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HomeMy Public PortalAbout9921 BROADWAY_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES r` WM. J. FOX, CHIEF ENGINEER I � ' G LD FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY B UILDI NG �1 L�/�� y DISTRICT NO. PL/A�N�C K.NCO. PERMIT NO. ADDRESS p�//(�46 y,/// V ��/-�0/fj 2 (j/I� q/ s LOCALITY /X�VlLLL ]] ltt� S7- RECEIVED BY DAT OLF�'APPTL. OACTJE IBXSUED 1 NEAREST /�W l/ /� ��' '�. �7 , /l•_� 7.�[/ / CROSS ST. BUILDING OWNER +�.P A �-✓ ADDRESS S J /AIL �Q.1/V\yn/}�/� �.r+� ADDRESS / SI ll.� tel. LOCALITY / /YY,.v� C/TJX TEL CROSSSTNEAREST. /0:::^// A,�E.Y •rte CITY �/( Ih.CL/IYYYI���WWW{{{�����/// NO. FIRE NO.OF TYPET GROUP, ARCHITECT OR TEL ZONE PLANS ENGINEER NO. V BLDG. ORD.NO. ADDRESS n SETBACK LIN / �Q�Y APPROVED . TEL BY DATE CONTRACTOR//• 1I�J TE ���I/J/� ADDRESS vJ -J�/CW/w-41 -O -�C.K-LL.-Z USE � APPROVED LEGAL /j ZONE � BY DATE DESCRIPTION LOT NO. `y BLOCK 'ye CPA CORryRECT/IONSS TRACT13// A �< ,./ /5 n �'l•� ///i+s �. SIZE OF LOT b �� NOW ON LOTS er- USE OF MIDI E9 I ROOMS n n EXISTING BLDG. /f ` �-;40, yT DESCRIPTION OF WORK NE WALTERATION ADDITION O A REPAIR / 2 MOVING DEMOLISH � RDOMB STORIES y 6IZE WALL Oor .r� COV ,INO /.vuA.c�aiu _I COVERING iQw.i-uO it UBE OF NEW BUILDING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR e DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS.MATERIALS „Q A3 /n /�� (�/� AND STATE LAWS REGULATING,BLIILDING CONSTRUCTION. L! L l PRANCIFIRE STDPS, /`/� Yp SIGNATURE OF „(K_(j! BRACING,BOLTS �' yy PERMITTEE LATH.INT.: AUTHORIZED AGT LATH,EXT.: II OBS-3 50M SETS 7-47 $ O CP O $ Q O PLASTER, INT. 7 s-0 0-" FEE ^r PLASTER,EXT. S VALUATION FEE Z FINAL I DIVISION OF BUILDING AND SAFETY BUILDING Depa. But of County Engineer I / County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLIC T TO FILL IN ADD RESB ,2 BUILDING ^ I I t LOCALITY DV ADRESS rfi 6'PAA.(A+I•M/ NEAREST LOCALITY CROSS ST. DISTRICT NO. PUN CK. OR Ree. No. PERMIT NO. NEAREST /'. CROSS ST. / 5 OWNER I , RECEIVED BY DATE OF APPL. TDATE ISSUED, /' AMAILD RES. X99 a I J.u-a.d.w�V 2 --q-- 7 ��pp ..yy..�� /�y1- USE ZONE NO. OF TYPE GROUP FIRE ZONE CITY l,l�lAl NO.I.l.! G U 33 n, PLANS ARCHITECTOR TEL. ZONING DATED ENGINEER NO. APPROVED BY- ADORERS l BUILDING ORD.NO. �{'.// n SETBACK LINE: CONTRACTOR /1• yli/d' (,�HA„�P NO e<;FG r137 BYPRoveD DATE (I ADDRESS PAL HOUSE NUMBERING C.VLN (� LEGAL I I MAP NUMBER NO. ASSIGNED BY DESCRIPTION I LOT NO. BLOCK , GATE CORRECTIONS I TRACT I INSPECTOR NO. OF SIZE OF LOT NOW ON LOTS USE OF NO. to O EXISTING BLDG. FAMILIES / I' DESCRIPTION OF WORK C n z NEW ALTERATION ADDITION D r REPAIR DEMOLITION SO. FT. NO. OF SIZE ROOMS STORIES EXT. WALL ROOF I COVERING I COVERING USE OF STRUCTURE 4Ar r7 r U atiLLQ�h u yt,.txu o I I APPROVALS INSPECTOR'S SIGNATURE DATE FOUNDATION: LOCATION 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FORMS, MATERIALS PLICATION AND STATE THAT THE INFORMATION GIVEN IS FRAME: FIRES TOPS' IRESTOPS, CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. /m Jr/ n� - n GA. VENT, DUCTS (I.. Cp SIGNATURE OF ! \ p�`. 