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HomeMy Public PortalAbout9551 BROADWAY_Building__ APPLICATION-FOR Il PUILDING PERMIT G FOR APPLICANT TO FILL IN Aooaess BUILDING ADDRESS LOCALITY CIT' NEAREST *YZIP _CROSS ST _ /L NO.OF BLDGS. ASSESSOR SIZEOFLOT v NOW ON LOT MAP.BOOK PAGE,' P CE •� DISTRICT - I GROUP TYPE•, 'FIRE R SED BY .N TRACT BLOCK' LOT NO. 1 1 RU CONS SE TEL.. 5 LL�f- Ga/�C OWNER NO. ' _ STATISTICAL CLASS[F}�A�T/)ON - S ER MA ' ADDRESS - CLASS NO.�J _DWELL.UNITS , BRI G CITY - L ZIP USE N MAP ' ARCHITECTORO' .. TEL. _ ENGINEER ' NO. - SPECIAL 3 CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑ CONTRACTO / r NO/AS/1/ 06Ci BLDG.SETBACK FROM NO CFRONT PROP.LINE OF [STREET) ADDRESS 6 HIGHWAY + YARD = TOTAL SETBACK FROM TYPEOF EXISTING QQ J�j LIC. FRONT PROP.LINE HIGHWAY WIDTH CLASS 0 _'. .. - ' CONSTRUCTION LENDER -- + a NAME AND BRANCH BLDG.SETBACK FROM ADDRESS CITY SIDE PROP.LINE OF [STREET[ - SO FT NO.OF NO.OF .'CHECK HIGHWAY + YARD TOTAL SETBACK FROM 'TYPE OF EXISTING U - SIDE PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE 1:1 + .. _ .. Z DESCRIPTI OF WORK NEW ADD ❑ -CORNERCUTOFF YES ❑ NO ❑ _ • ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ REPAIR USE OF4-1 ❑ IN COASTAL PERMIT ZONE 't YES. ❑ _ NO ❑- ,EXISTING BLDG. . DEM APPLICANT TEL (PRINT[ TEL BY(SIGNATURE) /I/O.. �IN/f��L�-��O/✓�•E� C / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE S,CORRECT AND AGREE TO COMPLY WITH ALLL,ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE A �'w • : WORK AUTHORIZED HEREBY f WILL NOT EMPLOY ANY PERSON IN VIOLATION OF /1 FST J 'THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN 3 COM - - - -- - PENSATION INSURA SIGNATURE OF FINAL BY - - PERMITTEE _DATE ADDRESS Et P.C. Fee$ Permit Fee CIE NO 'Issoonce'Fee VALUATION •�4 Total Fee ;PLAN CHECK VALIDATION - CW- M.O: CASH PERMIT-VALIDATION' CH. �n.o. CASH 9 2, n APR, 14 1 D 3 1.0 0 ©1 76A6389 CE/803B B/77 - 'j 1 APPLICATI N FOR B ILDING PERMIT FOR APPLICANT TO FILL IN (Pool Dr lvoe oGIYI BUILDING BUILDING ADDRESS ADDRESS 9551 BroadwayADDRESS 23 It-L- CITY Temple City ZIP 91780 �t —NO.OF BLDGS. LOCAL Y �. SIZE OF LOT NOW ON LOT - NEAREST CROSS ST. (A TRACT BLOCK LOT NO. ASSESSOR MAP BOOK PAGE PARCEL OWNER T C Townhouses NO 285 517 DISTRICT GRO TYPE FIRE ESSED BY CONST. ZONE J A pDR ESS J,�5� STATISTICAL CLASSIFICATION SEWER WAG CITY TeMple City, ZIP 918b0 ..��// ARCHITECT OR TEL CLA 55 NO.�L.DWEL L,UNITS��`` BK�j� ENGJNEE R NO. U�".�E SONDIONG ADDRESS Z �l.• b '��G CONTRACTOR LytlegoofingN0L 7 2 -L TI LIC. AD DEPARTMENT APPROVAL REQUIRED YES � NO ❑ ADDRESS NO. BLDG.SE CK FROM - - - CITY LIC. `'39 FRONT OP.LINE OF (STREET) CLA55 CONSTRU TI N L N R C;aHIGHWA + YARD = TOTAL SETBACK FROM TYPEOF EXISTING FRONT-PROP, LINE HIGHWAY WIDTH NAME AND BRANCH ADDRESS CITY - + Y Sq. FT. NO. OF NO. OF CHECK BLOG.SETBACKF a SIZE STORIES 2 FAMILIES '7 ONE SIDE PROP. LINE OF (STREET( U DESCRIPTION OF WORK NEW ❑ HIGHWAY + YARD - TOTAL SETBACK. FROM PE OF EXISTING ¢ SIDE PROP. LINE GHWAV WIDTH � eroof 2/15# felt and ADD ❑ + = w -ALTER Ela ine kayer of flemstone EPAIR® CORNER CUTOFF z- YES-❑ NO ❑ Z' USE OF EXISTING BLDG. DEMOL ❑ IN OPEN SPACE - YES ❑ NO ❑ APPLICANT, TEL IN COASTAL ZONE YES NO (PRINT) ND. c] ❑ BY (SIGNATURE). ENVIRONMENTAL CATEGORICAL EXEMPTION YES[] NO ❑ / ' IMPACT EXEMPTION DECLARATION SIGNED (DATE) VALUATION$ '65;:-60 �QO IMPACT REPORT PROCESSED (DATE) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL ORDINANCES AND LAWS REGULATING BUILOING CON- 57ROCTIO N. I CERTIFY THAT IN DOING THE 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 COMPENSATION INSURANCE. SIGNATURE OF FINAL BY PERMITTEE o DATE / S ADDRESS P.O. BOX 5327 . . P C $ [.c PMT. Pasadena CA TEL792 517 FEE Y FEE $ CITY NO. 21. 75 PLAN CHECK VALIDATION CK. N o. CAG. PERMIT VALIDATION CK ' M,o. sH 6.5"8 AFR:'14 1 _ 2 1:7 5 L' 76A636B CENS03A 5/73 76A638A C•iR803 B-BM APPLICATIO FOR .BUIL ING PERMIT COUNTY-OF.LOS ANGELES •. BUILDING DEPARTMENT OF COUNTY ENGIN$ER ADDRESS L'� /rY( BUILDING AND SAFETY DIVISIONtNEARE ITY d t ' -JOHN A. LAMBIE. COUNTY ENGINEERST: - COLEMAN W. JENKINS$u R'T.oFBu aDINd ST.CT NO. GROU TYPE.' -- -- PROCE SED BYFOR APPLICANT TO FILL IN_rB UILDING o cc r TICAL CLA SIFICATION 'SE ER'MAP-ADDRESS / 77 �� [// INO <P DWELL UNITS BK lPG- '7LOT NO. BLOCK NE MAP -L NO.TRACK O Y/yfK/ _G L.�t:. ' SPECIAL `ND: OF BLDOSCONDITIONSLSIZE OF LOT )NOW'ON LOT USE OF ._._ .. -. EXISTING QL12G. BLDG. SETBACK FROM _ TE FRONTPROP.'LINE OF (STREET) OWNER NO. �� TYPE OF EXISTING SETBACK HIGHWAY,,+ YARD = 'TOTAL ADDRESS ` jq HIGHWAY IDT 'f OM C.L. - -CITY d f+ .V - -+'" - BLDG. SETBACK ARCHITECT,ZR ` TEL. ,FROM -. .. .._ .: , ENGINEER ��'G EII NO. _. O SIDE PROP. LINE OF 19TREET7 _ / TYPE OF EXISTING SETBACK HIGHWAY- + YARD = TOTAL ADDRESS :Al- O• / HIGHWAY WIDTH FROM C.L. �• L. + = O CONTRACTOR` •A 'TEL) '.' LIC' CORNER CUTOFF YES E:] NO ❑ K ADDRESS NO. O CITY c c -SEE REVERSE SIDE FOR SPECIAL APPROVALS V. W DESCRIPTION OF,WORK cY 7-�-`-&6 —v aX _ NE -• ADD 'ALTER REPAIR DEMOLISH - �,- •/ Z SIZE T O(�', r• //SOT DRIES FA MIO IESr -J nJ A �� 1• .L T STRUCTURE E F/ve 1 //�'v �.�lJ1�rWRI� -A�wHf24.YiIA1/lM.l.'it��,/ .. es 9//af/err _'- ate ,p1w � . �,AOs r' 4''0 .►�1- SIGNATURE OF APP RIC ANT X / w •� �^� T n/. VALUATION L APPROVALS 4T INSPECTOR'S SIGNATURE PMT. OG FOUNDATION, MATERIALS ON FEES Lb /� FEE$ — -FRAME, FIRE STOPS, .I HEREBY THAT THE ABOVE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT ANDWIT STATE THAT THE ORDINANCES IS CORRECT TE AWS, REGULATING COMPLY FURNACE: LOCATION WITH 4LL COUNTY TI O, IA CE$ AND $TATE LAWS. THEWRK GAS VENT. DUCTS AUT O RIZ D HEREBY I WILL I�NOT IFY IN .PORNO THE WORN rt AUTHORIZED _HEREBY WILL NOT E STATE wNY.PERlCN IN VIOLA" - LATH. INT. - - •Ij MA/.�V TION OF THE LABOR C - OF THE STATE OF,CALIFORNIw gEL<T" ING TO WORKMEN'S MP SAY INSURw NCE - 1 C/ru LATH. EXT.' � IJ F SIGNATURE OF HOUSE NUMBER COR- PERMITTEE {�-.