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HomeMy Public PortalAbout10793 BLACKLEY ST_Building__ �! COUNTY OF LOS ANGELES TEMPLE CITY . 16, # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDFNTIAL'ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9808170043 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 13613 LT: 88 SQ. FT STORIES TYPE OCCUP GROUP 10793 BLACKLEY ST STRUCTURE: 748 2 VN R3 TEMP CA 917803502 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: MCCULLOCH 8573-007-016 OTHER: THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 04/20/99 UT 04/20/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FI BY: CODE: WINSTANLEY ERIK C;CATERINA RIZZI 1 55,350 10793 BLACKLEY ST TEMP 917803502 FEES PAID DESCRIPTION OF WORK ADDITION OF OFFICE, BATHROOM AND 2 BEDROOMS (748 SQ. FT.) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER B1 PLANCHECK W/ENERGY 55350.00 VAL 803.48 AA BLDG PERMIT ISSUANCE—_, 27.75 SPECIAL CONDITIONS: AC STRONG MOTION-RESID_�55350..00 VAL 5.54 82 PERM I,T�W%ENERGY,'ZELE ,,55M6 00 VAL 945.29 �� —TOTAL) ES 1,782.06 CONTRACTOR: TEL. NO: �� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS I 0� v. SOILS ENGINEER APPROVAL / ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS / LIC. N0: / – I 1 1 11 SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP01_� ] UNDERFLOOR INSULATION _\_� Lam _ 0" ��J1 ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: ` NO 21 \�\ C% / 0 ND LEVEL FLOOR SHEATH \\ � m_ SCHOOL WITHIN HAZARDOUS U t**. ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS /� ❑ 1= -"l NO NO NO L FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST ��0. ®dam BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: � G FRONT PL- ,�49p���� SHEAR PANELSel / SIDE PL- INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH 26 LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPR L �T REPORT ID: DPR261 ROUTE TO: BS0508 APPLICATION F,qtBUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby allt$that I have a certificate of consent to self insure, BUILDING'ADup KESS Rl or a certificate of Workers' Compensation Insurance,or a certified b ITY / f' "g"-OC Zlii `- copy thereof (Sec.3800,Lab.C.) CTG / IT ZIP ��V LOCALITY Policy No. Company SIZE G NO.OF BLDGS.NOW ON LOT El Certified copy is hereby furnished. NEAREST CROSS ST. • ❑ Certified copy is filed with the county building inspection TRACT 1 BLOCK LOT NO department. USE ZONE MAP NO. Date Applicant AS SSOR MAP BOO P A CEL 1 65-V SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER 'Lf,R COMPENSATION INSURANCE IF91K CA` LSI/n/S7F� L 7 WITHIN 1000 FT.OF SCHOOL? YEs No 4 (This section need not be completed if the permit is for one hundred ADDRESS �• BL✓1/���EV DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100) or less.) c� /"�L/ 7 CITY ZIP I certify that in the performance of the work for which this permit Cil- 1 ga ee is issued, I shall not employ any person in any manner so as to gRCHITECT OR ENGINEER T .�/ become Subject t0 the Workers'Compensation Laws. fr��� O�� �/ �2 (00 STATISTICAL CLf�SSIFICATION APT CONDO Date Applicant ADDR S �i11'' ��/!//Y O L `"��Giv CLASS NO. / DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of + 0v �� r �•�/" �� 1614 REQUIRED TOTAL SETBACK FROM EXIST Exemption, you' Should become Subject t0 the Workers' CONTRACTOR TEL NO. 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. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION PILE CIT LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT. IZE� O.OF I STORIES NO.O FAMILIES Professions Code,and my license is in full force and effect. NEW El BK PG a 1 VALUATION License Number Lia Class DESCRIPTION O WORK ADD N fo(E �� 0 $VA0 Contractor Date ALTER ❑ 1 am exempt under Sec. A2DI C�p N o0 REPAIR El $ BAP.C.for this reason DEMOL ❑ LDMA P/C# V ' � IJ,J Date: USE Q EXISTING BLDG. URM '❑ s . .......... Signature ..___ g APPLICANT(PRINT) T � LDMA Perm# z as owner of the property, or my employees with wages as � I e wvl `72 . Z '�•(_'•. ...... ._aro=' their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and /= 1tek FINAL DATE Q -- .. Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 'lr' i-Ii--'.•T a 3' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE _ _ ❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q '' Cr A C FINAL BY � ,-y,+4� o•;j f licensed contractors to construct the project (Section 7044, -- - VES El Business and Professions Code.) NOfL/ WILL THE INTEIVDUP_USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH - - --•. ,... ._.. .. -��T - •i}- .. CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR ;rJ ITAL 6 -b ® ZE3 GUIDELINES. I.