HomeMy Public PortalAbout5928 BURTON AVE_Building__ APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (P,,., O, type Onix)
BUILDING �O`I COUNTY OF .LOS ANGELES
D
ADRESS c DEPARTMENT OF COUNTY ENGINEER
CITY3 (J JC ZIP BUILDING AND SA TY DIVISION
NO. OF SLOGS. /' BUILDING q
SIZE OF LOT J NOW'ON LOT / ADORE L
TRACT BLVK4 L NO. LOCALITY
L. NEAREST
OWNER '� �( �10. CROSS ST.
J (� ASSESSOR
ADDRESS/7,� � �. �y J MAP BOOK PAGE PARCEL
I
DISTRICT GROUP TYPE FIRE PRO SSED BY
CITY s:( ZIP QQ T CONSZONE
ARCHITECT OR TEL. _
cJi/
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER M
ADDRESS CLASS NO./_?==-DWELL.UNITS -BK7/PG
CONTRACTOR TEFL. USE ZONE MAP
LIC. NO.
ADDRESS Np, _/ SPECIAL
CITY - LIC. CONDITIONS
CONSTRUCTION LENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES 0, NO ❑
NAME AND BRANCH �0 q BLDG.SETBACK FROM C
FROVT PROP.LINEOF (STREET) c
ADDRESS CITY HIGH AY } YARD - TOTAL SETBACK FROM TYPE OF E%(STING • C
Sp. ,3f�) NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES _ ONE L
DESCRIPTION OF WORK ��." NEW Z
ADD ❑ BLOG.SET OM
SIDE PROP. LINED (STREETI
ALTER ElTOTAL} YARD - TOTAL SETBA M TYPE OF E%($TING
REPAIR❑ SIDE PROP. LINE HWAY WIDTH
USE OF } c
EXISTING BLDG. - DEMOL E)
APPL �}
CAN _ TEL CORNER CUTOFF YES El NO ❑
(PRINT) C 0.
BY (SIGNATURE IN OPEN SPACE YES ❑ NO ❑
Y vvG IN COASTAL ZONE YES ❑ NO ❑
VALUATION V7 CATEGORICAL EXEMPTION 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 (GATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- `
STE UC TI ON, I IN
THAT IN DOING THE WORK AUTHORIZED ) IMPACT REPORT PROCESSED DATE)
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABWOROKMEN'S EOF THE COMPENSATONATE OF INSURANCEL CALIFORNIA IN RELATING TO A�4, _.yL,� L, � �r�. /2,
SIGNATURE OF
5 KAY s 111
PERMITTEE
ADDRESS z 4-1i' C;l "JL
,X TEIDATE
CITY /�//j+ (��C-'r W1 '�' NO. T FJ
MA KF CHECKS PAYABLE 10 FEE � .FEE'
HARVEY T. BRANDT. COUNTY ENGINEER L7)
PLAN CHECK VALIDATION _ PERMIT VALIDATION CN. I,, FaASH
5 1 S�"JAN 20 1 A 1 4,5 U e3o
76A638 CEA803 7/73 -
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4
APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (P,iw P, IYDB PDIYI
BUILDING C�j�g- / C/f� BUILDINGDDRE �i_• �-
BUILDING
S V / D v'Y
1 ADDRESS
CITY (,"-1 ZIP O
NO.OF SLOGS. LOCA LITV Eti�si[
SIZE OF LOT NOW ON LOT NEAREST
CROSS ST. p - ^7
TRACT 3,j Z BLOCK LOOT NO MAPESSOR BOOK _J 0��7 PAGE a.J� PARCEL l
TEL, DISTRICT GROUP TYPE FIRE P ESSED BY
OWNER NO. CONST ZO N
ADDRESS
STATISTICAL CLASSIFICATION SEWER MAP
CITY ZIP CCLASS NO�/_.DWELL.UNITS cBK IPG
ARCHITECT OR T L.
ENGINEER NO. USE ZONE MAP
NO.
ADDRESS _I SPECIAL
1 TEL. CONDITIONS
CONTRACTOR A.-A-I\ NO
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
LIC.
