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HomeMy Public PortalAbout9511 BLACKLEY ST_Building__ APPLICATION FOR BUILDING PERMIT BUILDING FOR APPLICANT TO FILL INADDRESS tS'/ BUILDING ,y ADDRESS 95AI LOCALITY CITYT eij 1 e C i;t' ZIP .9-1780. CROSS ST . �c NO.OF BLDGS. ASSESSOR i SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL DISTRICT GROUP. TYPE FIRE RO SED BY TRACT BLOCK ... LOT NO. CONSTt ZQLJE TEL. J 0 " `J✓ OWNER R o 6,.1er t a z e NQ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 9.5511 B,1aCkke CLASSNO.�DWELL.UNITS € BK J7/PG CITY Tem1 e ZIP USE ZONE NMOAP a . ARCHITECT OR TEL. �` SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ TE L CONTRACT. 'L Rand 1 co, NO288,.4Q4() BLDG.SETBACK FROM LIC. FRONT PROP.LINE OF (STREET) ADDRESS NO. . HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH CITY n CLASS CONSTRUCTION LENDER + } a NAME AND BRANCH BLDG.SETBACK FROM 0U SIDE PROP.LINE OF (STREET) 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 N DESCRIPTION OF WOR19"e 00 f]AUSe r NEW El z DID& ❑ CORNER CUTOFF YES ❑ NO ❑ n❑ IN OPEN SPACE YES ❑ NO ❑ USE OF REPAI�K IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL APPLICANT 'H.. 'L . R a n d o 1 NO. 288,4040 LGNNATURE( 0 �y EREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE ��'Q �c.�p-,./� Cf3 �t / j' - AJ a HE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES WS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE AUTHORIZED HEREBY WILL NOT EMPLOY ANY PERSON IN VIOLATION OF �ivS1� OR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. ION INSURANCE.TURE O FINAL BY TTEE DATESS 5 2San �dl�ri;e1 ro.288P.C.Fee$ PermitFeeQIssuance Fee ATION$ 6.0..4.Q.Q. Total Fee PLAN CHECK VALIDATION. CK. M.O. "CASH PERIT VALIDATION CK. M.O. CASH . 4 G i UL. :L t 1 v 1 U ©S 76A638B CE X80313 6/76 �, I ... ' DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES E34o I L WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY d.Qa / DISTRICT NO. PLAN CK. NO. yPER/MMIIT NO. BUILDADD EISS qs .0 Fill ;�.�iid�LS ,O� `''•_-- a�% 0 �. LOCALITY (/ O/ RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST (D CROSS ST. BUILDING ADDRESS OWNER MAIL V � , LOCALITY V ADDRESS � NEAREST yy ,I CITY (/ rfi if/ /A�/ NO. 4 A �f FIROESSST. � . OF l // PE GROUP ` ARCHITECT OR TEL. ZONE I PLANS - ENGINEER NO. BLDG. ORD. NO. SETBACK LINE ADDRESS } APPROVED TEL. BY DATE CONTRACTORNO. > USE APPROVED ZONE BY DATE ADDRESS HOUSE NUMBERING LEGAL .fes DESCRIPTION I LOT NO. / I BLOCK MAP NUMBER _FIELD CHECK BY TRACT r NO. ASSIGNED BY - DATE NO. OF BLDGS. CORRECTIONS SIZE OF LOT NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMI LIES DESCRIPTION OF WORK ' r NEW I I ALTERATION I I ADDITION REPAIR I I DEMOLITION SO. FT. NO. OF 'n SIZE ROOMS STORIES - Z EXT. WALL I ROOF ID' COVERING COVERING USE OF STRUCTURE APPROVALS INSPECTgR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND SITNTE BRACING, BOLTS LAWS REGULAT7;�� G CONSTRUCTION.`f( --- FURNACE: LOCATION, SIGNATURE OF GAS VENT, DUCTS LATH, INT. ADDRESS AUTHORIZED AGT. LATH, EXT. � PLASTER, INT. 76A636A- DBS3 10-80 $ P. C. $ ® FEE PLASTER, EXT. VALUATION FEE $ -0 FINAL I I ' �pEPARTMENT OF BUILD '�AND SAFETY APPLICATION FOR PERMIT I IEE �f �t3u vL I G 1 i COUNTY OF LOS ANGELES , WM. J. FOX, CHIEF ENGINEER 'FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY �--' DISTRICT NO. PLAN CK. NO. PE RMIT N_O,BUILD[N p ADDRESS�,��/ d"r J/1 ✓ I" {-1 VED BY DATE OF APPL. DATE ISSUED . LOCALITY �r` � �•� � q ` iY `��A NEAREST �'�^s' CROSS ST. �(' ,�J ':-t -^' rr�l BUILDING /'Q �-� - ADDRESS O 5/f C AY I A-4 OWNER .At s- 1�,' / rh MAIL LOCALITY SGC ADDRESS ' � £'✓� 1 I NEAREST CITY NO. �/p (', CROSS ST. ,� tifl- 1 �v a ZFIRE ONE �� I pO.tOSF .TYPE / / I GROUP/ d ARCHITECT OR TEL. (! ENGINEER NO. BLDG. ORD. NO. SETBACK LINE ADDRESS a APPROVED TEL. BY ('DATE CONTRACTOR NO. � ��; USE APPROVEW�lr �/ fZONEBY �i`i,J ,DATEy- , ( ADDRESS �' ' �'3`� 1 ,2��{,.'.✓II\,( HOUSE NUMBERING LEGAL DESCRIPTION PLOT NO. BLOCK MAP NUMBER 9-4¢' _FIELD CHECK BY TRACT NO. ASSIGNED BY--6�-DATE ♦ q NO. OF BLDGS. CORRECTIONS SIZE OF LOT •�� p � 1 �j I NOW ON LOT ���� G � � � / � y USE OF I NO. OF / EXISTING BLDG. FAMILIES DESCRIPTION OF WORK NEW I ALTERATION I I ADDITION REPAIR II DEMOLITION I . 1 SO. FT. NO. OF SIZE ROOMS STORIES Z EXT. WALL ROOF f r COVERING I COVERING �/(,JQ �- V-N USE OF STRUCTURE A APPROVALS 1p INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. I AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL-COUNTY ORDINANCES AND ST TE BRACING, BOLTS / yy�.G✓ oo LAWS REGULATING BUI�LDIN�G°CONSTRU C/T�I,ON. ` FURNACE: LOCATIO ,�I •„ Q.2 j,' _ P,f'F � F'' f �' GAS VENT, DUCTS 4 SIGNATURE OF /i LO�(/r ��/�� L y��� PERMITTE r " LATH, INT. . n �;4t ° •tom ADDRESS �„ �s� P �•, LATH, EXT. AUTHORIZED AGT. y PLASTER, INT. 76A638A DBS3 f0-SO P. C. $ / / Jr- (9) FEE PLASTER, EXT. $ VALUATION FEE �` FINAL %E-�"'' . . �. APPLICATION FOR PUILDING PERMIT COUNTY OF LOS ANGELES ' i l BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADDRESS q:t1 I LA IMI!