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HomeMy Public PortalAbout9556 BROADWAY_Building__ AI�PUCAMON F-OR. BW" __ - G PERNT _0 s . C6AN7�Y>(� LOS.ANGELES _ _ BUILD)NG AND SAFETY WORKER'S'COMPENSATION DECLARATION ( FOR APPLICAlti FILL IN t , • BwLDINc AODR/Ess hereby affirm that have a certificate of consent f0 self insure, BUILDING ADDRESS J or a certificate of Workers' Compensation Insurance,or a certified - s_ copy thereof (Sec.3800,Lab.,C.) CITY- I - - ZIP Policy No. Company u' gtri L7�•' COOLLY ff SI E OF LOT �+�T NO.OF BLDG NOW ON LOT Z'0 '>✓G ' ❑ Certified copy is hereby furnished. �J , NEAREST CROS6 ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT No. - depaFtmebt. - _ I USE ZONEMAP N0. Date Applicant ASSESSOR MAP BOOK ^� PAGE ^,n PARCEL AVL f-//`IAX1 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' owNEq, Kf_ COMPENSATION INSURANCE b � �S �gG.'G O8 �wIrHN t000 FT.of scriooL? -YEB, No (This sectionneed not he completed if the permit is for one hundredADDRES y �� - - (P. L4rlA Alk-. DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSEDBV - dollars (5100)or less.) � ., CIT - ZIP I'certify that in the performance of the rWork for which this permit 0 �, n� {�_� /•/rr is issued, I shall not employ any person in any manner s0 as'to` ARCHITECT OR ENGINEER TEL NO. become Subject to the Workers Compensation Laws. 1p`A STATISTICAL CLA�S$/IF/Ip,ATION_ - APT CONDO Date Applicant (� ADDRESS - CLASS NO. SQL DWELL UNITS NOTICE TO APPLICANT. If; after making this Certificate of 1v REOUI RED -TOTAL SETBACK FROM EXIST Exemption,' you should become subject to the Workers'(w CONTRACTOR�/ ��.// - TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith h 4 Iq Nom'!` FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS - LIG.NO. - PL LICENSED CONTRACTORS DECLARATION `U SIDE CITY - LIG CLASS PC hereby affirm that I yam licensed underprovisions of Chapter 9 1 - .SEWER MAP - p (commencing with Section 7000)of Division 3 Of the Business and SO.F S¢E�T NO.OF STORIES NO.OF FAMILIES /gyp y 177.i]} Professions Code,and my license Is in full force and effect. \ L�/{[��JJ NEW ❑ 'eK Pc 1tvV0•r d License Number Lic.Class - DES RIPTION OF WORK ADD VALUATION D 4� dM AnPI (cal A�iO ) w\\ O Contractor Date � ALTER C1 $ / � 7+ �©• vV 1 .ITEMS Q y - CA42 '^ . n ❑ I am exempt under Sec. - . v 4A VYtCOL REPAIR ❑ TOTAL 77 $ (J(, 12 7.190 e.&PA, for this reason '/, V DEMOL ❑ 191jE W ' 291E LDMA P/C#' - m7 1227e�� Date: u G .G, `D URM ❑ - _- . I, - D- V36 / (n Signature AP (CANT(PRINT) l �,�..// TEL NO. CDMA Perm# i �01 111 3 95? I, as owner-of the.property, or my employees with wages as GJ� e— 0 • &v-(v ''a'/ L4 3 � � $ r'i1 Ztheir Sole compensation,.will dothe work and the structure•is ADDRESS /n��- wM . F� / -0not intended Or Offered for sale (5eCh00 7044, BhaineSS and I 'Z W •M 0� CVb• LA` Cd FINAL DATE;- Q _Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS.MATERIAL ✓22 1 ITEMS OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO On GREATER THAN THE ❑ 1, as owner Of ftle property, am a%C USIVEy COn1Y2Cting Wlth AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE' 'FINAL BY1 licensed contractors to,Construct the project (Section 7044, `` - - - 'Ti ITAL 1487.10 Business and Professions Lode.) YES C3 NO �(J /'I/ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING ME\.rT 1487.10 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CONSTRUCTION LENDING AGENCY COAST'AIR'QUALITY MANAGEMENT'DISTRICT ISOAOMD)SEE'PERMITTING CHECKLIST FOR GUIDELINES _ CHANGE -i .00 I hereby affirm that there is a construction lending agency for YES El No❑ - - - - the performance of the work for which this permit i's issued(Sec. o' 3097,Civ.C.) \ I HAVE READ THE HAZARDOUSMATE RIALS INFORMATION GUIDE AND THE SCAOMO PE EMITTING r}) �'�(� p 1� N CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. I t 000-0001 11/299} TITLE 2.CHAPTER 2 0 .20 SECTIONS 2.20.100 THROUGH 2.20.100 CONCERNING HAZARDOUS L! Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. :7C 0 Lender's Address gOeACEN. _ 3474, 1 AM 11 0 d I certify that I have read this application and state under penalty 0 of perjury that the above information is correct. agree to comply P.C.FEE' ' / PERMIT FEE / �� pp ' With all county ordinances and State laws relating to building G A, Construction, and hereby authe a representatives of this County ISSUANCE FEE / O - IF Ct`o �er�up�on�t�he�ab�ow�e-m@�[f��ti0l�fpN�pT p/W,pert for inspecti0 purp /� ��lA.�"l/�.x !aY rn.11�/ �I ... r INVESTIGATION FEE TOTAL FEE / ,f / O miure M Moiuni u Mani / oma J SEE REVERSE FOR EXPLANATORY LANGUAGE ....... APPLICATION FOR BUILDING PERMIT S COUNTY OF LOS ANGELES ADU DRESS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY .MSN LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST Y _ CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. / DISTRICT NO. GROUP TYPE __ PROCESSED BY FOR APPLICANT TO FILL IN —I coNsr. BUILDING SEWER MAP ADD 5 STATISTICAL CLASSIFICATION BK PG CLASS. NO. - DWELL.UNITS I /J LOT NO. BLOCK MAP -.� STATE YES iNol NUMBER /. HWY. TRACT aI USEZONE SPECIAL NO.OF BLDGS. ♦- -> ^ CONDITIONS SIZE OF LOT r` �^ I NOW ON LOT / ,/y1 USE OF EXISTIN BLDG. BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT MAIL P.L. ADDRESS SIDE '- TEL. T - P.L. CITYNO. INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS TEL. CONTRACTOR NO. ADDRESS DESCRIPTION OF WORK NEW ADD ALTER ` REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES / USE OF STRUCTURE / I SIGNATURE OF APPROVALS APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS FRAME: FIRE STOPS. FEE BRACING.BOLTS VALUATION S _ FURNACE: LOCATION. FEE GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP. LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR. PERMITTE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. N.G. CASH PERBUT VALIDATION CIL M.O. icASH ' ®r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS FIRE SPRINKLER BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9612050013 PHONE: (818) 285-0488 EXT: LEGAL ID: NUMBER OF ADDED/RELOCATED BUILDING ADDRESS: ON FILE SO. FT SPRINKLER HEADS 9556 BROADWAY STRUCTURE: TEMP CA 917803135 ASSESSOR IN 0 0 R: - NEAREST CROSS STREET: 8588-026-007 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: ISSUED ON: PROCESSED BY: EX R S ON: EXIST OCC GRP: 03/17/97 LC 03/17/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE _FINAL BY: n CEDE. PILPA, JOSE (818) 286-6408- 3,300 /`/ n n f/ 9556 BROADWAY 7" yb 7n d,�n•,�l TEMP 917803135 FEES PAID DESCRIPTION OF W R~�' FIRE'SPRINKLERS FOR SINGLE FAMILY RESIDENCE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: - -y SUPERIOR FIRE PROTECTION, INC. (818) 913-3563- DO FIRE SPRINKLER PC 3300.00 VAL 98.69 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESIDf� 3300.00 VAL 0.50 _ D2 PERMIT W/0 EN-HC�' '.�c " 3300'00 VAL 116.10 TOTAL FEES 243.04 CONTRACTOR: TEL. NO: (�`a — -- �;�p APPROVALS DATE INSPECTOR SIGNATURE SUPERIOR FIRE PROTECTION, INC. (818) 913-3563- 20932 A CURRIER RD. _ LIC. NO - \`F��� FIRE D PAR NT INSPECT WALNUT, CA. 91789 664427 Cib FIRE SPRINKLER HANGERS ARCHITECT OR ENGINES --.--- TEL. NO: _ n 14 FIRED PAR N -ARYOVAT LIC. NO: V� 7 V 11111v P. MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CM00 B-U C %CC ll UK� N0. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT L S: ----- p� NO 20 p p SCHOOL ITH N HAZARDOUS AIR QUALITY: 1000 0FEET MATERIALS REPORT ID: DPR261 ROUTE TO: BS0508