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Home My Public Portal About5570 WELLAND AVE_Building__ WORKLIRS'COMPENSATION DECLARATION • affirm.that I havecertificate of consent to self I hecg�r APPLICATION FOR BUILDING PERMIT � ' insure,ocat s a certificate of.Workers'Compensation Insurance, • or a certified copy the"reof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDIN Y D SAFETY •. Policy No. Companyi a i. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING ❑ ADDRESS Certified copy is filed with the county building inspec- BUILDING ((EII tion department. ADDRESS Date�'-�! �7 Applic ria _ � CITY Tem le Cit CA_11W "_Iland Ave ZIP 917>30 LOCALITY CERTIFICATE OF EXEMPTION 66M WORKERS' NO.OF BLDGS. NEAREST SIZE OF Lo�2' X300 NOW ON LOT CROSS ST. COMPENSATION INSURANCE (This section need not be completed if the permit is for one ASSESSOR hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL OWNERDevelopment NOMAP • I certify that in the performance of the work for which this . 818.285- USE ZONE A-,3 .� NO. � permit is issued, I shall not employ any person in any manner ADDRESS633 S.San Gabriel Bl. #207 2906 �� SPECIAL IL so as to become subject to the W s'Compensation Laws. CONDITIONS O Date Applican CITYGabriel GA ZIP ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after ing this Certificate of DISTRICT�'T�FCONST. PE FIRE P C SED BY Exemption, you should become subject to the Workers' ENGINEER 18 960-198 ZONE P Y I Compensation provisions of the Labor Code, you must forth- ADDRESS1.3523 Francisquito #B BaldWlri Pk. c� IM - with comply with such provisions or this permit shall be y� deemed revoked. TEL STATISTICAL CLASSIFICATION APT. CON O. fA CONTRACTOR LICENSED CONTRACTORS DECLARATION Cp / CLASS NO. _DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS // L I VC;-Y7?60 (commencing with Section 7000)of Division 3 of the Business and LIC Q SEWER MAP Professions Code,,?Dd my license is in full force and effect. CI CLASS •f:J 114 VALID TII A 7 7/ SQ.FT. OF yNO.OF CHECK BK. F �' License Number P Lic.Class SIZE 1511 TORIES 2 FAMILIES 1 ONE P Q ' l 9-fl � VALUATION # o 0 0 0 '�3 Contractor V/�' Date /.• �° l DESCRIPTION OF WORK NEW ❑X ADD ❑ $ 78,000.00 ► ° 38690 I am exempt under Sec. Detached COridO , ALTER ❑. o - 386906 B.BP.C. for this reason REPAIR $ USE OF ❑' .1223-86 Date: EXISTING BLDG. DEMOL ❑} Signature APPLICANTFINAL OWNER-BUILDER DECLARATION (PRINT) Lee & ChiU Design 18)960=198 DATE l I hereby affirm that I am exempt from the Contractor's License ADDRES513523 Francis 11110 #B Baldwin Par Law for the following reason (Section 7031.5, Business and FI Professions Code): PRESENT ' ❑ 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. F I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS 7 3 6 4 A tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM o 0 0 0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1 1 hereby affirm that there is a construction lending agency for FRONT 1 o660.75 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. o a b b Q 7 5 c=, v Lender's Name „ LDMA Ref. # 0629-87 $ Lender's Address P.C.Fee$ t Permit Fee - 2`J I certify that I have read this application and state that theIssuance Fee �O LDMA P/C# ' c above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee J7 U J LDMA Perm. # u and hereby authorize representatives of this County to enter Iup a above-mentioned property for inspection purposes.0 �� 6•a9-�7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date 0 WORKERS'COMPENSATION DECLARATION Hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT � insure, or b certificate of Workers' Compensation ompensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) n COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. %7-5-1573P Company_ Jr4o -e F11" BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING / 7 �'`� tion department. ADDRESS 0676 Z I�/z f/� C�r�p/ 7� Date_V2 Applicant r CITY .PN/ /r (�•' ZIP `717��/ LOCALITY BLDGS. NEAREST CER FICATE OF EXEMPTION FROM WORKERS' NO.OF SIZE OF LOT $Z ,3d a NOW ON LOT CROSS ST. COMPENSATION INSURANCE r' +� (This section need not be completed if the permit is for one TRACT'i�g BLOCK LOT NO. G ASSESSOR hundred dollars($100)or less.) MAP BOOK PAGE PARCEL TEL' USE NE MAP OWNER -45 pe!/Wl0 �^1 14 NO.2 S 2 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 �33. .S.S�lr�o ��i d3��//� 2Q 3 SPECIAL so as to become subject to the Workers'Compensation Laws. '® �� CONDITIONS O CITY S� G.