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HomeMy Public PortalAbout9902 WOODRUFF AVE_Building__ WORKERS'COMPENSATION DECLARATION I re affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compensation Insurance, I, or a certified copy thereof(Sec. 3800, lab. C.) j COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. I FOR APPLICANT TO FILL IN BUILDING j) O . /,) ADDRESS C./ Certified copy is filed with the county building inspecBUILDING - tion department. ADDRESS `r' 2 r-, KJ00 9 RV rlT y/�/'� Date Applicant CITY I L ZIP ( 75 ( LOCALITY 1 NO.OF BLDGV. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOTI C)�U'� CROSS ST. COMPENSATION INSURANCE j 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.) OWNER {"tip• ' USE ZONE OP I certify that in the performance of the work for which this I Win( permit is issued, I shall not employ any person in any manner ADDRESS `'0 t?d ��f. '� "�/` CONDITIONS O so as to become subject to the Workers'Compensation Laws. j f, i ,/� U CITY r #'►'t f zip ' �l 1 7 e Date Applicant A,RCHITE R TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. Exemption, you should become -subject to the Workers' I h CONST �/� W Compensation provisions of the Labor Code, you must forth- ADDRESS JP-3o ��yf-�—� CL with comply with such provisions or this u) p y p permit shall be I TEL. STATISTICAL CLAS FI TION APIr CONDO. Z deemed revoked. CONTRACTOR NO. — LICENSED CONTRACTORS DECLARATION I LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. LIC. SEWER MAP aa (commencing with Section 7000)of Division 3 of the Business I BK � PG �C.Je� and Professions Code,and my license is in full force and effect. CITY CLASS VALIDATION $gQ. FT. NO.OF NO. OF CHECK License Number Lic. Class $IZE STORIES r FAMILIES Qjq)� ONE DESCRIPTION OF WORK APF-- oo ~ NEW El VALUATION Contractor Date I HOUSE $ 2 Q Q©t 00 , ❑I am exempt under Sec. ADD ALTER ❑ i B.&P.C. for this reason I $ I Date: USE OF REPAIR ❑ FatISTING BLDG. DEMO' ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION I (PRINT) NO DATE I hereby affirm that I am exempt from the Contractor's License i Law for the following reason (Section 7031.5, Business and ADDRESS FINAL 1 Professions Code): PRESENT By °v BUILDING 19 I, as owner of the property, or my employees with ADDRESS wages as theirsole compensation,will do the work and I ' � ° the structure is not intended or offered for sale(Section LOCALITY 333 0 98 7044, Business and Professions Code.) MOVINGTEL. 1 I- IBIS ❑ I,as owner of the property,am exclusively contracting rA'DDRE OR NO. with licensed contractors to construct the project (Sec- TOTAL 49 a 83 tion 7044, Business and Professions Code.) CASH 0r 1 TOTAL SETBACK FROM EXIST. 4A Jil °Vii P. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH Ihereby affirm that there is a construction lending agency for CHANGE °OICthe performance of the work for which this permit is issued(Sec. 3097, Civ. C.). 00[0"0001 11/1;-/89 L. Lender's Name ; �t r.°Permit Fee LDMA Ref. # ,57,1 1 AI�1G°IJV Lender's Address ` I certify that I have read this application and state that the Issuance Me LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, I Total Fe •0 LDMA perm. # ( and hereby authorize representatives of this County to enter upon the abov -menti ed property for inspection purposes. I j _ Vs s( ���� 1 SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent D e WORKERS'COMPENSATION DECLARATION - I.herby affirm that I have certificate of consent to self i APPLICATION FOR BUILDING �P E RM I T insure, or a certificate of Workers' Compensation Insurance, I `,or a certified copy thereof (Sec. 3800, Lab. C.) I COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company fAUDDRES BUILDING❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS❑ Certified copy is filed with the county building inspec- NG )z } 0 ` ! tion department. S ���j,/ £ C ZIP � , � LOCALITY`-•�/�v�'Date Applicant ! NO.OF BLDGS. NEARESTCERTIFICATE OF EXEMPTION FROM WORKERS' F LOT 5 NOW ON LOT CROSS ST.COMPENSATION INSURANCE ASSESSOR J(This section need not be completed if the permit is for one BLOCK LOT NO. MAP BOOKPAGE PARCEL hundred dollars ($100)or less.) R V' `y J G tI NO'Y"K USE ZONE MAP -�Z I certify that in the performance of the work for which this ((,^,/: n } ' 7 NO. permit is issued, I shall not employ any person in any manner ADDRESS _!6i o 2 (f (,)�� ( � �/� v CONDITIONS a so as to become subject to the Workers'Compensation Laws. `.' O CITY ?ZIP O Date Applicant ARCHITECT OR . TEL. DISTRICT GROUP TYRE FIRE ROCE ED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER )A h, NO. ST. ZONE Exemption, you should become subject to the Workers' J w Compensation provisions of the Labor Code, you must forth- ADDRESS U v ,7e a with comply with such provisions or this permit shall be i TEL STATISTICAL CLASSIFICATION APT. I CONDO. N deemed revoked. CONTRACTOR NO. L Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. 