HomeMy Public PortalAbout8863 ELM AVE_Building__ APPLICATION FORBUILDING PERMIT
FOR APPLICANT TO FILL IN (Print or type Only)
BUILDING - COUNTY OF LOS .ANGELES -
ADORE �' - DEPARTMENT. OF COUNTY ENGINEER:,.
CITY_ 1 ZIP _ .. .
BUILDING AND SAFETY DIV ISION• ` '
NO.OF BLDGS. _ BUILDING
_ � '��
SIZE OF LOT 6 NOW ON LOT ADDRESS
TRACT�' > BLOCK LOT NO. LOCALITY
� ��- EO
ST -
OWNER; C - CROSS
ST-. -
/ _ ASSESSOR
•.ADDRESS_ (� - MAP BOOK PAGE - PARCEL
DISTRICT GROUP ITYPE FIRE SED BY
CIT 1�19 J- ��i li IP ... 1 - L/ "� CON
ST. .ZONE
ARCHITECT OR T L.
ENGINEER NO.. _
�j -' � � STATISTICAL CLASSIFICATION � SEWER MpAP
i'
ADDRESS - a W 1_10 CLASS NO.r�2/ _DWELL•UNITS BK/O,PG
TEL..
CONTRACTOR NO 'USE ZONE NOP [/
LIC.
.ADDRESS l /" NO• • ��3 SPECIAL '
LIC. 1CONDIT.
I ONS
CITY CLASS - -
ROAD EPARTMENT APPROVAL REQUIRED YES❑ NO ❑
CONSTRUCTION LENDER s
.NAME AND BRANCH h BLDG SETBACK FROM '
FRON PROP.LINEOF '(STREET) >-
•ADDRESS CITY - HIGHW V } YARD TOTA-L SETBACK FROM'TYPEOF EXISTING' C:)
SQ. FT, NO. OF - NO. OF CHECK- FRONT PROP. LI-NE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE
O
DQE SC RIPTI ON OF WORKNEW ❑ U
�� BLDG.SETBACK FROM - d
ADD SIDE PROP. LINE OF TREET Z
7,alzz� � ALTER = TOTAL SETBACK. FROM TYPE OF XISTING
`..J'7 HIGHWAY } YARD SIDE PROP. LINE HIGHWAY IDTH
F`E PAIR
EXISUSE
OTING BLDG. 6>o b'�N[i•- DEMOL ❑ } - -
APPLICANT �tFEL f/� CORNER CUTOFF YES ❑. NO
(P R �[[!! jj OPEN SPACE - YES,,❑'. NO El,Kdj
BY (SIGNATURE _ _�_-
- QII COASTAL ZONE YES ❑ NO
VALUATION •Y CATEGORICAL EXEMPTION YES❑ NO ❑
I HEREBY ACKNALEDGE THAT I HAVE READ THIS APPLICATION' ENVIRONMENTAL
AND STATE'THAT THE ABOVE IS 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)
'HEREBY IWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S COMPE SATION INSUR NCE. .
SIGNATURE OF �� r ���'� �.T•- 01.rr'.�"•.-c'�-,
PERMITTEE A _
ADDRESS'
-/ --7�/
/_//•� FINAL / BY
CLT ��" C. /N NO.L ' DATE S...G, � 7
=N;II E CHLChS P.1]:11.3L�' 70• FEE $ PEE
HARVEY T. SRANDT, COUNTY ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH o PERMIT VALIDATION CK M-O. CASH
4 2.0 .0 &`8
76A638A CE#803 12/72 -
76A638A CE• .803 6-62
APRL9CATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES 1 BUILDIN
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION, ` LOCALITY
JOHN A. LAMBIE,:COUNTY.ENGINEER NEAREST "
WILLIAM A. JENSEN, SUPT OF BUILDING. CROSS ST.
DISTR�O. GROUP TYPE PRO ESS BY.
FOR APPLICANT TO FILL IN CONST.'
BUILDING STATISTICAL CLQ.�6$�i�FICATION SEWER MAP
ADDRESS �(J('
CLASS. NO. DWELL. UNITS BK P
LOT NO. '-Q /"gy pg WATER - NOT REQUIRED RECEIVED
CERTIFICATE:
TRACT 36 MAP, HIGHWAY
I NO.OF BLDGS. NO., 'CIRCLE) STATE MAJOR SECOND, OCAL
SIZE OF LOT �� NOW ON LOT USE ZONE .SPECIAL '
USE OF ^ CONDITIONS '
EXISTING BLDG.
