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HomeMy Public PortalAbout4850 CLOVERLY AVE_Building__ i 7 g , `t - `TEMPLE CITY 79AG30A C6 VOOD ,-a, APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDINCZ /j ' DEPARTMENT OF COUNTY ENGINEER ADDRESS b lJ l BUILDING AND SAFETY DMSION LOCALITY JOHN A LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN SUP T OF BUILDING CROSS ST DISTR T GROUP TYPE MOCE BY FOR APPLICANT TO FILL IN p r CONST BUILDING STATISTICAL CLASSIFICATION SEW R MAP ADDRESSCJBK PG CLASS NO DWELL UNITS /"-)Z— LOT NO �-- ) BLOC WATER NOT REQUIREDP�j RECEIVED .�C/ CERTIFICATE TRACT 'Al / HIGHWAY NO OF BLDGS NO (CIRCLE) STATE MAJOR SECOND OCAL SIZE OF LOT 0 A I bZJ I NOW ON LOT USE ZONE SPECIAL USE OF I CONDITION EXISTING BLDG TEL OWNER /i 4 NO BUILDING EXIST p YARD HWY STREET NAME ADDRESS S 6 �CRnC-IZ�-L SETBACK WIDTH FRONT � ARCHITECT OR TEL P L i ENGINEER NO SIDE I. P L ADDRESS TEL M /� J INSPECTION RECORD p CONTRACTOR L NO Z U ADDRESS v� L N� /� �� A�✓l;l(/J�� �V� OC DESCRIPTION OF WO r y� w �- /'os � ��rte►_ r .z ,_._ u') NEW ADD ALTER REPAIR D SH SQ FT �1 ' NO OF NO OF IZEq.Q STORIES FAMILIES 7//m/ /4I USE OF / ! STRUCTURE SIGNATURE OF , ' U14 vr/rs/�[r 1✓11 51" J APPLICANT + It l/ ' VALUATION t APPROVALS DATE INSPECTOR S SIGN/ATVRE FPPMT of C FEE $ FOUNDATION LOCATION ��� FORMS MATERIALS FRAME FIRE STOPS t I 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 RELAT ING TO WORKMEN COMPENSATION IN CE I LATH EXT SIGNATURE , C HOUSE NUMBER COR- PERMITTEE RECT AND POSTED .! i ADDRESS {� � FINAL CLYDE N DIRLAM,/'PRINC'IPAL STRU RAL ENGINEER PLAN CHECK VALIDATION CK. MO CASH PERMIT VALIDATIONcK m o CASH DEPARTMENT OF BUILDING AND SAFETY = APPLICATION FOR PERMIT COUNTY OF LOS ANGELES B U ' L ® 1 N G d� WM. J. FOX. CHIEF ENGINEER 77�7FOR APPLICA T TO FILL IN FOR OFFICE USE ONLY O DISTRICT NO 1 PLAN CK NO PERMIT NO BUILDING ''`` ,9 y. �►` / ADDRESS N �C/ / \ —• e/f n `) � 4 /` L ..J ♦ IIIYYY L GGG��� LOCALITY �� / (� REC��Y� } DAT OF APPL DATE ISSUED f NEAREST ` G ' CROSS ST J / 13UILDING 4 C • � �� , OWNER I {(J �G /� ADDRESS, MAIL \^ LOCALITY ADDRESS /0All 6Z k- �' / TEL _ NEAREST, CROSS ST CITY, - W - NO - - FIRE NO OF , TYPE GROUPS ARCHITECT O TEL ZONE ; PLANS .�•/�", j ENGINEER NOBLDG SEACK N ACK LIE '"�' V `/;'rd ( /� 10 ADDRESS _ ��//�� �y ��,y7 APPROVED CONTRACTOIY�" / i NO+, ,' BY + + DATE _ USE � APPROVED 1 1 ADDRESS 1 ZONE BY, DATE 1 LEGAL 2� .,.� CORRECTIONS ; DESCRIPTION LOT NO BLOCK TRACT NO OF SLOGS SIZE OF LOT O I NOW ON LOT }7�/ EOFN NO OF NO OF EXISTING BLDG iJ�'Q FAMILIES ROOMS — DESCRIPTION OF WORK 4F NEW ALTERATION I f ADDITION ^- .v ,OU REPAIR MOVING DEMOLISH SQ FTNO OF SIZE D ROOMS STORIES I �D WALL -ROOF j s y �+' r COVERING )S"L�V.*- y J.