Loading...
HomeMy Public PortalAbout9563 BROADWAY_Building__ ,76A638A.CeAS038-64APPLICATION FOR BUILDIN_ PERMIT COUNTY OF LOS ANGELES BUILDING Y DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND.SAFETY DIVISION LOCALITY JOHN A. LAMISIE-. COUNTY ENGINEER NEAREST COLEMAN W. JE NKINS,SUP'T.OF BUILDING CROSS Sr. Jliy "' / ` 'J fly l DISTRICT NO. GRO /s,TYPE,' PR HSSEDBY FOR APPLICANT TO-FILL IN �!,� CONSr. BUILDING -- STATISTICAL CLABSI FICATION� SEW R'MAP AODRESS /" ,�: s(,/ CLASS NO. DWELL UNITS - BK PG -� If LOT NO BLOCK USE ZONE MAP c� Y TRACT ns a may$ SPECIALC l g X� -+ NOWOONBLOOD. IOT SIZE OF LOT/pe ' S 'CONDITIONS l�A USE OF E I N BLDG. SETBACK FROM l /.errL /" A.. TEL. '0 FRONT PROP. LINE OF ,(STREET) OWNER/ eL%// V O. TYPE OF EXISTING- SETBACK HIGHWAY } YAP = TOTAL _ ADDRESS g HIGHWAY WIDTH FROM C OM L �C.L. CITY � F J ARCHITCllfL R TEL. BLDG. SETBACK PROM ENGINEER- p_ NO. r9' O SIDE PROP. LINE OF (STREET) _ L TYPE OF E%IST'NG SETBACK HIGHWAY } YARD TOTAL AD Dft ESS ell,14 A/T/f ir�rt HIOHW AY WIOTM FROM C.L. a J - CONTRACTO �LILVL/•G ��W F>�O L. . . _ + - Q LIC. CORNER CUTOFF YES El NO K 'ADDRESS - NO. O clrr c` s 'SEE REVERSE SIDE FOR SPECIAL_ APPROVALS V DESCRIPTION OF WORK w x- NEW ADD - ALTER REPAIR DEMOLISH .FT. O NO. OF NO. OF SIZE STORIES FAMILIE U52STIR UOCTU REe,S In17 BC , . .,SOD � Q C {� T .. • - SIGNATURE O APPLICANT _ VALUAT10 - 6C, U D �/ APPROVALS DATE - INSPECTGWSSIGNATIJRE P.C. Q PMT. (JL FOUNDATION, LOCATION FEE$ J �"J FEES FORMS MATERIALS _ `— _ -FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE�TNAT HAVE READ THIS APPLICATION BRACING BOLT 01 AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION' �Y F WITHALL COUNTY OROINANCES AND STATE LAWS .EG ATING GAS VENT. DUCTS 9UILDI NG CONSTRUCTION, 1 ,CERTIFY THAT. IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR C(j E OF THE STATE OF ALIFORNIA RELAT- V ING TO WORKMEN'S IT �ENSAT I ON INSUR,. fJ LAT M. EXT. / lV SIGNATURE OF HOUSE NUMBER COR PERMITTEE _ RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL ST"c RAL ENGINEER PLAN CHECK VALIDATIONcK. M.o' GASH PERMIT VALIDATION OK. M.o- CASH 0. 0.8!2 ftp!? 20 2 31 3 x.5.05 H ,.14 oz2UG IAY11 1 D 26 7.00- N APPLICATION FOR � ' BUILDING PEI MI BUILDING _ G' FOR APPLICANT70 FILL-IN ' - ADDRESS BUILDING // L ADDRESS 'Cj 'LOCALITY (J NEARES CITY �� ZIP. �O �. CROSSS -t "NO.OF SUGGS. 'ASSESSOR ^ -A C SIZE OF LOT O 4:: WON L07 MAPBOOK PAGE EL DISTRICT GROUP TYPE.,-' FIRE' PR ED BY TRACT BLOCK .LOT NO. '\ .1 CONST TEL OWNER �NO: S7ATISTICALCLA551FICATION 91 MAP ADDRESS CLASS NO__xg__�DWELL.UNITS �BK CITY .ZIP USF O F MAP n ARCHITECT OR TELO` C/ ENGINEER - -NO. SPECIAL CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO❑ A TEL CONTRACTO NO ' 06 67 BLDG.SETBACK FROM LIG ♦) /f /' FRONT PROP.LINE OF (STREET) ADDRESS NO pLAl6 _ TOTALSETBACKFROM TYPE OF EXISTING LIC. HIGHWAY + : YARD - FRONT PROP.LINEIHIGHWAYI WIDTH CITY CLASS CONSTRUCTION LENDER O NAME AND BRANCH BLDG.SETBACK FROM v SIDE PROP.LINE OF (STREET) ADDRESS CITY - O SQ.FT. - NO.OF NO:OF - ' CHECK ,' HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING w SIZE STORIES FAMILIES ONE: SIDE PROP.LINE HIGHWAY WIDTH ..o = Z DESCRI TIONOF WORK - NEW ' ADD ❑ - CORNERCUTOFF YES. _❑ ".4 NO ❑ '' ALTER ❑ IN OPEN SPACE YES ❑ NO USE OF REPAIR IN COASTAL PERMIT ZONE-: .'VES, ❑ NO ❑ EXISTING BLDG. DEMOL ❑ APPLICANT TEL - (PRINT( NO. BY(SIGNATURE( ,,��y� ,'F'G �� ,J I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE //`T%�J� /7/US � /%k_65O� ,"11V,- THAT 1N/'THAT THE ABOVE S.CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.