HomeMy Public PortalAbout9640 CRAIGLEE ST_Building__ ,
;� • � PPUC�Q
MON FORo �L�DO I� p�.��0T
COUNTY .OF.LO,S ANGELES:v ,,, BUILDING AND SAFETY
WORKER'S.COMPENSATION DECLARATION FOR APPLICANT TO FILL IN
''BUILDING AD REss
I hereb aff rm have a certificate consent sensure,
that I hatificate of nt-to iBUILDING AD RESs 11 �•i7o L!C
or a certificate oWorkers' Compensatlon._Insurance,or a certified � vQ� lei a .
• CITY ZIP.
copy, thereof'(Sec.3800,Lab.C.)
Lim l� G� 9+-7a �,.
LOCALITY
f Polic"y,No ...' • Company
SIZE OF LOT NO.OF BLDG S.NOW ON LOT .
❑ Certified copy is hereby furnished 5 X ,f 0-7 . Z NEAREST CROSS ST.
El Certified copy is filed with the county-building inspection TRI1ACTC BLOCK LOTt9NO.
• department: - .. _ - I r0�• Il lj� __GSEZONE MAP NO.
.Date Applicant ASSESSOR'MAP PAGE PARCEL ` V .
- .OWNER N. TEL'NO.. - _ SPEC AL CONDITIONS
CERTIFICATE-OF EXEMPTION FROM WORKERS' 2,q-9,461
3 4 '•
COMPENSATION'INSURANCE KG PGR I I=T�f WITHIN 1000 FT.OF SCHOOL? YES NO
,
(This section,need not be completed if the permit is for one hundred= ADDRESS ` Q "'DISTRICT GROUP. TYPE CONST. FIRE ZONE PROCESSED BY
dollars($100)'or less.).
CITY ZIP
I certify"that in the performance of the work for which this permits,
is issued, I shall,not employ any person in any manner, so as to :O / 4lr 0
ARCHITECT OWENGINEER
become subject to the.Workers'ComLaws.pensation L - ENGTEL NO.
r ,
- rR.J� C(VQ � �Z4"O'1O�J 'STATISTICAL CLASSIFICATION APT CONDO
Date'�`Z'o-9 'Applicant � I!/n� _ �Q - ADDRESS - �, CLASS NO. �` f DWELL UNITS'
NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you '*should become subject to •the Workers' 'CONTRACTORS - TEL NO. /��,, SET BACK YARD HWY PROP LINE - WIDTH
Compensation provisions of.the.Labor Code, you must forthwith n , ` J�+3'lG���d FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. - - - •P L
LICENSED"CONTRACTORS DECLARATION, r' 6(v2 SSC? `SIDE
CI LIC.CUSS P L
I hereby affirm'that I am licensed'underprovisions of Chapter 9" D i�j SEWER MAP
(commencing.with,Section 7000.)of Division 3 of the Business and SQ.FT.SI E NO.OF STORIES NO.OF FAMILIES
Professions Code,and my license is in full force and effect. �7 I �. NEW ❑ BK /{I `PG �-
'License Number�0a1L:Seg. _ Lic.Class _ _ DESC¢21P`IOj<1 OF WORK - ® � Q ` ADD �] ,VALUATION .,..D - _ U
II�T..CC iWI K
Contractor Chile c4^ Date 7x'93 ALTER ❑ $ 3S 9.9S ,3o
0� kuv Se . REPAIR . ❑ OO
El am exempt under.Sec.
