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Home My Public Portal About9671 BROADWAY_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT .'`.COUNTY OF LOS ANGELES �1 A ® I tl�� WM. J. FOX _ ', CHIEF ENGINEER U L n�'d OR APPLICANT TO FILL IN ``' FOR OFFICE USE ONLY �. - DISTR 'NO. PLAN CK. O. PE MIT NOl rLOCAL[TY R f/6 RE IVED BY 1 DATE OF APPL. DATE[SSYFP ' `"' ' -� 'RESTwS9 'T:ERL qqRESSS�,` � /- �, -NEAREST : CROSS 8Tn/ 7� NO.��6 j 9 : - , \`i_ _ 'ZONE' I PLANS r I ARCHITECTOR � TEL. ENGINEER NO. BLDG. - ^ .� r� / I�ORb� [i 0. SETBACK LINE /ti E T•'S!{G ADDRESS ,APPROVED - _T TEL /J BY - - DATE 1 CONTRACTOR , NO. .a 36 ZONE �/ BYPROVED - - DATE ADDRESS /Q (L L�� _ C• HOUSE NUMBERING LEGAL DESCRIPTION LOT NO.JS- I BLOCK MAP NUMBER IELD CHECK BY _ TRACT NO, ASSIGNED BY ATE NO. OF SLDG . CORRECTIONS -- SIZE OF LOT �0 Z I NOW ON LOT S" `� USEOF NO. OF ( -/-/ EXISTING BLDG. FAHiusg I x el ♦ - DESCRIPTION ZF WORK _ NEW ,"_.I LrI ALTERATION I ADDITION 0 'REPAIR .'` I DEMOLITION SIZE L'o NOROOMS -STORIES . ,EXT. WALL ROOF I" COVERING ^, I COVERING USE OFI6TRUCTURE APPROVALS INSPECTOR' SIGNATURE DATE T HEREBY ACKNOWLEDGE THAT 1 HAVE .READ THIS AP- FOUNDATION: LOCATION ' 19 Sz PLICATIONANDSTATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS y ' CORRECT. . - - _ ' I, AGREE TO COMPLY ITH THE CORRECTIONS LISTED -FRAME: FI RE STOPS, HEREON AND WITH 'ALL OUNTY ORDINANCES AND STATE BRACING, BOLTS 'LAWS REGULATING' B 1 DING CONSTRU ON. FURNACE: LOCATION, K�v2 L SIGNATURE OF GAS VENT, DUCTS PERMITTE - 'LATH,INT. ADDRSSS LATH. EXT, AUTHORIZED AGT. -- ' - PLASTER, INT. 76AGSOA-1311"' to-no $ - - P. C. f O PLASTER, EXT,.0 1 y VALUATION ��0 J FEE 7V . FINAL zw COUNTY OF LOS ANGELES TEpPLE,CITY # 0°:1.SLj'fFCDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS -IDENTIAL ADD/ALT/REP - 'BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 0508 9807270002 PHONE: (818) 285-0488 EXT: LEGAL ID: - - NO. OF CONST NEW BUILD14IG ADDR .SS: ON FILE SQ. FT STORIES TYPE OCCUP GROUP 9671 BROADWAY STRUCTURE: 390 1 VN R3 TEMP CA 917803211 ASSESSOR INFORMATION NUMBER- GARAGE: NEAREST CROSS STREET: - 8588-010-019 OTHER: THOMAS 'PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 07/27/98 UT 07/27 99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: LOPEZ DANIEL G;BRUNO NANCY A (626) 287-8052- 1 28,800 9671 BROADWAY TEMP 917803211 FEES PAID DESCRIPTION OF RK NEW BEDROOM (3RD) AND BATH FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:- APPLICANT: TEL. NO: D N N CONSTRUCTION (626) 568-8466- AA BLDG PERMIT ISSUANCE 27.75 2671 SAN MARCOS DR. AC STRONG MOTION.RESiD--,28800.00 VAL 2.88 SPECIAL CONDITIONS: PASADENA, CA AX BUILDING,REVIEW-FEE 54.70 B2 PERMITi W/ENERGYC,ELES 28800':OOWAL 575.36 M" TOTAL�F_EES660.69 CONTRACTOR: TEL. N0: Q5 ' ,Vj� D N