�'_'� RECT AND POSTED ADDRESS FINAL i/L/� V JOHN F. LEWIS, PRINCIPAL ST RAL'ENGINEER PLAN CHECK VALIDATION cN. M.o. CASH _ PERMIT VALIDATION cK. .'M.P. CASH _'t4( 0 ; 1 _ n X20 23 D 1 5 .1 .5 Oil, _ " ~ - jAC&l46O—� Wi1.1 1 D 303.00 76A63BAC.:08038-Bli APPLICATIO FOR BUIL ING PERMIT T� COUNTY OF LOS ANGELES BUILDINGG DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE-. COUNTY ENGINEER NEAREST COLEMAN W. JENKINS•SUP'T.OF BUILDING CROSS ST. Y DISTRICT NO. GROU TYPE. - PROCEiSED BY FOR APPLICANT TO FILL IN J caNsr 'BUILDINGSTATISTICAL CLA SI FICATION SE ER�iMAP ADDRESS 9 �Q/ /CQ CLASS NO. DWELL UNITS - BK / PG 7[ LOT NO. BLOCK USE ZONE MAP ✓ ,(, L NO.. C� _ TRACT �` p vId/V G Ls'. � SPECIAL v/-; ) ND. OF BLDGS.� CONDITION . -9 SIZE OF LOT ! ' � NOW'ON LOT _ USE OF EXISTING BLDG. BLDG. SETBACK FROM TEFRONT PROP. LINE OF - (STREET) OWNER _ AffNO.T T111 01 I f%19TIN0 SETBACK HIGHWAY } YARD - TOTAL ADDRESS %A HIGHWAYWIDTH 'FROM C.L. - - } _ CITY O E ARCHITECTR y TEL. BLDG. SETBACK FROM " ENGINEER �0'C/ E�i NO. O SIDE PROP. LINE OF (STREETI w TYPE Oi E%19TIN0 SETBACK HIGHWAY' } YARD = TOTAL ADDRESS Ai- �- / HIOHW AY WIDTH FROM ILL. d TEL. } = O CONTRACTOR' ", U LIC. CORNER CUTOFF YES NO C ADDRESS - NO O CITY c c SEE REVERSE SIDE FOR SPECIAL APPROVALS u LU DESCRIPTION OF WORK Z$ �6�0 - OL NE ADD ALTER REPAIR DEMOLISH �- .FT. NO. OF NO. OF ' SIZE Off' . sSTORIES FAMILI ESI ' N '�' +O STRUCTURE SIGNATURE OF 9/H%✓O~' 1/ J �Y/ /.1M/ /I 1 i APPLICANT w Ail VALUATIONw^ O APPROVALS TE INSPECTOR SSIGNATURE P.C. /J SO PMT. Q'�f FOUNDATION, LOCATION J/ ' FEE <j /� FEE FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACNNOWLEOGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION `Er�� WITH ALL COUNTY ORDINANCES ANO STATE LAWS REGULATING GAS VENT. DUCTSM 9UILDING CONSTRUCTION. 1 CERTIFY THAT. IN GOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OP THE LABOR C - OF THE STATE OF CALIFORNIA RELAT- _ ING TO WORK MEN'B NP iSAT10N INSURANCE LATH. EXT. JS �� ti5Q SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED // / •.•�.�iL'1 ADDRESS - FI NAL - -7710W JOHN F. LEWIS, PRINCIPAL ST RAL'ENGINEER PLAN CHECK VALIDATION cK. M.D. CASHPERMIT VALIDATION «. M.D. CASH C. ; 1 2e nr220 2 .3 D 1 5 1 .504 W. Lj{C;o1460�2 MAY 11 1 D 303.00- WORKERS' COMPENSATION.DECLARATION -I hereby affirm that I have a certificate of consent to self _ /U\ pp��1( ���OB V FOR D ���D�ll \l C� 0 �0�l1V ll�� insure, or a certificate of Workers' Compensation Insurance, (rLl �7 oro er cgppther (Sec. 3800,-Lab. C.) - - �,,(,5p,�)/fy�� !l��6 � � COUNTY OF l05 ANGELES BUILDING AND SAFETY Po iT cy 176 Company � BUILDING ❑ Certified copy is herebyfurnished. FOR APPLICANT TO FILL IN ADDRESS BUILDING 9.ss Certified copy is filed with the count b inspe<- - BULKING /? �•C/ a tion department. Date Applicant �® - CITY `� - ZIP LOCALITY NO. OF BLDGS. NEAREST RTI 7E OF EXEMPTION FROM WOR SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE _ _ ASSESSOR . (This section need not-be completed if th ermit is for one TRACT - BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) - - TEL' USE ZONE MAP OWNER.' .fL�' NO. I certify that in the performance of the work for which.this -i'('- SPECIAL -` >_permit is issued, I shall not employ any person in any manner ADDRESS ,t7-. 