BAP.C.for this reason M,`"�.Kl C �j ?y DEMOL ❑ DMA•P/C# V
- - 4 USEOF EXISTING BLDGs-
LLI
Date' URM ❑ 2+. 0)
Signature 1 •". - AP..PLICANT(PRINT) � . � � � TEL NO. • LD_MA Perin# � � .�.. � V.fi �-T sg � Z
❑ I, as owner of the property, or.my employees with wages as ZO ifr
their sole compensatio , will`do the work and the.structure is ADDRESS _ I 1 P, .I,
i
not intended or offered for sale (Section 7044, Business and FINAL DATE f (f Q
Professions Code))
WILL SHE APPLICANT OR FUTURE BUILDING OCCUPANTHANDLE A HAZARDOUS,MATERIAL L
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 + " n 8
licensed contractors to construct the project (Section 7044,
YES❑ NO 91
Business and Professions Code.) Y 307 J_o
- WILL THE INTENDED USE OF THE BUIDLING BTHE APPLICANT OR FUTURE BUILDING - i =• -
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR' `' s f E1 iy�
ti'
GUIDELINES.
I hereby,affirm that there is a construction lending agency for YES❑ NOi
the performance of the work for which this permit is issued(Sec: �'"tl'
4-9
w m
- ... - IHAVE READ THE HAZARDOUS MATERIALS IN GUIDE AND THE SCAOMD PERMITTING ,
h' � `
I y
3097,CIV.C.) ' CHECKLIST. UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,.. f•." - CHI •{• {i T
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20:140 CONCERNING HAZARDOUS - - L:tai ,
Lender's Name MATERI°�LSS,REPORTIN FOR OBTAINING A PERMIT FROM THE SCAQMD.
f''-{fit# GE t'
01 Lender's Address ✓�t. �_ --
O OWNER OR AGENT ..
I certify that I have read this application and state under penalty
o P.C.FEE PERMIT FEE
of perjury that the above information is correct.I agree to comply t j e /� %any t+� 01 1 ^' C
with all county ordinances'and State laws relating to building C/ `, ��JV / i rl "S—¢'I�}
m construction, and hereby authorize representatives of this County ISSUANCE FEE �jj// -="I.7:j1_. 4 E ac•,
.• .to enter upon the above-mentioned property for inspection purposes. • D
14
INVESTIGATION FEE' TOTAL FEE • - � �� " ""
Signmt—of Applicant or Agent Date
SEE REVERSE FOR EXPLANATORY LANGUAGE s
LZEP,ARTMENT OF BUILDING AND:SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
WM. J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
!�BUILDING f�J /� mow® DISTRIC/PNO. PLAN CK.NO. - PERMITNO..
ADD ESS (//J P I /"K'Y/`s C-�r. g .
LOCALITY // -!y�l ,!' �`"� �// Y ,y,( �Gf,;/ RECEIVED BY DATE OF AP.PP LL. DATE ISSUED�9
NEAREST / / ��►�� ,7 I E! �1�� ro
CROSS ST.
h� , �1 BUILDING
OWNER 9, �7 r
q�ps, / ADDRE5 ,ai _ q,6 Q G �
MAIL
ADDRESS--,O' — �"�o .-s'�+l LOCALITY / (^,yy""/ ♦ C I'
CITY' "f t��6-� � / NO. �CG� NEAREST
TEL CROSS ST.
FIRE NO.OF. TYPE GROUP
ARCHITECT OR TEL. ZONE PLANS .
ENGINEER NO.
BLDG. / �e ORD.NO.
ADDRESS SETBACK LINE
TEL
CONTRACTOR /-0/6% 77— NO.NO.�r 7/�j�j�'" BY
PROVED DATE
//��1 ` USE APPROVED
ADDRESS / E� ZONE BY DATE
LEGAL ,.p CORRECTIONS
DESCRIPTION LOT NO.
7 BLOCK
TRACT / /j /q �� "! 24'U�a
1
SIZE OF LOT �f( ` 6 7 I NOW ON LOTS/�/(J ,., Q,� S
USE OF I NO.OF I ND.OF
EXISTING BLDG. FAM,L�Ee ROOMS _
DESCRIPTION OF.WORK
NEW ALTERATION I ADDITION O
REPAIR MOVING DEMOLISH
SIZ FT. ' ® � NO.OF / 'y�,n ���
SIZE RWALLp�OOMS 6� ST/�O(q/RIE$ew(J L'i /�-�-�� (jbf"j3t �/�r�Frl(( � �!'�/iT r
COVERING ,._ '°�'t.Q,.� td, I COVERING ( "[} [ �o ��
v. �ps 41E
a _ ,/� /�
BUELDING OF W C ��ry6 ��' OILS�ne ���I�� /�'"!