ADDRESS NO. BLDG,SETBACK FROM
CITY LIC. FRONTPROP.LINEOF (STREET)
CLASS
CONSTRUCTION LENDER HI G WAY } VggD = TOTAL SETBACK FROM TYPE OF E%)STING
NAME AND BRANCH ONC
FRONT PROP. LINE HIGHWAY WIpTH
ADDRESS CITY }
Y
50. FT //,, NO. OF NO, OF CHECK B G.SETBAIN FROM - a
SIZE l�V STORIES FAMILIES ONE SI PROP. LINE OF )STREET) �
U
NEW ❑ HIGHWA } VARp _ TOT L 5 TBAC FROM TYPE OF EXISTING EC
DESCRIPTION OF WORK � C}A I PROP. NE HIGHWAY WIDTH CD
DD ❑ V
} V
61 ALTER ❑ Z
REPAIR❑ CORNER CUTOFF YES ❑ NO ❑USE OF
EXISTING SLOG. DEMOL ❑ IN OPEN SPACE YES ❑ NO ❑
APPLICAN. ,. TEl IN COASTAL ZONE YES ❑ NO ❑
(PRINT) S�j' .9ai N0. �� -
BY (SIGNATURE) ENV CATEGORICAL EXEMPTION YES❑ NO ❑
I
IMPACTflONMENTpL EXEMPTIONDECLARATION SIGNED (DATE)
`f Od
VALUATION S V� IMPACT REPORT PROCESSED (DATE)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPE ATION INS RA E.
SIGNATURE OF FINAL
PERMITTEE) �� (( DATE
ADDRESS 2 G b v... P.C. ( PMT,
FEE • FEE $
CITY
(� �GU/+�[>`- NO. V
PLAN CHECK VALIDATION K. M.o. CASH PERMIT VALIDATION' cH. //M.O. CASH
s�o�2�euit 24 1 a �1-6.0 0 .y6
76A638B CE4803A 5/73
76AG38A .E 9803 1/71
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
`$MM)7RG AND SAFETY DIVISION BUILDING p L
ADDRESS
COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY
�C
FOR APPLICANT TO FILL IN - NEAREST
Print .' tY.I, GHI CROSS ST. 8�2�
DISTRICT NO. G OUR TYPE ESSED BY
ADDRESSFE
CONST.
�) l STATISTICAL CLASSIFICATION SEWER MAP
LOT NO. 1�J� "1�•A �,Cv' BLOCK CLASS NO. OWELL.UNITS= SK�- PG7
TRACT _J USE ZONE MAP //1�O
)//}} NO.OF BLOCS. / NO. ZL.�•
SIZE OF LOT O•/` / (D NOW ON LOT SPECIAL
USE OF CONDITIONS
EXISTING BLDG. C "
1 TEL.
OWNER NO. BLDG,SETBACK FROM
FR ROP.LINEOF (STREET)
ADDRESS _
T TYPE 0 TING SETBACK HIGHWAY } YARD = TOTAL
CITY { HIGHWAY WI ROM C.L.
ARCHITECT OR TEL. } =
ENGINEER NO. BLDG.SETBACK FROM
ADDRESS SIDEPROP.LINEOF (STREET)
TEL. TYPE OF EXISTING SETBACK HIGHWAY } YA TOTAL d
CONTRACTOR NO. HIGHWAY WIDTH FROM C.L.
CD
N LIC. CD
ADDRESS d ` NO. t = &
LIC. H
CITY CLASS CORNER CUTOFF _YES ❑ NO w
CONSTRUCTION LENDER d
NAME AND BRANCH 21N� SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS
SO. FT. STORIES FAMILIES NEW ❑ `,� ���� "'-� �
USEEOF ADD Li7g-AMC.- fi �-
STRUCTURE
ALTER ❑
REPAIR❑
SIGNATURE OF
APPLICANT DEMOL
VALUATION S CSA-LJ APPROVALS DATE INSPECTOR'S slceA TU Nc
P.C. PMT. FOUNDATION: LOCATION
FEE S FEE 5 ��� FORMS, MATERIALS
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE STOPS,
BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT All AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL OI CERTIFYINANCES AND LAWS DOING
LAYING K ALCINGUTHORIZED CON- GAS VENT, DUCTS
HEREBY I . 1 CERTIFY THAT IN GOING THE WORK AUTH OR(ZED
HEREBY 1 WILL NOT EMPLOY ANY PERSON VIL4TION OF THE LATH, INT.