11 LATH, INT. PERMITTEE _t�/--U-Y➢.! / ADDRESSw'��J��aUV�y LATH, EXT. /�, r� AUTHORIZED AGT. PLASTER, INT. S � ;V,�� C.S PLASTER, EXT. FEP. E HOUSE NUMBER COR- RECT AND POSTED B VALUATION FEE " I mO�' FINAL 4 go 76A898A Dee 3 A-88 - - - -, 1-2 76A638A CE#803 8.69 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING E. DEPARTMENT OF COUNTY ENGINEER ADDRESS99;)l R�nn'iUrAV BUILDING AND SAFETY DIVISION LOCALITY Temple City JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENBEN. SOFT of BUILDING CROSS ST. DISTRICT N GR TYPE PS BY F-R OR APPLICANT TO FILL RY �} �' coNsr. STATIST AL CLAS IFICATION SEWER MAP 21 E, Broadw Tem 1e Clt SK PG CLASS. NO. pW ELL. DNITS BLOCK WATERNOT REQUIRED RECEIVEDCERTIFICATE: 3 MAP HIGHCWANO. OF BLNO. STATE MAJOR SECOND. LOCAL NOW ON LOT USE ZONE SPECIAL USE OF CONDITIONS EXISTING BLDG. OWNER Chris Cashmore - TEL626- �/6 5/ BUILDING ,ARD HWV STREET NAME EXIST. 9921 E. Broadway, Temple Cit SETBACK WIDTH ADDRESS FRONT ARCHITECT OR TEL. P� L. ENGINEER NO. SIDE ADDRESS TEL. ® Virgin Roof Co. 287-0507O CONTRACTOR � NO. ADDRESS 600 So. San Gabriel Blvd. S (" DESCRIPTION OF WORK rr W NEW ADD ALTER REPAIR roOt EMOLISH N SQ. FT. NO, OF NO. OF SIZE STORIES FAMILIES ' STROUCTURE Reroof house and garage with - 235 .' compo. shingles SIGNATURE OF VIRGIN ROOF CO. APPLICANT VALUATION $ 630.00 APPROVALS PATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE $ FEE $ 8.00 FORMS, MATERIALS FRAME: FIRE STOPS. 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA_ LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA REI-AT-ING TO WORKMEN'S CbCMPENSATIONZ INS R NCE LATH. EXT. SIGNATURE OF , ry/� A I .f i1 HOUSE NUMBER COR- PERMITTEE �U. .v_\tl/ RECT AND POSTED arcia a enq SecE'y. / ADDRESS FINAL abriel JOHN F. LEWIS. PRINCIPAL STR TURAL ENGINEER PLAN CHECK VALIDA NG CK. M D. GASH PERMIT VALIDATION DK. M.D. CAEN LA15 NOV 15 ... 1 O 8.00---V •�••,�sa•o•.... APPLICATION FOR BUILDING .PERMIT Z COUNTY OF LOS ANGELES BUILDING ADDRSS DEPARTMENT OF COUNTY ENGINEER E BUILDING AND SAFETY DIVISION LOCALITY .JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CA69ATT O.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT NO. GP I TYPE )/ I PROCESSED BY FOR APPLICANT TO FILL IN y� CONSr X BUILDING �qg J gR�IZ ^)14V BK PG ADDRESS p 7 :( .L STAT ISTI CALL SI FICATION I SEWER MAP LOT NO. / —I CLASS.NO. DWELL. UNITS o . 11 BLOCK MAP ,STATE YES NO NUMBER �.QO HWY. TRACT k VS USEZONE SPECIAL SIZE OF LOT /� I NO.OF OGS. /1 , CONDITIONS NOW ON,LLOT USE OF EXISTING BLDG. O BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER may, ^'{ /CF� FRONT MAIL ' 1 P.L. _ ADDRESS - SIDE CITYYp e'A]LF_ CTI No' P.L.L INSPECTION RECORD ARCHITECT R TEL. ENGINEER NO. 'ADDRESS CONTRACTOR A. A 4DSCRIPADDRESS /D SCRIPTI N OF WORE �� ""''^' .NEW .ADD ALTER REPAIR DEMOLISH SO.FT. n NO.OF NO.OF SIZE Qj(. STORIES FAMILIES USE TRUCT E SIGNATURE OF APPROVALS APPLICANT DATE- INSPECTOR:S.SIGIATURE ADDRESS I FOUNDATION:MATERIALS CATION _ FORMS.MATERIALS � 'Sd� © O !!_'o P. C. $ FRAME: FIRE STOPS, p FEE BRACING, BOLTS �7 JI VALUATION S a— FURNACE: LOCATION. FEE GAS VENT. DUCTS _ I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PLICATION AND STATE THAT THE EIS CORRECT AND LATH, INT. AGREE TO COMPLY W H NT ORDINANCES AND STATE LAWS LATH, EXT. I� RE U A CONSTRUCTION. SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL �I D ✓O CLYDE N. DIRLAM. