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HomeMy Public PortalAbout9927 BROADWAY_Building__ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL N7 BUILD G DDREss BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers' Compensation Insurancecertified C W copy thereof j �I Oma b.Q) � I ,� � CIT m IL zip q18O ,SFO 1_un LOCALITY Policy NO. o Company r SIZE OF Lq I NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST GROSS S? ❑ Certified copy is filed with the 'Icounty '.building inspection TRACT BLOCK LOT NO. Datea�a In S Applicant �I N I/Vl'L'T II {.�"' frd' ASSESSOR MAP BOOK PAGE PARCEL USE ZONE MAP N0. . J SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OGWNER / 1 YES NO COMPENSATION INSURANCE eZ TEalu I J WITHIN 1000,FT OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS dollars ($100) or less.) 5r(m Q/ 9✓P d- DISTRICT GROUP TYPE CONST. FIRE ZONEOPROCESSED BY _ CITY ZIP 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 ARCHITECT OR ENGINEER TEL NO Vo J l become subject t0 the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NOr 0 DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REGUIRED TOTAL SETBACK FROM EXIST Exemption, you Should became subject the Workers' CONTRq)r /] , T NO- SET BACK YARD HWY PROP LINE WIDTH Compensation provisions.of the Labor Code, you must forthwith ilJ1// 14k //�/W I FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS [� u p L LICENSED CONTRACTORS DECLARATION lg 7 O fiz SIDE CITY LIC.CLASS/1 P L I hereby affirm that I am licensed underprovisions of Chapter 9Zem C. SEWER MAP (commencing with Section 7000)of Division 3 Of the Business and SO F?SIZE/ NO.OF St5AIES. NO.OF FAMILIES Professions Code,and m license is in full force and effe NEW BK PG a License Numb@r� DOCRIPTION OF RK ADD Cl VALUATION C_7 , O Contractor A� der ss ALTER ❑ $ W�• ❑ I am exempt under Sec. YVl j{'11» {,` REPAIR ❑ OO B.&PC. for this reason Y- M SA » DEMOL ❑ CDMA PIC* LUL( Dat /7 USE OF E (STING BLDG. URM ❑ EL Signature 4 APPLICANT(PRINT) TEL NO. LDMA Perm# Z ❑ I, as owner of t* perty, or my employees with wages as Zv O HC:C.1. their sole compensation, will do the work and the structure is ADDRESS not intended Or Offered for sale (Section 7044, Business and FINAL DATE M Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �Z L � i IT�1 ISI ❑ I, as owner Of the property. am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY 7 Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE1 licensed contractors to construct the project (Section 7044, TOTAL t�L Business and Professions Code.) Yes❑ No❑ WILL THE INTENDED USE OF THE eUIpLING BY THE APPLICANT OR FUTURE BUILDING �J i T07.! C OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH7Wa UTl FitC1i IJ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT SCAOMM SEE PERMITTING CHECKLIST FOR �/ GUIDEUNEs. I hereby affirm that there is a construction lending agency for YES El No El w the performance of the work for which this permit is issued(Sec. 3D97,CIV.O, I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE. TITLE 2.CHAPTER 2.20 SECTIONS 2,20 100 THROUGH 2.20.140 CONCERNING HAZARDOUS Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address 1_111? y o 0.7er ofl A.em o I.certify that I have read this application and state under penalty 4 of perjury that the above informatio is crrect. agree f0 Comply PC.FEE PERMIT FEE with all county ordinances and ttelows relating to building COnstfuctioP, and hereby au orintatives of this Cou ty ISSUANCE FEE to ent n abov me lone rfor inspec' urpo a /e ,y✓� INVESTIGATION FEE TOTAL FEE AaM Pere SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES ', TEMPLE CITY ` # 0508 a BUILDING PERMIT DEPARTMENT OF PUBLIC,WORKS .9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMFLE CITY CA 91780 BL 0508 9907070063 PHONE: (626) 285-0488 EXT: - LEGAL ID: - NO. OF CONST NEW BUILDING ADDRESS: . TR: 13805 LT: 8 SQ. FT STORIES TYPE OCCUP GROUP 9927 BROADWAY STRUCTURE: 592 1 VN R3 TEMP CA 917802635 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: - 8588-015-008 OTHER: THOMAS PAGE:.597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE TONE: ISSUED ON: PROCESSED BY: EXPIR S ON: EXIST OCC GRP: 07/08/99 UT 01/04/00 _ OWNER: TEL. N0: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY:' CODE: SWATEZ JUDITH E;JACK J (626) 287-1236- 1 43,800 9927 BROADWAY �' �-O j ��.. TEMP 917802635 - FEES PAID DESCRIPTION OF WORK - FAMILY ROOM, BEDROOM/BATHROOM, CLOQT AND PORCH FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - - AA BLDG PERMIT ISSUANCE 27.75 ADSTRONGMOTION RESID 43800.00 VAL 4.38 SPECIAL CONDITIONS: AX BUILDING REVIEW-FEE 55.00 B2 PERMIT WLENERGYGE LF C 43800.00 VAL 793.98 TOTAL7FEES 881.11 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER ' V LIC. NO �^' \\ LOCATION AND S TBAC _ AR HI ECT OR ENGINEER: TEL. NO: i F N1Q�DAT10! EICH FORMS - LIC. NO: I( SLAB/UNDER FLOOR RAISED FL00 F AM ING MAP NO: SEWER MAP BOOK: PAGE: FIRE-ZONE- CMP- 'l n I r�Jq\1 n`1 /q/�� �P//7 j UNDERFLOOR INSULATION - 3 vi' U!L3,1 C J' \J 3" lll(\�l] ► ST' LEVEL FL00 SHEATH NO. OF FAMILI S:-DWELLING UNITS: PT/COND: STAT CLASS: --_---_ - --- --------- ------{ - NO 21 'L, a - ` ,,} ND LEVEL FL05F SHEATH - - SCHOOL WITHIN HAZARDOUSROOF SNE THI AIR QUALITY: 1000 FEET - MATERIALS 0 \ ' ' �i NO NO NO I-� FIRE DEPT. NG FRAME INSPECT SET REQUBACK YARD: HWY:IRED TOTAPROP LLINE:CK F OM - WX IDTH. (/ b�'C - t� BLDG DEPT..FRAME INSPECTD_7 - FRONT PL- SCrV1C2 �I(1a4 SHEAR PANELS - SIDE PL- - - INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL J - EXTERICR LATH .. _ LOT DRAINAGE SMOKE.DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 � I - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0010040003 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 13805 LT: 8 SQ. FT STORIES TYPE OCCUP GROUP 9927 BROADWAY STRUCTURE: 0 1 VN R3 TEMP CA 917802635 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8588-015-008 OTHER: 312 1 VN R3 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/04/00 UT 04/03/01 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINA ?BY: CODE: SWATEZ JUDITH E;JACK J (626) 287-1236- 3,100 i�1ry_©� �' J 9927 BROADWAY l TEMP 917802635 S PAID DESCRIPT ON OF C OPEN PATIO (COVERED WITH CO GATED PLASTIC ROOF)-312 SQ.FT FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 3100.00 VAL 0.50 SPECIAL CONDITIONS: AX BUILDING REVIEW-FEES` 54.70 D2 PERMIT W/O�EN-HCJEI c C 3100.00 VAL 115.80 P.� TOTAL7FEES 198.75 CONTRACTOR: TEL. NO: SOS �.�J�,� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS � InZs oa SOILS ENGINEER APPROVAL ARCHITECT ENGINEER: TEL. N0: FOUNDp7 ON/TRENCH ORMS LIC. N0: -_ -- 11 11]1 SLAB/UNDER FLOOR (jll'JJJrrr�l((� RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:: �f'i (lr�r, �i�/� \\1/,�\ /j�n���'/J UNDERFLOOR INSULATION 1 U ,I�JI ILIS!UIIi�"J. \I/1\1vl/ IIIJI I,'�l1 ST FLOORS ATH 0. OF FAMILIES: DWELLING UNITS: APT/CON : STAT CLASS:- NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ` r. ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS 0y FT'i NO NO NO FIRE DEPT. FRAME INSPECT q ❑ �1_a REQUIRED TOTAL SETBACK FROM EXISTG l�'� BLDG T. FRAM INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: b�i�. 'J q FRONT PL- `SO'lVICO yha SHEAR PANELS SIDE PL- INSULATIO /WEATH STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508