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Home My Public Portal About4948 BALDWIN AVE_Building__ � e 1 76ASSSA CE#803 687 APPLICATION FOR BUILDING PERMIT �. COUNTY OF LOS ANGELES BUILDING f /1 DEPARTMENT OF COUNTY ENGINEER' _ ADDRESS / BUILDING AND SAFETY DIWSION w LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST r1 CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST _ DISTRICT NO GROUP .TYPE SEWER MAP FOR APPLICANT TO FILL IN CONST BK P BUILDING � STATISTICAL CLASSIFICATION ADDRESS Gii�il/7 �y CLASS NO �DWELL UNITS----A LOT / BLOCK MAP / STATE NUMBER /�� HWY YES ; ') TRACT USE ZO E SPECIAL O I NO OF BLDGS CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG BUILDING EXIST , ) /J� �— 'y/ SETBACK YARD HWY STREET NAME WIDTH OWNER/U LJ///y— (�— V rJ FRONT T/ G' �Ql�(�(/J41 P L ADDRESS _ SIDE P L CITY No 4`/ INSPECTION RECORD ARCHITECT TEL ENGINEER NO ADDRESS TEL CONTRACTOR NO ADDRESS DESCRIPTION OF WORK NEW //ADD ALTER REPAIR DEMOLISH SO FT NO OF NO OF SIZE STORIES FAMILIES USE OF STRUCTURE 1 -Va SIGNATURE OF APPROVALS APPLICANT DATE I BPECTOR S SIGNATURE ADDRESS FOUNDATION LOCATION FORMS MATERIALS $ � P C S ,.�� FRAME FIRE STOPS FEE BRACING BOLTS VALUATION S ��// U FURNACE LOCATION FEE f' GAS VENT DUCTS (� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LATH INT PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COU Y ORDINANCES AND STATE LAWS TING BUIL G CONSTR CTION LATH EXT SIGNATURE OUSE NUMBER COR ��r PERM RECT AND POSTED ADDRESS ,FINAL OHN A LAM E COUNTY IV ER CLYDE N DIRLAM PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDAMN CK M O CASH PERMIT VALIDATION CK M O CASH C 47871 DEC 3 1 2 0 0 o OF t r v +Z APPLICATION FOR BUILDING PERMIT F R APPLICANT TO'FFILL IN (Print or type Only)4N j TEMPLE CITY BUILDING ° _ c, C6UNfTZP ZS ADDRESS 4948 Baldwin A e t DEPARTMENT OF COUNTY ENGINEER CITYZIP t BUILDING AND SAFETY DIVISION f { I r NO OF BLDGS BUILDING SIZE OF LOT NOW ON LOT ADDRESS ti TRACT 61/z, LA LOT NO f LOCALITY , OWNER UEAREST tl a J n®� 444017 NROSS ST ADDRESS 4948 Baldikin Ave MAPESSOR BOOK PAGE PARCEL /� {, r n��On DISTRICT GROUP TYPE , FIRE SED BY CITY Temple C ^t ZIP 7 8G CONSi� ZONE s ARCHITECT OR" r TEL 1:5 c 00 ENGINEER NO + STATISTICAL CLASSIFICATION SEWER M P ADDRESS CLASS NO DWELL UNITS B PG Ho a d Randol NOL288 4014Aill CONTRACTOR r, U ONE MAP J► � 1 , ' LIC _ , ADDRESS , x LI ✓r SPECIAL - CONDITIONS CITY LIC , San Gahrid CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES NO CONSTRUCTION L8NIJER NAME AND BRANCH BLDG TBACKFROM FRON PROP LINEOF — (STREET) ADDRESS CITY v HIGHW Y } YARD TOTAL SETBACK FROM TYPE OF EXISTING SQ FT 1 NO OF NO OF CHECK FRONT PROP LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORKU e and NEW '❑ ' } s CD ❑ BLDG SETBACK FROM y U deck usin Plastic ShakeADD SIDEPROP LINE OF s (SWE T) 1 E{Ot LTER ElTOTAL} YARD = TOTAL SETBACK FROM TYPE OF EXI NG U REPAIR SIDE PROP LINE HIGHWAY WIDT LtJJ EXISOT NG BLDG DEMOL El } F APPLICANT EL kCORN R CUTOFF YES ❑ NO (PRINT) - Liward L . Rando_ O1 i '� r IN PEN SPACE J4 YES ❑� NO BY (SIGNATUR � r QQ IN COASTAL PERMIT ZONE YES NO 'E]VALUATION,$ 2000�.0Q _ — I IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT7THE ABOVE IS CORRECT AND AGREE TO COMPLY — WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON K f s STRUC TION I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 f HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATI TO + WORKMEN S COMPENS TION INSURA