HomeMy Public PortalAbout8715 WENDON ST_Miscellaneous__ W7RKLRS'C 'OMPENSATION DECLARATION 76M444
CE 875(11-84) MISCELLANEOUS APPLICATION
I su ' yf m hat I have a certificate of consent tself COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
ensuV; certificate of Workers'Compensation Insurance,e,or
a certified copy-thereof(Sec.3800,Lab.C.).
Polij No. Company FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is hereby furnished. BUILDING LOCALITY
E
ADDRSS
Certified copy is filed with the county building inspectionLOCALITY NEAREST
department. L L�✓� j 73CROSS ST. Iti
Date Applicant NEAREST DISTRICT N`O. / OUP CONST f OCESSED BY
GROSS ST. D A - 2ITYP VZz Y _ I J
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL CJ ✓ ! �¢Y�
COMPENSATION INSURANCE DESCRIPTION LOT NO. Z BLOCK P HIGHWAY
STATE MAJOR SECOND LOCAL
NO. OF NO (CIRCLE))
(This section need not be completed if the work involved TRACT ' NOW ON LOT Use ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) usE of /'
I certify that in the performance of the work for which this SIZE OF LOT j _ EXISTING BLDG. fI JJ/ � , a
permit is issued,I shall not employ any person in any manner OWNER \ LI�G(�L/ o
so as to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP �3 0
ADDRESS ~
Date Applicant uUJ
NOTICE TO APPLICANT: If,after making this Certificate of CITY No. [�� ,`] OCCUPANT LOAD
Exemption, you should become or Cot , the Workers- APPLICATION FOR EXIT HARDWARE:
Compensation provisions of the Labor Code,you must forth- -
. Knowl.
with comply with such provisions oI this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION ❑ No Spec ❑ _
deemed revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices
El
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW)
9 (commencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS
ness and Professions Code,and my license is in full force and
effect. PARKING REq•D D PROVIDED
SPACES
License Number Lic. Class •3 - i -112Y 7
LIMITED T USE
Contractor Date — DATE DATE
❑ I am exempt from the licensing requirements as I am a .
licensed architect or a registered professional engineer SIZE OF t NO.OF FROM: T ° I SIGNATU E
acting in'my professional capacity (Section 7051, Bus- EXISTING BLDG. it S / sroRE
iness and Professions Code). FINAL APPROv L
PRESENT USE OF BUILDING
Lic.or Reg.No. Date
zl
i�
HOME OWNER-BUILDER DECLARATION O. OF EXISTING BUILDINGS
ON LOT AND USE '• J:
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): NO. PARKING --- -•
ElI, as owner of the property, will do the work and the SPACES PROVIDED 1 y i
structure is not intended or offered for sale (Section
7044,Business and Professions Code). � s
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING
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.Q.
Lenders Name
PROPOSED MAX. OCC. I.' -:tilwly a.•�
Lender's Address
I certify that I have read this application and state that the PERMIT FEE
above information is correct.I agree to comply with all County ISSUANCE FEE
ordinances and State laws relating to building construction,
and hereby authorize re re entatives of this County to enter TOTAL FEE p�
upon the above-mention rty for inspection purposes.
/�_ � SEE REVERSE FOR EXPLANATORY LANGUAGE
�/
Signature o ermittee Date
L
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1003030002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE. (626) 285-0488 EXT:
ILEG ON FILE I N0. OF CONST NEW I BUILDING ADDRESS:
SQ. FT STORIES TYPE OCCUP GROUPI 8715 WENDON ST
[ASSESSOR INFORMATION NUMBER: ISTRUCTURE: 1 V-B U I SGAB CA 917752628 1
I NEAREST CROSS STREET: AVON 1
15386-006-033 [EXIST BLDG USE: I THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY, Cl
(EXIST OCC GRP: USE ZONE: I I
ITENANT: I ISSUED ON: PROCESSED BY: EXPIRES ON:
IBLDGS. NOW ON LOT: VALUATION: 03/03/10 SR 08/30/10
I I 0 I I
(OWNER: TEL. NO: I IFS;NAL DATE FINAL PY., CODE: [
]CHANG, RONNIE R (626) 437-2210- ILIST ITEMS: [ O 1
18715 WENDON ST I I -A:-4I
tc
ISGAB 917752628 I IDESCRIPTION OF WORK 141
[ I IRECONVERT STORAGE ROOM ATTACHED TO GARAGE, DOMOLISH STORAGE 1
IOCCUP LOAD EXIST: AREA ON SOUTH SIDE OF PROPERTY & DEMOLOSH CARPORT COVER
(APPLICANT: TEL. NO: IOCCUP LOAD NEW:
IWILLIS (909) 717-3588- 1 [_
18715 WEDON ST. 1PARKING SPACES REQUIRED: ISPECIAL CONDITIONS:
ISAN GABRIEL CA 91775 1PARKING SPACES PROVIDED: I
1 __[EXIT HARDWARE: I 1
ICONTRACTOR: TEL. NO: I I LIMITED TIME USE 1
IWILLIS, FREDRICK (909) 717-3588- 1NBR OF EXITS: I FROM TO I
[8715 WENDON STREET LIC. NO I I 1
SAN GABRIEL, CA 91775 NONE 1 FEES PAID
I I IAPPRCVALS DATE INSPECTOR SIGNATURE I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I
(ARCHITECT OR ENGINEER: TEL. NO: I ITRAILER USE I I I
I - LOA PERMIT ISSUANCE 27.75 1 1 1 1
LIC. NO: 101 R/M OCC/USE INSPECT 145.95 ISAFETY PERMIT I I I
TOTAL FEES 173.701 1 I
[TEMP. STRUCT. APPROVED I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 ITEMP. STRUCT. REMOVED I [
1153H261 I I I 1
I I I I I
INO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: I I I I I
I NO
1 SCHOOL WITHIN HAZARDOUS [ [ I
1AIR QUALITY: 1000 FEET MATERIALS I I 1
1 NO NO NO I 1 I [ I
REQUIRED TOTAL SETBACK FROM EXIST
I
SET BACK YARD: HWY: PROP LINE: WIDTH: I I I I I
[FRONT PL- I
SIDE PL- I I I I I
I I I I I I
I I I I I I
I I I I I I
I
I I I
I I I I I I
1 (REPORT ID: DPR267 ROUTE TO: SS0508