�6 /P zip ])f U Date Applicant P' NOTICE TO APPLICANT: If, after makingthis Certificate of ARCHITECT OR /�, TEL. DISTRICT GR UP TYPE FIRE PROCESSED BY O ENGINEER L�i®�ClI �/ �• 4'/iNO. 60' J� Exemption, you should become subject to the Workers' 2 G� CONST. ZONE t; Compensation provisions of the Labor Code, you must forth- ADDRESS 3.x,2 rxd&e: b?', B ✓a IL with comply with such provisions or this permit shall be ?A deemed revoked. `� TEL. STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTOR i(id-/L R! C�/r(/ NO. `-2 /�� LICENSED CONTRACTORS DECLARATION LIC, CLASS NO._ /L V DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 3 S-<69-4 �: / NO. 3 (commencing with Section 7000)of Division 3 of the Business andLIC SEWER MAP Professions Code, and my license is in full force and effect. CITY � /!w4v 61 p CLASS BK Y ��! VALIDATION HECK License Number ` Lic.Class SQ EA V( STORIES FAMILIESONE fl_0_r-D C�sI a VALUATION � Contractor Dafe DESCRIPTIO OF WORK NEW ❑D , I am exempt under Sec. ADEl $ ❑ ALTER B.BP.C. for this reason REPAIR ❑ $ Date: USE OF DEMO' EXISTIN LDG. ❑ APPLICANT TEL. r ;26754A Signature PRINT L � C&A-C-1; NO.2 -2 FINAL �� OWNER-BUILDER DECLARATION DATE 1 hereby affirm that I am exempt from the Contractor's License # 0 0 0 0 0 1 Law for the following reason (Section 7031.5, Business and ADDRESS 6?7 `'_S-A-Q31X;e/ JVW ��+- 2 d� FIN Professions Code): PRESENT B I o.1 81, 1 3 BUILDING 1, as owner of the property, or my employees with ADDRESS o a 18 1. 1 3 6 wages as their sole compensation,will do the work and poolthe structure is not intended or offered for sale(Section LOCALITY 0 3,27-87 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). REQUIRED TOTAL SETBACK FR 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. (Sec. 3097, Civ. C.). SIDE P.L. v Lender's Name LDMA Ref. # Lender's Address P.C.Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee 4 c LDMA P/C# a above information is correct. I agree to comply with all County Investi anon fee g ordinances and State laws relating to building construction, g u and hereby authorize representatives of this County to enter Total Fee LDMA Perm. # ;5 upon t above- entioned prop y for inspection purp ses. I R ` SEE REVERSE FOR EXPLANATORY LANGUAGE Si Pure of Applicant or Agent ate 0 i WORKERS'COMPENSATION DECLARATION ent to sf insure, or�afcertif carte of Worke s''Compensat on Insurance, APPLICATION FOR BUILDING. PERMIT or a certified copy thereof(Sec. 3800, Lab. C.) P❑olicyNo.0738247 Company CNC CONSTRUCTION COUNTY OF LOS ANGELES BUILDING AND SAFETY Certified copy is hereby furnished. OR APPLICANT TO FILL IN BUILDING -7 ADDRESS I"X Certified copy is filed wi t e county buil 'ng inspec- BUILDING -- 131 tion department. ^ ADDRESS Welland Ave. Date ' Applicant r \1. CITY Temple City, CA ZIP 91780 LOCALITY 2j CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 3 O O s X$2 s NOW ON ONO.OF TS NEAREST _J 6 CROSS ST. COMPENSATION INSURANCE -o �Se-- (This section need not be completed if the permit is for oneTRACT 10898 BLOCK A LOT NO27 ASSESSOR : hundred dollars($100)or less.) MAP BOOK PAGE PARCEL OWNER ALBERT CHEN no. 575-145 NE MAP Z I certify that in the performancis he work for which this _ NO. 7 permit is issued, I shall not empyyyyylyyyY a y person in n manner SPEC AL ADDRESS CONDITIONS so as to become subject to the r rs'Compe ti n Laws. V CITY Temple Cit C&P 91780 Date A licant ARCHITECT OR TEL. pp DISTRICT GROUP TYPE FIRE ESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. 60-1 n Exemption, you should become subject to the Workers' CONST. � ZONE U Compensation provisions of the Labor Code, you must forth- ADDRESS —4,01,f 3 W with comply with such provisions or this permit shall be D.' deemed revoked. TEL STATISTICAL CLASSIFICATION APT. CONDO. CONTRACTORCNC Construct LICENSED CONTRACTORS DECLARATION LIC, CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS5311 N. T ler 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 Ci.t CLASS BK PGVALIDATION SQ.41��-� Lic.Class('' vfe • NO.OF NO.OF CHECK License Number SIZE STORIES FAMILIES ONE VALUATION % Contractor/. DESCRIPTION OF WORK Install NEW E]a V C Date 9` ADD ® I am exempt under Sec. enclosed pato t0 eXZStl QQ ❑ FfLTER � } REPA B.BP.C. for this reason dWellin IR ❑ 9 Date: USE OF DEMOL ❑ ✓ V EXISTING BLDG. Resident Housin Signature APPLICANT TEL. FINAL PRINT CNC CONST. NO,575-1455 OWNER-BUILDER DECLARATION DATE J I hereby affirm that I am exempt from the Contractor's License ADDRESS 5311 N. T ler Ave.Law for the following reason (Section 7031.5, Business and FINAL Professions Code): 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. # $ $ H Ll I, as owner of the property,am exclusively contracting CONTRACTOR NO. rl' with licensed contractors to construct the project (Sec- ADDRESS I o - 87,38 tion 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY REQUIRE YARD HWY TOTAL ETPROSETBACK-Mrs" WIDTI' 00087.385 I hereby affirm that there is a construction lending agency for FRONT 1229-87 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name 1 LDMA Ref. # m P.C.Fee$ Permit Fee (p d Lender's Address I certify that I have read this application and state that the Issuance Fee U• �'� LDMA P/C 0 o ve information is correct. I agree to comply with all County Investigation Fee Q c ord information and at laws relating to building construction, Total Fee ��/J LDMA Perm. R N on hereby auth riz representatives of this County to enter � u n�_ ope- tionecLproperty for inspection purposes. � Yn SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date