�/ .5� I hereby affirm that I have a certificate of consent to self insure, C (y`� or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY��M��� CITY ZIP !:l j p� Policy No. Company l 'l Q`� LOCALITY SIZE OF LOT /� ,, t"�',� NO.OF BLDGS.NOW ON LOT El Certified copy is hereby furnished. ,,J x l elve 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 14 -7 Date Applicant ;C"0 4O6— O� / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER �/ J T f o. tri MIL HORAK 1r•-7ft r YES NO COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOLS ADDRESS (This section need not be completed if the permit is for One hundred DISTRICTGROUP TYPE CONST.' FIRE ZONEZSEDBY dollars($100)or less.) CITY ZIP n I certify that in the performance of the work for which this permitDy ,// Y is issued, I Sh811 not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. /� G1�G become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.11 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST R Exemption, you should become Subject t0 the Workers' CONTRACTOTEL.NO.�z�,�� 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 deemedrevoked. ADDRESS LIC.NO. PL SIDE CL LICENSED CONTRACTORS DECLARATION CITE' LIC.CLASS PL c U 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 SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES G Professions Code,and my license is in full force and effect. lts4- NEW El BK PG F-: DESCRIPTION OF WORK DV License Number Lic.Class VALUATION L4,r Contractor Date NEW I6D RM ALTER ❑ r 2 2 5 z )�pP I''/� 4- I'�D© ONo' REPAIR 11❑ I .& exempt under Sec. S F•baww, 9-, d w44"6 PlAj1A;4 f M DEMOL ❑ B.BP.C.for this reason LDMA P/C# eUSE OF EXISTING BLDG. LIRM ElSignatur.FE—. APPLICANT(PRINT) TEL.NO. LDMA Perm# -•- I, as owner of the property, or my employees with wages as p N•T their sole compensation, will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and FINAL DATES / C - Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL • ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN Q _. Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project.(Section 7044, YES❑ NO❑ it_: : x, Business and Professions Code.) _ WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - •Aw' -.- CONSTRUCTION LENDING AGENCY OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. '•'�-"-•C' I hereby affirm that there is a construction lending agency for ves❑ No❑ • the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD . - .,s._ _ •+-._ �.: :`' 3097,CIV.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name AZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address .O .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 N ordinances and State laws relating to building construction,and U 930, F ; i,";._rt;yE q 1:.•_;' ` a. hereby authorize representatives of this County to enter upon ISSUANCE FEE theabov ntione ert or ins lon purposes. � �c� t=".•' s� l:;=i'�; �,e �Z INVESTIGATION FEE TOTAL FEE,,�� Sip un of Applicant or Agent Deb a SEE REVERSE FOR EXPLANATORY LANGUAGE AA ;� - ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0506090018 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 17190 LT: 7 SQ. FT STORIES TYPE OCCUP GROUP 9511 BLACKLEY ST STRUCTURE: 638 1 VN R3 TEMP CA 917803143 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8590-005-009 OTHER: 500 1 VN R3 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/30/06 JK 01/25/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: - ,• VALUATION: FINALT FINAL BY: CODE: ZHANG, SAM (626) 203-9639— 99,500 9511 BLACKLEY ST TEMP 917803143 FEES PAID DE RIP ION OF WORK ADD ON BEDROOM, ONE BATHROOM, AND FAMILY ROOM 638. SF. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: REMODEL EXISTING BEDROOM, KITCHEN 500 SF. APPLICANT: TEL. NO: ZHU (626) 203-9639— B1 PLANCHECK W/ENERGY 66330.00 VAL 906.15 556 W. LAS TUNAS DR AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: SAN GABRIEL AC STRONG MOTION RESID 99500.00 VAL 9.95 B2 PERMIT W/ENERGY 99500.00 VAL 1,425.44 TOTAL FEES 2,369.29 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE NOVEL DEVELOPMENT, INC. (626) 202-5448- 319 N. SAN GABRIEL BLVD. LIC. NO LOCATION AND SETBACKS SAN GABRIEL, CA 91775 855491B SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 3 01 1ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL— SHEAR PANELS SIDE PL— INSULATION/WEATHER STRIP !4 _ .^ INTERIOR LATH/DRYWALL 40Y ` l �1/j EXTERIOR LATH LOT DRAINAGE / a SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508