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Home My Public Portal About9613 BROADWAY_Building__ 76A638A CE4803 9-68 APPLICATION FOR BUIL'IDING ERMITR COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BrOa way 6848 BUILDING AND SAFETY DIVISION LOCALITY Temple City JOHN A. LAMBIE, COUNTY ENGINEER NEAREST COLEMAN W. JENKINS, SUPT OF BLILDING CROSS ST. F R APPLICANT TO FILL IN 01sTRI nD NO... GROU TYPE R ssED By (Print or fy0e only) ..�J -O/ CONST. BUILDING STATISTICALSSIFICATION ER MAP DDR AESS GLASS NO. OWELL,UNITS BKE PG/ LOT NO BLOCK US ZONEMAP NO. TRACT SPECIAL NO,OF BLDGS. - CONDITIONS SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF (STREET) OWNER NO. 287-8211 TYPE0 ISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS HIGHWAY TH ter FROM G.L. Temple Cit } ARC DG, BSETB ARCHITECT OR TELSILIN FRO . DE PROP. LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK GHWAY } YARD = TOTAL ADDRESS - HIGHWAY WIDTH FROM G.L. 7 TEL. = C CONTRACTO NO. 7—n o7 ADDRESS600 S. San Gabriel Bl.NO 160650 CORNER CUTOFF VES ❑ ❑ CC CITY San Gabriel 91776 c ASS C-39 SEE REVERSE SIDE FOR SPECIAL APPROVALS 4 CONSTRUCTION LENDER n NAME AND BRANCH rr Z_ ADDRESS SQ. FT. NO. OF NO. OF NEW ElSIZE STORIES 1 FAMILIES USE OFADD ❑ STRUCTURE ALTER ❑I� SIGNATURE OF REPAIREX APPLICANT DEMOL ❑ VALUATION S 384.00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE S FEES FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS 57RUC TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATIO INS URA NC E.��J LATH, EXT. SIGNATURE OF /// � HOUSE NUMBER COR- PERMITTEE _:o7 RECT AND POSTED _. ADDRESS FINAL JOHN F. LEWIS. PRINCIPAL STHU RAL ENGINEER PLAN CHECK VALIDATION CH. M.O. CASH _ PERMIT VALIDATION CK. M.O. DAG. i t 2.y,5 7 d DEC 3 1 D 9.0 0 v - .. .', _�/ 6✓✓� IIS 06F OEHB93-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELESBUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESSr BUILDING AND SAFETY DIVISION' LOCALITY E JOHN A. LAMBIE.COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. _ 0ISTRJaT N GROUP TAPE P OC O Y FOR APPLICANT TO FILL IN �y CONST. - . BUILDING �� l7 STATI SYICAL CLASSIFICATION SEWER MAP ADDRESS �/ �, WATERS. NO._O_DWELL UNITS [� P LOT Nqt�', NOT REQUIRED ILLI RECEIVED CERTIFICATE: ✓J� TRACT , MAP HIGHWAY NO. OF BLDGS. NO. O (CIRCLE) STATE MAJOR SECON SIZE OF LOT, ,� 'C/ NOW ON LOT USE ZONE SPECIAL . USE OF CONDITIONS EXISTING BLDG. - - TEL OWNER ( NO BUILDING YARD HWY STREET NAME EXIST. - ! .SETBACK WIDTH ADDRESS -.t/ . FRONT oI ARCH ITEC OR TEL. P. L. ENGINEER NO. SIDE P. L ADDRESS TEL. //.�«��I lei./- //I/L,"40-40- '4_ •b- rAlJ�f:, O CONTRACTOR NO. 'y t /"iT`L41 - t'{ } �= ADDRESS O DESCRIPTION OF WORK ( (' �� =I ✓ F u NEW AD ALTER REPAIR DEMOLISH ^ ! i R r, /,n P 'r W � Z SIZE ,J,,GP ' STORIES FAMILIES � J la.�' F✓-.p .gi-' ' USE OF s4./(4•..//CSAR..�.f.�2.�/.•pIE� STRUCTURE �L _ / {/¢tLa I .�r'sYfif.Clf..Ml��4Y �Zk`TL�F. may.. �9L rE'.T SIGNATURE OF APPLICANT VALUATION $ �LrV APPROVALS I DATE INSPECTORS SIGNATURE PT FOUNDATION: LOCATION FE FEE FORMS. MATERIALS ~� FRAME: FIRE STOPS, / I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A FLI CATI ON BRACING, BOLTS // AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS ~ Af BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'5 COMPENSATION INSURANCE. LATH. EXT. SIGNATURE O - HOUSE NUMBER COR- PERMITTEE '�✓ -� -Ct BE AND POSTED ADDRESS' t FINAL JOHN F. LEWIS. PRINCIPAL STRUCTURAL E PLAN CHECK VALIDATION GK- MD. GASH _ PERMIT VALIDATION CK. M.O. DASH. Go 4 9 0 o J-AN 14 1 D 1 5.00-- iWORk4.RS' COMPENSATjON