HomeMy Public PortalAbout8912 & 8912 1/2 BROADWAY_Building__ N`7"0 C44141
7GA699A-Ce'#803:10-68• APPLICATION FOR BUILDINGPERMIT -
COUNTY OF LOS ANGELES ADDREss8912 & 89121 E. Broadwa . •
DEPARTMENT OF COUNTY ENGINEER -
BUILDING'AND SAFETY-'DIVISION :LOCALITY . San.Gabr i6l
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D. GRIFFIN,`SUP'T OF BUILDING CROSS ST. -
FADDRDISTRICT NO. GROUP TYPE P SSED BY
FOR,APPLICANT TO FILL-.IN , _ I CONST. `
E
G' STATISTICAL CLASSIFICATION SEWER MAP
$ 1 E Broadva S.G. CLASS.NO: DWELL UNITS L BK PG8 C edule C BLOCK MAP NUMBER- '2018 LTATYES,. NUSEZONESPECIALNO.OF.BLDGSCONDITIONS
LOT I NOW ON LOT C-2`
USE OF
EXISTING BLDG. Dv'jelling & Garage - _ BUILDING YARD HWY STREET NAME EXIST.
SETBACK WIDTH
OWNER '` FROL T 10 - Broad-way 60
MAIL
ADDRESS -9 1355 E Las-Tunas Dr. SIDE --
P.L.
CITY "'C Callf .NO`AT 6-635 ' "INSPECTION RECORD -
ARCHITECT�t _ - TEL,, -
ENGINEER•Ifob't'. DUgf Nat 6-210
ADDFRESS 5549 IST: Rosemead Tem le Cit '° �7.
�.�'S L'/a.f�—S o mon/ SiTEJ,
-- - TEL.'
CONTRACTOR Owner NO. - -
-ADDRESS _ 7 ,
DESCRIPTION OF WORE L ���-s O �4'STF.a�-
NEW ""ADD ALTER REPAIR "-"DEMOLISH _
SQ.FT: NO.OF NO.OF',
-SIZE , r_I -668 STORIES 1 FAMILIES •-, - '
USE OF
STRUCTURE
S T C C O MFs/a' EO�D f� ✓E�t'L�}/'
SIGNATURE OF
APPLICANT APPROVALS DATE MSPE( OR•S SIGNATURE
ADDRESS - S �S ! �C. FOUNDATION:LOCATION �/
FORMS,MATERIALS - 9
VALUATION$s U O FRAME:FIRE STOPS. '
BRACING,BOLTS
PC /�� FURNACE:LOCATION.
Q6. / -
F E $ FEE $ CO - - GAS VENT,DUCTS
I HEREBY ACKNOWLED E THAT I HAVE READ THIS AP_ - --
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH.INT.
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AN
STATE- LAWS RE UL TING BU LDING CONSTRUCTIO LATH,EXT. �G 6 •//�'/{7 ,rXT-J '
SIGNATURE OF HOUSE NUMBER COR- ,
PERMITTEE RECT AND POSTED -/
ADDRESS INAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURALINE
PLAN CHECK,VALIDATION CK: M.O. ASH ` .[ PERMIT VALIDATION CK, M.O. CASH
.I r 0 'o 5 7
ff r, 17 n 12 .00
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I havecertificate of consent to self A•P P L I CATION , -BUILDING3
' 'insure, or a certificate of Workers' Compensation Insurance, - FOR, . PERMIT.' '
.- ,
or a certified copy thereof (Sec' 3800lLab:.C:) COUNTY OF LOS ANGELES:'% BUILDING AND SAFETY
Policy No. ompariy
BUILDING
Certified copy is Hereby_furnished. �- `h- FOR APPLICANT TO FILL- IN r ADDRESS,
Certified,copy is filed with the county building mspec-' BUILDING
ADDRESS.
tion department: rr ���Q AA W
Date r, APPlicant�U►:�.1 ' �V CITY ZIP- '. LOCALITY r
n .,.NO. OF BLDGS.. NEAREST r
CERTIFIQATE'OF'EXEMPTION FROM WORKERS'_ < SIZE OF LOT•+ NOW ON LOT' CROSS ST.
COMPENSATION I-NSURANCE ASSESSOR ' -
'(This section,need not,be completed if the permitis'fo`r one 'TRACT BLOCK '` LOT NO. MAP BOOK-` PAGE PARCEL'
hundred dollars-($1'00).orless:), TEL,'^
OWNER jZ NO. - -` USE ZONE • MAP
I'ce'rtify that,in the•performance of the work.forwhicli this �- NO
permit is issued;-I shall not employ any person in any-manner ADDRESS ' .t 1:1� SPECIAL
CONDITIONS
so as to become sublecT to the-Workers'Compensation Laws. 0
CITY ZIP.
r,Date Applicant' - ARCHITECT OR TEL DISTRICT' GROUP' TYPE FIRE ' PROCESSED BY Q
NOTICE TO:APPLICANT: If, after makmg.;This'Certificate of ENGINEER CONST. ZONE lJ.