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT INSPECTOR DATE
FOUNDATION!:AT LOCATION
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FORMS,MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS, p s
SIGNATURE OF �� �RC ��jf`, ` BRACING,BOLTS
a PERMITTEE— _ _ /// �• jj)'�.` ,f /'1_p.�
�¢ LATH, INT. r•�ff' 7 4 1 U
AUTHORIZED AGT V y'b
LATH, EXT.
76A636A-3 7-49 $ P.C. PLASTER, INT.
FEE
PLASTER,EXT.
VALUATION 7 t+' 1 �. ^
7 FEE 6 FINAL
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 1201260008
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
ITR: 16867 LT: 26 SQ. FT STORIES TYPE 9640 CRAIGLEE ST
p (STRUCTURE: 2500 V-B TEMP CA 917801408
(ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: TEMPLE CITY 1
.15383-015-016 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 ' TISSUED ON: PROCESSED BY:
(EXIST OCC GRP: 101/26/12 SR
(OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: (FINAL DATE' FINAL BY: CODE: 1
IPERINI KATHRYN E - J 6,100
19640 CRAIGLEE ST
ITEMP 917801408 FEES PAID DESCRIPTION OF WORK
I IREMOVE EXISTING ROOF INSTALL 30 YEAR COMP SHINGLE OVER
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: JEXISTING PLYWOOD _ 1
JAPPLICANT: TEL. NO: 1 I
IKEEFER, BRIAN (909) 608-0622- JAA BLDG PERMIT ISSUANCE 27.80 1
JAB STATE GREEN BLDG FEE 6100.00 VAL 1.00 ISPECIAL CONDITIONS: . I
J JAC STRONG MOTION RESID 6100.00 VAL 0.60 I
I ID2 PERMIT W/O EN-HC 6100.00 VAL 166.60 J
TOTAL FEES 196.00 J
ICONTRACTOR: - TEL. NO: 1 (APPROVALS DATE- INSPECTOR SIGNATURE
IKEEFER'S ROOFING (909) 608-0622- 1 1
11216 BEGONIA COURT LIC. NO 1 ILOCATION AND SETBACKS J 1
1UPLAND CA 91784 760903 C39 1 I_
1 I ISOILS ENGINEER APPROVAL 1 1 I
JARCHITECT OR ENGINEER: TEL. N0: J . IFOUNDATION/TRENCH FORMS 1 1
J LIC. NO: JSLAB/UNDER FLOOR I I
I
IRAISED FLOOR FRAMING
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I
1153H269 3 001 I - I
I I 1FLOOR SHEATHING
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I
J 0 NO 21 1 IROOF SHEATHING 1 1 1
1 SCHOOL WITHIN HAZARDOUS 1 (SHEAR PANELS I I I
JAIR QUALITY: 1000 FEET MATERIALS 1 I- I
NO NO NO 1 1FRA.ME INSPECTION 1 I 1
IFIRE SPRINKLER HANGERS 1
I 11NSULATION/WEATHER STRIPI I I
I (INTERIOR LATH/DRYWALL 1 I
I I
1EXTERIOR LATH 1 J J
. � IRATED FLOOR/CEIL ASSEM. I J
IRATED WALL ASSEMBLIES I J
IRATED SHAFTS/OPENINGS J ,:
I IT-BAR CEILINGS I J I
I ILOT DRAINAGE I I
IREPORT ID: DPR261 ROUTE TO: BS0508 J 1 I
I I I I I I