HomeMy Public PortalAbout5421 BALDWIN AVE_Building__ (2) TEMPLE CITV
76A888A CE#8081-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING // c,
DEPARTMENT OF COUNTY ENGINEER ADDRESS r I
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST f g
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DISTRICT NO. GRQI�P�. TypEIr
P ESSED BY
FOR APPLICANT TO FILL IN I _ CONST. i
BUILDING STATISTICAL CLASSIFICATION SEWPERMAP
ADDRESS 3aldwin BK G
CLASS. NO. DWELL.UNITS
LOT NO. BLOCK WATER NOT REQUIRED RECEIVED
aldwints Addition #2 CERTIFICATE:
TRACT MAP HIGHWAY
Jan a Anita `vO Ony NO.OF BLDGS. NO., - (CIRCLE) STATE MAJOR SECON 1_ CAL
SIZE OF LOT dn�T Ln I NOW ON LOT USE ZONE SPECIAL
USF :Lz. • ,,�! CONDITIONS .fie I
EXSING BLDG. Dwel�"1 ngR� (;?Ya�C� ((( IL % 17
OWNER Santa Anita Constr.Co-NO AT7, BUILDING YARD HWY STREET NAME EXIST.
`7 L' . Las TL_r1aS San Gabriel SETBACK WIDTH
ADDRESS FRONT
ARCHITECT ORTEL. P. L.
ENGINEER none NO. SIDE
P.L. }
ADDRESS
TEL INSPECTION RECORD O
CONTRACTOR Sant 1 ��� '""NO. rqZ V
ADDRESS -n,3 TL_na5 an Gabriel. °C
O
DESCRIPTION OF WORK
W
CL
NEW,`-,i ADD ALTER REPAIR DEMOLISH H
SQ. FT. ,.+.�{.�Q Att.NO.OF NO.OF _ z
IZE 1f, STORIES 1 FAMILIES
USE OF o
STRUCTURE
Ln
SIGNATURE O
APPLICA
VALUATION$ 'illj
/t APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. C� PMT. C' /)-/) FOUNDATION: LOCATION
FEE $ � FEE (,1(,� FORMS, MATERIALS
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT.
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSA ION INSURANCE. LATH, EXT.
SIGNATUR —' p-,,,.. HOUSE NUMBER COR- ?.? y
PERMITTEE 1 AND POSTED - r+- "
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUGTURAL ENG) ER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION / CK. . M.O. CASH
Ar 4 10
(
"V, RKERS''OCOMPENSATION DECLARATION
affirm that I havecertificate of consent to self A P P L I CAT I O N- PO R E B U I L D I N G PERMIT
.insure, at a certificate of Workers'
p
kers'Com ensation Insurance,
or a certified copy thereof (Sec. 3800,•Lab, C.) '-COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS
Certified copy is filed with the county building inspec- BUILDING p
Tion department. /] —AlDRESS S4-Z 1 RA.LDLO W N p (� o
Date o' 91A:: Applicant [ ('X•�-<! CITY � ZIP' � y� p0 LOCALITY
CERTIFICA E OF EXEMPTION FR M WORKERS' NO. OF BLDGS. NEAREST .
COMPENSATION INSURANCE SIZE OF LOT �1 NOW ON LOT CROSS ST.
(This section need not•be'completed if the permit is for oneASSESSOR
hundred dollars ($100)or less.) TRACT BLOCK LOT NO. MAP BOOK • PAGE PARCEL
OWNER �. L SG�QL I'T 7-87 7 USE ZONE
I certify thin the performance''of the work for which this O.MAP
at N >.
permit is issued, I shall not employ any person in any manner (- SPECIAL d.
ADDRESS �> V"L�
so as to become subject to the Workers'Compensation Laws. CONDITIONS u.
-CITY T'.C`• ZIP
Date Applicant ARCHITECT OR tL�, TEL. O
NOTICE 'TO APPLICANT: If, after making this CeFtificate of ENGINEER t�v GAJ_) O Z DISTRICT. GROUP TYPE FIRE PROC SED BY FVVV•
Exemption, you should become subject to the Workers' CONST.' ZONE
Compensation provisions of the Labor Code,.you must forth- / c�-:* �
P P y ADDRESS p� WLLVA<x7
with comply with..such provisions or this permit shall be v!
TEL.-7/4 STATISTICAL CLASSIFICATION APT. IINDO. Z
CONTRACTOR
deemed revoked. t�}�j I�T Mt,6 'NO.
LICENSED CONTRACTORS DECLARATION, LIC. CLASS NO. IDWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 7--Z-33 w 4JO1
(commencing with Section 7000)of Division 3 of the Business and G� , . w n AIC. SEWER MAP
Professions Code, and my license is in full force.and effect. CITY V s 1�� tib CLASS VALIDATION
. � 1 BK. PG.
SQ. FT. O NO. OF NO. OF CHECK
License Number Lic.Class SIZE JV STORIES FAMILIES 1 ONE
VALUATION
DESCRIPTION OF WORK 40P 1 f• 0 0 NEW ❑ �•
Contractor Date p /+ ^❑ 1:1s , ;24064A
O�I /F-�. L:JT�J7O � � ADD I am exempt under Sec. ALTER ❑ _
�)
8.8P.C. for this reason P�y�.� UCl
REPAIR ❑ s a D —�� # m o e o 23
USE OF
Date: ' EXISTING BLDG. L 1./ DEMOL ❑ / I ® 3 2 a 9 5
Si nature APPLICANT gEL. _
g OWNER-BUILDER DECLARATION PRINT) d aCeA—t-)co ov&NOL. v FINAL o m 3 2 8 9 5
DAT
I.hereby affirm that I am exempt from the.Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS z� �-���/ "� ST• L� FIN 0 2 1.9-86
Professions Code): PRESENT 9Y.
