HomeMy Public PortalAbout5139 BALDWIN AVE_Building__ DEPARTMENT OF B*lLDIN A' D S ' ,,�` I PLICATIO�"FOR PERMIT
i BOUNTY OF LOS ANGELES
WM J FOX CHIEF ENGINEER /
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
\ NG
BUILDIDISTRICT NO 1`INO PERMIT
AY3 ADDRESS 1,316E -7 �< q
LOCALITY �� i RECEIVED BY DATE OF APDL
/) DATEISSUED
NEAREST t♦ ,)� // /�- / 9 ! •'�� �,/ 1
CROSS ST /ZIP A /
BUILDING ,
OWNED �� ADDRESS ® �J���/ 191911D4111,14-1
/ ,,fi�r///
Q _ADDRESS f MAIL LOCALITY T�/�/ L� /Y
NEAREST
CITY / TEL
FQ - / CROSS ST
s FIRE NO OF TYPE GROU
ARCHITEC�I ENNTGgqNEERT OR '��yffB /lo- pg'Tfa ZONE PLANS C
1 A D' AZ►d/®R4li/LA N —,oCi � BLDG �G D F LO7
V __ O00"' SETBACK LINE
//� APPROVED I \
CONTRACTORL.� i� Np 57-7 BY _ DATE
ADPRESB ® `j USE APPROVE
`1 C� Y &bNE / BY DATE
LEGAL -' ' �Q CORRECTIONS
DESCRIPTION LOT NO 2,
v BLOCK i z zG 8
TRACT
NO OFBLDGS /
SIZE OF LOT NOW ON LOT
USE OF -�//a+nI-]Yn� NO OF NO OF
EXISTING EXISTING BLDG I ES rC�r-Iv�FAMILIEB��ROOM.rC�+�/'�`�FAMILIEB��ROOM. '
DESCRIPTION OF WORK
NEW ALTERATION ADDITION
a
REPAIR MOVING DEMOLISH
Sq FT NO OF
SIZE ROOMS ✓ STORIES ✓� D
WALL / ROOF / [-
COVERING I COVERING ✓ 1
USE OF NEW \
BUILDING
i
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THISAPPROVALS
APPLICATION AND STATE THAT THE ABOVE 18 CORRECT FOUNDATION LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS MATERIALS ,rfN$
AND STATE LAWS REGULATI G BUILDING CONSTRUCTION V
1 FRAME FIRE STOPS
SIGNATURE OF BRACING BOLTS
PERMITTEELATH INT
AUTHORIZED AGT-/-Yf ~
i LATH EXT
76A639A 3 7 49 P C III PLASTER INT
FEE \ o PLASTER EXT
VALUATION FEE [ /�' ` FINAL ��,.►� �� �/ Y'C
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78A83BA CE o SB APPLICATION FOR -BUILDING PERMIT 1
COUNTY OF LOS ANGELES BUILDING �j _
DEPARTMENT OF COUNTY ENGINEER ADDRESS 5/ m)
BUILDING AND SAFETY DIVISION LOCALITY �gvll ,67 _Tli
JOHN A LAMBIE-COUNTY ENGINEER NEAREST -
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST
t
TRICT NO GROUP TYPE PRO ES BY
FOR APPLICANT TO FILL IN1j S coNs�
BUILDING ,(' _ TISTICAL CLASSIFICATION SEWER MAP
ADDRESS �I I I P
LASS NO MAP �7 W/ELL UNITS
LOT NO // BLOCKNUMBER OHO/fes S.jWYE YES O
TRACT- (OQ ZON SPECIAL' '
CONDITIONS`
NO OF BLDGS SIZE OF LO NOWONLOT USE OFEXISTING BLDG DING YARD HWY STREET NAME EXIST
BACK WIDTH
OWNER /` ONTAMAILDDRESS ,/ L�Y / TEL DE
CITY T• NO C/ INSPECTION RECORD ` �V
ARCHITECT OR TEL
ENGINEER NO
/f t
ADDRESS TEL
CONTRACTOR r NO Qy?
ADDRESS r �C.. �1 .