TEL.
OWNER �. .y� NO.aa-11Q' BUILDING EXIST.
HWY STREET NAME
SETBACK YARDWIDTH
ADDRESS FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE i
ADDRESS
10-mf
2 TEL. V
CONTRACTOR 10- NO. h
ADDRESS )
O
DESCRIPTION OF WORK
a
NEW ADD .ALTER REPAIR DEMOLISH - N
SQ. FT.- NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE _
SIGNATURE O
APPLICANT
VALUATION -
APPROVALS ,DAT�E/ INS
PECTOR'S SIGNATURE
P.C. PMT. FOUNDATION:
O , ON
FORMSMATERIALS FEE
FRAME: FIRE STOPS. q- /
'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
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'S COMPENSATION INSURANCE. —LATH, EXT.
SIGNATURE OF r HOUSE NUMBER COR- `
PERMITTEEAND POSTED n
ADDRESS FINAL
JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.G. CASH
O
ACo 1 G 8 0� FEB 1.9 1 A 4.G'I ' IX
t
COUNTY OF LOS ANGELES. , �. BUILDING AND SAFETY
WORKER'S'�COMPENSATION DECLARATION FOR APPLICANT TO FILL IN �ILDING ADDRESS + �c7-
I hereby affirm that I have a certificate,,of consent to self.in sure, BUILDING ADDRESS �''d' 3 �/�, G""( c,4
S/M&E ,�j�'
or a certificate of Workers' Compensation Insurance, or a certified C T ZIP T�+ e G'� V J /WTD "
copy,thereof(Sec.3800,Lab.C.) L �®
Z LOCALITY
Policy No Company .SIZE O. LOT NO.OF BLOGS.NOIV ON LOT -
❑ Certified copy is hereby furnished. TT',3 �. NEAREST CROSS ST Qr,�/. T' ��^
❑ Certified copy is filed with the county building,inspection TRACT BLOCK LOT NO: .. 'ww'�� 41"4 ,y,,tq.�
department. USE ZONE MAP NO
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL
53 87 l V 13 ,SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER r f TELL NO.
COMPENSATION INSURANCE /�I � Or`f'� �9 �l —� WITHIN 1000 FT.OFrSCHOOL? YES NO
(This section need not be completed if.the permit Js for one hundred ADORES /�!/f p
dollars($100) or�less.)„ p p �` Z`- • 'sr•�„G / .DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
e , CITY ' ` ZIP - FC / w
I'certify that,in the performance of the work for which this permit r+C� f � _ �f/(� /t.-�
is issued, I shall not employ any person in any.manner so as .to ARCHITECT OR ENGINEER .TEL NO:
become e subject to the Workers'Compensation Laws. .STATISTICAL CLASSIFJCATION APT CONDO
Date - ADDRESS - - - .7 CLASS NO. DWELL UNITS
NOTICE TO A ICANT.' If, er ma Ing, this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the 'Workers' CONTRACTOR - TEL NO: - SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith..
FRONT
comply-with such provisions or this permit shall'-be deemed revoked. ADDRESS LIC.NO. P L
LICENSED CONTRACTORS DECLARATION SIDE
ITY LIC.CLASS P L
I hereby affirm that I am licensed underprovisions.of Chapter 9
SEWER MAP .ICL
(commencing with Section 7000)of Division 3;of the Business and SQ.FT.SIZE -NO.OF STORIES NO.OF.FAMILIES -
Professions Code,and my license is in full force and effect. �[�(� NEW ❑ BK PG D 0
License Number Lia Class. DESCRIPTION OF WORK // - ADD. ®- VALUAAT�IO
Contractor Date Q� ALTER ® $ / ��' �� 0
CB oS fD 714 o
❑ I am exempt under Sec. /Q REPAIR ❑ $ U
B.&P.C.'for this reason DEMOL '❑ W
LDMA P/C# -d
- Date: - USE OF EXISTING BLDG. URM ❑ N
Signature APPLICANT(PRI T) , TEL NO. LDMA Perm# - r•s '�'
d� i z
I, as owner of the property, or my'employees with wages as Z
their sole compensation, will do the-work and the structure is ADDRES6 / �/� c• O •� __a•_ •
not intended or offered for sale (Section 7044, Business*and O 3 �� S"rR /'�+'y1/' INAL DATE G� Q {
PfOfeSSlOnS Code.) _ ILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE"A HAZARDOUS MATERIAL !� �� ! /TG __ S
CPR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J ,¢
❑ I, as owner of the property, am exclusively contracting with MOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATIOWGUIDE? {? ¢
licensed contractors to construct.the project (Section,7044, No> FNA,
Business and Professions Code.)