N CONSTRUCTION (626) 568-6466- APPROVALS DATE INSPECTOR SIGNATURE �' 2671 SAN MARCOS DRIVE LIC. NO LOCATION AND SETBACKS PASADENA, CA 91107 729586 e Q SOILS ENGINEER APPROVA ARCHITECT OR ENGINEER: TEL. NO: / FOUNDATION/TRENCH FORMS JJ _ \J LIC. N0:- i I- — - --`- i�111 ` SLAB/UNDER PRFLOOR RAISEDRAMING ` MAP N0: SEWER MAP BOOK: PAGE: FIRE 20N3: CId1 J�'� ,I 1,�l�Il�nl��K, G UNDERFLOOR INSULATION 1 U v S" T LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS; NO 21 \ 6T ND LEVEL FLOOR SHEAT SCHOOL WITHIN HAZARDOUS -''-i;i ROOFS EATHING AIR QUALITY: 1000'FEET MATERIALS NO NO NO U `�ev ' FIRE DEPT. FRAME IN—SP CT REQUIRED TOTAL SETBACK FROM %IST GGA• L O`er BLDG DEPT. FRAME INSPECT SET FROBACK YARD: HWY: PROP LINE: WIDTH: YC Servic a That SHEAR PANELS SIDE PL- l4 INSULATION/WEATHER S RIP INTERIOR LATH/DRYWALL p J6 ' EXTER:OR LATH i -{ 9v LOT DRAINAGE lqt�— SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 i APPLICATION FOR BUILDING PERMIT ' Cj•;.. R - _ .. COUNTY`OF LOStANGELES . �BUILDING:AND SAFETY _ - - _WORKERS COMPENSATION - LEWD �s Ru l /O I DECLARATION' FORAPPLICANT- BUILDING ADDRESS " TO FILL IN ;I hereby affirm that have'a certificate of.consent to self insure„ ..9671. BROADWAY- or.a certificate of'.Workers Compensation Insurance, or a certified copy thereof(Sec 3800, Lab.,C.) _ .- CITY " - ZIP - - - 10,4614A STATE FUND ' TEMPLE CITY, CA, .91780 . ocquTv — PQllcy No; Company SIZE OF LCT - NO:OF SLUGS.NOW ON.LOT - ❑ Certlfi.d c-py is'hereby,furnished. 'NEAREST CROSSS . _ Cerafied"copy is filed with theoc.unty building Inspection,, . TRACT ;BLOCK LOT NO. department., , USE ZONE _MAP NO. _. . ., - bate 11—.1'-94 r 'RANDOL .ROOFING ASSESSOR'MAP BOOK --- PAGE' PARCEL ' Applicant.. - _ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEE NO - - - - COMPENSATION'INS URANCE NANCY.'BRUNO., 287-8052 :WITHIN 1000 F} of SCHOOL? YES No ' =Action need not be completed if the permit is for one hundred ADDRESS -: - P P DISTRICT GROUP TYP ONST FIRE ZONtPROC�SSE.Ddollars (SloojDr less) 9671 BROADWAY CITVZIPl.perhfy that in.the performance of tM1e work for which this permit TEMPLE CITY ' CA91780 �;�� 3 �{is issued, I shall not employ any person in any Uri s0 as f0 OR'ENGINEER"' = TEL NO: -' ✓become subject to the Workers CompensationLaws.: STATISTICAL CLgSSIFI ATION Date =Applicant'- ADDRESS '" - '- CLASS NO. DWELLUNITS NOTICE TO APPLICANT If; ;aft& making this Certificate 'of - REOuIHED TOTAL SETBACExemptipn, you should became subject t0 the Workers' CONTRACTOR TEC-,NO:. - •SET:BACK YARD HWY PROP LI '.Compensation provisions.of the Labor Cade, you must forthwith. RANDOL ROOFING . 