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HomeMy Public PortalAbout5759 CLOVERLY AVE_Building__ Temple City [� 76A638A CE#803 I-67 APPLICATION_ FOR BUILDING PERMIT ILII COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION (LOCALITY JOHN A LAMBIE COUNTY ENGINEER NEAREST COLEMAN W JENKINS SUP T OF BUILDING CROSS ST DIS TBJ. T NO;, GRP P- TYPE FOR APPLICANT-TO FILL IN '5 . CgCONST BUILDING STATISTICAL CLASSIFICATION SEWER MAP ADDRESS5759 Clover! Tem leCit /l ' CLASS NO �! DW ELL UNITS BK ,PG / LOT NO BLOCKUSE ZONE MAPj7 /F .. / No l/ V TRACT 1 SPECIAL CON I I NS NO Of BLDOS ' , SIZE OF LOT NOW ON LOT ' USE OF } BLDG SETBACK FROM ' L+ TEL FRONT PROP LINE OF 7777777c477,7 (STREET) OWNER E NO — [�7[�[� TYPE OF EXISTING SETBACK HIGHWAY fYARD - TOTAL J/ J7 ADDRESS . Cloverl HIOHW Y FROM C L ' CITY e City, Ca 3- BLDG TBACK FROM ARCHITECT OR TEL 91DE PROP LINE Of �' �h'-`� "" `� (STREET) ENGINEER NO _ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS - H(IIGHWAY WIDTH//-�� FROM C L _ CONTRACTOR H L Rando NOL 288-4040 k�'<t V _ '- + ' �(, G ADDRESS L CORNER CUTOFF_ ,YES NO �O Y13 cLIQ 'SEE REVERSE SIDE FOR SPECIAL APPROVALS_ o DESCRIPTION OF WORK t LLjLL NEW ADD ALTER REPAIR DEMOLISH I Z SQ FT NO OF NO OF SIZE STORIES FAMILIES USE OF e STRUCTURE Re-roofing SIGNATURE OF APPLICANT ' VALUATION$ 20000 •00 APPROVALS DATE INSPECTOR'SSIGNATURE P C PMT FOUNDATION, LOCATION FEE$ FEE$ 6 ,00 FORMS, MATERIALS FRAME, FIRE STOPS, 1 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 IUILOI NG CONSTRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY NV PERSON IN VIOLA LATH INT TION OF THE LABOR CODC OF THE STAT F CA FORN RELAT ING TO WORKMEN S C MP NSA N IN."__ NS R CE LATH EXT SIGNATUR OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL l2 f$�7 :f7I SSP s PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL STR TURAL ENGINEER PERMIT VALIDATION CK M D CASH t 'WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION F O W BUIL®I N G .PERMIT � µ iP2sure or a certificate of Workers Compensation Insurance, J or a certified,copy thereof (Sec 3800 Lab C ) f ' ; COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 4 Company ❑ o BUILDING , `Certified copy is hereby furnished - FOR APPLICANT TO FILL IN ADDRESS v 1 , Certified copy isfiled with the county building,°mspec- � BUILDING - r " hon department Y ,F ADDRESS ed2 G r�� Date r, °'' r Applicant»`Y` a J'. o v � CITY (.�[� ZIP LOCALITY Tr_ CERTIFICATE OF EXEMPTION,FROM`WORKERS' t% ,a �( -NO OF BLDGS NEAREST, _ r' COMPENSATION'I NSU RANCE SIZE OF LOT _13r? S NOW ON LOT CROSS ST„ (Thi' `section need not be completed if the permit is for'one L Cy��j r ' 70 7 ASSESSOR - v hundred dollars4(3100)`o'r less ) a TRACT BLOCK _4F LOT NO ,b n~ MAP BOOK PAGE, PARCEL" i MAP rl certify that'in the performance"of the work,fortwhich this ` OWNER �/� �fQi NO d -G27 USE NE NO, u e permit+rs issued, I_shall'not`employ any personIin any manner ���C� ov�il �� / I SPECIAL