The URL can be used to link to this page

Home My Public Portal About5568 WELLAND AVE_Building__ WORKS'COMPE(VSATiON DECLARATION I hengk affirm:that I'have a certificate of consent to self APPLICATION - FOR BUILDING PERM insure, ar a certificate ofrWorkers'Compensation Insurance, • or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY o Policy No. Compon BUILD / E] CNG ertified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING 5 fI tion department. ADDRESS 56 Welland Ave (Type A) Date 'u / Applica CITY Temple City ZIP 91780 LOCALITY CERTIFICATE OF EXEMPTION FR WORKERS' NO.OF BLDGS. NEAREST , COMPENSATION INSURANCE SIZE OF LOT 82 X 300 NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one 10898 A 27 ASSESSOR .hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNER H&S Development NJ-818)285-29 SE ONE MAP I certify that in the performance of the work for which this NO. -7 permit permit is issued, I shall not employ any person in any manner SPECIAL !� so as to become subject to the Wo r Compensation Laws. ADDRE55633 S. San Gabriel Bl. #207 CONDITIONS 0 r a CITY San Gabriel ZIP 91776 cc Date Apf, ARCHITECTDR TEL. NOTICE TO APPLICANT: If, after maki this Certificate Of ENGINEER LQee & Chiu Desicin f 8 960-198 DISTRICT IGROUP TYPE FIRE ED BY Exemption, you should become su Iect to the Workers' [/y� CONST. ZONE Compensation provisions of the Labor Code, you must forth- ADDRESS13523 Francis uito Ave., Suite B �og v\ IL IL with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR _ �-YIM/ N�7 7 5' STATISTICAL CLASSIFICATION / APT. CONDO. g LICENSED CONTRACTORS DECLARATION p LIC•�[ CLASS NO. 00 DWELL. UNITS—1— I I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �� L NO./ 7 "-!r SEWER MAP (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CI a'6~' CLAS BK f PG. VALIDATION �/�r$�®� p SQ. FT V90.OF 2 FA OF 1 CHECK License Number / Lic.Class j� SIZE ORIES FAMILIES ONE VALUATION DESCRIPTION Contractors,. Date r DESCRIPTION OF WORK NEW ADD ❑ $ pill. �554,4A ❑ I am exempt under Sec. Detached Cnndn ALTER ❑ C B.BP.C. for this reason REPAIR $ (JJ[ # 0 0 0 0 2 3 Date: EXISTIING BLDG. Vacant DEMOL ❑ 1 - 449.45 Signature APPLICANT Lee & Chiu Design f. 18 960-198 FINAL a/ OWNER-BUILDER DECLARATION PRINT 5 ry ) DATE Z (( � ° ° 44q45' I hereby affirm that I am exempt from the Contractor's License 13523 Franeisquito Ave. B 0 1.01 -86 01 -8b Law for the following reason (Section 7031.5, Business and ADDRE FIN Professions Code): PRESENT BY f BUILDING ❑ I, as owner of the property, or my employees with ADDRESS 6 1 O wages as their sole compensation,will do the work and [ADDRE ITY ' # 0 0 0 0 2 the structure is not intended or offered for sale(Section 7044, Business and Professions Code). G TEL. 7 I,as owner of the property, am exclusively contracting ACTOR NO. I ° 1 O 3 2 7 with licensed contractors to construct the project (Sec- SS ° ° 0 12 7 5: tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY EQL ACK YARD HWY TOTAPROP.ETBALINE CK FRO WIDTH 1223-86 1 hereby affirm that there is a construction lending agency for NT the performance of the work for which this permit is issued P.L. 15' t (Sec. 3097, Civ. C.). SIDE 101 11 m e L. Lender's Name LDMA Ref. # e$ Permit Fee J�Lender's Address ' I certif that I have read this a lication and state that theY PP D 3 � Issuance Fee /V ,�� LDMA P/C# above information is correct. I agree to comply with all County gation Fee ordinances and State laws relating to building construction, Total Fee Qo7 LDMA Perm. # ;27 u and hereby authorize representatives of this County to enter 3 6 A u ve-mentioned property for inspection purposes. S ` (�.7 SEE REVERSE FOR EXPLANATORY LANGUAGE g a ure of Applicant or Agent Date i WORKERS'COMPENSATION DECLARATION t f ure affirm that I have certificate of consent to self APPLICATION FOR BUILDING P E RM I T insure, or a certificate of Workers'Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) Policy No. S 7 Company S'f4* FPA"'D COUNTY OF LOS ANGELES BUILDING AND SAFETY 9 10 ElCertified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS ulJ Certified copy is filed with the county building inspec- BUILDING y tion department. ADDRESS J 6 2 • a v� i¢�f/ �j J� Date 27 Applicant ` CITY Tto r' ZIP - G1 �v LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT Z 0 O NOW ON LOT CROSS ST. (This section need not be completed if the permit is for one 91 ASSESSOR dsundred dollars($100)or less.) TRACT 3(r v BLOCK LOT NO. MAP BOOK PAGE I PARCEL TEL US ONE MAP /fid OWNER P LtP� fJo N0.2 '2 (J I 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 ry iy fJ ru2Q �3 SPECIAL L so as to become subject to the Workers'Compensation Laws. CONDITIONS 0 Date Applicant CITY lk 44 "� ZIP NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. 96d DISTRICT G UP TYPE FIRE PROCESSED BY Exemption, you should become subject to the Workers' ENGINEER �e G f P�f� MVO. / IN CONST, / ZONE i� Compensation provisions of the Labor Code, you must forth- ADDRESS (7{ g with comply with such provisions or this permit shall be I S2 �i� N ci Z deemed revoked. 