Loading...
HomeMy Public PortalAbout5122 BARELA AVE_Building__ APPLICATION FOR BUILDING PERMIT t, COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, / sftR � T� �� I or a certificate of Workers'Compensation Insurance,or a certified of zIP copy thereof(Sec.3800,Lab.C.) T_ �m LOCALITY----7 ,r INN � � 1 I,S� - � Policy No. Company SIZE Of-,LOT NO.OF BLDGS.NOW ON LOT El Certified copy is hereby furnished. --y0-b 1 6 NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS'- A� (14� �kL. T O 19 YES NO COMPENSATION INSURANCE +' WITHIN 1000 FT OF SCHOOLS. DDR , p (This section need not be completed if the permit is for one hundred 151,19 )�) DISTRICT GROUP TYPE CONST.' FIRE ZONE P OCY dollars($100)or less.)Ot `3 .�9 r� I certify that in the performance of the work for which this permit CI��nF- �.�J z j r—)� '.3 , 0�/� `�{/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 I NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CO lTAACTQR �_ SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith T , 1 I� "�'ti�'t O I— comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. FRONT PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS p L / n- 0 I hereby affirm that I am licensed under provisions of Chapter 9SEWER MAP c..1 (commencing with Section 7000)of Division 3 of the Business and SQ. ?F l NO.OF STORES NO.OF FAMILIES Professions Code,and my license is in full force and effect. di/I NEW ❑ BK PG i U D RIPTION OF WORK ❑ License Number Lia ADD Ctass VALUATION ` w� Contractor Date ALTER ❑ z ❑ I am.exempt under Sec. REPAIR ❑ B.&P.C.for this reason DEMOL�' LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) _ _ EL.NO. LDMA Perm# s ❑ 1, as owner of the property, or my employees with wages as z s.1-k -)✓ Se- 1 O O their sole compensation,will do the work and the structure is ADDREVS not intended or offered for sale (Section 7044, Business and J FINAL DATE a ;-- " IIMI Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 3 i/ �// ;4 ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY / V71- Business /y� 00 licensed contractors to construct the project.(Section 7044, YES❑ No❑ p :r//� , > _;k=.I - Business and Professions Code.) - I RL �� `_ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDINGci: OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1.5�2_L.rE ?L'a CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. Il 1 hereby affirm that there is a construction lending agency for YES El NO❑ t" ��.�� B" 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 REQUIREMENTS UNDER THE LOS ANGELES �. COUNTY CODE,TITLE2.CHAPTER 2.20SECTIONS 2.20.100THROUGH 2.20.140 CONCERNING Iii;j"'i 'I_I�.:��) _+}:`_,_.'.+'-r'I Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. " a ri Lr Lender's Address QOWNER OR AGENT .. o' I certify that I have read this application and state that the above information is correct. I agree to comply with all county RC.FEE PERMIT FEE ?� ordinances and State laws relating to building construction,and d 0 ¢. hereby authorize representatives of thi County to enter upon ISSUANCE FEE the bove- entione rope f r insp c'on purposes. r� 6 00 INVESTIGATION FEE TOTAL FEE p� SIBnBNrO of hent or Agent �� SEE REVERSE FOR EXPLANATORY LANGUAGE L 1 APPLICATION FOR BUILD14d-09 MIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING' COUNTY OF LOS ANGELES ADDRESS ,Z Z �-BA Z&-ILA DEPARTMENT OF COUNTY ENGINEER F CITY Q/ } /� IP / io BUILDING AND SAFETY DIVISION SIZE OF LOT +��J [ l NOW ON LOT ADDRESS ->jj TRACT BLOCK LOT NO. 4 LOCALITY ✓ TEL.�(yy/ NEAREST OWNER NO. '� CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROU TYPE FIRE PROCESSED BY -CITY ZIP J7 ;�y CONST. ZONA l ARCHITECT OR TEL. Trl/ � f f V ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS 77777� BK PG TEL.. rr ,/ CONTRACTOR �%ID6� NO. .fir �� USE ZONE MAP NO. ADDRESS T(.