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 COM. PENSATION INSURANCE. - - SIGNATURE OF FINAL BV PERMITTEE - _ DATE ADDRESS TEC. P.C. Fee$ - 'Permit FEB CITY NO. 066 IssiLo,e Fee / VALUATION s - Total Fee PLAN CHECK VALIDATION ` - cRd m.o. 'cAsH' PERMIT VALIDATION cK." m.o. cwsH 9 � 1-9' APR' +1.4 -Z;,o :. 31.Q AU".' ®5 76A638B OE/803II a . APPLICATIfJ'FOR BUI - ING PERMIT FOR APPLICANT TO FILL IN (Rrinl R (roe on 1Y) ;_' BUILDING BUILD61 ING - - - ADDRESSADDRESS 'Lf CITY Temple CitzIP91780 LocALdr NO.OF BLOCS. SIZE OF LOT NOW ON-LOT NEAREST ' 7'e CROSS S 'TRACT BLOCK LOT NO ASSESSOR - MAP BOOK -PAGE PARCEL TEL'. D15T,RICT GROUP TYPE FIRE CESSED BY OWNEW C Own H .uses No. 285 972 Co z N ADDRESS 9551 Bvoadwa STATISTICAL CLASSIFICATION WE MAP CITY Temple City ZIP 61880 CLASS NO -OWELL.UNITS K� ARCHITECT OR TEL. _ ENGINEER NO, USE ZONE NOP' ADDRESS - _3 SPECIAL DTI_ �' ' TEL. CONDITIONS G. - CONTRACTOFLtle RoofingNo '792 517 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ ADDRESS 2948 East Walmu .. C39 BLD SETBACK FROM CITYLIC.' FRO TPROP.LINEOF (STREET(- -. Pasadena CA CLAss1863 3 -CONSTRUCTION LENDER HIGHW Y + Y:RD o TOTAL: SETBACK FROM TYPE OF EAST IHG NAME AND BRANCH Unknown FRONT PROP. LINE - ADDRESS CITY + SO. FT. NO. OF NO. OF CHECK BLDG. TEA SIZE STORIES FAMILIES ONE SIDEPRO P. LINE OF (STREET). U DESCRIPTION OF WORK NEW ❑ HIGHWAY + YARD TO AL SETBACK FROM T E OF EXISTING -O SIDE PROP. LINE HIGHWAY WIDTH- „V Reroof 2/15# felt and on °DER ❑ + z laver of flexstone EPAIR© CORNER CUTOFF YES ❑ NO ❑ USE OF EXISTING BLDG. EMOL' 1:1 IN OPEN SPACE - YE5-❑ NO ❑ APPLICANT TEL IN,COASTAL ZONE YES ❑ NO ❑ (PRINT) NO. CATEGORICAL EXEMPTION YES[:]" NO BY (SIGNATURE) ENVIRONMENTAL ❑ pff.' �{ IMPACT' EXEMPTION DECLARATION'SIGNED IDATEF VALUATION S /�V IMPACT REPORT PROCESSED (DATE) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATINGBUILDING-CON- STRUCTION. 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 CO MPENSAT.ION INSURAHC E. .SIGNATURE OF �U e _��/ FINAL PERMITTEE `�✓/"' DATE -Hn� / ADDRESS P.C. $ - PMT:Q Pasadena, A TEL. 792 51 fEE D FEE Y 21. 75 CITY NO. i PLAN CHECK VALIDATION K. MD. =ASH PERMIT VALIDATION « LASH `. ra 57fii;ARR 14 1V 1 7 5 ®S8. �]bg63RB CE#R03A 5/]3 - .-. WORKERS' COMPENSATION DECLARATION /,� n F�II FOR p p p I'here4v affirm that f have a certificate of consent to self �PP��fr rye`���H FO I_p DB U I L O Iryll G _P E R r�. �. � lT insure, or a certificate of Workers' Compensation Insurance, - `V—!N 11 V 11 00 LJ II V II u�u u o Cyr�fye c there/of (Sec. 3800;(Lab 'C�.)� Q COUNTY OF LOS ANGELES - - BUILDING AND SAFETY Polis ^�C Company lL"L/Js O ❑ "Certified'copy is her furnished. FOR APPLICANT TO FILL IN ADDRESS �— Certified copy is filed with the count b g inspec- BUILDING r /jam �w� /- / tion d partmenY ADDRESS J�/ PLe y 6 , Date Applitont - _ CITY T/n/='GE 6,z ZIP / jj LOCALITY _ NO. OF BLDGS. NEARESTJr • ERTI CATE!OF EXEMPTION FROM WORKERS' - SIZE OF LOT NOW ON LOT CROSS SL COMPENSATION INSURANCE _ ASSESSOR ' (This section need not be completed'if th'e'p it is for one TRACT. " BLOCK LOT NO. - MAP BOOK PAGE PARCEL hundred dollars ($100)or less:) _ TEL. S a� OWNER• ell Oy✓�J 4//tr P. — USE ZONE MAP19 I certify tha4,in the performance of the work for which this NO. ,permit is issued,'I sholknot employ any' >person in any manner - ADDRESS Q r p SPECIAL a ,l CONDITIONS . so as to become subject to the Workers'Compensation Laws. - - o - O .. I CITY L� C!