`_ OADDRE NO. �.. I,as owner of the property,am exclusively contracting ;..� y '•, ,•�+..� + �,•+; '°with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code.) CONSTRUCTION LENDING AGENCY REQUIRED YARD HWY TOTAPROPALINEFROM EXIST. ID H I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name Permit Fee Sc LDMA Ref.# r, Lender's Address _ 0 1 certify that I have read this application and state that the Issuance Fee o2�� LDMA P/C# $ above information is correct. I agree to comply with all County " Investigation Fee R ordinances and State laws relating to building construction, ? Total Fee LDMA Perm. p a and hereby authorize representatives of this County to enter u on th ve-mentione per for inspection purposes. r. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of App tcont or Agent Date WORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I h@reby affigm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation surance, or a certifi d copy/thereof(Sec. 3800, L b. .) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 1AM A— Company V ° N Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRIESS S2_( 6.,UC /`i A.0 Certified copy is filed with the county building inspec- BUILDING / ti tion department. ADDRESS CITY G L. ZIP LOCALITY Date Applicant MAIN NEAREST / CER FICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT WON LOT CROSS ST. (_ (VL aq 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.) L/ TEL. USE ZONE MAP OWNER L. NO. NO. I certify that in the performance of the work for which this / permit is issued, I shall not employ any person in any manner ADDRESS �� Z" l /4N ��— SPECIAL a so as to become subject to the Workers'Compensation Laws. CONDITIONS O CITY 4- ZIP U Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP COPNST. FIRE PROCESSED BY Q Exemption, you should become subject to the Workers' ��mm �J i/ o b Compensation provisions of the Labor Code, you must forth- ADDRESS d'vd /°��3 f� J CL with comply with such provisions or this permit shall be �l , U TEL NO 7 I STATISTICAL CLASSIFICATION APT, CONDO. Z deemed revoked. CONTRACTOR /"4 — LICENSED CONTRACTORS DECLARATIONLIC. p CLASS NO. DWELL. UNITS — I hereby affirm that lam licensed under provisions of Chapter 9 ADDRESS L NO. u 7S1 LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business C)�, d�L� CLASS —Zj VALIDATION and Professions Code,and my license is in full force and e''ffff�ectt.Q. CI NO. OF NO.OF CHECK BK. PG. Licens cab L G� Lic. Class L Z SIZE STORIES FAMILIES -ONE DESCRIPTION OF WORK — lb 0_( NEW ❑ VALUATION Contract a e $ '� � o•t7 ❑I am exempt under Sec. l� O r ADD ❑ Poo.ALTER ❑ B.&P.C. for this reason +'jLc- REPAIR ; Date: USE OF EXISTING BLDG. a DEMO Signature APPLICANT TEL. OWNER-BUILDER DECLARATION (PRINT) rl NO. g Vag . FINAL •-Z �g I hereby affirm that I am exempt from the Contractor's License ADDRESS /U. kTE FINAL Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. ,_ ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. - •:_ - a 'c with licensed contractors to construct the project (Sec- 'SR . ems. tion 7044, Business and Professions Code.) ADDRESS 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 r• the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name ;i d /O LDMA Ref. # -- _P.C. Fee$ Permit Fee Lender's Address I certify that I have read this application and state that the Issuance Fee O� /� LDMA P/C# above information is correct.I agree to comply with all County investigation Fee / Q ordinances and State laws relating to building construction, Total Fee 1 Ix' fv J LOMA Perm. # hereby authorize representatives of this County to enter up9h taboe- entioned prVerty for inspection purposes. ° L la 1 Z SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Date