DESCRIPTION OF WORK T. G
NEW" ADDVX ALTER REPAIR DEMOLISH �
SO FT +- NO OF NO OF ` (�t�( a A(" D
SIZE y7 STORIES / FAMILIES
USE OF
STRUCTURE
� _ l
SIGNATURE
OF
APPLICAryS/- APPROVALS DATE INSPECTOR S SIGNATURE
ADDRESS FOUNDATION LOCATION
FORMS MATERIALS
VALUATION 5 FRAME FIRE STOPS ZL!S r v f
BRACING BOLTS
PC I PMT _ FURNACE LOCATION
FEE FEE J`' GAS VENT DUCTS �y
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP I J
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH INT
AGREE TO COMPLY IT LL COUNTY ORDINANCES AND T
STATE LAWS RE G BU ING CONSTRUCTION LATH EXT
HOUSE NUMBER COR- f
SIGNATURE OF RECT AND POSTED f
PERMITTE
ADDRES FINAL
T CLYDE N DIRLAM RINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION CK M O CASH
- 3
' b- LACo 1 6 s Fv� 13 17 A "7.0 U 10
4
I -
DEPARTMENT OF BUILDING AND SAFETY Y ' R
COUNTY OF LOS ANGELES
WM J FOX, CHIEF ENGINEER APPLICATION
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
Q DIBTRI NO PLANCK OR REc'NDF b11T�Ol 3
SUMADDRESS ,'S / � / Q' ✓ �/O 33
R&PEIVED BY DATE OF APPL DATE ISSUED
LOCALITY _ `�
NEAREST ' •c�
CROSS ST BUILDING 3 �/ 1�G N
ADDRESS I Lam/
OWNER /J J . LOCA f
MAIL /
ADDRESS �� f//��(�y�Aa NEAREST'
-y- TEL CROSS ST Z_
CITY / NO , FIRE I I NO OF G ;
_
ARCHITECT R f TEL ZONE PLANE
+
ENGINEER NO BLDG
O/ I SETBACK LINE
26 L��,
ADDRESS n �/ �-� USE �,AL APPROVED
L f
TEZONE // , - BY ' DATE
CONTRACTOR 9.S NO g HOUSE NUMBERING I
ADDRESS MAP NUMBER 14 NO ASSIGNED BY
LEGAL CORRECTIONS
DESCRIPTION LOT NO BLOCK
TRACT /
/ /�4 / NO OF BLDOB +
SIZE OF LOT R 3 /,J NOW ON LOT ,
USE OF NO OF
EXISTIN BLDG �/}�yN1,Q FAMILIES
DESCRIPTION OF WORK A
NEW ALTERATION x ADDITION ZD
r
REPAIR DEMOLITION
NO OF
9 ZE F-T /��� ROOMB STORIESEXT J
COVERING Q �,rY I COOF/ 9oaS/I// /Al
USF OF STRYCT RE
16 ]L/ f7 P e
I v G
r
r L
INSPECTION FOR
APPROVALS
OCCUPANCYAS INSPECTOR S SI GNATURE DATE
FOUNDATION LOCATION
FORMS MATERIALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP
PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME FIRE BTOPB,
CORRECT BRACING BOLTS
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION
AND STATE LAWS REGULATING BUILDING
/CEINSTRUCTION GAS VENT DUCTS
SIGNATURE OF/ V ,�/ ! l L14
LATH INT
PERMITTEEav ��A 4n n "`]SXX.L.L�1L�1777
h
ADDRESS �Y �C�� A(j A� �c LATH EXT
'C _
PLASTER INT
AUTHORIZED AOT
PLASTER EXT
$ P C III
FEE HOUSE NUMBER COR-
RECT AND POSTED
VALUATION FEE o FINAL
76AS38A DBS 3 7 51
IDBS 3 SSM SE644
DEI ARTAENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT .i
/"COUNTY OF LOS ANGELES BUILDING UILD ' NG
WM J FOX, CHIEF ENGINEER
FOR APPLIICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING �� �� r DISTRICT NO I PLAN CK NO PERMIT NO
g /
ADDRESS ® �(eLP'S/ s f / y,,, 9- 3
LOCALITY , ��14AII RECEIVED BY DATE OF APiPL '%DATE ISSUED
NEAREST ,1 ��(/!� � J� 7,1 ov -4,1- 6
CAOSS ST
BUILD
NG
OWNER r/ {�/ , �/"Cid ADDRESS / t�✓//7,, Z,6
XMAIL
ADDRESS /,si.� � LOCALITY
NEAREST
TEL CROSS BT
CITY NO J
FIRE NO OF ,TYPEGROUP/_/_,� �r
ARCHITECT OR C�� TEL ZONE ! PLANS I v I lA1/I
ENGINEER NO
N BLDG ORD NO
ADDRESS SETBACK LINE
APPROVED
TEL BY DATE
CONTRACTOR , it/Q_A i NO
PROVED
ADDRESS
/ l {.Q Q_��7� �"�"'W�"1,( "ZONE/ BYDATE
LEGAL -� CORRECTIONS
DESCRIPTIA{ON�j,��'() LOT NO
f� � I BLOCK _-
LOCK q
TRACT ��// /7 S
SIZE OF LOT[��5'G/`�J I NO OF BLOT _
NOW ON LOT �A�N�! �•{�`Ll� !/
USE OF NO OF -NO OF
EXISTING BLDG f I FAM'
LI[B ROOMS V��,��// ��/ �A➢ "' �',� /� �N.�,,,.,�.i
DESCRIPTION OF WORK
NEW wALTERATION ADDITION O
REPAIR MOVING DEMOLISH
SQ .(^'IDO
,�d U ROOMS 9TORIE9 D
SIZE
r
WALL ROOF
COVERING �+ '� I COVERING +sl
USE OF NEW
BUILDING o Id
APPROVALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
N PECTOR DATE
APPLICATION AND STATE THAT THE ABOVE 19 CORRECT FOUNDATION LOCATION, Ir �
AND AGREE TO COMPLY WITH ALL COLNTY ORDINANCES FORMS, MATERIALS q � xu.