% ZIP / / 78 Q 6. U Date Applicant ARCHITECT OR TELTYPE _ 3: NOTICE APPLICANT: If, after making this Certificate of ENGINEER NO. - ` - -'DISTRICT GROUP CONST FONE P OCESSED BY O Exemption, you'.should become subject to the Workers' - {O� _3 ✓ U Compensation provisions of the Labor Code, you must forth- ADDRESS - cJ 0- with comply with such provisions or this permit shall be TELSTATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked: - CONTRACTOR NO. � Z LICENSED CONTRACTORS DECLARATION //6 ® ��A LIC. /1 CLA55 NO._1 D11_IL. UNITS- I hereby affirm that'l am licensed under provisions of Chapter 9 ADDRESS/ NO. r�B (commencing with Section 7000)of Division 3 of the Business LIC. SEWER MAP y �(� CLASS n 2 and Professions Code,and my license is in full force and effect. CIN LO✓ 9-4z � . l:-�J BK. PG_ VALIDATION SQ. FT �^� NO. OF NO. OF Q CHECK License Number- Lic.'Closs� SIZE _ipryc� STORIES FAMILIES U ONE //✓� p ❑ VALUATION Contractor - / / / l Date - / DESCRl PPON OF WORK NEW $ O Ell am exempt under Sec. ADD El �"/PEC. n g'! /CC'aT ALTER i❑pr 8.8P.C. for this reason REPAIR Date: � USE OF /A/.O/ / '-- _ EXISTING BLDG. (50/l O DEMOL ❑ Signature - APPLICANT TEL. FINAL - OWNR- ILDER DE RATION (PRINT SS FI NO. — I herebyaffirm that I am exem om the Contractor's License q�r /J/���y 711a: � _ DATE "Law for the following reas (Section 7031 5, Business and ADDRESS /S 3 of I` ,O&,% #7 / z a: FINAL ' .�J Professions Code): . PRESENT By ❑ 1, as owner of the property, or m employees with BUILDING a s--N:-- - P P Y• YADDRESS :- , - wages as their sale compensation,will do the workand •• - - = L the structure is not intended or offered for sale(Section' LOCALITY D TUT G m SS 7044, Business and Professions Code.) MOVING - TEL. ❑ 1, as owner of the property,.am exclusively contracting CONTRACTOR NO. - t - with licensed contractors to construct the.project(Sec-' - ADDRESS U� f'l+at .LIa tion 7044, Business and Professions Code.) - - - CONSTRUCTION'LENDINGAGENCY; —REQUIRED -YARD HWY TOTAL SETBACK FROM EXIST. SET BACK PROP. LINE WIDTH hereby offirm'that'there'is a construction lending agency for '- FRONT - - iheperformance of the work.for which this permit is issued "P.L.' - - i h�EJ1] t r'T_ (Sec. 3097, Civ. C.). .r .SIDE.... - - rJ.f7c / . P.L.- - - S Fi Iola i Lender's Name. p � m .. .. /D ? 'CDMA Ref. N Lenders Address -. ,� -" P.C. Fee$ Permit Fee D- ' � ., , I certify that I have read this application and state that the - - Issuance Fee - " CU CDMA P2 q 8 . aboveinformation is correct. I agree.to comply with:all County Investigation'Fee / p� R - ordinances acid State laws relating to building construction, Total Fee I/ O CDMA Perm. M a and hereby authorize representatives of this County'to enter _ upon the above-mentioned property for,inspection purposes. - - - - - - - a SEE REVERSE FOR EXPLANATORYLANGUAGE Signature ofAppllcont or Agent Date -