HomeMy Public PortalAbout9823 BROADWAY_Building__ ,BARBS. CEBBOB.B-GRAPPLICATION FOR BUILDING PERMI
COUNTY OF LOS ANGELES BUILDING �j
DEPARTMENT OF COUNTY ENGINEER ADORES.
2 3 QF1 oAO
BUILDING AND SAFETY DIVISION LOCALITY % ,c i T
JOHN K
COA. L. MSIE-. COUNTY ENGINEER NEAREST G d L-bF/✓ Iq//"-.9
COIL W. Y�NKINSSUP•T OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN u DONsr. 9j
BUILDING q STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS €1 Z E , j? STATISTICAL p H D W H CLASS NO. 1 ELL UNITS BK
LOT NO. I BLOCK U -ZO/NE MAP hJ
NO. � O
TRACTI � S SPE IAL
/ NO OF BLDOS. OQ CONDI IONS
SIZE OF LOT 1OjO K 1 2.O NOW ON LOT 2
USE TI C L12 C-1
\E-S. /,e '-''l BLDG. SETBACK IROM
TE .
OWNER
S L L � �V NOL ZdS 3�TEJ TYPE OFFRONT F.EXISTING NE I SETBACK HIGHWAY + YARD = (STREET)
ADDRESS 7. C� 1 OIAJO%IDLj4Lf HIGHWAY IWIDTH 'IRQM C.L.
CITY E LE C aCA sor I
ARCHITECT OR TEL. BLDG. SETBACK FROM
ENGINEER NO. SIDE PROP. LINE OF (STREET)
TYPE Of 1 EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS //�� ..CE� �I TE' 1 _1 y a HIGHWAY WIDTH FROM C.L. d
CONTRACTOR EI .B • IAA7 INSC/E1 NO 2-8I--6/iC1 + = O
ADDRESS I• :L.0 C/t L NOLIC 1 [�T. CORNER CUTOFF YES No O
CITY C • CLASSLIC P� 1 SEE REVERSE SIDE F SPECI APPROVALS u
DESCRIPTION OF WORK gl Z
NEW ADD X ALTER REPAIR 0EMO LIS
H T C.
77
S ZET I ROTOR EA
S I FMIOLIES I (O N/ C
USE OF
STRUCTURE - ,On
SIGNATUREOF
APPLICANT / f-vt
VALUATIONSf J Q O APPROVALS 9A7 INSPE TOR'9 ligoATURE
P.C. PMT.
q FOUNDATION, LOCATION
S"
FEES FEEFORMS, MATERIALS $'
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS
9U ILO NG CONSTRUCTION, I CERTIFY THAT. IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT.
TION OF THELABOR CODC OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S CO PEN TION INSURANCE. • LATH. EXT.
SIGNATURE OFi �� HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS FINAL fp
JOHN F. LEWIS. PRINCIPAL STR TURAL ENGINEER
PLAN CHECK VALIDATION CK, M.G. CASH _ PERMIT VALIDATIO CK. M.G CASH
LAC05 2 1 9�S AN- 26 1 D 2 2.50of
-
. �����
APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (prior or rope a lY)
"'LDl r:c COUNTY OF LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
H.clTv ZIP BUILDING AND SAFETY DIVISION
_ , l NO.OF BLDGS., BUILDING ��
SIZE OF LOT NOW ON LOT ADDRESS
LL
TRACT O`JI BLOCK I LOT NO. / LOCA LIT
TEL. NEAREST
OWNER John H . Ellpndt NO. CRO55 ST.
ASSESSOR
ADDRESS MAP BOOK _ PAGE PARCEL
9— E . BrOadway DISTRICT I GROUP ITYPEFIRE SED BY
CITY ZIP //�� a T CONST. ZONE
780
ARCHITECT CI9MP - L. `:o(� ,f1
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO._ -DWELL,UNITS BK PG
CONTRACTOR NOLAP-AnAn L ZONE MAPLIC o
NO.