� COVERIN [J USE OF NEW BUILDING,,,, w I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT' INSPECTOR DATE AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCESFOUNDATION LOCATION AND STATE/LAWREGULATIN G ILDINCOt4STRUCTION, FORMS, MATERIALSFRAME FIRESTOPS,SIGNATURE O + BRACING,BOLTS PER MITTE LATH, INT Gl AUTHORIZED AOT 6 LATH, EXT 7GA638A 9-48 OBS-3 SOM SETS $ P C $ PLASTER, INT FEE PLASTER,EXT VALUATION FI NAL N_ 7` i `� ! y FEE t DEPARTMENT,OF BUILDING AND SAFETY i APPLICATION FOR PERMT COUNTY OFLOS ANGELES 1BUILDING WM J FOX, CHIEF ENGINEER ,FOR„APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO _' PLAN CK NO PERMIT NO ADDRESS N. clovej�a 6r 7 ' RECEIVED BY DATE OF APPL- ` DATE ISSUED LOCALITYTmple City NEAREST CROSS ST -cs/i ADDRESS U , n OWNER -John A Wain Cott MAIL LOCALITY ADDRESS 4 A48 N. Cloverly _ NEARESTI TEL CROSS ST CITY lelII �ZB city NO FIRE NO OF_ _I TYPE_►�J7 I GROUP ' ARCHITECT OR` TEL ZONE PLANS ��,(�� ENGINEER NO BLDG ORD NO SETBACK LINE ADDRESS ` '� APPROVED ' TEL BY DATE CONTRACTOR Keeler NO AT 6 11 USE APPROVED' , '- _ ZONE BY DATE ADDRESS 5425 N Te=le Ci Blvd T 1 HOUSE NUMBERING LEGAL , DESCRIPTION(, I LOT NO I BLOCK MAP NUMBER_ ` FIELD CHECK BY TRACT �� NO ASSIGNED BY SAT NO OF BLDGS CORRECTIONS SIZE OF LOT n I NOW ON LOT USE OF - , I NOOF EXISTING BLDG - FAMILIES ' DESCRIPTION OF WORK NEW I, I ALTERATION I I ADDITION I - O REPAIR .I I DEMOLITION I I gQ FT NO OF O SIZE ROOMS STORIES - Z D EXT WALL q - a ROOF r COVERING COVERING UIE OF STRUCTURE Ins IF 'r APPROVALS INSPECTOR'S SIGNATURE DATE I HEREBY, ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS - CORRECT . I 1 AGREETOICOMPLY WITH THE CORRECTIONS LISTED FRAME FIRE STOPS, } HERGON AND WITH ALL COUNTY ORDINANCES AN STATE BRACING, BOLTS LAWS)REGULATING UILDI GMOSTR >�TION FURNACE LOCATION, SIGNATURE OF' GAS VENT, DUCTS ` PERMITTE 0 i .. LATH, INT ' ADDRESS 0. ' LATH, EXT AUTHORIZED AGT PLASTER, INT 7GA938A cess fo-Eo $ P C $ _ k mss,A FEE /ZB O PLASTER, EXT ` $ VALUATION FEE FINAL �aClw'"�_ ys' {" WORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I herebor'affirm that I have a certificate.of consent to self insure,'bxr a certificate of Workers' Compensation Insurance, ' ' or;a c�ert4fied copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli y No./O Ff&4PanY .SCIr BUILDING/ Y Certified copy is hereby furnished. 1FOR APPLICANT TrO�(FILL jIN ADDRESS g� r< u Certified copy is filed with the county building inspec- BUILDI S nJ C��� �/C/ ry tion department. _LDDREJ��1 �/ Date_ / 7 Applicant 71O" '�`� �f CITY ( / ZIP M LOCALITY I _ ) NO. OF BLDGS. NEAREST ,t�1t ERTI CATE OF EXEMPTION FROM WORKERS' SIZE OF LOT / NOW ON LOT CROSS ST. lJ't/ ,)—Usk COMPENSATION INSURANCE j ASSESSOR (This section need not be completed if the permit is for' one TRACT BLOCK LOT NO. y© MAP BOOKPAGE PARCEL hundred dollars ($100) orless.) (A/1TEL. USE ZONE MAP Q OWNER NO. NO. J I certify that in