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HomeMy Public PortalAbout9924-9926 WOODRUFF AVE_Building__ WORKERS'COMPENSATION DECLARATION, -+ i • n ° y hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure,or a certificate of Workers'Compenstibn Insurance,or � a certified copy thereof(Sec. 3800, Lab. C.) / i COUN;,SOF LNGEL BUILDING AND SAFETY Policy No. Company �CJ°� >- 20 ElCertified copy (s hereby furnished. i FOR APPLICANT TO FILL IN BUILDIN �- ADDRESS � / 7` d �v /YG Certified copy is filed with the county build' g i ec- BUILDIN +7 mfr ff tion department. ADDRESS 1 ^!0 ( LOCALITY NEAREST Date 7-2 _Applicom- CITY ZIP CROSS ST. Y. CERTIFICATE OF EXEM FROM WORKERS' NO.OF BLDGS. ASSESSOR yF COMPENSATI INSURANCE 1 SIZE OF LOT 76 X1rJ NOW ON LOT MAP BOOK PAGE I PARCEL - (This section need not be completed if the permit is for one ��j tQZ USE ZONE MAP U Hundred dollars ($100)or less.) TRACT 6�O BLOCK LOT NO. , NO. °-- I TEL-2-91. L. -�97 SPECIAL I certify that in the performance of the work for which this OWNER / i NO�dr�'c�6j �- CONDITIONS permit is issued, I shall not employ any person in any manner 1�' 1�� �,• "' DISTRICT GROUP TYPE FIRE PRO ESSED BY so as to become subject to the Workers'Compensation Laws. ADDRESS 1 Im �oil n . CONST. / ZONE Date Applicant CITY ZIP STATISTICAL CLASSIFICATION FT. CONDO. U ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of , _ Ue Exemption; you should become subject to the Workers' ENGINEER NOS CLASS NO. e-2 UNITS 2 H Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be 2 deemed revoked. �� _ T L' BK. FPG,r '� VALIDATION - CONTRACTOR / e" O. ©. LICENSED'CONTRACTORS DECLARATION 5 ft'NS. NOIC. I hereby affirm that I am licensed under provisions.of Chap �ter 9 I ADDRESS 26 - . fff'I VALUATION (commencing with Section 7000)of Division 3 of the Business and �� / LIC. i Professions Code, and my license is in full force and effect. CI7Y / CLASS $ e•' 7 SQ. FT. NO.OF NO.OF 77 CHECK License Nusm11b8er Lic.Class® � SIZEIIISTORIES � FAMILIES �-S ONE Contractor' e� Date ! '�22rr� DESCRIPTION OF WORK 1� NEW $ f /T ❑ ADD [J 'I am exempt from the licensing requirements as I am a b(OF lKb- � L1 �+� `1 ❑ J t licensed architect or a registered professional engineer v ALTER ❑ DATE FINAL acting in my professional capacity (Section 7051, ��' REPAIR Business and Professions Code). ❑ FINAL -'6504A DEMOL By e c o o '� ' EXISTING BLDG. ❑. 91.1c.or Reg.No. Date APPLICANT TEL.�y p OWNER-BUILDER DECLARATION ! PRINT) t80iL°�(7.ZQ I hereby affirm that I am exempt from the Contractor's License• 1 /0<---) 15-;77�� p � f v •1 0 0 54,00 Law for the following reason (Section 7031.5, Business and ADDRESS.? ;Z6 ` m ' /7� ®% !&� 0 0 0 �j[( 0(1 Professions Code): PRESENTa2.3 _ I, owner of the property, or my employees with ADDRESS /�s',-2 CT 0 9, 25-F 2 wages BUILDING es as their sole compensation,will do the work and 4' the structure is not intended or offered for sale(Section LOCALITY r 6 5 5 A 7044, Business and Professions Code). MOVING TEL. �� 3 I, as owner of the property, am exclusively contracting CONTRACTOR NO. i c o 0 0 0 1 with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code). I ADDRESS 1 c G C REQUIRED TOTAL SETBACK FROM tEXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE ;WIDTH 0 t' 1 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. ,t t _ r (Sec. 3097, Civ. C.). - SIDE ` P.L. ; Lender's Name Lender's Address P.C. Fee S t Sit () Permit Fee I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws relating to building,construction, Total Fee Q� i and hereby authorize representati es of this County to enter I = upo a abo -m tinned Prop, y for inspection purposes. / I SEE REVERSE FOR EXPLANATORY LANGUAGE r o Signature of Applicant or Agent to ®s� ' I a 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 0609050024 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: BK: 154 PG: 12 PC: 1 SQ. FT STORIES TYPE 9926 WOODRUFF AV STRUCTURE: 31 VN TEMP CA 917801729 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8587-031-023 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-2 ISSURD ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 09/05/06 JK 08/31/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL B FINAL BY: CODE: LETICIA & KEN - 6,600 9924 WOODRUFF AV v TEMP 917801729 FEES PAID DESCRIPTION OF WORK TEAR OFF EXISTING ROOF TO SHEATING RE-ROOF WITH 30 YEAR GAF FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: H 2 0 ROOFING (626) 705-3261- AA BLDG PERMIT ISSUANCE 27.75 2031 E. GLADSTONE AC STRONG MOTION REBID 6600.00 VAL 0.66 SPECIAL CONDITIONS: GLENDORA, CA 91740 D2 PERMIT W/O HN-BC 6600.00 VAL 166.20 TOTAL FEES 194.61 CONTRACTOR: TEL. NO: I APPROVALS DATE INSPECTOR SIGNATURE H2O ROOFING (626) 705-3261- 2031 E. GLASTONE LIC. NO LOCATION AND SETBACKS GLENDORA, CA 91740 829291 C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: I FOUNDATION TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 15OH269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS 19 AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INST)LATION WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508