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Home My Public Portal About5758 CLOVERLY AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) �+ COUNTY OF LOS ANGELES ADDReIss �. c> DEPARTMENT OF COUNTY ENGINEER CITZIP BUILDING AND SAFETY DIVISION OF BLDGS. BUILDING SIZE OF/LOT � OW ON LOT ADDRESS TRACT (Gz-/ BLOCK LOT 1O_t1q 1O_ ,4// LOCALITY c. TEL NEAREST OWNER i L NO. CROSS ST. !n ASSESSOR ADDRESS "p�(lG...r MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FRE , P ESSE BY CITY ZIP CONST. I z R ARCHITECT OR TELL ENGINEER NO. STATISTICAL CLASSIFICATION SEWER AA P ADDRESS A411 CLASS N@DWELL.UNITS �. B PG CONTRACTOR TE . �� *USE ZONE MANO. P LIC ADDRESS NO �{`' "I D SPECIAL o� LIC, CONDITIONS CITY `,�_ T CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CON UCTION LEN15LfR NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK HIGHWAY { YARD - FRONT PROP. LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ''ONE DESCRIPTION OF WORK E]NEW + U BLDG.SETBACK FROM (STREET) 7: ADD SIDE PROP.LINEOF ALTER ❑ _ TOTAL SETBACK FROM TYPE OF EXISTING ~ HIGHWAY + YARD - REPAIR SIDE PROP. LINE HIGHWAY WIDTH LLICL ^ _ _ N USE OF + v Z EXISTING BLDG. DEMOL ❑ APPLICAN TEL^)G CORNER CUTOFF YES ❑ NO ❑ (PRINT / N0,. Q� BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION, �-- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- •y �� 0 „� STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED ddd _ .0Ij - HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMP E ,ION INSURANCE) SIGNATURE OF PERMITTEE - ADDRESS TEL. FINAL BY DATE CITY � NO. MAKE CHECKS PAYABLE TO: FEE FEE.$ JHARVEY T. BRANDT. COUNTY ENGINEER PLAN'CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION(J. M.O. CASH 1 4. 3C"_'MAR 11 . 1 0 ' +3 9.0 U ®JG 76A636A CE#603 5/74 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY S FOR APPLICANT TO FILL IN BUILDING ADDRES WORKER'S COMPENSATION DECLARATION J!."7..7 I hereby affirm that I have a certificate of consent to self insure, BUILDING'AODRESS�.�S�f Z or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY,7— ZIP ; LOCALITY Policy No. Company SIZE OF LOT C NO.OF BLDGS.NOW ON LOT El �Certified copy is hereby furnished. NEAREST CROSS ST/' /C 11Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. ,L�1U!/3!N 11�, department. USE ZONE MAP No. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER T O COMPENSATION INSURANCE l� �L WITHIN 1000 FT.OF SCHOOL? YES No s section neenobe completed the permit s for one hundred ADORES �j ��,t �/� (Thiineed ltd ifhii p l�IOGfJs/r�i�Q� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) r- Icertify that in the performance of the work for which this permit CITY----/� ZIP -C�� is issued, I shall not employ any person in any manner so as to r �` become subject t the WOrkerS C pensat, Laws [ADDRESS RCHITECT OR ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Da Applic +1/+'� CLASS NO.- -1-2 DWELL UNITS NOTICE TO APPLICAN . If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRAC R ��, 7 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions,of the Labor Code, you must forthwith s>✓62✓�� Q �/ / 31 FRONT comply with such provisions or this permit shall be deemed revoked. AD �f$ LIC. O P L ✓ Z X�-0 SIDE LICENSED CONTRACTORS DECLARATION ITYLIC.CLASS/ P L I hereby affirm that I am licensed underprovisions of Chapter 9 C— (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO,OF FAMILIES SEWER MAP Professions Code,3vld q1 icen a is in full force and effect. NEW ❑ BK PG O /p� n U l v` C DESrrC�RIPTI.�ONa OF WORK ADD ❑ VALUATION �_. License Number Lic.Class `�- l9�.