CE v r SIGNATURE OF� _ PERMITTEE ADDRESS TEL FINAL ,� BY CITY San Gal2rl1e1 ] Cd NODATE MARE CHLCKS PAIABLE 70 — P C $ � � � PMT $ HARVEY T BRANDT COUNTY ENGINEER FEE FEE 21.75 i PLAN CHECK VALIDATION CK M 0 CASH _ _ PERMIT VALIDATION \ M`0 CASH ` t 2t6 6Wg� 17" 1 D 2 1.7 5 �Od � t 78A838A CE#803 574 i t �s WORKERS COMPENSATION DECLARATION ti I hereby affirm that I have a certificate of consent to self t� K APPLICATION F O BUILDING PERMIT insure or a certificate of Workers Compenstion Insurance or a lacy No CS113066�med copy thereof (Sec ,.n Lab C ) COUNTY OF LOIS ANG LES BUILDING AND SAFETY Policy . Maryland .as 1a.1t Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec BUILDING4948 Baldwin I tion department ADDRESS LOCALITY American Builder NEAREST / Date Applicant CITY Temple t ZIP CROSS ST lam/ CERTIFICATE OF EXEMPTION FROM WORKERSSIZE OF LOT $6X205 NOW F BILDGLOTS 1+ MAP BOOK PAGE PARCEL t It ASSESSOR COMPENSATION INSURANCE (This section need not be completed if the permit is for one ZON MAP hundred dollars ($100) or less ) TRACT BLOCK LOT NO / NO O§i,qB.An arson and N(444-0714CONDITIONS PECIAL a I certify that in the performance of the work for which this LA L- ICT GROUP TYPE FIRE cO permit is issued I shall not employ any person in any manner VgPADDRESS 4948 Ba dWin CON r 4 so as to become subject to the Workers Compensation Laws �f�� c� IM IM CITY Temple city ZIP 91780 Date Applicant STATISTICAL CLAS$IF ATION CONDO . ~ ARCHITECT OR TEL NOTICE TO APPLICANT If after making this Certificate of ENGINEER None NO W Exemption you should become subject to the Workers CLASS NO DWELL UNITS IL I Compensation provisions of the Labor Code you must forth V) ADDRESS I SEWER MAP - � with comply with such provisions or this permit shall be American 111 erS TEL I deemed revoked — CONTRACTOR - + NO ^ BK�P VALIDATION LICENSED CONTRACTORS e DECLARATION p D`5E%19k Temple Cit BI.r2 104325 I herebyaffirm that I am licensed under provisions of Chapter 9 AD VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC 00 YTe Professions Code and my license is in full force and effect CIT mple City CLASS B-1 $ P SQ FT NO OF NO OF CHECK License Number Lic Class SIZE STORIES FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW - $ / I am exempt from the licensing requirements as I`am a 2 Bedrooms 1� Bath ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051 and Wet Bar DATE Business and Professions Code) USE OF REPAIR FINAL t i I EXISTING BLDG 3ngDEMOL ❑ By Loc or Reg No Date APPLICANT TEL — OWNER BUILDER DECLARATION PRINTAmerlcari ullderSNO r/ — I hereby affirm that I am exempt from the Contractor s License T.0 ��✓ / Law for the following reason (Section 7031 5 Business and ADDRESS �819TemDle Professions Code) PRE ENT ;2 3 2 1 5 A BUILDING I as owner of the property or my employees with ADDRESS ! ' , # 0 0 0 o s 1 w wages as their sole compensation ill do the work and the structure is not intended or offered for sale(Section LOCALITY - 2 n 24850 7044 Business and Professions Code) MOVING TEL 1 as owner of the property am exclusively contracting CONTRACTORNO —� e c 249505 with licensed contractors to construct the project (Sec v tion 7044 Business and Professions Code) - 1 1 26-80 Y ADDRESS REQUIR D TOTAL SETBACK FROM dWXID'STTH, CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE 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 - PL _ Lender s Name m P C Fee$ v Permit Fee ' Lender s Address w 