�/� s NO. ' SPECIAL ` J LIC. �Ljg CONDITIONS CITY Pte( CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD SQ.FT. �NO.OF NO.OF CHECK = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES OLIoNE } CL DESCRIPTION OF WORK NEW + O ADD ❑ BLDG.SETBACK FROM Ix SIDE PROP.LINE OF (STREET). O ALTER ,❑. TQTAL SETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH h .USE OF REPAIR ❑ Z EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) S NO -w IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ 01 O 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES //� AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE '0-0 ,/lk �L1.t �]�� T7-1f WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- �d�� 'NW ( _ PENSATIONINSURANCE. ��. c.Y /��� 116 OA/�" 4�y SIGNATURE OF /Za PERMITTEE �`L ADDRESS FINAL BY CITY --NO. GLlz� DATE J ✓ ©i�� r MAKE CHECKS PAYABLE E FEE C. FEET p Y IiARVET.BRANDY,COUNTY ENGINEER /�. ✓�j PLAN CHECK VALIDATION cK M.O. CASH PERMIT VALIDATION GRZ) M.O. CASH 643&-SEP 71.1). 1 6.65_ . 6 SS 76A63BA CE NS03 3.75 6. 4 4 C SEP 7 1 0 5,55 0 ,&58 APPLICATION FOR •• - -•• '-�311•ILDING PERMIT `: --- • • � - BUILDING FOR APPLICANTTGFILLalN'. ADDRESS Z Z / v —7 _ 14 BUILDNG ADDRIESS /w� y/ •LOCALITY CITY . ZIP. g d �'. CROSS ST, NO.OF BLDGS. ASSESSOR SIZE OF LOT - NOW-ON LOT' MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PROCESSED'BY - -TRACT BLOCK LOT NO. CONST ZONE �� '1J OWNER TEL.... .• NO., ' -. STATISTICAL CLASSIFICATION. SEWER MAP f ADDRESS �{ AJ CLASS NO. 1!� DWELL.UNITS BK PG 6 CITY �[ ZIP /� USE ZONE MAP " ARCHITECT OR TEL. NO• . /�� ,/ SPECIAL ENGINEER NO �.•., _ CONDITIONS ' ADDRESS ROAD.DEPARTMENT APPROVAL REQUIRED YES❑ - •NO`❑ - TEL .. - - BLDG.SETBACK FROM CONTRACTOR TEL LIC' FRONT PROP.'LINE OF (STREET)' ' ADDRESS NO. TOTAL SETBACK FROM 'TYPE OF EXISTING LIC. HIGHWAY '+ YARD1 = FRONT PROP.LINE. HIGHWAY WIDTH CITY- - CLASS. _ ... _ CONSTRUCTION LENDER + a NAME AND.BRANCH. BLDG.SETBACK FROM SIDE PROP.LINE OF ' (STREET) Ce ADDRESS CITY • O SQ.FT.'• NO.OF, NO.OF '' CHECK HIGHWAY + YARD = TOTAL SETBACK FROM. TYPE OF EXISTING U SIZE STORIES FAMILIES ONE. SIDE PROP.LINE HIGHWAY...WIDTH ii DESCRIPTION OF WORK NEW ❑ `,� �o y, ADD CORNER CUTOFF YES ❑ NO ❑ Al ALTER. _ J�X _ ❑ IN OPEN SPACE' YES ❑ NO, REPAIR ❑ USE.OF DEMIOL. '❑ ,IN COASTAL PERMIT ZONE _ YES ❑ NO ❑ EXISTING BLDG., APPLICANT TEL :(PRINT) NO. BY(SIGNATURE). c • I•HEREBY ACKNOWLE THAT I E•READ THIS APPLICATION AND STATE .rD?NrE THAT THE ABOVE IS CO AND EE'TO:COMPLY WITH ALL ORDINANCESAND LAWS REGULATING BUILDING C STRUCTION.I CERTIFY THAT IN DOING THEWORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OFTHE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM•PENSATION INSURANCE.SIGNATUREOF r ?7 BYPERMITTEE-'•'ADDRESSTEL. Permit Fee, CITY NO. Issuance Fee VALUATION ' Total Fee PLAN CHECK VALIDATION CK M.O. —CASH PERMIT VALIDATION CK. M.O. CASH 7 E'QGT' 6 . •-1 o J.O. 0 &!38.. ®f.7SA63SS-CE#608136/78 - - 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 of consent to self insure, ti ILD, G ADDRES or a certificate of Workers'Compensation Insurance,or a certifiedEy" a' R copy thereof(Sec.3800,Lab.C.) V' CI _ G '� LOCAL, �/� ) f Policy No. Company SIZE OF LOT NO.F BLDGS.NOW ON LOT °— ���r- l , ❑ Certified copy is hereby furnished. x/97 NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRA T BLOCK LOT No. USE ZONE MAP NO. department. Date—Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER ADDRESS c TE No. _l ` Y NO COMPENSATION INSURANCE WITHIN 1000 Fr..OF SCHOOL? (This section need not be completed if the permit is for one hundredDISTRICT GROUP TYPE CONST.' FIRE ZONE iiROCESSED BY dollars($hat or less.) r a p� _� I certify that in the performance of the work for which this permit CI zIPG �� U is issued, I shall not employ any person in any manner so as to ARCHIT CT OR ENGINEER TEL.NO. _ become subject to the Workers'Compensation Laws. S � _`1 9 ti� � STATISTICAL CLAS IFICATION APT COND Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you Should become subject to the Workers' CONTRA T R �E NO. SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith 1(� 11 FRONT comply with such provisions or this permit shall be deemed revoked. 