'Exemption, you ,should- become-subject,to, the,Workers' . ' Dt p '/ W
Compensation•provisions o£-the Labor Code,,you•must forth-,,-, ADDRESS �lJi7 ��Z ` '/ r a
with comply with, such provisions•or this permit,shall be J ( TEL STATISTICAL CLASSIFICATION APT CONDO. Z
CONTRACTOR: /�( R O. y'
deemed revoked.' L !*l+ —
LICENSED CONTRACTORS.DECLARATION LIC. /, CLASS NO DWELL'UNITS
Thereby affirm that I am licensed under provisions of Ghapter 9 _ _ ADDRESS -t� O F� - NO 14�
SEWER,MAP
LIC 2
(commencing;with Section 7000)-of Division`3 of-the Business CITY, ` CLASS'
and ProfessionsrCode,and m license is in full force and'effect., gK,: PG
_ VALIDATION
2 S SQ. FT f F NO•'OF NO. OF, CHECK
License Number tfJ L Lic. Class••J. ✓ SIZE .{p` STORIES FAMILIES ONE -
/�^(( !� .VALUATION,•,'
Contractor rF\ 1 �f Date � �'• DESCRIPTTIION OF WORK NEW ❑ ; -
A 1 ADD S. -
❑I am exempt under Seca,
t _ ALTER ❑.
B.&P.C. for.this reason REPAIR ❑
4
D USE OF
EXISTING BLDG.- DEMOL ❑"
APPLICANT- t ((' TEL%73
„ Signature WNER- LD R DECLARATION: (PRINT) `'e7 S U A�C lq�jRNO. . �O"��(Z{7i FINAL
DATE• ,., y
-. .s-.
Thereby affirm that lam exempt from the Contractor's License.
w- nE•� , e?
CO'(L`�j E
La 'for the following reason .(Section•7031. ADDRESS
•5, Business and' FINAL' - - _.,,., - ^�� ,-,'•,
Professions.Code)':t. °: - L S '7
PRESENT. By, :..-: F.. 1•_'+.G_
BUILDING' _
❑ I, ds owner The property,;or my employees'with, ADDRESS
wages as their sole com ensation,'will,do the work and ~' =1• u
g P" LOCALITY.. a Z' ,�a, �*-
7 the structure-is not infended:dr offered for'sale(Section' �_-G:' ��. : Til1f L ,a, m ,'p
MOVING• 'r TEL,
7044, Busihes' and Professions Code^) = ti
= CONTRACTOR NO 1,-(�t..F, v:�. �5.
❑ ' 1, as owner of.the property;am exclusively contracting'
with licensed contractors To construct+the, roI ect ( 'Sec- f
` =
Tion 7044, Business and Professioris,Code.) ADDRESS _
REQUIRED � TOTAL SETBACK FROM. 'EXIST
''CONSTRUCTION LENDING AGENCY. SET BACK .`,YARD. HWY PROP. LINE WIDTH:
I hereby affirm.that There is a construction lending agency for FRONT 1' 1`i!I'f [ I f t{ ' 9/27
':'
the performance'of the_work for;which this'perrriit-is issued PA, _ 0 s , ::, moi
(Sec. 3097,•Crv. C.). SIDEP L - .. ?,. 5599
ct�r i.' ° ? .
Lender's Name �.� p�/
LDMA Ref. #
^ P C Fee$ Permit Fee
Lender's Address Poo-
o _ pjicatiw :t
o I^certify that I have read thi•1 agree•to comply,ws apon and state that-the Issuance Fee- LDMA P/C#
8 above information-is correct. ith all-County Investigat,on'Fee
0 ordinances and State laws relating to'building construction, Total-.Fee. • LDMA Perm # •• _
a and hereby authon;e representatives of this County to enter
upon the above-mentioned property for inspection-purposes.
a
- SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SIGN
�= BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0107180040
PHONE: (626) 285-0488 EXT:
L GA UMBER OF SIGNS: 1 BUILDING ADDRESS:
ON FILE SIGN DESCRIPTION: NON-ELEC. SIGN 8912 1/2 BROADWAY E
SGAB CA 91776
ASSESSOR INFORMATIO NUMBER: NEAREST CROSS STREET: ROSEMEAD
5388-024-025 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EXPIRES ON:
WONG, TERRI EXIST OCC GRP: 07/18/01 UT 01/14/02
OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINA D E FINAL BY• CODE:
BURROUGHS EDWARD L TR BURROUGHS TRU (818) 287-7782- 1,164 Z�
8914 BROADWAY
SGAB 917762201 FEES PAID DESCRI TION OF WORK
NON-EL C. SIGN
APPLICANT:
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
EL. N0:
SUCCESS SIGN PRINTING (626) 444-8181- AA BLDG PERMIT ISSUANCE 27.75
9621 VALLEY BL #A AE STRONG MOTION OTHER, 1164.00 VAL 0.50 SPECIAL CONDITIONS:
EL MONTE CA 91731 AX BUILDING REVIEW-FEE— � 54.70
D2 PERMIITW/0'EN-H E� 1,164:00 VAL 82.20
Qa TOTAG-FEES 165.15
CONTRACTOR: TEL. NO: � w6j� APPROVALS DATE INSPECTOR SIGNATURE
SUCCESS SIGN (626) 444-8181-
9621 VALLEY BLVD #A LIC. NO LOCATION AND SETBACKS
EL MONTE, CA 91731 739177 C45
' SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: - "� —� � �� �� FOUNDATION/TRENCH FORMS
LIC. NO,�j�� F- _ l �`�111111� `�� SUPPORT STRUCTURE
I
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:-
Do
NO. OF FAMILIES: DWELLING UNITS: PT/COND: STAT CLASS: —-- - - - — - --_— -- - -- "-'
NO 20
—�-'�
SCHOOL WITHIN HAZARDOUS
AIR DUALITY: 1000 FEET MATERIALS
NO NO NO
REPORT ID: DPR261 ROUTE TO: BS0508