HomeMy Public PortalAbout5434 CAMBURY AVE_Building__ I -APPLW.ATION FOR BUILDING PERMIT
FDR"APPI,IGANT TO FILL`IN (p,ir,, D, Tvoe oHl,,) '
BUILDING , COUNTY OF LOS ANGELES
ADDRESS .
J' i'h' (l2 ✓ DEPARTMENT OF COUNTY ENGINEER
CITY 6 y��" Cf // p BUILDING A QD LSAFETY DIVISION
SIZE OF LOTA4 1,J NOW ON LOTS ADDRESS 3
TRACT 00 Z- I BLOCK LOT NO, .,[.� LOCALITY
OWNER- NEAREST A(6NOL y CROSS ST. OU U25
ASSESSOR /�
ADDRESS S MAP BOOKzqq PAGE / PARCEL
DISTRICTGROUP TYPE FIRE SED BY
CITY ZIP Q CONST. ON -
ARCHITECT OR TEL. �DU
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS CLASS NO��DWELL_UNITS BK PG
CONTRACTOR TEFL. U ZONE MAP
NO
LIC. NO DQ
ADDRESS NO. /1 SPECIAL
LIC. CONDITIONS
CITY CLASS
ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER y
NAME AND BRANCH BLDG.SE BACK FROM
FRONT PYROP.LINE OF ISTREETI 6C3
ADDRESS CITY
HIGHWAY } YARD TOTAL SETBACK FROM TYPE A E%IGTING C
SO. FT NO. OF NO.fOF / CHECK FRONT PROP. LINE HIGRWAY WIDTH H
SIZE ,.yl�/'�i {S+nTORI ES FAMILIESLH
ONE L,
DES C R IPTION BF WORK (�(,O SVL NEWS ❑ V
❑ BLDG SETBACK FROM Z
zny`` /hJ zy(No ADD S IDEPROP. LINE OF ISTREETI
J ALTER _ TOTAL SETBACK FR TYPOE%ISTING
HIGHWAY + YARD - ryWAy WIDTH
USOF
REPAIR❑ SIDE PROP. LINE
EXISTING BLDG. 0" o6�6a(J DEMOL ❑ +
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
IPNINT) /A NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
$ ;2,4
2 !!�. IN COASTAL ZONECFTE GORICAL EXEMPTION YES[_] NO ❑ \
NO
VALUATION S /, 6 o w
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)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
1 HENEBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF'TNE
LABOR CODE OF TX STATE CP FORMA-IN III iING TOL.^J/p_.A A/ �/ _ /
WORKMEN'S COMPENS TION INSU A CE N fi0A /J /c Q�-s�b - /�
SIGNATURE OF ` �4/7 ] EFr NO r,5 i Y✓ L�ti (/ ,
PERMITTEE AA A4A c7
ADDRESS $ ) NAL
,/`yZ /nV
C I T Y4�W ge NOL / DATE
V/�'�y' / B�' / //1[I✓
MA KI: CHECKS PAYABLE 7"U: Fc, ee '(AAA��,pYYY��` /L�lF[M-T.
HARVEY T. BRANOT. COUNTY ENGINEER FEE 7 V ,�C� FEE SSG s-0
PLAN CHECK VALIDATION CN. M.O. CASH PERMIT ALIDATION cK. ' 'M/,o. CASH
1O0wSEP L5' ` 1 0 28.50e
76A638A CEG803 7/73
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 0611150018
PHONE: (626) 285-0488 EXT: .
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 17002 LT: 23 SQ. FT STORIES TYPE 5434 CAMBURY AV
STRUCTURE: VN TEMP CA 917802619
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OLIVE
8588-019-006 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 11/15/06 JK 11/10/07
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINkL DAT - FIN CODE:
VINTON, CANDY (816) 287-1975- 10,000
5434 CAMBURY AV
TIME 917802619 PEES PAID D SC IPT IO14 OF WORK
TO COMBINE EXISTING BEDROO AND PERMITTED COVERED BREEZEWAY
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TO MAKE ONE MASTER BEDROOM WITH BATHROOM
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION REBID 10000.00 VAL 1.00 SPECIAL CONDITIONS:
AX BUILDING REVIEW FEE 54.70
B2 PERMIT W/ENERGY 10000.00 VAL 238.26
TOTAL FEES 321.71
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION AND SETBACKS
' SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LSC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CM3: UNDERFLOOR INSULATION
147H269 3 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHE'R PANELS
AIR QUALITY: 1000 FEET MATERIALS -NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- .TNBULA WEATHER STRIP
SIDE PL-
INTERIOR LATH DRYWAL
t ((�� EXTERIOR LATH
'o2 �6CL0 \ RATED FLOOR/CE ASSEM. 1
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
' REPORT ID: DPR261 ROUTE TO: ES0508