so as`to become subject to the Work' o pensati aws ^, ADDRESS II�� CONDITIONS " ZIP �i� 70 Date Applicant ��� CITY . n � `L _� ARCHITECT OR TEL r, DIS,RICT R P ,TYPE FIRE) SSED BY` O NOTICE TO APPLICANT' If,'after`making this`Certificate of ' _r CONST; ) Z U Exemp(ion, you should become subject to the Workers' ENGINEER s NO ' Compensation provisions'of.the Labor Code, you must forth-' ADDRESS 4 ti�' s LU with comply with ',such provisions,or ,this permit shall be ILL «deemed revoked ` , TEL STATISTICAL CIASSIFIC TION - "`APTLN,DO u N"' " CONTRACTOR /� NOvLICENSED CONTRACTORS DECLARATION, . - LICz CLASS NODWELL UN t -I hereby affirm"thdt I am licensed under provisions of Chapter 9 ADDRESS !NO (commencing with Section 7000)of Division 3 of the Business and ~_ !UC x SEWER MAP r Professions Code and my`license is in full force and effect CITY 'CLASS VALIDATION ' - o t ar SQ FT NO OF NO OF, CHECK a BK PG w License Number Lic Class SIZE STORIES FAMILIES '` ONE r . O VALUATION " , ' '8 i 1'' DESCRIPTION OF WORK NEW- 4 Contractor Date _ s >l o ' ❑ I am exempt under Sec �U 0171' G' �� D I TIP �� ALTER B 8P C"for this reason REPAIR a❑ $ USE OF Date EXISTING BLDGDEMOL ❑ 9 4 b 3'A Si nature „ '' ° APPLICANT [ Qp TEL yQ l g PRINT be a, ©SCS NO FINAL FINAL �Q OWNER-BUILDER DECLARATION, } 9 DATEx �z U- M " : , # °'°,° ° • I hereby affirm that I am exempt from,the Contractor s License ��� � Low for the following reason (Section 7031 5, Business`'and^ ADDRESS FIN _ °" 4 I -1 5 3,0'0 Professions Code) n, �jD ` - gy i Y BUILDING El 1, as owner of the property,' or my employeesFwith ADDRESS w o xe � j�j Q 0^� s wages as Their sole compensation,will do the work and 4 - the structure is not intended or offered for sale(Section _ LOCALITY +` " Q 4,2 6-.148 ,7044, Business and Professions Code) i MOVING "TEL ® CONTRACTOR NO + , �I, as owner of the property, am exclusively contracting i with licensed contractors to construct the project (Sec-", ADDRESS tion 7044, Business and Professions Code) SETBACK CONSTRUCTION LENDING AGENCY ` SETQBACK YARD HWY` TOTAL LINE WIDTH I herebyaffirm that there is a construction lending a enc for 1 ' 9_9 Y FRONT the performance;of the work for which'tHis permit is issued P L (Sec 3097, Civ C ) " I SIDE 4 P L Lender's Name f - ' LDMA Ref ;a Lender's Address x ° i P C Fee$` 3 Permit Fee" „I certify that I have read this application and state that the IP Issuance Fee Q LDMA P/C q o t ® ^ above information is correct I agree to comply with bll County Investigation Fee2 o ordinances ond.State jaws relating to building construction, Total Fee "�J CLDMA"Perm hand her thonze repro atives of this County to enter ° - upon the o -m nho operty for inspecttiio/n' purposes �f l '-.2l?"o rF ; t SEE REVERSE,FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date I + COMPENSATION DECLARATION " _ I hereby affirm that I have a certificate of consent to self insure, .gr a certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS - EJ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS ®FIgge.1Z 041eg. Date Applicant CITY _,F_; C/ry ZIP LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. NEAREST COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT OSS ST. (This section need not'be completed if the permit-is for one7 SSESSOR hundred dollars ($100)or less.,) TRACT BLOCK LOT NO. 0- MAP BOOK- PAG PARCEL TEL, USE Z NE MAP I certify that in the performance of the work for which this OWNER E NO. NO.. } permit is,issued, I shall.not employ any person in any manner _ ' SPECIAL so as to bec me su'ject to the Work'Compensa on Laws. ADDRESS CONDITIONS OU. CITY ._. T ZIP, @� Date Applican - DISTRICT GROUP TYPE FIRE PRO SED BY � ARCHITECT OR TEL. NOTICE TO'APPLICANT: If, after making this Certificate of ENGINEER NO' U Exemption, you should become subject to the Workers' _ / CONST.'/ ZO�N�E &U Compensation provisions of the Labor Code, you must forth- ADDRESS '"" '/ ✓ M. with comply with such provisions or this permit shall be deemed revoked. CONTRACTOR TEL.NO. - STATISTICAL CLASSIFICATION APT. CON Z LICENSED CONTRACTORS DECLARATION _ IC CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ' NO., SEWER MAP (commencing with Section 7000)of Divis'ian 3 of the Business and LIC. a•� Professions Code, and my license is in full force and effect. CITY /��/ +� CLASS BK. PG.131 VALIDATION SQ. FT. NO. OF NO.OF CHECK License Numbera;p 7 Lic.Class � SIZE STORIES FAMILIES ONE ❑ VALUATION Ov Contractor -X Date DESCRIPTION OF WORK NEW $ ooD E ADD ® , I am exempt under Sec. ALTER B.S,P.C. for this reason REPAIR $ Date: USE OF n� AS- DEMOL Q EXISTING BLDG. 6T Signature APPLICANT TEL. FINAL _ OWNER-BUILDER DECLARATION (PRINT) NO. DAT — —g hereby affirm that I•am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT By BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. b 3.8 0 A ETI, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ° ° 4 9.8 tion 7044, Business and Professions Code). ADDRESS 4 �', . REQUIRED TOTAL SETBACK FROM. I t. 0 0 0 9,8 8 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT O 1.2.1 --8 7 the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE m P.L Q Lender's Name g LDMA Ref. # m P.C. Fee$ - Permit Fee Lender's Address ' > !' I certify that I have read this application and state that the - - Issuance Fee / - iV LDMA P/C# • ¢ above information is correct. I agree to comply with all County. Investigation Fee v ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize representatives of this County to enter upon the)6bove-mentioinped property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0 ignature of Applicant or Agent ' Date �' - 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 1301080075 PHONE (626) 285-0488 EXT ILEGAL ID I NO OF CONST NEW BUILDING ADDRESS I ITR 6561 LT 707 SQ FT STORIES TYPE OCCUP GROUPI 5759 CLOVERLY AV STRUCTURE 68 1 V-B U I TEMP CA 917802552 I ASSESSOR INFORMATION NUMBER GARAGE NEAREST CROSS STREET 18587-010-013 OTHER 112 1 V-B U THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY CAI I I TENANT JEXIST BLDG USE USE ZONE (ISSUED ON PROCESSED BY (EXIST OCC GRP 111/21/13 SR OWNER TEL 3- IBLDGS NOW ON LOT VALUATION TllDSCR � F`.