8 - J CONDITIONS O- so as to become subject to,the Workers'Compensation Laws. 1717,90 Q 0 CITY z C)4 ZIP l l7 p0 U . Date 'Applicant ARCHITECT OR TEL. - K NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER •NO. ;DISTRICT I GROUP TYPECONST jF IpRE PR ESSED BY Q Exemption, you. should become subject to the Workers' - �I NE w Compensation provisions of the Labor Code, you must forth- ADDRESS - - UO ✓ �( with comply with such provisions or-this permit shall be TEL STATISTICAL CLASSIFICATION APT. CONDO. z Z ,'deemed revoked. CONTRACTOR NO _ - LICENSED CONTRACTORS.DECLARATION 6� �f 14LIC C-39 CLASS NO. / DWELL UNITS_ I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS (commencing with Section 7000)of Division 3 of the Business LIC Q SEWER MAP and Professions Code,.and my license is in.full force and effect. CITU LAS CLASS BK. PG. VALIDATION / 50. FT. N0. OF �j NO. OF CHECK License Number �8�(99 'Lic. Class 1:..�3 SIZE STORIES /L FAMILIES ONE , 6 -• - � - VALUATION Contractor�/" /�i Date P / DESCRIPTION OF WORK NEW ❑ $ 15"7 77Q ❑I am exempt under Sec. E' 6 F ADD ❑ •7 / O s _ ALTER El D B.BP.C. for this reason REPAIR CJ f ate: • USE,ON _ y - EXISTING BLDG.Q �.(i7.0A/j>OS DEMOL ❑ _ Signature APPLICANT TFL FINAL - OWNER-BU LDER DECLAR N (PRINT) ,D • 1C_;;1 IN _DATE 10_,Z _R _ y�a:I .i _ I hereby affirm that I am exempt from a Contractor's License ADDRESS 3 lyCv JJ�/T '�'C s. Zc Law for the fallowing reason (Se on 7031.5, Business and FINAL ";yi;7 llv. -' Professions Code): PRESENT By II By 1 1!tl l ❑ I, as owner of the property, or my employees with ADDRESS _ wages as their sole compensation;will do the work and - -(i I;AL suis the structure is not intended or offered for sale(Section LOCALITY t�c L 7044, Business and Professions Code.) - - -- MOVING - TEL - D -•-- CHECK with CONTRACTOR NO. ❑ I, as owner of the property,am exclusively contracting `. L� with licensed contractors to construct the project (Sec- ADDRESS CHANGE tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. - CONSTRUCTION LENDING AGENCY - SET BACK YARD - HWY PROP. LINE WIDTH _ I hereby affirm that there is o construction lending agency for FRONT the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE �—� - .. •.�. P.1. 7. 53 1 Arl y-. ' Lender's Nome p Q - - P.C. Fee 5 t Permit Fee le J", 06 LDMA Ref. If Lender's Address - 2 D o I certify that I have read this application and state that the - Issuonce LDM Pee ?• ' A P/C R 0 $ above information is correct. agree to comply with all County Investigation Fee / r/ - $ ordinances and State laws relating to building construction, Total Fee . O LDMA Perm. R a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. - - SEE REVERSE FOR EXPLANATORY_LANGUAGE - Signature of Applicant or Agent Dote