ADDRESS 52VE-Valley S . G NO.1 86,086 ` SPECIAL
LIC. 1 CONDITIONS
CITYSan Gahrip] CLASS '
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG. FROM
FRONT POOR.LINE d
OF (STREET) V
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
iiIGHWAY } YARD - C
SQ FT. NT0 OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH C
SIZE STORIES FAMILIES ONE
}
DESCRIPTION OF WORK
NEW El N
ADD ❑ BLOG.SET KFROMRe
Z
_ SIDE PRO)wlgP. LI )STREET)
Gar ALTER ❑ HIGHWAY } YARD = TOTAL SE OM TYPE OF EXISTING
E PAIR
SIDE PROP. LINE GHWAY WIDTH
USE OF } _
EXISTING BLDG, DEMO L" ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
IPRINTI 10.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
Q IN COASTAL ZONE YES ❑ NO ❑
VALUATIONY CATEGORICAL EXE MPTION YES❑ NO ❑
I 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)
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORN AUTHORIZED IMPACT REPORT PROCESSED `)DATE)
HEREBY I WILL NOT EMPLOY ANY PERSPA IN VIOLATION OF THE
LABOR CODE OF TME STA E CA F RNIA IN R EATING TO
WORKLABOR ECO GOOF NSAT� X NS PN
SIGNATURE -
PERMITTEE
ADDRESS
FINAL BY
CITY San Gabriel NOL _ DATE((
HARVEY. TK BRANDT. 'COUNTY ENGINEER FEE i G� FEE 15 . 00
PLAN CHECK VALIDATION CK. M.D. CASH PERMIT VALIDATION CK. M.o. CASH
9 .O.tiJIjN aa` 1 A "1 5.0 0 e
76A638A CER803 7/73
APPLICATION FOR-BU.LDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILOwG RESS
I hereby'affirm that I have a certificate of consent to self insure, 8UNG.ADDRESS
or a certificate of Workers' CompensationInsurance,or a certified
copy thereof(Sec.3800,Lab.C.) CITY . . Zlp '
Gjl 9/�� LGCALI y,
Policy N0. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished I NEAREST CROSS ST.
Certified copy is filed with Oun buil in eption TRACT BLOCK LOT NO.
depart m. USE ZONE MAP))/ ,J�
Date Appli ASSESSOR MAP BOOK pQ,/�, PAGE n PARCEL /J �/
. _ *0 f7 i "(/ A(/ / SPECIAL CONDITIONS
-
P
ATE OF EXE TION F WORKERS' owNERI TEL ND. /� �r
COMPENSATION INSURANCE �� �y �S WITHIN 10
00 FT OF SCHOOL? YES No
ADD S
(This section need not be completed if the permit is for one hundred .� Ik�A DISTRICT GROUP TYPE CONST' FIRE ZONE PROCESSED BY
dollars ($100)or less.) -
I certify that in the performance of the work for which this permit /
is issued, I shall not employ any person in any manner so as to CITY --3
become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO.
STATISTICALCLASSIFI ATION APT CONDO
Date Applicant - ADDRESS - - CLASS NO.. DWELL UNITS
NOTICE TO APPLICANT If, after making this Certificate Of REQUIRED' TOTAL SETBACK FROM EXIST
Exemption, you should become subject t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith S
FRONT
comply with such provisions or this permit shall De deemed revoked. UC.No. p L
ADDRESS
LICENSED CONTRACTORS DECLARATION SIDE
CITY,- / LIG.CLASS PL
I hereby affirm that I am licensed underprovisions of Chapter 9 /�/����
(commencing with Section 7000)of Division 3 of the Business and SO.FT SIZE NO.OF STORIES NO.OF FAMILIES NEW ❑ SEWER MAP r0
Professions Code,a my license is in full force an effect: ED
DESCRIPTION OF WORK r VALUATION
License Number 41,211
Lic.Class ADD ® o
y $ OOO,f't' 1-
Contracto Date- ALTER ❑
G!/S7� _
w
ElI am exempt under Sec. REPAIR ❑ $ Ga
z
B.&P.C.for this reason DEMOL ❑ LDMA P/C# ,
Date:- USE OF EXISTING BLDG. _ URM E3Signature gpPLIC NT) TEL NO. LDMA Perm
❑_
[,,as owner of the property, Or my employees with wages as Z