LABOR CODE OF THE STATE OF CALIFORNIAIIN RELATING TO
WORKMEN'S COMPENSATION INSURANCE.
LATH, EXT,
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESSTi 12 �' FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIONCK. N.C. CASH
LAC,o 2 3 2' O= SEP 10 1 3 A O 0 N
I
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COUNTY.OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT,OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0101180040
PHONE: (626) 285-0488 EXT:
LEG NO. OF CONST NEW BUILDING ADDRESS:
TR: 5903 LT: 100 SQ. FT STORIES TYPE OCCUP GROUP 5928 BURTON AV N
STRUCTURE: 765 1 VN R3 SGAB CA 917752630
ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: HERMOSA
5386-014-057 OTHER: THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY
TEA IST BLDG USE: S ONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 03/01/01 LS 08/28/01
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FIN/AL DATE F CODE:
BEISSER ERIC A;ELLEN M (626) 309-0560- 1 80,000 !�
5928 BURTON AV
SGAB 917752630 FEES PA D SCAR T16N u� OR
D 1 BA (76 SF)
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ADDITION OF 2 B
APPLICANT: TEL. N0:
M.P. CONSTRUCTION CO (626) 852-5866- B1 PLANCHECK W/ENERGY 80000.00 VAL 1,026.49
P.0.BOX 116 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS:
TEMPLE CITY,CA AC STRONG MOTION RESID 80000.00 VAL 8.00
B2 PERMIT W/ENERGY- 80000.00 VAL 1,207.64
.. TOTAD FEES 2,269.88
CONTRACTOR: TEL. NO: - APPROVALS DATE INSPET SIGNATURE
M P CONSTRUCTION CO. (626) 852-5866-
P.O. BOX 116 LIC. NO LOCATION AND ETBACI
TEMPLE CITY, CA 91780 677136 B .3 - bUl
SOILS ENGINEER APPROVAL N
ARCHITECT OR ENGINEER: TEL. N0: FO AT ON/ NCH 0 S 3 13 pal
LIC. NO: SLAB/UNDER FLOOR
1{n{ I t it 2.7
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ' `VUC1.y� ' UNDERFLOOR INSULATION
NO. OF FAMILIES- DWELLING : A T COND: STAT CLASS: 1p S VEL LO SH H
NO 21 ��/' W�l� 1.(-�-4 ND LEVEL FLOOR SHEATH
M
SCHOOL WITHIN ARYYY ROOF-SHEATHING
AIR QUALITY: 1000 FEET MATERIALS JI
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED AL SETS C FROM XIST BLDG DEPT. FRAME INSPECT
SET BACK YARD: HWY: PROP LINE: WIDTH: t112-
FRONT
12-
FRONT PL- - SHEAR PANELS
SIDE PL- --- 5 o I
INSULA
INTERIOR
AT NER S IN�i
INTERIOR LATH/DRYWALL Y/
V
EXTERIOR LATH
LOT DRAINAGE 1
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508
`NORKERS' COMPENSATION DECLARATION /'�. /�"9Sj)+ E� p p. �p p p p/� .gyp p
I hereby affirm that haver certificate of consent to self ypy F _ ��OII�UI FOR L'�'•(II II��O�IIHII[l m PERNT" .
insure, or a certificate of Workers' Compensation Insurance, - • � illi 11 (�,�,•,,,�✓rp 11 V u FJ V u �l�:/
or a certified copy thereof (Sec. 3800 L bC �S
TY .BUILDING AND SAFETY
COUNTY •F LAS ANGELES
Policy No// Componr alt. Cl4G,r�
I�I� BUILDING 92' JQ
LJ Certified copy Is Hereby furned. FOR APPLICANT TO FILL N ishs'�' ALL L"'
❑ Certified co is filed with count building inspec- BUILDING -
tiondeportment. _ y 9 P ADDRESS- AA{�'
✓Date �Applimnt _ CITY' if JEL ZIP LOCALITY
NO. Jr BUDGE. NEAREST AM
CERTIFICATE OF EXEMPTION FR W KERS' SIZEOF LOT - - NOW ON LOT „ CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit-is for one '- TRACT BLOCK LOT NO: 00 MAP BOOK PAGE PARCEL
hundred dollars ($100) or less'.) - xp '�))
OWNER NO.TEL USE ZONE MAP
Pr Q` •V d�
I certify that in the performance of the work for which,this NO.