DECLARATION _ SI sure, of fico haver certificate of consent to self APPLICATION FOR BUR DING PERMIT LI IS insure, or a cePtifica{� of Workers' Compensation Insurance, or a certifiecicopy thereof (Sec. 3800, Lab. C.) , COUNTY OF LOS ANGELES BUILDING AND SAF Policy No._ mpony BUILDING ❑ Certified coop MIRFgby furnished. FOR APPLICANT TO FILL IN ADDRESS �� • ❑ Certified copy is filed,with the county building inspec- BUILDING J p p , tion department. ADDRESS (Y/3 LOCALITY q O NEAREST Date - Applicant CITY Ti C ZIP S CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' O, of BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT I MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one !y)/59l4A USE ZONE MAP 7- hundred G dollars ($100)or less.) TRACT (J ICN [S BLOCK LOT NO.!—�� N0 l TEL. I SPECIAL I certify that in the performance of the work for which this OWNER �� Q fiL NO. gL-79.33 CONDITIONS 1 permit is issued, I shall not employ any person in any manner "' DISTRICT .GROUP TYPE FIRE ESSED BY O so as to b ome subject to t r ter C ensatio a s. ADDRESS q 6/3 E- e D,b,} !JA CONS ZONE V / I ' poi Q 3IF Datq-4/ Apphcan r arY 'Te �C ZIP 7�D STATISTICAL CLASSIFICATION APT. CONDO. �F . NO IC TO APPLICANT: If, after maki this Certificate of ARCHITECT OR TFL. V Exemption, you should become subl ct to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS_ d r, Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP N with comply with such provisions or this permit shall be ? deemed revoked. TEL' BK. PG, VALIDATION CONTRACTOR NO. LICENSED CONTRACTORS DECLARATIONLIC, I hereby affirm that I am licensed under provisions of Cho pter9 ADDRESS '+ NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC 7 Professions Code, and my license is in full force and'effect. CITY CLASS $ t, 0 0' SQ. FT' NO.OF NO, OF CHECK , License Number Lic.Class SIZE STORIES If FAMILIES ONE Contractor Date DESCRIPTION OF WORK NEW ❑ $ J // �t ADD ❑ am exempt under Sec /�gjG11C.�/7`!d N Y• Q.Ht ALTER ❑ FINAL 8.8P.C. for this reason RODI PAIR ❑ DATE Date: USE OF / FINA EXISTING BLDG. Reel 4 DEMOL ❑ BIt \ Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT N0. I hereby off irm that I am exempt from the Contractor's License Law for the fallowing reason (Section 7031.5, Business and ADDRESS rofe ions Code): PRESENT /y I BUILDING 17cf I, as owner of the property, or my employees with ADDRESS T L�•�1 wages as their sole compensation,will do the work and ' t the structure is not intended or offered for sale(Section LOCALITY ` 7044, Business and Professions Code). MOVING TEL. ❑ I . ' �' Al , as owner of the property, am exclusively contracting CONTRACTOR NOL� t �� -d With licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). y. LFRONT TOTAL SETBACK FROM EXIST. r 1. 8 4.2 A 'CONSTRUCTION LENDING AGENCY YARD HWV PROP. LINE WIDTH I 5 I hereby affirm that there is a constwction lending agency for , # s e ° ° .,J the performance of the work for which this permit is issued -(Sec 3097, Civ, C.). 1 ° 28200 iii Lender's Name ° ' 2 8 Z Q Q v Lender's Address P.C. Fee$ Permit Fee /• 52 0 1. 1 3=86 w I certifythat I hove read this application and state that the pp Issuance Fee s ry a above information is correct. I agree to comply with all County Investigation Fee _ �7 j ordinances and State laws relating to building construction, Total Fee d and hereby authorize representatives of this County to enter m yperrf a above-mentione operty for inspection purposes. - `/ SEE REVERSE FOR EXPLANATORY LANGUAGE Sigo Applicant or Agent Date ®s