AND STATE LAWS REGULATING BUILDING CONSTRUCTION FRAME FIRE STOPS,
SIGNATURE OF /\ BRACING BOLTS 3Q^^r
OWNER LATH INT �ptis /1 / y
AUTHORIZED AOT . LATH EXT
p C p�� PLASTER INT
FEEtiy'` PLASTER, EXT
VALUATION / Cf ( lJ FINAL
FEE=7/4
WORKERS' COMPENSATION DECLARATION "—,C,— w 000
to sf
insure, or afirm certif carte of Worke s' Comtpensat on of coent Insuran e, APPLICATION FOR BUILDING PERMIT
or a certified copy thereof (Sec. 3800, Lab. C.)
1039547 State Compensation . COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. CompanyBU DING �-�
❑ Certified copy is hereby furr�gfrance Fun FOR APPLICANT-TO FILL IN ADDRESS -3 I�CLI T
Certified copy is filed with the county bu'ding in c- BUILDING
El
5139 R,Idwin
tion department. ADDRESS
Date 2-3-89 Applicant CITY Temple City ZIP 91780 LOCALITY
CERTIFICATE OF EXEMPTION FR96 WO ERS' NO. OF BLDGS. NEAREST
COMPENSATION INS ANCEI SIZE OF LOT NOW ON LOT CROSS ST: L�
(This section need not be completed if the permit is for one ASSESSOR.
hundred dollars ($100).or less.) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL. USE ZONE MAP
I certify that in the performance of the work for which this OWNER Al Trivett NO.401-3501 NO.
permit is issued, I shall not employ any person in any manner 5139 Baldwin SPECIAL
so as to become subject to the Workers'Compensation Laws. ADDRESS �— CONDITIONS
CITY Tem ZIP
Date Applicant ARCHITECT O TEL. TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after makingthis Certificate of `hone DISTRICT GROUP
Exemption, you should become subject to the Workers' ENGINEER NO. CONS ZONE
Compensation provisions of the Labor Code, you must forth- ADDRESS ✓ - ('J/
with comply with such provisions or this permit shall be TEL. STATISTICAL CLASSIFICATION APT. CONDO.
deemed revoked. CONTRACTORUnited Roof ing N — /J
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. v DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 1821 DAly ST. NO 137650
(commencing with Section 7000)of Division 3 of the Business and SEWER MAP
Angeles 90031 An eCL
Professions Code, and my license is in full force and effect. CITY Los g CLASS C-39 •. BK PG.
VALIDATION
ff
SQ. FT. NO. OF NO. OF CHECK
License Number 1 5.0 tic.Class C-39 SIZE STORIES FAMILIES ONE
existing NEW VALUATION
2-3-89 DESCRIPTION OF WORK Tear off HIR ❑ 7800.00 O
Contractor ate I n ADD Si .1
ppod bake. Instasta l plywood ❑
I am exe under c. ri t In 1 erg ass S ing a LTER ❑ L,E f' i•-'f'
B.BP.C. for this reason Class A REPAIR ❑ $
CL
N
Date: USE OF DEMOL, ❑ s f
EXISTING BL 'S((AL .�..U6 o !-3
Signature APPLICANT United Roofing CO. NO.223-4081 FINAL _. ,Y..-.• I��=€
OWNER-BUILDER DECLARATION PRINT DATE ;-? CK
I hereby affirm that I am exempt from the Contractor's License 1821 DAly St. , Los Angeles, CA 90031 #y: °4°Iii_ _�?i 1
Law for the following reason (Section 7031.5, Business and ADDRESS FINAL F •1
Professions Code): PRESENT By
BUILDING
I, as owner of the property, or my employees with ADDRESS ._YOy ii
wages as their sole compensation, will do the work and Pi•._
the structure is not intended or offered for sale Section [AD
LITY , � ;,; f"a -s i
7044, Business and.Professions Code). ING TEL J ,
I, as owner of the property, am exclusively contracting TRACTOR NO.
with licensed contractors to construct the project (Sec-.
tion 7044, Business and Professions Code).
