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HomeMy Public PortalAbout9619 BROADWAY_Building__ TEMPLE CltY eu,...l#mf. l-eo APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILD]s [. DEPARTMENT OF COUNTY ENGINEER — qq BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS STc .cmc FOR APPLICANT TO FILL IN DISTRICTNO. GROWTYPE Pft CESSED BY �J ,6 CON BUILDING n STATISTICAL CLA IFICATION SEBKR MAP PG ADDRESS (J (� o .r CLASS. NO.-Q_OWELL. UNITS e 1 4— LOT NO. A LOCK WATER• NOT REQUIRED RECEIVED Fj � r TRA M P A HIGHWAY STATE MAJOR SECOND. LOCAL cc�� NO.OF BLDGS. SIZE OF LOTJS ��(} 8' INOW ON LOT USE ZONE SPECIAL USE OF I CONDITIONS EXISTING BLDG. T . OWNER NO. BUILDING YARD HWY STREET NAME EXIST. SETBACK WI TH ADDRE Sg&#6' FRONT ARCHITECT OR TEL. P. L. DC7 Cl ENGINEER NO. SIDE P. L. ADDRESS T / INSPECTION RECORD 0 CONTRACTOR •S N V ADDRESS IVX- DESCRIPTION OF WORK O 0 W d NEW ADD ALTER REPAIR DEMOLISH Z SO. FT. NO.OF NO.OF _ IZE STORIES FAMILIES USE OF STRUCTURE ^ Lr �d SIGNATURE OF PPLICANT B' VALUATION S � I > APPROVALS DATE INSPECTOR'S/SIGNATURE FEE S FEE $ �a FO FORMS. MATERIALS LOCATION s ,)T-lb' � 2 F RAME' FIRE STOPS, ' IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS n I BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK '/ AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. .41fly TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT ING TO WORKMEN'S COMPENSATION IN SU ANCE. U I LATH,EXT. PEROUSE NUMBER COR- MAITTEE F Y HRECTAND POSTED ADDRESS FINAL I W M CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E R PLAN CHECK VALIDATION cK. N.G. Z,sH PERMIT VALIDATION cK M.o. usx Lt}110 9 8 9 e Aug 2 APPLICATION FOR BUILDING PERMIT FOR AP ''LICANT TO FILL IN (Priv+o, typo only) BU L9ING 7 COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY ' Temple Cit 4 Ca:hif. 91780 BUILDING AND SA DIVISION NO.OF SLOGS, BUILDING SIZE OF LOT NOW ON LOT ADOR ESS /� 3 TRACT BLOCK LO O. LOCALITY TEo// NEAREST OWNER Paul Za is NOB(J- CROSS ST. r ASSESSOR ADDRESS 8851 Wedgewood MAP BOOK PAGE PARCEL City, v /� �/p DISTRICT GROUP TYPE FIRE CESSED BY CITY Temple lilt Ca.ZIP 91780 CONST Zp ARCHITECT OR TEL. •06 4 fC-A•F - ENGINEER NO. STATISTICAL CLASSIFICATION SEWER AP All,A DRESS CLASS NO. DWELL.UNITS '- BYPG CONTRACTOR NEOL. P87-q USE ZONE MAP AOIDRESS1317 E.Las Tunas LIc 2 �` SPECIALGO� LIC. CONDITIONS CITY San Gabriel Ca. cL, B-1 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION LENDER 'F�x7j�yci�[c NAME AND BRANCH z'vLx Y BLOG.SETSACK FROM FRONT PROP.LINE OF FROM (STREET) Y� ADDRESS CITY HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF E%tSTI CD IDTNG $O. FT NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WH C.J SIZE C STORIES FAMILIES ONE C © + } O DESCRIPTION OF WOR..T[Y.�-1 s_eG�L4.-:-..tlEW - C.D 'Y2�JI2�Ti d�B b1 ui�ld'CApp ❑ SIDEGPROP. L NEOP M (STREET) z LTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING a 20 x 20 detached Gar. REPAIR❑ SIO' PROP. LINE HIGHWAY WIDTH USE OF + _ EXISTING BLDG. DEMO APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION$ Jr�01U D CATEGORICAL EXEMPTION YES❑ NO ❑ HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WIT HALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (GATE) HEREBY I 'HILL N 0 T EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPEN NSUR SIGNATURE PERMITTEE •"� ADDRESS / FINAL TEL. DATE V CITY NO. / 1 P.C, MT. )IAKh CHECKS P:11.4131E '10: FEE $ 'FEE HARVEY T. BRANDT, COUNTY ENGINEER 1-2\5— PLAN CHECK VALIDATION M.o. CASH PERMIT VALIDATIO c, M.D. GASH 4 9 5i;JAW 17 1 0 4 8.7 5 Sys 76A636A CE R80312/72 APPLICATION FOR BUILDING PERMIT FOR AlDntICANT TO FILL IN (Prior o. IYPe OnIV) BUI SDI NG , �✓� .