SPECIAL permit is issued, I sholI not employ any person in any manner ADDRESS — CONDITIONS O
..so as to become subject to the Workers'Compensation Laws. U
CITY ZIP
Dote Applicant ARCHITECT OIR ' TEL ���/pq DISTRICT GROUP TYPE FIRE PROCESSED.BY 0
NOTICE TO APPLICANT:, If, after making this Certificate of ENGINEER •NnO,i /LJ�DO+ CONST. Z NE 1F
Exemption, you should .become subject to the.Workers' gDDRESS e�^ ' �,'w!V"� W
Compensation provisions o8 the Labor Code, you must forth- Dt- ��� "-/ V `� Gam"`"G«"t� a-
with comply with such provisions,or this permit shall be .r .TEL. STATISTICAL CLASSIFICATION APT. CONDO. ` N
deemed revoked. CONTRACTORS (�5 NO11
Z
LICENSED CONTRACTORS DECLARATION �^L r� ^ LIC. CLASS NO.- DWELL UNI75
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS UV') `'1f'��- �-T7�14N0.
(commencing with Section 7000)of Division 3 of the Business '' '' �,r 1le2
LIC. SEWER MAP
and Professions Co e,and m hcense is in full force and effect. CITY'Wf'T r TUCLASS BK P VALIDATION
SO. F _ IN OF NO. OF CHECIi
License Number O� Lia Class SI STORIES FAMILIES ' ONE .;
�,, / _ /�.,r! //las VALUATION
.Contractor ?frilei ago Dote � � .DESCRIPTION OF WORK ANEW ADD ❑ V$ Q 0
I� + ' D
❑I am exempt under Sec. � � ALTER El - ,
B.BP.C. for this reason REPAIR ❑ f '
Date: ��f�r'/ EXISTUSEOING BLDG. 'Bt^. DEMOL El -
_
\\ S'annt rn APPLICANT _IJ -�_ TEL. FINAL
M,- J E - UIL DECLARATION - (PRINT) •�f .PC� rr Wr�b� -NO. �/b-SS11 DATE z5�
hereby affirm that I exe pt from the Contractor's License - ADDRESS
/�-� 1✓ P���"�D / -
Law for the following reason (Section 7031.5, Business and FINAI .'
Professions Code): PRESENT -
❑ 1, as owner of thero ert or m to ees with BUILDING
P P Y em Y ADDRESS r ,
wages as their sole compensaa tion;will do the work and
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code.) MOVING
El 1, NO.
S
I, as owner of the property, am exclusively contracting CO
with licensedcontractors to construct the project.(Sec-
ADDRESS
tion 7044, Business and Professions Code.) _
REQUIRED YHWV - TOTAL SETBACK FROM EXIST. - �';Ib.
CONSTRUCTIONARD-LENDING AGENCY SET BACK PROP. LINE - I WIDTH.
I hereby affirm that there is a construction lending agency for FRONT 17 r _
the performance of the work for which this permit is issued E- "' - - 51
(Sec. 3097, Civ. C.). SIDE itllEl� ._E a =i
P.I. _
Lender's Name •I"-
m �J [" D LDMA Ref. If f'KI
P.C. Fee$ d• d Permit Fee I ,'j/ G D CH 1;_C+ ' •e1 L`:
Lender's Address q ! _ -
a I certify that I hove read this application and state that the 'Issuance Fee LDMA P/C N
8 above information is correct. I agree to comply with all County Investigation Fee _
�
// t.-
ordinances and State laws relating to building construction, Total Fee /// Ii LDm MA PerN
a . and hereby authorize representatives of this County to enter _ ttn'?� 5 F'j -
m upon the above-mentioned property for inspection purposes. ri{' ��€ih
a
SEE REVERSE FOR EXPLANATORY LANGUAGE -
" Date
Signature of Applicant or Agent
t