{ I hereby affirm that there is a construction lending agency for YES❑ NO� a. the performance of the Work for which this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING - I,fV.3- TITLE Wil- i �f 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. - IHV.3- a�f_• N TITLE 2. HAPTER 2.20 SECTIONS 2,20,100 TH OUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATE Q DENG AN OR OBFIN G ERMIT FROM THE SCAQMD. o Lender's Address f ff 1 4 —! Si{ ..O• OWNER OR AGENT � o I certify that I have read this application and state under penalty "" " `09.35 r,*1A:c' 0 of perjury that the above information is correct.I agree to comply P.C.FEE � PERMIT FEE :r_i 1 '! ?E1#; tom y4 with rill county ordinances and State laws relating to building `1 < const ction nd hereb authorize representatives of this County ISSUANCE FEEce eD to t�u he a ve ention prop rty for inspection rpos (O• /CJ jAIr v � INVESTIGATION FEE TOTAL FEE Sgnature I Appli nl or Agent Dete SEE REVERSE FOR EXPLANATORY LANGUAGE 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, BUILDING ADDR `nV' or a certificate of Workers' Compensation Insurance,or a certified o � `"' LIU copy thereof (Sec.3500,Lab.C.) CITY ZIP -7 RO a 6 '' LOCALITY Policy No. Company SIZE OF LQT NO.OF BLDGS.NW ON LOT ❑ Certified copy is hereby furnished. (p NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRA T BLOCK LOT NO.,87 o USE ZONE MAP NO. department. Date _ Applicant _ ASSESSOR MAP BOOK PAGE - ARC SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER L N YES NO COMPENSATION INSURANCE LCY WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars ($100)or less.) CITY ZIP .� I certify that the performance of the work for which this permit � 7 © D is issued, I shall not employ any person in any manner so as to ARCHITECT ORE GIN R TEL NO become subject to the Workers'Compensation Laws. FC WG' � C) STATISTICAL CLA S�ICATION APT CONDO cVVvv�N 3 $' :�� Date Applicant ADD CLASS NO. DWELL UNITS NOTICE TO APPLICANTIf, after making this Certificate of U � � REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONT ACTOR TEL NO. SET BACK - YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith LA-)0 eV— FRONT comply with such provisions or this permit shall be deemed revoked. ADDRE LIC.NO. P L LICENSED CONTRACTORS DECLARATION PILE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and SQ.FT.SIZE NO,OF STORIES NO.OF FrILIES Professions Code,and my license is in full force and effect. !\ NEW E3 BK PG , d License Number Lie.Class DESCRIPTION OF WORK ADD ❑ VALUATIQ Contractor Date S t O ALTER $ U IY AIR ❑ O El am exempt under Sec. $ I-' BAP.C.for this reason � (' Will, Tt*'Z DEMO � ' L ❑ LDMA P/C# W Date: URM ❑ 11 t U) 'Signature APPLICANT(PRINT) TIE—L NO. LDMA Perm# D91, yam, as owner of the property, or my employees with wages as Z v their sale compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATE Q --- {�-Z�f t Professions Code.) 0 t-�'j-t WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J L I_I._ ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE .__. _ _ Y g AMOUNTS SPECT O ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY i'i licensed contractors to construct the project (Section 7044, ves❑ No r_ �`} I Business and Professions Code.) 77 c WILL THE INTE DED SE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING t_t -•�. J. �•�c OCCUPANT RE DIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR _ GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ N N the performance of the work for Which this permit Is Issued(Sec. IHAVE READ TH HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097,Civ.C.) CHECKLIST. UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, I. !_.r l i !.F N TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS - y Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. - ' o Lender's Address OWNER OR AGENT O 0 1 certify that I have read this application and state under penalty O of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE o with all county ordinances and State laws relating to building < construction, and hereby authorize representatives of thi 9C my ISSUANCE FEEco M t4�ifQr vpo above mentioned property for inspecti n ur p�(p. 40 m `l�/1_��1 INVESTIGATION FEE TOTAL FEE Signature of Applicant or Agent Dale O ! O SEE REVERSE FOR EXPLANATORY LANGUAGE