F] 1,I, as owner of the property, or my employees with ADDRESS
wages as their sale compensation,will do the work and L• l w
the structure is not intended or offered for sole.(Section LOCALITY oil"7044; Business and Professions Code). " MOVING TEL.
I, as owner of The property, am exclusively contracting CONTRACTOR NO. 44 7_ 0 A
with licensed contractors to construct The project (Sec- ADDRESS
tion 7044, Business and Professions Code). i tl` „ ,# 0 0 0 0 2 3
REQUIRED TOTAL SETBACK FROM EXIST. i ' ; `,_
CONSTRUCTION LENDING AGENCY SET BACK YARD' HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT ti:: •. _` ( `J _''-.( o o7 IL 6 0
the performance-of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE \.� 0 0 074,6 0 v
m P.L.
Lender's Name v S 0 4, 1 8—&6
m LDMA•Ref.\#' r ' '`
•- P.C.-Fee$ ��- Permit Fee f - -•• - - -
16
Lender's Address 1 `•4 4 7.•1 A
-1 certify that I have read this application and state that the 7 �j Issuance Fee Qi kDA P/C# c
a above information is correct. I agree to comply with all County Investigation Fee L� �Ss # 0 0 0 0 0 1 '
ordinances and State laws relating to building construction, Total Fee V n� L LDMA Perm. # _
b and hereby authorize representatives of this County to enter ,0 0°�(j���j �C..)up n the move-m@rationed perty for inspection purposes.. 4 T
off "' ` SEE REVERSE FOR EXPLANATORY LANGUAGE
Si nature of Applicant 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 1112280029
PHONE (626) 285 0488 EXT
LEGAL ID NO OF CONST BUILDING ADDRESS
I ON FILE SQ FT STORIES TYPE 5421 BALDWIN AV 1
I ISTRUCTURE 2200 V B TEMP CA 917802625
ASSESSOR INFORMATION NUMBERNEAREST CROSS STREET 1
18588 019-025 1 I THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY CAI
TENANT IEXIST BLDG USE RESID USE ZONE R 1 JISSUED ON PROCESSED BY
EXIST OCC GRP 112/28/11 SR
DOWNER TEL NO 1BLDGS NOW ON LOT VALUATION IFINPL DATE FINAL BY CODE 1
ISCIOLINI ALDO (626) 287 7206 1 1 6 500 /
15421 BALDWIN AV I "//�
�
ITEMP 917802625 FEES PAID IDIESCRIPTION OF WORK 1
IREMOVE EXISTING ROOF MATERIAL INSTALL 30 YEAR COMPOSITION 1
IFEE DESCRIPTION QUANTITY UOM AMOUNT I 1
(APPLICANT TEL NO
ISUNNY ROOFING (213) 254 7909 JAA BLDG PERMIT ISSUANCE 27 80 I 1
11921 5TH AVE JAB STATE GREEN BLDG FEE 6500 00 VAL 1 00 ISPECIAL CONDITIONS 1
ILOSA ANGELES CA JAC STRONG MOTION RESID 6500 00 VAL 0 70 1 I
ID2 PERMIT W/0 EN HC 6500 00 VAL 166 60 1 rn_7
1 I TOTAL FEES 196 10 1 f\ J
ICONTRACTOR TEL NO 1 JAPPFOVALS DATE INSPECTOR SIGNATURE 1
ISUNNY ROOFING I1
11921 STH AVE LIC NO 1
ILOS ANGELES CA 90018 1LOCATION AND SETBACKS I I I
858962
I 1 ISOIIS ENGINEER APPROVAL 1
1ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS I I
I LIC NO 1 1SLPB/UNDER FLOOR I I 1
I I I
I
IRA-SED FLOOR FRAMING I 1
I I I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP 1 1UNDERFLOOR INSULATION I I I
1147H269 3 001 I 11 1
1 1 IFLOOR SHEATHING I 1 I
IND OF FAMILIES DWELLLING UNITS APN/COND STAT CLASS 1 I I
O / 1 1
1 IROOr SHEATHING I
SCHOOL WITHIN HAZARDOUS 1 ISHE R PANELS r
1AIR QUALITY 1000 FEET MATERIALS 1 I_ I I I
1 NO NO NO 1 IFRAME INSPECTION
I I I
1 I IFIRE SPRINKLER HANGERS I 1 I
I I I
I 11NSULATION/WEATHER STRIPI I
1 1 11NTERIOR LATH/DRYWALL I I I
1 I 1EXTERIOR LATH 1 1 I
I I I
I IRAT D FLOOR/CEIL ASSEM I I I
1 I IRAT-D WALL ASSEMBLIES
I I I
IRATED SHAFTS/OPENINGS I I
I 1 IT B4R CEILINGS 1 1
I `I ILOI DRAINAGE 1 I I
I I I
1 IREPORT ID DPR261 ROUTE TO BS0508 1 I 1