YES 0
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR.FUTURE BUILDING
OCCUPANT REQUIRE A..PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH �•+
CONSTRUCTION LENDING` AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT ISCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES. '
1 hereby affirm that there is a construction lending agency for ves❑ Nom =3 I r f3- —°�&- �8-
w the performance of the work for which this permit is issued(Sec.` ,_•r
p� I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING ,,,,_� �, , + �f(�
3097-,CIV.C.) CHECKLIST UNDERSTAND MY REQUIREMENTS UNDER THELOSANGELES COUNTY CODE,' .+`''<'+ ` CNEr
TLE 2,CHAPTER 2.20 SECTIONS 2.20.1 V THROUGH 2.20.140 CONCERNING HAZARDOUS _
Lender's Name, MATERIALS REPORTING/@ JpR, BTAIWiNG A PES MIT FROM THE SCAQMD f' ;Al-.f
o Lender's Address V
o arvNEa oa Errf -
o I certify that I have read this application and state unde enalty _ _
q Of perjury that the above'information"is curt tt. I agree to comply P.C.FEE- = r PERMIT FEE )Ji,I Ij t iE:,E_f; j1 t
with all county ordinances' and State laws relating to building 'cJ O ��v '
construction, and hereby authDrize representatives of this County ISSUANCE FEE �/^ __:? (. , -a
to enter upon th ve-mens ned p erty for inspection purposes. -•_
� � INVESTIGATION.FEE TOTAL FEE
SEE REVERSE FOR EXPLANATORY LANGUAGE
V
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 1104260059
PHONE: (626) 285-0488 EXT:
ILEGAL ID: 1 NO. OF CONST I BUILDING ADDRESS: 1
ITR: 3623 LT: 102 SQ. FT STORIES TYPE I 8863 ELM AV 1
I (STRUCTURE: , 1950 V-B 1 TEMP CA 917801843 1
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
15387-010-013 1 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
I I I I
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-3 (ISSUED ON: PROCESSED BY: 1
I IEXIST OCC GRP: 104/26/11 SR I
I I I I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFI AL D TE FINAL BY: CODE: 1
(ALAN CHIAN (626) 387-0971- 1 3,300 1
18863 ELM AV f 1 I
ITEMP 917801843 1 FEES PAID IDESCRIPffION OF WORK 1
I I ITEAR OFF INSTALL BASE #15 AND SHINGLES 30 YEARS I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 I
1APPLICANT: TEL. NO:
ISU, CARMEN (626) 709-7866- IAA BLDG PERMIT ISSUANCE 27.80 1
11428 AMELUXEN AVE. IAB STATE GREEN BLDG FEE 3300.00 VAL 1.00 (SPECIAL CONDITIONS: 1
HACIENDA HTS 91745 IAC STRONG MOTION RESID 3300.00 VAL 0.50 I
1 ID2 PERMIT W/O EN-HC 3300.00 VAL 116.00 I 1
1 TOTAL FEES 145.30 I 1
(CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
ISWIFT-MEND ROOFING INC. (626) 709-7866- - 1
11428 AMELUXEN AVENUE LIC. NO 1 ILOCATION AND SETBACKS
IHACIENDA HTS, CA 91745 918419 C39 I I
ISOILS ENGINEER APPROVAL
I I I I I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 1FOUITDATION/TRENCH FORMS I I I
LIC. NO: - (SLAB/UNDER FLOOR 1 1
I IRAISED FLOOR FRAMING
I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I
1150H265 3 001 1 - 11 I
I I IFLOOR SHEATHING I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I_ • I I
1 NO 21 1 (ROOF SHEATHING
� I I
1 SCHOOL WITHIN HAZARDOUS' 1 ISHEAR PANELS I I 1
1AIR QUALITY: 1000 FEET MATERIALS I I
1 NO NO NO (FRAME INSPECTION
I IFIRE SPRINKLER HANGERS I I
1 I (INSULATION/WEATHER STRIPI I
11NTERIOR LATH/DRYWALL I
(EXTERIOR LATH 1
I I I
RATED FLOOR/CEIL ASSEM.
I (RATED WALL ASSEMBLIES I
I IRATED SHAFTS/OPENINGS
I I IT-BAR CEILINGS I I I
I ILOT DRAINAGE
I I I
1 IREPORT ID: DPR261 ROUTE TO: BS0508 _ I
I I I I I I