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Home My Public Portal About5217 WILLMONTE AVE_Building__ WORKERS'COMPENSATION DECLARATION � nsu`reboraafirm certif carte of Workers'tificate of Compensat on ensuran nt to elf or a certified copy thereof(Sec. 3800, Lab. C.) APPLICATION F®R BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING / - ADDRESS 7 '21 ❑ Certified copy is filed with the county building inspec- BUILD ING � tion department. ADDRESS� Date Applicant CITY ZIP / LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' O.OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT .7 5 / NOW ON LOT CROSS ST. (This section need not be completed if the permit is for oneTRACT BLOCK LOT NO �� ASSESSOR . hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL �' L.S��TEL. USE ZONE MAP I certify that in the performance of the work for which this OWNER NO. S NO. permit is issued, I shall not employ any person in any manner SPECIAL so as to become subject to the Work 'C6m ensation La ADDRES�/g �J CONDITIONS 0, Date App a C TY ZIP DateNOTTO APPLICANT: If, of er ma ing this Certificate of ARCHITECT OR TEL. DISTRICT OUP TYPE FIRE PROCESSED BY O Exemption, you should become ject to the Workers' ENGINEER NO. ^ CONST.' / Z E Compensation provisions of the La or Code, you must forth- ADDRESS �F V with comply with such provisions or this permit shall be deemed revoked. TEL. STATISTICAL CLASSIFICATION APT. Lo. N CONTRACTOR NO. 9� LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 7 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 and LIC, SEWER MAP Professions Code, and my license is in full force and effect. CITY CLASS BK PG VALIDATION SQ.FT. NO OF NO.OFCHECK License Number Lic.Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK .-,—AV O ADD ❑ $ ❑I am exempt under Sec. A� '� ALTER JE] (1 , B.BP.C. for this reason !� W//ilOd S— /?CsS� REPAIR ❑ $ Date: USE OF DEMOL E]EXISTING BLDG. 00 4 1.1 A APPLICANT �/ 11 TEL. FINAL Signature OWNER-BUILDER DECLARATION PRINT L//1.�� clNO." DATE # 0 0 0 0 0 1 1 hereby affirm that I am exempt from the Contractor's License ADDRESS � �� FINAL ) o 0 9 7 5 Law for the following reason (Section 7031.5, Business and Professions Code): SENT BY BUILDING o 0 0 9 6,7 56 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work andI 88 $12 0 the structure is not intended or offered for sale(Section LOCALITY ' P �({ 7044, Business and Professions Code). MOVING TEL. [ f ❑ r I, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). ROM CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTAPROPpLINE CK F WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name LDMA Ref. # m P.C. Fee$ Permit Fee ' A Lender's Address �J] I certify that I have read this application and state that the Issuance Fee �J(/ LDMA P/C# 0 above information is correct. I agree to comply with all County Investigation Fee 9 ordinances and State laws relating to building construction, Total Fee LDMA Perm.# $ and hereby authorize representatives of this County to enter m upon a abo -men' ned rop �formsp�ecflonurposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r )Signatureof 4ptirant or Agent Date 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 9901110048 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADD ESS: TR: 12268 LT: 13 SQ. FT STORIES TYPE 5217 WILLMONTE AV STRUCTURE: VN TEMP CA 917803241 ASSESSOR INFORMATION NUMB R: NEAREST CROSS STREET: 8589-006-022 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY TENANT: ERTST BLDG USE: RESID USE ZONE: R-1 ISSUED0N: PROCESSED-BY: EXPIRES ON: EXIST OCC GRP: 01/11/99 UT 01/11/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAIDATE FIN CODE: WILSON JAMES F;LINDA A - 1 6,300 //rr 5217 WILLMONTE AV 7f TEMP 917803241 FEES PAID YE—SCRIPTION OF WORK TEAR OFF, INSTALL 1/2" CDX P D, INSTALL 30 YR. ELK FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: COMP SHINGLE APPLI NOBLE ROOFING (626) 445-4315- AA BLDG PERMIT ISSUANCE 27.75 1710 IDAHOME ST. AC STRONG MOTIOUESLD=----,j6300.00 VAL 0.63 SPECIAL CONDITIONS: WEST COVINA, CA D2 PERMIT .00 VAL 166.20 �NGELESTO, F 194.58 CONTRACTOFING EL. N445-4315- �.®5 ��T� APPROVALS DATE INSPECTOR SIGNATURE 1710 E. IDAHOME STREET LIC. NO LOCATION AND SETBACKS WEST COVINA, CA 91791 492656 C39 / SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEEREL. 0: FOUNDATION/TRENCH- FORMS LIC. NSLAB/UNDER FLOOR ISED FLOOR FRAMING 147H269 SEWER MAP BOOK: PAGE: FIRE ZONE: M e DD ��1 O UNDERFLOOR INSULATION �ILraKS L00R SHEATHING 0. OF FAMILIES: DWELLING I S: N : STAT C AS NO 21O ❑0 a' ROOF SHEATHI NG �C 0S0IHAZARDOUS SHEAR ANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO �; ��y FRAME INSPECTION REQUIRED 0 SETBACK FROM EXIST � ElFIRE SPRINKLEIR FRONTSET APL-CK YARD: HWY: PROP LINE: WIDTH: �C Se --g lho�vV INSULATION/WEAT ER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED-FLOOR/CEIL ASSE . RATED WALL ASSEMBLIES RATEB S A TS/0 E I GS -BAR CEILINGS LOT DRA NAG REPORT ID: DPR261 ROUTE TO: BS0508