288-4040 FRONT comply with such provisions'or this permit shallbe deemed revoked ADDRESS " - '- - ' uCNo" 'pis - LICENSED CONTRACTORS DECLARATION '529 E. VALLEY BLVD. 451937 1SOE CITY - LIG CLASS PL f�hereby affirm that I am licensed underprovlslonS of:Chapter 9 — SEWER MAP _ - , .d (commencmg'with Sectlon.7000)of Division3 of the Business.and S FT.SIZE NO OF STORIES NO.OF FAMIDES - - - O Professions Code antl my license Is In full force NEW '6K PG - ;•License.Number 451937 Lic.ClasS C-39 - I DESCRIPTION OF WORK - - ADD' ❑ VALUATION V -- cpntractorRANDOL ROOFINCpate 1-31'=96. HOUSE & GARAGE WITH ALTER ❑ $,4,000.00 'rA" :FIBERGLAS �, CLASS99—YEAR. REPAIR ~ ❑ 1 am exempt under Sec: - _ - � ' O B.&PC.for this reason DEMOL ❑. $I - . . W • Y. USE _ LDMA P/C 11 ' .Date' 'OF.EXISTING BLDG: - " - 11RM ❑ - - a' _U) g . Si nature SFD- - - _ ,gppLICANT(PRINi)- -- . TEL NO. WMA Perm 9 ❑ I, as.owner of the-property ,or my employees wnn;wages as OL- ROOFING 288-4040 - z _ their sole compensation, will do the=work and the structure is ADDRESS- _ _ _ O _ �5 i._ not Intended of offered for'sale (Section 7044, Business and 1 6 ;FINAL DATE r.G 1 l LYO PfOfE5S10n5 Code). _ ---- ,WILL THEAPPLICANT OR FUTURE BUILDING CCLUPgNT HANDLE A.HAZARDOUS MATERIAL I O TOT ' OR A MIXTURE.CONTAINING A HAZARDOUS MATERIAL EQUAL TD OR GREATER THAN THE 't 137 (� r,❑ I as OWna( of the property, am exclusively contracting with AMOUNTS'SPECIFIED ON THE HAZARDOUS MATERWLS INFORMATION GUIDE? FINAL BY • I!'IF'= .Lv2 a _ {—{ licensed contractors to construct the project (Section 7044, _ '' - Business and Professions Code.) vest❑ "No.❑ ° -'. '- .-- - - "� i'HEf_X - 1d7.40 ' v WILL THE INTENDED USE OF,THE BUGLING BY THE APPLICANT OR FUTURE BUILDING 'j LFS OCCUPANT BE. AE A PERMIT FOR CONSTRUCTION OR MODIFICATKIN FROM THE SOUTH C•NAN _ .. I ri i • CONSTRUCTION'LENDING` AGENCY „-1 COAST.AIR OUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR r GUIDELINES ._.�� I hereby-affirm that there is a construction lending agency for 'YES❑ 'NO❑,- the performance of the work for which this permit is issued(Sec_ ;_fj�ll_ I Irvl i y Cr `A. j - HAVE READ THE HAZARDOUS MATERIALSINFORMATION GUIDE AND THE SCAOMD PERMITTINGjz� Crv.C.) °-. . ry' 3097 CHECKLIST I UNDERSTAND MY'REQUIREMENTS UNDER THE LOS ANGELES COUNTY.CODE. - �: , TIT 2,CHAPTER'2.20 SECTIONS 2.20.100 THROUGH 220.140 CONCERNING HAZARDOUS 51ltif 1 Lender's Name `- - - - r MATERIALS'REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD - -I' N - o Lender's Address I - .. awe NT .. o, F ceNdy that),have read this application and state under,penalty 0 of perjury that the above information is correct I agree to comply IPC FEE 'PERMIT FEE • with all count ordl ncesl and State laws relating' to-b ilding m construction•a y authOLiz re Sentatives of is ntp ISSUANCE FEE - to ente e- tion Fly for Inspe r s 26.40 - '^ INVESTIGATION FEE - TOTAL FEE 137.40 - .redru SEE REVERSE FOR EXPLANATORY LANGUAGE -