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HomeMy Public PortalAbout9542 BLACKLEY ST_Building__ r_DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT ' f COUNTY OF LOS ANGELES WM. J.-FO)1; CHIEF`ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY DISTRICT NO.' PLAN CK. NO. PERMIT NO. ADDREISS RECEIVED BY DATE OF APPL. DATE ISSUED LOCALITY /�/ -� (v - /0-Sti 1 NEARESTBUILDING CROSS ST. ( c � � ADDRESS �••� OWNER' MAIL ���� LOCALITY ADDRESS f a.V`+L NEAREST • // v ' TEL. _ CROSS ST. ✓`�-nc`✓G 4Ct_ CI NaLiz1:4 FIRE NO. OF �'-(•II TYPE I GROU ZONE PLANS. P _ ARCHITECT OR TEL. —` l ENGINEER NO. BLDG / (, ORD. NO. a SETBACK LINE7— ADDRESS APPROVED TEL., p'� e� BY DATE NO - - .�C_ sC USEI�y,l APPROVED ' 'ZONE-- BY DATE ADDRESS HOUSE',NUMBERING-�_�____ LEGAL 00 DESCRIPTION I LOT NO. BLOCK MAP NUMBER�"'� /"� FIELD CHECK BY TRACT NO ASS IGNED'BY DAT • NO. OF BLDGS - - CORRECTIONS .1 SIZE OF LOT ,3 c7 �,3bvl NOW ON LOT USE OF I NO. OF EXISTING BLDG. FAMI LIHS ' 'DESCRIPTION OF WORK NEW I I ALTERATION I I ADDITION I , 0 DEMOLITION REPAIR - - - SO. FT. NO. OF / D SIZE / �� ROOMS' STORIES Z D EXTEWALL ROOF r COV RING �(�p I COVERING ©I , USE OF RUCLURE v- I I APPROV LS INSPECT 'S SIGNATURE DATE 1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION ' PLICATION AND STATE THAT THE INFORMATION GIVEN IS , FORMS, MATERIALS CORRECT.'AGREE-TO COMPLY WITH THE CORRECTIONS LISTED FRAME. FIRE STOPS, HERRON AND WITH?ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING ILDING'CONSTRUCTION. ds � FURNACE- LOCATION, / _r,�,9 SIGNATURE OF GAS VENT, DUCTS `J PERM �-C7 LATH, INT. 4 ' } �'��'S2 ADDRESS _LATH, EXT. , AUTHORIZED AGT. CJ PLASTER, INT. 76ASSBA, DDSH 10-80 P. C. �, Q ' V ✓ c7( FEE /D PLASTER, EXT.; ' VALUATION T /CP(J�` / FEE $�n�."� FINAL WORKERS''COMPENSATION'DECLARATION _ herebirm that I, havea certificate consent to self insure, oraceitificate of Workers' Compensation Insurance, APPLICATION F®R B U I L D I N O PERMIT or a certified copy thereof (Sec 3800, Lab C ) Policy N01039547 Compony'State Compensastion COUNTY OF LOS ANGELES BUILDING AND SAFETY ❑ Certified copy is hereby furnisbmsurance Fund' FOR APPLICANT TO FILL IN BUILDING ADDRESS r 1J ® Certified copy is filed with the county b�1 ,enslBUILDING do d rr t ADDRESS 9542 ,Blackley' ST. ,.. Ah1)6te 8x:2 Applicant, : CITYTem le City ZIP r LOCALITY 64 CERTIFICATE OF EXEMPTIO FRO OR S' NO OF BLDGS NEAREST COMPENSATION.INSU R CE SIZE OF LOT NOW ON LOT CROSS ST- (This section need not be:completed if the permtt`is for one ASSESSOR hundred dollars ($100)or,less,) - - TRACT BLOCK LOT NO- MAP BOOK PAGE PARCEL OWNER Jud Le ore NO —- Z E MAP I•certify that,in the'performance of'the work for which this NO permit is issued, I shall not employ any person in any manner SPECIAL 8ft, so as to,become subject to the Workers'Compensation Laws ADDRESS CONDITIONS - C)j CITY Temple ,City. , ZIP 91780 U=' Date Applicant- ARCHITECT OR - TEL � NOTICE TO APPLICANT If, after making this Certificate of DISTRICT GROUP TYPE FIRE PROCESSED BY 0. ENGINEER none NO CONST ZONE -. --_ Exemption,;you should become subject to the Workers' U Compensation pro`vistons'of-the-Labor=Code,-,you,m'ust forth- ADDRESS with comply with such provisions or this permit shall 6e STATISTICAL CLASSIFICATION APT C DO N deemed revoked CONTRACTORUnited Roofiri` Co.'r13-2'23-408 ,_�. _ Z LICENSED CONTRACTORS DECLARATION LIC CLASS NO _� "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 LIC SEWER MAP Los Angeles, Ca 90031 CLASS C-39. . - Professions Code, and my license is m full force and effect " "- CITY g � BK- � VALIDATION SQ FT NO OF NO OF, CHECK License Number 1376,W' L,c Class C-39 _ SIZE STORIES FAMILIES ONE VALUATION 8-12=88. DESCRIPTION OF WORK Install —ta NEW ❑ Contractor Date $ ❑ I am exem and Sec iberglass shingles Class"A" ADD ❑ over existing s ing e roo s. ALTER ❑ BAP C- for this reasontnpe, and REPAIR ❑ $ M Date EXISTING BLDG House and garage DEMOL ❑ Signature ,, ' APPLICANT TE FINAL i [J (� Signature PRINT United' Roofin Co. r•1�13-2234081 © 0 � A OWNER-BUILDER DECLARATION DATE 1 hereby affirm that I am exemjiJrom the Contractor's License _ Law for the following.reason,(Section 7031 5, Business and -ADDREsi821 -Daly St. Los .An eles .90031 FINAL - #"•;e ••• o sl Professions Code) „ PRE By BUILDING ,,;1 •,^0 5 9,2 5 ❑ N I, as owner of the praperty,'.or_ my employees with ADDRESS • • • Qtwages as their sole compensation,will do the work and pop- TOO' he structure is notintended or offered for sale(Section LOCALITY7044, Business and Professions•Code) - MOVING TEL 1, as owner of the property, am exclusively contracting CONTRACNO r• with licensed contractors to construct the project (Sec- - ' tion 7044,-Business and Professions Code) ADDRESS ' REQUIRED TOTAL SETBACK _ CONSTRUCTION LENDING AGENCY SET BACK= YARD. .HWY PROP LINE WIDTH' I hereby affirm that there is a construction lehding agency for. FRONT ' the performance'of the work'-for which this permtt,is issued P L' (Sec'3097, Civ C ) SIDE - PL Lender's Name -� P C Fee$ - Permit Fee LDMA Ref N Lender's Address I certify that I have read this.application and state that the Iaauonce Fee 10.50F LDMA P/C M o above information is correct I agree to comply with all County Investigation Fee a ordinances and State'lowselahn buiIdm construction, o' 9 9 Total Fee.t LDMA Perm q and hereby-authorize re septa sof this County to enter upon the a e-ment d pr y for inspection purposes m 8-12—HH SEE REVERSE FOR EXPLANATORY LANGUAGE r Signof Ap ant or Agent x-Date ., APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANPELES BUILDING AND SAFETY WORKERS COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING ADD � �+1 hereby affirm that I have a certificate of consent to self insure, r s� ora certificate of Workers'Compensation Insurance,or a cert -�f copy thereof(Sec 3800,Lab C) DCITY ZIP � U EL ' LOC ALI Policy NO 62� ,�,� L� ��l1 Company SIZE OF LO NO OF BLDGS NOW ON LOT I Lf Certified CO - NEAREST CROSS ST r �� copy Is hereby furnished b ❑ Certified copy is filed with the county 4ilding inspection TRACT BLOCK LOT NO department USE ZONE MAP NO ASSESSOR MAP BOOK PAGE PARCEL Date Z Applicant !�D QD Da SPECIAL CONDITIONS OWNER :J TEL NO - YES NO CERTIFICATE OF EXEMPTION FROM WORKERS' 6 WITHIN 1000 FT OF SCHOOL? -COMPENSATION INSURANCE AD RESS (This section need not be completed if the permit is for one hundred 96 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 N� is Issued, I shall not employ any person in any manner so as to ARCHITEgr OR ENGINEER TEL NO ✓ v become subject-to the Workers'Compensation-Laws __ _ t _ STATISTICAL CLASSIFICATION APT CONDO Data Applicant ADDRESS -CLASS NO ;14 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of CO OR TEL NO REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' /_ y SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith v � lY 3 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LC NO I� btiY/J X 70 P L LICENSED CONTRACTORS DECLARATION CITY LIC LAss SPL IDE I hereby affirm that I am licensed under provisions of Chapter 9 y SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and SO FT SIZE NO OF STORES NO OF FAMILIES Professions Code,a d my license is in full force and effect I NEW ❑ BK PG ® CD R I License Number OrI4_V7 Llc Class DESCN OF WORK VALUATION okwtE ❑ f! 00 Contractor Date ZZ ALTER ❑ $ v 4000 z_ ❑ I am exempt under Sec. _ REPAIR ❑ $ B&P C for this reasonq N DEMOL C3LOMA P/C B to �2 / ` USE OF EXISTING BLDG URM ❑ Signature APPLICANT(PRINT) TEL NO