the performance of.the work for which this _„ SPECIAL >- permit is issued, I shall not employ any person in any manner ADDRESS ij/✓<7-{ CONDITIONS CL so as to become subject to the Workers' Compensation laws. O CITY ZIP V Date Applicant ARCHITECT OR TEL. NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT G OUP TYPE FIRE ROCES ED BY CONSTZ ZONE O Exemption, you should become subject to the Workers' f'� U Compensation provisions of the Labor.Code, you-must forth- ADDRESS ls� d with comply with such provisions or this permit shall be /� r3 _ •� STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR li Q�Al/ � J Z 60 LICENSED CONTRACTORS DECLARATION LIC. / CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 09 C/ /— o W � NO. rz(p 6�G (commencing with Section 7000)of Division 3 of the Business ��/1/�r/�/ / r� LIC. SEWER MAP /� and Professions Code,and my license is in full force d effect. CITY �ILf��r► (J XV,5 6-CLASS BK.L PG.�V VALIDATION �� / SQ. FL �� SNO.TORIES OF / FA OF CHECK License Number_ (9 6 Lic. Class SIZE STORIES FAMILIES ONE ©�#A/ '// ,�[''� VALU TION Contractor VNr2AC'�e d DESCRIPTION OF WORK 2{i�61 NEW ❑ VVi V ❑1 am exempt under Sec. 0 � w ADD S (J ► ALTER ❑ B.&P.C. for this reason l/ ' 0 REPAIR ❑ $ Date: USE OF EXISTING BLDG. / DEMOL ❑ Signature APPLICANT TEL. g . OWNER-BUILDER DECLARATION (PRINT) Q Al NO. Q? �Y � FINAL I hereby affirm that I am exempt from.the Contractor's License DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT Fly ACC a ❑ I, as owner of the property, BUILDING CR.•�rgn8 p p y, or my.employees with ADDRESS },y(]7 33 wages as their sole compensation,will do the work and ��,i,,? the structure is not intended or offered for sale(Section LOCALITY ITEMS 7044, Business and Professions Code.) MOVING TEL. ' 1 1 I Gt l�S ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. Il���i 13 with licensed contractors to.construct the project (Sec- L 1P 0 tion 7044, Business and Professions Code.,) ADDRESS CHEV(ti 181.17: REQUIRED TOTAL SETBACK FROM EXIST. L CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH g hereby affirm that there is a construction lending agency for FRONT ` CHANGE` o► 101 the performance of the work for which this permit is issued P.L.' ` (Sec. 3097, Civ. C.). SIDE 9/122/v- ''0000-0001 ]! Lender's Name P.L. 0000-0001 7gqls �Q"Y LDMA Ref:-# CC 1 ti �� P.C. Fee$ Permit Fee i 6 '1= Lender's Address ► o I certify that I have read this application and state.that the Issuance Fee LDMA P/C q 8 above information is correct. I agree to comply with all County Investigation Fee R ordinances and State lawsrelating to but ing construction, Total Fee g v 3 LDMA Perm.it a and h e y aut riz r resentativets is County to enter upor�t abo. - t' ned pr pe 'or inspection 96rpoos. a � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date