'p TEL. // STATISTICAL CLASSIFICATION APT. g CIA, CONTRACTOR �F i►' t 5 NO. to LICENSED CONTRACTORS DECLARATIONLIC, L CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS6733 Sr�fb NO. 7+10 Q3� (commencing with Section 7000)of Division 3 of the Business and LIC ¢� SEWER MAP Professions Code,and my license is in full force and effect. CITY Awl- S-01-4441-01CLASS Y BK F PG /� VALIDATION L O a rSQ.FT. NO.OF NO.OF CHECK 1 License Number' 4/Z :? C-Lic Lic.Class SIZE STORIES FAMILIES ONE Contractor# CT/,4Qa1� CM 37.Date � Z 2 VALUATION ,r r DESCRIPTION F WORK NEIN ❑ $ /� XoJfv✓ ADD ❑ V pill.I am exempt under Sec. ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ 6 7 5 3 A Date: USE OF DEMOL EXISTING BLDG. ❑ # 0 0 0 0 0 1 Signature APPLICANT TEL• FINAL OWNER-BUILDER DECLARATION PRINT) iC L fYJ I^U,�i${, NO. '2 DAT 1 hereby affirm that I am exempt from the Contractor's License ADDRESS G`3� S. S�F.i' CAb/r:e/ $,G. � Q- I o 1 $ 1� 1 3 Law for the following reason (Section 7031.5, Business and FIN Professions Code): PR NT B = ❑ BUILDING o o 181. 135 I, as owner of the property, or myemployees with ADDRESS ++ wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY ' 0327-87 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). CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPIESETBACK-FRO 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 m P.L Lender's Name , LDMA Ref.1# P.C.Fee$ Permit Fee r 6 3 ' Lender's Address / I certify that I have read this application and state that the Issuance Fee l O 1-S—�/�) LDMA'P/C# above information is correct. I agree to comply with all County Investigation Fee 2 ordinances and State laws relating to building construction, Total Fee t �J LDMA Perm.# U and hereby authorize representatives of this County to enter ;9 upon the above-men•oned prgiverty for inspection purposes. a ? A7 SEE REVERSE FOR EXPLANATORY LANGUAGE a Sbfiature of Applicant or Agent Dae O i WORKERS'COtAPENSATION DECLARATION I hereby 8ffcer that I have APPLICATION F®R B m I L D I N G PERMIT insure, or a certificate of Workers' certificate of consent to self kers'Compensation Insurance, or a certified copy thereof (Sec. 3800, Lab. C.) Policy No. 0738247 Company CNC CONSTRUCTION 111111101111111 4 a z7 COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ADDRESS Certified copy is filed witLecouInt 'Iding inspec- BUILDING logFil tion department. ADDRES Welland Ave. Date-P- . -MApplicanQpm CITY Tem le Cit , CA 2191780 LOCALITY �^ CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 3 O O s X $2 1V0.OF BLDGS.ON OT 6 NEARESST. 1na� COMPENSATION INSURANCECROSS (This section need not be completed if the permit is for oneTRACT 10898 BLOCK A LOT NO. 27 MAS BOOK PAGE PARCEL ASSESSOR hundred dollars($100)or less.) TEL -1455 U ONE P 1 certify that in the performance of the work for which this OWNER Albert Chen NoO2-7 7 permit is Issued, I shall not employ any person in any manner - SPECIAL so as to become subject to the Workers'Compensation Laws. ADDRESS 5311 N. Tyler Ave. � CONDITIONS O CITY Temple City, CA zip 91780 V Date Applicant IX NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL, DISTRICT GROUP TYPE CESSED BY O ENGFIRE ENGINEER 1 NO• - CONST. ZONE 11- Exemption, you should become subject to the Workers' t W Compensation provisions of the Labor Code, you must forth- ADDRESS 13523 Francis IIl with comply with such provisions or this permit shall be a- deemed revoked. CONTRACTOR CNC Const. TEL STATISTICAL C SIFIC TION APT. CONDO. Z NO-57-9-1455 LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS5 311 N. Tyler Ave NO. 477605 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 Temple Cit CLASS VALIDATION HECK License Number M 14 -� Lic.ClassQl-� SIZE S O ES ORIIES FAMILIES CONE BK PG. `�. VALUATION Contractor C— �-• Date DESCRIPTION OF WORK Install NEW ® ; 500 enclosed patio to existin ADD polo, F1 I am exempt under Sec. ALTER El for this reason dwellingREPAIR (3 $ Date: USE OF EXISTING BLDG. Resident Housing DEMOL ❑ �O(I Signature APPLICANT TEL. FINAL VV OWNER-BUILDER DECLARATION PRINT CNC CONST. No.575-1455 DATE I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS 5311 lAve- FINAL f Professions Code): PRESENT By ❑ BUILDING 1, 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 [AD LITY 7044, Business and Professions Code). ING TEL. ❑ I,as owner of the property, am exclusively contracting TRACTOR NO. with licensed contractors to construct the project (Sec- RESS -9 8 6 7.9 A tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY BACK YARD HWY TOTAL SETBACK NE WIDTH $� 0 0 0 0 0 I hereby affirm that there is a construction lending agency for ONT ° - 87.38 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). DE . 00087.3860 Lender's Name �� LDMA Ref. # 2,29-87 m Lender's Address Fee$ Permit Fee --,I certify that I have read this application and state that the Issuance Fee 6 v LDMA P/C q above information is correct. I agree to comply with all County stigation Fee go finances and State laws relating to building construction, Total Fee t. LDMA Perm.# N a d hereby a orize representatives of this County to enter on thea e- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date