+C BG4/ /C � $ � C) Contractor�T/�� '''��Date �` ALTER ❑ U LU ❑ I am exempt under Sec. Lr/Il Z REPAIR ❑ $ z BAP.C.for this reason L DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT PRINT) 41LDMA Perm# ❑.I„as owner of the property, or my employees with wages as '� .G, 3 Z M their sole compensation, will do the work and the structure is ADDRESS c1=f_ ; not intended or offered for sale (Section 7044, Business and C, t FINAL DATE Q Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ,_ '•='-F== 1i�i�:�i''_ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1, as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY J. licensed contractors to construct the project (Section 7044, ves El No ElL Business and Professions Code.) s`1 iT,AL 13 7 &0 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH I. 4�' r"r•`� 13-7.i CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR - ;+�"I�'±y 1'� +j i GUIDELINES. I hereby affirm that there is a construction lending agency for YEs❑ No❑ f.^at ;°•a�_ ,'_.l a the performance of the work for which this permit is issued(Sec. 3097, CIV.C. (HAVE READ I HE UNDERSTAND MY INFORMATION GUIDE AND ANGELHE ES COUNTMD MITTING CODE, N ) 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. -001(#� i EL Lender's AddressC. {Ly} OWNER OR AGENT iil`•j'S ,c 1 oI certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE _ o with all county ordinances and State laws relating to building ' d construction, and hereby authize re esentatives of this County ISSUANCE FEE co atoe car upon the ab o -m ed p erty fo pection p os e + I/ ./-- INVESTIGATION FEE TOTAL E �•Sgnature.ol Applicant pr geq If/Date ! C SEE REVERSE FOR EXPLANATORY LANGUAGE 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 0911090055 PHONE: (626) 285-0488 EXT: ILEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 6561 LT: 696 SQ. FT STORIES TYPE 1 5758 CLOVERLY AV STRUCTURE: V-B TEMP CA 917802551 1 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 1 18587-011-015 1 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXIST OCC GRP: 111/09/09 SR OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: IFINAL DATE F13AL BY: CODE: ICHI MING HONG (626) 757-3543- 1 9,400 / 9� 15758 CLOVERLY AV I '� TEMP 917802551 FEES PAID JtSCRIPTTON bF WORK 1 1 (REPLACE 13 WINDOWS IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( 1 (APPLICANT: TEL. NO: I I ICOLE, RANDY (619) 402-0828- JAA BLDG PERMIT ISSUANCE 27.75 I 1 IPO BOX 711564 JAB STATE GREEN BLDG FEE 9400.00 VAL 1.00 ISPECIAL CONDITIONS: 1 ISANTEE, CA 92072 IAC STRONG MOTION RESID 9400.00 VAL 0.94 1 1 ID2 PERMIT W/O EN-HC 9400.00 VAL 216.60 1 TOTAL FEES 246.29 I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 ITHD AT HOME SERVICES, INC. (562) 981-1600- 1 1 112774 E FLORENCE AVE LIC. NO I ILOCATION AND SETBACKS 1 1 ISANTA FE SPRINGS CA 90670 836021 B i I 1 I ISOILS ENGINEER APPROVAL 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 JFOUNDATION/TRENCH FORMS I I I I LIC. NO: 1 - 1SLAB/UNDER FLOOR I 1 I I I 1 (RAISED FLOOR FRAMING 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: I JUNDERFLOOR INSULATION 1150H26S 3 001 1 11 1 1 _1 IFLOOR SHEATHING I I I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I 1 I I NO 21 1 (ROOF SHEATHING I 1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS I I 1 11 I I NO NO NO I IFRAME INSPECTION I I I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I (FRONT PL- I 11NSULATION/WEATHER STRIPI I I I SIDE PL- I JINTERIOR LATH/DRYWALL I I I 1 IEXTERIOR LATH I I I I I I IRATED FLOOR/CEIL ASSEM. I 1 IRATED WALL ASSEMBLIES 1 I I I I I 1RATED SHAFTS/OPENINGS I I I I IT-BAR CEILINGS 1 I I I 1 1 ILOT DRAINAGE I I I I_ I I +REPORT ID: DPR261 ROUTE TO: BS0508 I I I I