-7COUNTY OF LOS ANGELES ADDREss DEPARTMENT OF COUNTY ENGINEER arv ' A:4;— zip zIP 5s^'%� `1 BUILDING AND TTY DIVISION NO,OF BLDGS. BUILDING ) SIZE OF LOT �,� 7-�b' NOW ON LOT_ (OO TTj / ADDRESS J -�� LOCK L'O T,NO/ LOCALIT TRACA3 12- TEL. 1 NEAREST OWNER NO. CROSS 5. ASSESSOR ADDRESS ✓ / i"Gr.jr�CLl+'�C'�iL'� MAP ROOK PAGE PARCEL —� J�J p DISTRICT GROUP TYPE FIRE ESSED BY CITY _ "�"" ZIP //�! C.) CONST. ZONI ARCHITECT OR !TEL -y/- ENGINEER NO, STATISTICAL CLASSIFICATION((// SEWER MAP ADDRESS nn CLASS NO��� .DWELL,UNITS BK PG CONTRACTOR ,J NO�� � T SEZ EMAP •/ LIC //{gip NO.- ;,,5 ADDRESS ADDRESS �j �/1f Oj/,�Jj(.30,� I /� �) SPECIAL LIC. V CONDITIONS CITY CLA55 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM d FR9<TPROF. LINE OF (STREET] ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING Cd H HWAY } VAftp - SQ. FT.F/ .0 NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH p SIZE ( U STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ + 1 V ADD ❑ 510E 'SE PBL CEPOF (STREET) ? �J ALTER ❑ HIGHWAY + YARD _ L SETBACK FROM TYPE OF EXISTING ❑ SIDE LINE HIGHWAY WIDTH REPAIR USE OF + _ EXISTING BLDG. DEVOID APPLICANT TEL CORNER CUTOFF YES ❑ NO (PRINT) NO. I BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL ZONE YES ❑ NO ❑ VALUATION $ _' CATEGORICAL EXEMPTION YES❑ NO ❑ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- ST-UCTION. I – THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPE NN N�RANC0 - SIGNATURE OF ,s � A�0 10 PERMITTEE _ - ^/ L ADDRES "I I I 1 FINAL r 8� TEL. CITY NO. DATE hiA KFBC//ECKS I'A YA RLE To FEE ellPMT.¢ FEE HARVEY T. RANDT. COUNTY ENGINEER PLAN CHECK VALIDATION cK. M CASH _ PERMIT VALIDATIO �. M.O. CASH 4 9-4 i`JAN 17 .1 8{N O 3.0 0 Asa 76A638A CE4803 7/73 - V_ DEPARTMENT OF BUILDING AND SAFETY - I APPLICATION FOR PERMIT CbUNTY OF LOS ANGELES ® ' wt,,r /► V WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY,:4245 BUILDING qq qq /(a / DISTR I CT NO. PLAN CK.NO. PERMIT NO. ADDRESS /+4I - r.- dlG..?-3.tY '/ 1 1J.-7,�7 4� �� 07/ 3A /^ LOCALITY I,A//,'//1 /j�1 RECEIVED BY DATE OF APPL. DATEISSUED CROSSHT. �/./n A_� /J_ - -Y "7 asl ILDING OWNER AREBS I2` /+ 19,eognw/I� MAIL YA/f LOCALITYADDRESS TEL NEAREST7- CITY NO. M'Tf�/D�N CRO99ST. ✓ ry J I�- FIRE NO.OF TYPE -./ GROUP ARCHITECAR ® TEL. ZONE— PLANS V ENGINEER' NO. BLDG. �© / /)� ORD.NO. ADDRESS SETBACK LINE I f APPROVED TEL. CONTRACTOR NO. BY DATE USEAPPROVED ADDRESS ZONE IS .DATE LEGAL CORRECTIONS DESCRIPTION J� LO BLOCK TRACT (J Q / 9 ."f NOW ON LOTH /dam r SIZE OF LOT - / S7 ' USE O NO BLDG. ,Q,�Q t NO. NO.OF FAMILrE$ ROOMS DESCRIPTION OF WORK NEW ALTERATION ADDITION O �/ a REPAIR /1 �/X MOVING DEMOLISHSQ.F � or SZET IT .i n/30 :RO/OMS 6 STORIES D WALLCOVERINp q/'� w..4.X COVERROOF �fl,d'!11 F USE OF NEW BUILDING ` i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS' SIGNATURE OF /BRACING,BOLTS (/ 4 ryg OWNER y/�/ LATH, INT.: AUTHORIZED AOT � AA I I F)I �� Z �" -'l-" LATH,EXT.: 095-3 35M SETS 4-47 $ P C. PLASTER,INT. p4Q a FEE PLASTER.EXT. VALUATION >8 FINAL UILDING BUILDING ADDRESS n APPLICATION LOCALITY �. I; .n; LA/L n 171 N[AREHT-Z DIVISION OF BUILDING AND SAFETY "a IT. BT. Deportment of County Engineer - DISTRICT NO. ' Y RECEIPT NO. PERMIT NO. County of Los Angeles WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DAT[IBHUHD/1 CAHBATT D. GRIFFIN, BuwT OF BWIOIMB _7,/`r/ , FOR APPLICANT TO FILL IN Typee CCONST. RECEIVED BY �IISSU D BY/ � . OWNER 0 "i •.-I'/' CiS MAIL MAP STAT!NUMBER HWY YES NO ADOBE 8 ' USE ZONE SPECIAL ' TEL CONDITIONS CITYMll Q ARCH ITECT OR TEL ENGINEER N0.' BUILDING YARD HWY STREET NAM[ EXIST.. ARE S9 SETBACK WIDTH FRONT A CONTRCTOR : I 6 / P. L - 1 , / BIDE A ORE39 1 P. L - BUILDING DATE CORRECTIONS INSPECTOR ADDRESS LOT NO. BLOCK TRACT N0.OF BLDDS. SIZE OF LOT I NOW ONLOT USE OF EXISTING BLDG. DESCRIPTION OF WORK °x 0 NEW ADD ALTER REPAIR DEMOLISH• SO.FT. NO. OF NO.OF I r SIZE STORIES FAMILIES USE OF STRUCTURE U NO.OF EPLO MYEES 1. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- PLICATION AND STATE THAT THE INFORMATION GIVEN 13 CORRECT. APPROVALS INSPECTOR'S SIGNATURE GATE IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES ' FOUNDATION: LOCATION AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS,MATERIALS FRAME: FIRE STOPS, SIGNATURE OF ` Qvl�_ .BRACING,BOLTS PERMITTE ` URNACE: LOCATION. /�� // I ADORE _ /�.I Je /J.�, G•OH VENT,OUCTH ! pi,�.c._. /F3/.S) LATH, INT. AUTHORIZED AS - LATH, EXT. S , 4P.C.B HOUSE NUMBER COR- / PEE RECT AND POSTED �/' VALUATION FEE ® G C FINAL , P - /i}'•5� 76A639A OBS 3 4-54 v WORKERS'COMPENSATION DECLARATION There ,:..:qm that I have ra certificate of consent to =elf APPLICATION FOR , BUILDING PERMIT ._ insur a certificate of Workers' Compensation Insurance, orad copy thereof (Sec. 3800, Lab. C.) - - _ _ , COUNTY OF LOS ANGELES', BUILDING AND SAFETY "Policy No, !:�4!Ppnv,% Certified copy is hereby furnished. ',FOR APPLICANT TO FILL IN ti ADDRESS 8 1 Certified copy is filed with the county building inspec- BUILDING ((�� _ - tion department. ADDRESS `T LOCALITY NEAREST Date Applicant CITY c-1cl-ly ZIP q1-1 pa CROSS ST. _ NO. OF BLDGS. -L ASSESSOR COMPENSATION INSURANCE SIZE OF LOT X NOW ON LOT /� MAP BOOK P E CERTIFICATE OF EXEMPTION FROM WORKERS' PARCEL (This section need not be completed if the permit is for orie USE 7�CNE MAP - rl AO hundred dollars ($100)or less.) TRACT BLOCK LOT NO. U/ NO. [•(J J TEL. IL SPECIAL OWNER (q } b NO. CONDITIONS 1 certify that in the performance of the work for which this DISTRICT I GROUP TYPE / FIRE PROCESS D BY O permit is issued, I shall not employ any person in any manner ADDRESS / 7{ n CONST. / ZONE U so as to become subject to the Workers'Compensation Laws. �yU - ..�-*/-s Ir// CITY 9p7�,r's V w Date Applicant C7L "u' e CIS ZIP -/� ) p� STATISTICAL CLASSIFICATION APT. CON _ I- N NOTICE O APPLICANT: If, after mg this Certificate of ENGINEER OR NL. U CLASS NO. DWELL UNITS_ Exemption, you should become subject to the Workers' y Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be PZ deemed revoked. CONTRACTOR NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION - LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC j) Professions Code, and my license is in full force and effect. CITY CLASS $ f/ , SO. FT NO. Of NO. OF CHECK License Number Lic.Class - - SIZE .STORIES FAMILIES ONE r� Contractor Date DESCRIPTION OF WORK N $ NEW ❑ $ 2 7 7.2 A I am exempt under Sec. ADD ® - e e e e a ALTER ❑ FINAL _ 8.8P.C. for this reasonREPAIR ❑ DAT .( • e87.38 USE OF DEMOL RY e e e 8 7.3 8 5 Data: EXISTING BLDG. CSI once _ Signature APPLPRINTT IL/f OWNER-BUILDER DECLARATION (,S M TEL.NO' �} I hereby affirm that I am exempt from the Contractor's License 5a (/YJ bVy.e_ ► 8 2 2`:�8 rJ rm Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): I PRESENT X71 - J� I, as owner of the property, or my employees with BUILDING wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). - ' MOVING TEL ' ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS - 'tion 7644, Business and Professions Code). REPLACED CONSTRUCTION LENDING AGENCY RSET BACK YARD HWY TOTAL PSETBACK FROM EXIST. ROP. LINE WIDTH I hereby affirm that there is a construction lending agency for .. FRONT ►• -- - - the performance of the work for which this permit is issued P.L. ` (Sea 3097, Civ. C.). SIDE P.L. El Lender's Name Lender's Address _ P.C. Fee$ Permit Fee I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with.all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee u 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 Date ®s