ESS
' UIRED TOTAL SETBACK FROM
YARD HWY
CONSTRUCTION LENDING AGENCY BACK PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for ONT '
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.). E G. ✓>
.
Lender's Name
LDMA Ref. #
Fee 5 none Permit Fee
Lender's Address
I.certify that I have read this application and state that the Issuance Fee LDMA P/C#above information is correct. I agree to comply with all County tigation Fee
0 ordinances and State laws relating to b Haling construction, Total Fee 106. 13 LDMA Perm. #
o and hereby authorize re sentative this County to enter
upon the a ave-ment' d proper r inspection purposes.
9 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signotu of Applica r Agent Date
APPLICATION FOR BUILDING PERMIT �
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
I hereby affirm that I have a certificate
ADDRESS of consent to self Insure
l3lfied LJ t VA 1
Wo
or a certificate of Workers Compensation Insurance or a ceVqh,6 C) etiwl �-e Cs ZIP LOCALITY
Ori N ' Company �' SIZE OF LOT O OF BLDGS NOW ON LOT IV112LE \/�
/ / rl
❑ led Copy 18 hereby furnished NEAREST CROSS ST
Certified copy Is filed with the c u ty building Inspection TRACT BLOCK LOT NO
d rt ant USE ZONE MAP NO
� -I U ASSESSOR MAP B�pp PAGE PARCEL j
Date Applicant74 F0 1' l SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION M WORKERS rl Q -J S
TE NO
COMPENSATION INSURANCE V�' 0 WITHIN 1000 FT OF SCHOOL? vas No
F
ADDRESS
(This section need not be completed If the permit Is for one hundred A;f o l<f_ D STRICT GROUP TYPE CONST FIRE ZONE TSSED BY
dollars($100)or less) CITv zip �''D(/ ///►� �'I certify that In the performance of the work for which this penult `I,/1 (J/� IX . 3is Issued I shall not employ any person In any manner so as to ARCHITECT OR ENGINEER TEL NOV\ �/
become subject to the Workers Compensation Laws STATISTICAL CLASSIFICATION APT e CONDO
Date Applicant ADDRESS CLASS NO DWELL UNITS
NOTICE TO APPLICANT If after making this Certificate ofREQUIRED TOTAL SETBACK FROM EXIST
Exemption you should become subject to the Workers CTORjL O��7D SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code you must forthwith (P
comply with such provisions or this permit shall be deemed revoked ADDRESS et `4 FRONT
I �O PL
LICENSED CONTRACTORS DECLARATION CITY t Q LIC CLASS C PIDE S
I hereby affirm that I am licensed under provisions of Chapter 9 / SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SFfyS17F NO OF ORES NOJ0,1AMIES
Professions Code an�d7 y lice Is m full force andff�ct� ( O CJ NEW ❑ BK PG U
License Num r I LIC CI CCiiSS DESCRIPTI N OF WO ADD ❑ VALUATION
�oa c�W( poli. LL
a
Contractor JLqL Date ALTER ❑ $ Z
GV ' REPAIRI am exempt under Sec $
B&PC for this reason DEMOL ❑ LDMA P/C#
Date USE OF EXISTING BLD URM ❑Signature APPLICANT(PR NT) LDMA Perm k
❑ I as owner of the property or my employees with wages as - 6 ;17— &-Al'JB A-1 O
their sole compensation will do the work and the structure Is ADDRESS 0
not Intended or offered for sale (Section 7044 Business and FINAL D TEQ
Professions Code) G 1017 116.3:'
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
❑ I as owner of the r0 am eXCIUSIVBI contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN i
property Y 9 THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL `J 1 ITEMS
licensed contractors to construct the project (Section 7044 YES❑ No❑
Business and Professions Code) TFITA,_ :1 -16
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH (j j'K,,// 116.&0 i
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST HE(t 116•LGn4_
FOR GUIDELINES
I hereby affirm that there is a construction lending agency for YES❑ NO❑ C HANGE a 0LI
the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD
3097 CIV C) PERMITTING CHECKLIST I UNDERSTAND MY REOUIREMENTS UNDER THE LOS ANGELES
COUNTY CODE TITLE Z CHAPTER 220 SECTIONS 2 20 100 THROUGH 220140 CONCERNING ��,,����� 1 4/-2`tf �
Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD I I �J
Lender's Address OWNER OR AGENTy 3-J51 1 AM 9:r�J
0 1 Certify that I have read this application and state that the above PC FEE PERMIT FEE
Information Is correct I agree to comply with all county
ordinances and State laws relatin to building construction and
hereby authonze representativ of this County to enter upon ISSUANCE FEE /
the above-mentioned pro r Inspection pu i
/ !Q INVESTIGATION FEE TOTAL FEE (j
Slg_.IAP0k n DAY o
SEE REVERSE FOR EXPLANATORY LANGUAGE
t