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH LAC 5 508 OCT 6 1 A 3.0 0 n ®. APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUIL DRESS so , I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS C or a certificate of Workers' Compensation Insurance, or a certified 9921 E. BROADWAY copy thereof (Sec.3800,Lab.C.) Policy No. 1046140 Company STATE FUND CITY ZIP TEMPLE CITY 91780 LOGAUT SIZE OF LOT NO,OF BLDGS.NOW ON LOT ElCertified copy is hereby furnished. I NEAREST CROSS ST Certified copy is filed with the county building inspection TRACT BLOCK LOT N0. department USE ZONE MPP NO. Data 11-1-95 Applicant RANDOL ROOFING ASSESSOR MAP BOOK PACE PAgCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O NEER LUXFORD 799-4335 ves No TEI COMPENSATION INSURANCE WITHIN 1000 FT,OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS dollars (S100) or less.) 1849 SPRUCE ST. DISTRICT GROUP TYP ONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit OI SOUTH PASADENA TY zIP91030 is issued, I Shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers Compensation Laws. STATISTICAL CLASSIFICATION 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.AA� SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT . comply with such provisions or this permit shall be deemed revoked. ADDRESS LID.NO P L LICENSED CONTRACTORS DECLARATION 529 E. VALLEY BLVD. 451937 SIDE CITY LIG,GLASS P L hereby affirm that I am licensed underprovisions of Chapter 9 SAN CARAIEL. CA 91776 C-39 SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and SO.FT SIZE N0,OF STORIES I NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW ❑ BK PG d License Number Lic.Class DESCRIPTION OF WORK ADD ❑ VAUA O GARAGE WITH $Y,8�'0.00 V Contractor Date ALTER ❑ ❑ I am exempt under Sec. — FIBERGLAS REPAIRM $ 0 BARC.for this reason SHINGLES OVER EXISTING COMP. DEMOL ❑ LDMA P/C Date: uS§ EXISTING BLDG. URM ❑ CD 3. iq Signature ARALf, ATTN�Tr�I 1 ) TE LDMA Perm# yi 125.55 ? ❑ I, as owner of the property, or my employees with wages as "'i""" OOFING 12 8-4040 ITC�'1�� _55their sole compensation, will do the work and the structure is ADDRESS ' TOTAL `1•"� not intended or offered for sale (Section 7044, Business and 529. E. VALLEY, SAN GABRIEL, CA 91776 FINAL DATE Professions Code.) MALL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL PO OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J J ❑ licensed a5 owner co Of the property,ons am theexcproject contracting ing 44,ith AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE] FINAL BY j CHECK, 125.55 'C 55 licensed contractors to construct the project (Section 7044, ,1,.r`I Business and Professions Code.) ves❑ Na❑ OWILLCC THE INTENDED USE OF THE BUGLING BY THE APPLICANT OR FROM T BUILDING OCCUPANT QUALITY REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE CONSTRUCTION LENDING AGENCY COAST AIR OUAUTV MANAGEMENT DISTRICT 1SCAQMDI SEE PERMITTING CHECKLIST FOR .00 GUIDELINES. s.. I hereby affirm that there is a construction lending agency for YES NO ���—��i 9/14/95 the performance of the work for which this permit is issued(Sec. 3097, CAV.C. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING N ) CHECKLIST I UNDERSTAND MY REQUIREMENM UNDER THE LOS ANGELES COUNTY CODE, TITLE 2.CHAPTER 220 SECTIONS 2.20.100 THROUGH 2,20 140 CONCERNING HAZARDOUS 7,07 1 ANI i. Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SOAQMD 1 111111 a 021 Lender's Address Q avmeA CR nceuT o I certify that I have read this application and state under penalty of perjury that the above information i5 correct. I agree to comply P.C.FEE PERMIT FEE 98.25 With all county Idinances and State laws relating to building m Constru do lereby pp utl rite representatives f this/Country ISSUANCE FEE a toe 1 up no qve-rL:1 netl propefty for i SEE. /IY/?f/yr INVESTIGATION FEE TOTAL FEE 125.55 SEE REVERSE FOR EXPLANATORY LANGUAGE