7'siDRESS LIC.No. PL SIDE LICENSED CONTRACTORS DECLARATION CITY , LIC.CLASS PL o Q 1rri cj I hereby affirm that I am licensed under provisions of Chapter 9 `\. SEWER MAP c..3 (commencing with Section 7000)of Division 3 of the Business and SFT NO.OF STORES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG /� O License Number Lic.Class DESCRIPTION OF WORK (� ADD VA UATION - W I ^ !J r� H v n s _ E? Contractor Date - ALTER Elt Cn P LA a 1.�Jy\ 8� REPAIR ❑ 1 ��/U 0 _1:330 1756.=1i— ❑ I am exempt under Sec. �' 1DEMOL El P/C N ;LM 1 B.& P.C.for this reason _ USE OF EXISTING BLDG. TOTa Date: URM ElI:I.H_ ate' -_ r m _ Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# r-Hf:, K 74 e i ❑ I, as owner of the property, or my employees with wages asp E _t•�IE+' their sole compensation,will do the work and the structure is ADDRESS H CHECK —745.51 not intended or offered for sale (Section 7044, Business and FINAL DATQPoo-CHECKc' i Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �� �j :iC o.I1 1, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO TI GREATER THAN Y g THE AMOUNTS PE FIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY (,�•;HNGE licensed contractors to construct the project.(Section 7044, YES❑ No /� Business and Professions Code.) as WILL THE INTENDE USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING -y COAST AOCCUPAIIR QUALITY MANAGEMENT DT REQUIRE A PERMIT FOR IISTRICT(I CON AQMD)SEECATION CHECKLIST.ECK ST 00 fI1-'13001 �"29 `0FROM THESOUTH CONSTRUCTION LENDING AGENCY FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NOX `, LI 1 HI`I the performance Of the Work for Which this permit IS ISSUBd(SBC. I HAVE READ THE HAZARDOUS MATERIAIb IIaEORMATIO aUIS":AN�HE SC 1WD�? h' '� r't r;i ii G•f 7j F• I 3097,CIV.(`i.). PERMITTING CHECKLIST.I UNDERSTAND NWIRE'61L�IIREME S111NgE,R TR6�OS ANG t;RS'. 17 t�e .S• �,., t._� C�+I ,"1 1:x•.1 I.,I ,_",, f_o-.( m. COUNTY CODE,TITLE 2,CHAPTER 220 Edfl_ON ,t�Q0p100T a,�iUG t.CONCERNING__ P-1 I;�a TJ' 1"r'II.�j o Lender's Name HAZA DOUS ATERIALS R RTING D( 'PA F RMT ER� THESCAOMb.o "CI 1771 i� *' "'•3 '�i -..,a E. I .1 Lendel'sAddress � n ;r' i7a M ,p o 1 certify that I have read this application and state that the above p.C.FEE PpR1:iIIT FEE n -� p,,� 1 1 $ information is correct. I agree to comply with all county Jr' ,I , , J ordinances and State laws relating to building construction,and VI 6�� In. r_0 Q hereby authorize representatives of this County to enter upon ISSUANCE FE the bove ention prop f inspe ion purposes. D. •-�I 1 �' ' + _—T '7 c•. I'...I t•J G INVILSTIGATION FEE j r.OTAL FEE a A A.U. t _ o SigMW` 1 pfluvt or Agmt Deb v .,I I 1 1 'J-1 d�-t ..f_'3 r-1 _i� �_n t.J SEE REVERSE FOR EX GANI4TORY CgN1idA49 F-• r- ��, r ,_B :_11 �','j #�6a 0 +• 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 0612050031 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 15683 LT: 47 SQ. FT STORIES TYPE 5122 BARELA AV STRUCTURE: VN TEMP CA 917803846 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CAMELLIA 8589-011-019 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 12/05/06 JK 11/30/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE41L, CODE: BAGADLIAN HOUSEPH J, HOURING (626) 840-2395- 2,000 / ? 5122 BARELA AV TEMP 917803846 FEES PAID DESCRIPTION OF WOR TAKE OUT ROOF TILE REPAIR FELT PAPER & PLYWOOD WHERE NEEDED. FEE DESCRIPTION: QUANTITY: UOM-. AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 2000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 2000.00 VAL 82.20 TOTAL FEES 110.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAIDED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDIRFLOOR INSULATION 144H269 3 01 ` FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS 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- INSULATION/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