El I, as ownf the oproperty, LDMA Perm qAL p perty, or my employees with wages as _ =r 5 their sole compensation,will do the work and the structure Is � j�,•� -� �-: not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL (�- ❑ 1, as owner of the property, em eXCIUSIVBI COntraCtin with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN _ Y g THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE7 FINAL BY l > k - t,�_ licensed contractors to construct the project (Section 7044, YES❑ NO❑ €LI �j �r " 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 FROMTHE SOUTH = CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST (_ jtj:s6 1 Sr- FOR GUIDELINES - I hereby affirm that there is a construction lending agency for 'YES❑ NO❑ the ,Civ Cance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD w- •+ ) - PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 3097,CIV Lender's Name COUNTY CODE.TITLE Z CHAPTER 220 SECTIONS 2 20 100 THROUGH 220140 CONCERNING HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD '--L - 1_• -- Lender's Address IQ O"ER OR AQENr ' o_ 1 certify that I have read this application and state that the above information Is correct I agree to comply with all county PC FEE PERMIT FEE ,r ' ordinances and State laws relating to building construction,and d hereby authorize representatives of this County to enter'upon ISSUANCE FEE the above-mentioned property for Inspection purposes a INVESTIGATION FEE TOTAL FEE m SW�of Appko m Aur De SEE REVERSE FOR EXPLANATORY LANGUAGE, C^ 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 1010120059 PHONE (626) 285-0488 EXT- ILEGAL ID 1 NO OF CONST 1 BUILDING ADDRESS: 1 ITR. 17712 LT: 2 BL. .001 I SQ FT STORIES TYPE I 9542 BLACKLEY ST 1 I (STRUCTURE: 244 V-B I TEMP CA 917803142 I (ASSESSOR INFORMATION NUMBER: I - I NEAREST CROSS STREET. 1 18590-007-002 1 1 THOMAS PAGE 596 GRID J4 LOCALITY: ITEMPLE CITY, Cl (TENANT: 1EXIST BLDG USE RESID USE ZONE R-1 (ISSUED ON. PROCESSED BY: I 1 (EXIST OCC GRP ' 110/12/10 SR 1 I I I I 10WNER: TEL NO IBLDGS. NOW ON LOT VALUATION: IFINAL DATE FINAL BY: CODE 1 ILEPORE MICHELE P JR;JUDITH A (626) 232-3459- 1 6,220 1 Ja I 19542 BLACKLEY ST I 11 l O I ITEMP 917803142 1 FEES PAID IDESCRIPTION OF WORK vI I I IREMOVE EXISTING 3 LAYER OF ROOFING REROOF WITH CLASS A 40 YRI IFEE DESCRIPTION QUANTITY: UOM: AMOUNT (COMPOSITION SHINGLES 1 (APPLICANT TEL NO- I I IJN DAVIS (626) 815-1279- IAA BLDG PERMIT ISSUANCE 27 80 1 - I IAB STATE GREEN BLDG FEE 6220 00 VAL 1.00 (SPECIAL CONDITIONS I I IAC STRONG MOTION RESID 6220.00 VAL 0.60 I I ID2 PERMIT W/O EN-HC_ 6220.00 VAI, 166 60 1 I I 1 TOTAL FEES 196 00 1 I (CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1 IJ N DAVIS ROOFING CO (626) 815-1279- 1 1 I 11308 E COLORADO BLVD., #B LIC NO ILOCATION AND SETBACKS I I I (PASADENA, �A 91106 572125039 I I I I I I ISOILS ENGINEER APPROVAL 1 ARCHITECT OR ENGINEER. TEL NO 1 (FOUNDATION/TRENCH FORMS I I I 1 LIC NO: I (SLAB/UNDER FLOOR I I I I I I I I I I I IRAISED FLOOR FRAMING I I I I I I I I I IMAP NO SEWER MAP BOOK: PAGE FIRE ZONE- CMP-1 1UNDERFLOOR INSULATION I I I 1147H269 3 OOI 1 1-1 I I I - IFLOOR SHEATHING 1 I I INO OF FAMILIES. DWELLING UNITS APT/GOND. STAT CLASS. I • , I I I I 1 NO 21 IROOF,SHEATHING ryry I V 1 SCHOOL WITHIN HAZARDOUS Y (SHEAR PANELS I I (AIR QUALITY 1000 FEET MATERIALS1 I' 1 NO NO - NO 1 CIFRAME INSPECTION I 1 I I I I I I I I IFIRE SPRINKLER HANGERS I I I 1 I I 11NSULATION/WEATHER STRIPI I I I (INTERIOR LATH/DRYWALL I I I I I 1EXTERIOR LATH I I I I I I I I I IRATED FLOOR/CEIL ASSEM IRATED WALL ASSEMBLIES I I 1 I I I I I I I IRATED SHAFTS/OPENINGS I I I IT-BAR CEILINGS I I I 1 I* ADDITIONAL DATA ON FILE I I I I ILOT DRAINAGE I I I I IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I I I I I