their sole compensation, will do the work and the Structure is ADDRESS - O
Trot intended or offered for sale (Section 7044, Business and FINAL DATE Q
Professions Code-)
WILL THE APPLICANT OR FUTURE 6UILOING OCCUPANT HANDLE A HAZARDOUS MATERIAL
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EOUAL TO OR GREATER THAN THE
I, owner of the property, am exclusively contracting with
AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
licensed
sed contractors to construct the project (Section 7044, - "-
Business and Professions Code.) ves❑ Noy,
WILL THE INTENDED USERMI THE B'NSTR BY THE APPLICANT OR FUTURE BUILDING -
OCCUPANT REQUIRE TY A PERMIT FOR CONSTRUCTION DR MODIFICATION FPOM THE SOUTH
CONSTRUCTION LENDING AGENCY GUIDE AIR ouqury MANAGEMENT olsTfllcr Iscgomo)SEE PEpmrrTlrvc cnscxusT FOR
culoeurves _ _
I herebyaffirm that there is a construction lending agency for _r
9 9 Y YES N _ I1,ENL .tee—' f � '+i- y
ro the performance of the work for which this permit is issued(Sec. ;�
W IHAVE READ THE HAZARDOUS MA ERIA INFORMANDERT E OS THE ANGELES
OPERMITODE I';�.{[('I� _
N 3097,CIV.C.) CHE TAND MV OU MEN15 UNDER THE LOS ANGELES COUNTY COOS CHP-
�' ' °
TI 2,CHAPT 0 CT S 2 .100 THROUGH 2201<0 CONCERNING HAZARDOUS
T
3 Lender's Name TEpIALS R I' O P O AWING A PEPMIt FgOM THE SCAOMO. CHANGE v(_I_I
o Lender's Address
Q PYNER OR AGVT
o I certify that I have read this application and state under penalty _
4
of perjury that the above information is correct.I agree to comply PCFEE / / PERMIT FEE I/i(/ .4
w' ordinances and State laws relating to building A,� y
OnsUucton, a hereb M out ize representatives of this County ISSUANCE FEE Lr / �^ .+_�-_ - 1 - { �_ _:I
to enter upo ov
an Red property for inspection pro s.
INVESTIGATION FEE TOTAL FEE L� p�
0 4quM� nl • D ✓ G
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0201140044
PHONE: (626) 285-0488 EXT:
LEGAL D: NO. OF CONSTBUILDING .
TR: 13805 LT: 18 SQ. FT STORIES TYPE 9823 BROADWAY
STRUCTURE: VN TEMP CA 917802634
ASSESSOR RUNWAY IO B . NEAREST CROSS STREET: GOLDEN WEST
8588-012-014 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG S ISSUED PROCESSED BY: EXPIRES 0 :
- EXIST OCC GRP: 01/14/02 JK 07/13/02
OWNER:
TEL. N0: BLDGS. NOW ON LOT: VALUATION: FIS/IpL DATE FIN LL BY: CODE:
GBROADWAY VEI (626) 304-9477- 4,000
9823 - % � NIL
^
TEMP 917802634 EES P SCRIPTi N F WORK
1/0 HOUSE & GARAGE; II TALL PLYWOOD AND 25YR ASPHALT SHINGLE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
SAME AS OWNER - AA_BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 4000.00 VAL 0.50 SPECIAL CONDITIONS: .
D2 PERMIT W/O EN-HC.- 4000.00 VAL 115.80
TOTAL FEES 144.05
CONTRACTOR: TEL. N0: - - APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION SETBACKS
TBACK
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: _ FOUNDATION/TRENCH ON/TRE C
LIC. NOi( !�_ SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: - - UNDERFLOOR INSULATION
147H269 3 01 _
FLOORSHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/COND; STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN RDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECT ON
REQUIRED TOTAL SETBACK FROM EXIST - FIRE SPR N HANG RS
SET BACK YARD: HWY: PROP LINE: WIDTH: - -
FRONT PL- - - - INSULATION/WEATHER STRIP
SIDE PL-
- INTERIOR LATH L
--- ------ -- -- EXTERIOR LATH
-�
RATED FLOOR ASSE .
RATED WALL ASSEMBLIES
-� - RATED SHAFTS/OPENINGS
- -- --- T-BAR CEILINGS
DRAINAGELOT
REPORT 1D OPR261 - ROUTE T0: 850508 . -