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 Businessi LIC. SEWER MAP and Professions Code,and my license is in full force and effect. CITY CLASS BK. PG VALIDATION SQ. FT. ( NO. OF NO. OF CHECK License Number Uc. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTIO-`N OF WORK + ) S e d I NEW ❑ ElI am exempt under Sec. 9II W(!L(J i,! I Al - A .74 ADD ❑ O� ► ' ALTER ❑ B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL, OWNER-BUILDER DECLARATION j (PRINT) «�h js NO FINAL I hereby affirm that I am exempt from the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL ' Professions Code): PRESENT G��+ f '�� (� ``iL By ._ j` 4 I, as owner of the roe or m em to ees with BUILDING W r property,rtY. Y P Y ADDRESS wages as their sole compensation,will do the work and u -- _ 77 the structure is not intended or offered for sale(Section LOCALITY 6>,� I-; , _.•- - ;1 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 4- 4. .= tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. - - CONSTRUCTION LENDING AGENCY YARD HWY SET BACK 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. 3097,3097, Civ. C.). SIDE P.L. Lender's Name - 8 LDMA Ref. N Lender' P1. Fee$ Permit Fee s Address �. �� :+ •L e ' I , •'I I certify that I have read this application and state that the Issuance Fee i• �� LDMA P/C# 3 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. N and hereby authorize representatives of this County to enter upon the above-mention d property for inspection purp ses. o �gJC �� �� r7w,, LIJ 261kci SEE REVERSE-FOR EXPLANATORY LANGUAGE S nature of Applicant or Agent Dat , r' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0111190062 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF CONST NEW BUrLDING ADDRESS: TR: 6561 LT: 48 UN: .002 SQ. FT STORIES TYPE OCCUP GROUP 9902 WOODRUFF AV STRUCTURE: 449 1 VN R3 TEMP CA 917801729 ASSESSOR 0 GARAGE: NEAREST CROSS STREET: AGNES 8587-031-022 OTHER: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY TENANT: XI SE: USE ZONE: ISSUED ON- PROCESSED EXPIRES O : EXIST OCC GRP: 11/19/01 JK 05/18/02 OWNER: TEL. NO: SLOGS. NOW ON LOT: VIEWION: FIW DATE FINAL CODE: TRAN, BIEN HAI - 1 44,000 9902 WOODRUFF AV �� TEMP 917801729 FEES-PAID C 0 OF WORK C/O 8 WINDOWS, COLORCOAT OVER EXISTIRG SECTION HOUSE, ADD APPLICANT: 0• FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 BD,, 1BA, LAUNDRY, CONVERT EXISTING-PATIO TO DEN HONG A. MIU (626) 281-3881- AA BLDG PERMIT ISSUANCE 27.75 1809 S. MONTEREY ST AC STRONG NOTION RESID 44000.00 VAL 4.40 SPECIAL CONDITIONS: ALHAMBRA 91807 B1 PLANCHECK WANERGY 44000.00 VAL 672.63 B2 PERMIT W/ENERGY44000:00 VAL 791.34 � GELE TOTAL-F.EES% 1,496.12 CONTRACTOR: TEL. NO: APPROVALS D E INSPECTOR SIGNATURE ••:`. 1809 MONTEREY ST. (626) LIC.3N01 i'G ` ���► LOCATION SETBACKS ALHAMBRA, CA 91801 755456 B SOILS ENGINEER APPROVAL .6,/• '1 �' �'I �''•+rte 1 ARC CT OR G NEER: T L. N0: \+� UNDA ON TRENCH 0 S LIC. NOe�� I { 1111111111 \` SLAB% NDER FLOOR ' 6i� RAISED FLOOR FRAMING AP N0: SEWER MAP BOOK: PAG FIRE ZON3• CM01: r� 1'j-�� IIn Il!( '�'' 1 i �• Iffi_��r,1 �,�1 f'; d UNDERFLOOR INSULATION ST , EEL FLOOR SHEATH 0. OF FAMILIES: DWELLING UNITS: CO S A C ASS•— —__ _—__ _—________—__-- dd I,v NO 21 V, TND LEVEL FLOORS TH RDO SCHOOL , 1rhl ryROOF S EATH G AIR QUALITY: 1000 FEET MATERIALS \ . \�' ,;i �l I_� NO NO NO , / 1 s;_=��li /,% FIRE DEPT. FRAME INSPEC REQUIRED 0 EX S i ` BLDG—DEPT. FRA I SPEC SET BACK YARD: HWY: PROP LINE: WIDTH: °� ,� �� —_,/� � FRONT PL- Z' $ a-�! SHEAR PANELS SIDE PL- `-�I VIC E !� 5 L I O / ER STRIP Y INTERIOR LATH/DRYWALL EXTERIOR LOT DRA NAGE SMOKE DETEC0 DEVICS IR �DEPAR MEN APPROVAL REPORT ID: DPR261 ROUTE T0: BS0508