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 nvestigation Fee ordinances and State laws relating to building construction and hereby au raze represe sof this County to enter y Total Fee u qn the rr�it p� or inspection purposes m pq mer ail )3 l P P P a • SEE REVERSE FOR EXPLANATORY LANGUAGE 0 ignatu�e of#1 icont or gent J Date _ m w _ ®s APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING �V I hereby affirm that I have a certificate of consent to self insure, � or a certificate of Workers'Compensation Insurance,or Certified CIT ZIP copy.thereof�$gc.,3$ ) r n LOCALITY Policy No. II/JS/ o Company C�✓�IU OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy Is hereby furnished. NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACTO ^ BLOCK LOT O. depnartment. d� ! USE ZONE MAP NO. Date `��/ Applicant I 961 ASSESSORM� O PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER . �� r YT�L.NO. COMPENSATION INSURANCE sty, WITHIN 1000 FT.OF SCHOOL? Yes No ADDRES (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY zIP I certify that in the performance of the work for which this permit J"O� is issued, I shall not employ any person in any manner so as to ARCHITECT OR EN I TEL.NO. 'v c! become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATIONAPT CONDO Date Applicant ADDRESS CLASS NO. DW UNI NOTICE TO APPLICANT: If, after making this Certificate Of CON CTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' r SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. AD E S L I C,.N O. P //yy SIDE LICENSED CONTRACTORS DECLARATION CI i LI CLLAASS PL °g p I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP =�°I•= ==+°7 v (commencing with Section 7000)of Division 3 of the Business and .FT SIZE NO.OF STO ES NO.OF FAMILIES CLI Professions Code,9nd mIse is in full force and ect. NEW El BK PG DESCRI TION OF WORK License Num d� Lic.Class ADD VALUATION csti;i;s° a Contractor — ALTER ❑ ®� + 777 07 = -z REPAIR ❑ ❑ I am exempt under Sec. +��tP DEMOL ❑ B.&P.C.for this reason USE OF EXISTING BL G. LDMA P/C# _ _.:s 5_- - 9L Date: URM ❑ I I I ? `—' _ Signature APLA1 µyT�(PR�NT) TEL.NO. LDMA Perm# CH,C. ❑ I, as owner of the property, or my employees with wages as `" �' ""'�L O �"`=h3'=- °I_I'_ their sole compensation,will do the work and the structure is ADDRESS =1! Ut not intended or offered for sale (Section 7044, Business and / iV C. FINAL DATE G Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q �`' j!-I{ I 3 i'f „j,ir'i j• ❑ I, as owner of the property, am exclusively contracting with THE AMOUNTS SPEC IED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B , ' > "'t1�' licensed contractors to construct the project.(Section 7044, VES❑ NO '�:: �' Business and Professions Code.) - WILL THE INTEND D USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST I hereby affirm that there is a construction lending agency for FOR GUIDELINES.ves El No F, the performance of the wor"k�for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C.). /j PERMITTING CHECKLIS UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �. l//t�J COUNTY CODE,TITLE ,C APTER 2.ZO SEC TIONS 2.20.100 THROUGH 2. .740 CONCERNING to Lender's Name HAZARDOUS MAT O TING INING PERMIT OM THESCAQMD. Lender's AddressOWNOR�� o 1 certify that I have read this application and state that the above information is correct. I agree to Comply with all County P.C.FEE �' / PERMIT FEE ^ ordinances and State laws relating to building