(/ NY CODE ILIU, ANNIE & SACK (626) 203-1879- 1 5,254 Y`15759 CLOVERLY AV IITEMP 917802552 FEES PAID IPT ION OF WORK I ZE STORAGE ROOM ATTACHED TO SUMMER HOUSE AND LEGALIZE IFEE DESCRIPTION QUANTITY UOM AMOUNT 1COVER PATIO JAPPLICAAT TEL NO I I JXU, JENNY (626) 388-4919- IDI PLANCHECK W/O EN-HC 5254 00 VAL 127 00 1 16260 TEMPLE CITY BL IAA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS ITEMPLE CITY CA 91780 JAB STATE GREEN BLDG FEE 5254 00 VAL 1 00 ICOVENANT RECORDED I IAC STRONG MOTION RESID 5254 00 VAL 0 50 I 1 _JD2 PERMIT W/O EN-HC 5254 00 VAL 149 40 (CONTRACTOR TEL NO I TOTAL FEES 305 70 JAPPROVALS DATE INSPECTOR SIGNATURE JADC CONSTRUCTION (626) 233-1273 1 I 117588 E ROWLAND STREET #A206 LIC NO ILOCATION AND SETBACKS ICITY OF INDUSTRY CA 91748 692222 * I SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER TEL NO IFOUNDATION/TRENCH FORMS LIC NO (SLAB/UNDER FLOOR IRAISED FLOOR FRAMING I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I JUNDERFLOOR INSULATION I I I 3 001 1 11 I I 11ST LEVEL FLOOR SHEATH I INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I I 0 NO 21 1 12ND LEVEL FLOOR SHEATH 1 I I I I I I I SCHOOL WITHIN HAZARDOUS I IROOF SHEATHING I I JAIR QUALITY 1000 FEET MATERIALS I I I 1 NO NO NO I IFIRE DEPT FRAME INSPECTI I I I I I I I I (BLDG DEPT FRAME INSPECT�� I ISHEAR PANELS I I I I I I I JINSULATION/WEATHER STRIPI I I I I I I JINTERIOR LATH/DRYWALL I I I I I (EXTERIOR LATH I I I I I I ILOT DRAINAGE I I ISMOKE DETECTION DEVICES I I I I I I I I IFIRE DEPARTMENT APPROVALI I I* ADDITIONAL DATA ON FILE I I I I I I I I I I I I I I IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I I 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 1401220024 PHONE (626) 285-0488 EXT (LEGAL ID NO OF CONST BUILDING ADDRESS ITR 6561 LT 707 SQ FT STORIES TYPE 5759 CLOVERLY AV 1 ISTRUCTURE V-B TEMP CA 917802552 (ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET 1 18587-010-013 I THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY CAI I I I ITENANT (EXIST BLDG USE RESID USE ZONE R-1 (ISSUED ON PROCESSED BY 1 (EXIST OCC GRP 101/22/14 SR I f I I (OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFINAL DATE FI Y CODE ILIU, ANNIE & JACK (626) 203-1879- 1 1,500 I 1 15759 CLOVERLY AV I I I ITEMP 917802552 1 FEES PAID JDjSCAIPTf0N OF WORK I INEW WALL FOR FIREPLACE OF SUMMER HOUSE i IFEE DESCRIPTION QUANTITY UOM AMOUNT 1APPLICANT TEL NO I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 80 1 IAB STATE GREEN BLDG FEE 1500 00 VAL 1 00 ISPECIAL CONDITIONS 1 IAC STRONG MOTION RESID 1500 00 VAL 0 50 1 IBI PLANCHECK W/ENERGY 1500 00 VAL 90 30 I IB2 PERMIT W/ENERGY 1500 00 VAL 90 40 I ICONTRACTOR TEL NO I TOTAL FEES 210 00 1APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I I I I LIC NO I ILOCATION AND SETBACKS I i I I I I I ISOILS ENGINEER APPROVAL I I I I I I (ARCHITECT OR ENGINEER TEL NO I IFOUNDATION/TRENCH FORMS I I 1 LIC NO I ISLAD/UNDER FLOOR I I I I I I I IRAISED FLOOR FRAMING I I I I I I I I IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMD 1 (UNDERFLOOR INSULATION 1 3 001 1 I I I I IFLOOR SHEATHING I I INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I I I I NO 21 IROOF SHEATHING I I I I I I SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I (AIR QUALITY 1000 FEET MATERIALS I I 1 NO NO NO I IFRAME INSPECTION I 1 I IFIRE SPRINKLER HANGERS I I 1 I I I I I I I 11NSULATION/WEATHER STRIPI I I I I I I I (INTERIOR LATH/DRYWALL I I I I I I I I (EXTERIOR LATH I I I I I I I IRATED FLOOR/CEIL ASSEM I I I I I I I IRATED WALL ASSEMBLIES ri IRATED SHAFTS/OPENINGS I I I I I I I I I IT-BAR CEILINGS I ILOT DRAINAGE I I I I I I IREPORT ID DPR261 ROUTE TO BS0508 I I I I I I 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 1301080074 PHONE (626) 285-0488 EXT LEGAL ID NO OF CONST NEW BUILDING ADDRESS ITR 6561 LT 707 SQ FT STORIES TYPE OCCUP GROUP, 5759 CLOVERLY AV I _ISTRUCTURE 335 1 V-B R3 I TEMP CA 917802552 ASSESSOR INFORMATION NUMBER GARAGE NEAREST CROSS STREET 8587-010-013 OT`-IER THOMAS PAGE 596 GRID J3 LOCALITY TEMPLE CITY CAI TENANT IEXIST BLDG USE USE ZONE JISSUED ON PROCESSED BY IEXIST OCC GRP 111/21/13 SR I OWNER TEL NO JBLDGS NOW ON LOT VALUATION IFI AL DATE MY CODE ILIU ANNIE & JACK (626) 203-1879- 1 49,660 15759 CLOVERLY AV ITEMP 917802552 FEES PAID TfON OF WORK IADD MASTER BEDROOM AND BATHROOM IFEE DESCRIPTION QUANTITY UOM AMOUNT 1APPLICANT TEL NO IXU, JENNY (626) 388 4919- JB1 PLANCHECK W/ENERGY 49660 00 VAL 747 10 6260 TEMPLE CITY BL 1AA BLDG PERMIT ISSUANCE 27 80 ISPECIAL CONDITIONS ITEMPLE CITY CA 91780 JAB STATE GREEN BLDG FEE 49660 00 VAL 2 00 ICOVEVANT RECORDED 1 I JAC STRONG MOTION RESID 49660 00 VAL 5 00 1 I _JB2 PERMIT W/ENERGY 49660 00 VAL 878 90 ICONTRACTOR TEL NO 108 CERTIF OF OCCUPANCY 101 40 IAPPR-'VALS DATE INSPECTOR SIGNATURE 1ADC CONSTRUCTION (626) 233-1273- 1 TOTAL FEES 1 762 20 1 117588 E ROWLAND STREET #A206 LIC NO I ILOCATION AND SETBACKS CITY OF INDUSTRY CA 91748 692222 * 1 SOILS ENGINEER APPROVAL ARCHITECT OR ENCINEER TEL NO IFOnIATION/TRENCH FORMS 1 / LIC No I SLAB/UNDER FLOOR 1 I CI I RAISED FLOOR FRAMING IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMp I IUNDFRFLOOR INSULATION 3 v0 i �- _ { 1ST LEVEL FLOOR SHEATH NO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASSS I / 0 NO 21 ' I2ND LEVEL FLOOR SHEATH 1 WITHIN HAZARDOUS IROOE SHEATHING / 1 1000 F AIR QUALITY 1000 FEET MATERIALS �/�' NO NO NO FIRE DEPT FRAME INSPECT IBLDG DEPT FRAME INSPECT 1 SHEAR PANELS 1 _1 INSULATION/WEATHER STRIPI 11NTERIOR LATH/DRYWALL IEXTERIOR LATH LOT DRAINAGE I ISMOKE DETECTION DEVICES IFIRE DEPARTMENT APPROVALI I I 1 J* ADDITIONAL DATA ON FILE 1 1 ' IREPORT ID DPR261 ROUTE TO BSO508