construction,and 7 ¢ hereby authorize representatives of this County to enter upon ISSUANCE FEE the ab mentioned p operty for inspect' n purpo es. � . ¢ INVESTIGATION FEE TOTAL FEE Sig-t—°I I° Ap c°n.,Agent — J L0°te SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION Q_��. be,;ate;� BUILDING ADDRESS 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY ZIP. 91 780 LOCALITY Policy No. 1046140 Company STATE EIM SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CROSS ST. J3 Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 1 1-1-9 2 Applicant R ANDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS OWNER TEL.NO. CERTIFICATE OF EXEMPTION FROM WORKERS' PAULA JONES 444-07.14 WITHIN 1000 FT OF SCHOOL? YES No COMPENSATION INSURANCE ADDRESS (This section need not be completed if the permit is for one hundred 4948 BALDWIN DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) CITY zIP 5 PN certify that in the performance of the work for which this permit TEMPLE CITY 91780 . '3 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT coNdo Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. . FF L e 529. E. VALLEY BLVD. 451937 SIDE d' LICENSED CONTRACTORS DECLARATION CITYSAN GABRIEL, CA 91776 LI�-013 PL o I hereby affirm that I am licensed under provisions of-Chapter 9 SEWER MAP cr_ (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG DESCRIPTION OF WORK VALUATION Ai'" License Number 4519'37 Lic.Class C-39 ADD ❑ CL ContractorRANDOL ROOFING ate 1-31-94 ALTER ❑ $ 3,000.00 ti,7 �'` %= �" 11 I am exempt under sec. CEMWOOD SHAKE. TEAR OFF OLD REPAIR XJ B.&P.C.for this reason SHAKE, CLASS A. ROOFING. DEMOL ❑ LOMA P/C It USE OF EXISTING BLDG. Date: SFD 1 .URM ❑ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm k RANDOL ROOFING 2884040 Z IIS: _• El — I, as owner of the property, or my employees with wages as p their sole compensation,will do the work and the structure is ADDRESS H not intended or offered for sale (Section 7044, Business and LVD. SAN GABRIEL FINAL DATE Professions Code.) 1 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL j .-;,y.-- •yszi",;. OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q HIM!j,'. ",;../ ❑ 1, as owner of the property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL Y moi" licensed contractors to construct the project.(Section 7044, YES❑ NO❑ Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING :.�,_ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ''j /� ' CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I herebyaffirm that there is a construction lending agency for a 9 g Y VES❑ NO❑ the performance of the work for which this permit is issued(Sec. 3097,CIV.C. 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD rn ). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES "y g i'°`F,¢ •"'u .S.x m. COUNTY CODE.TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING •• '- -••- --F+••'�••- = �•••�'= Lenders Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. a Lenders Address OWNER OR AGENT o 1 certify that I have read this application and state that the above •�"I� F`tiy r 8 information is Correct. I agree to comply with all County P.C.FEE PERMIT FEE 88.88 ordina es a S laws relating to building construction,an ¢ he by auth presents' as o is County to a ter upo ISSUANCE FEE Fj}h; —:S;:j_i ) ve op r• spection pur 1 24.75 _= _ "!"d r u•,:_ INVESTIGATION FEE TOTAL FEE .��?_!!ryTa- a — •�S 113.63 w SEE REVERSE FOR EXPLANATORY LANGUAGE