HomeMy Public PortalAbout5432 ENCINITA AVE_Building__ 76A630A CE#803 10.56 APPLICATION FOR BVIL®ING PERMIT
W.MDING AND SAFETY DIVISION BUILDING 3
2
Department of County Engineer ADDRESS
County of Los Angeles LOCALITY
JOHN A LAMBIE, COUNTY ENGINEER NEAREST
CASSATT D GRIFFIN, SUP T OF BUILDING CROSS ST
DISTRICT NO G TYPE SEWER AP
FOR APPLICANT TO FILL IN K P >
BUILDING '' C �" .}. '��T. CONST
ADDRESS �ti(. /yC I I / �, .� STATISTICAL ASSIFICATION I
I
LOT NO / •7,z„ r BLOCK 'CLASS NO DWELL U TE
MAP O O HWY YE3 O
,J NUMBER
TRACT a 0'I C� _C USE Z NE SPECIAL _
NO OF BLDGS CONDITIONS
SIZE OF LOT I NOW ON LOT
USE OF
EXISTING BLDG BUILDING EXIST
YARD HWY - STREET NAME
SETBACK WIDTH
OWNER A, /�'�r J .��? FRONT
MAIL P L
ADDRESS IVc— SIDE
TEL
P L
CITY / NOINSPECTION RECORD
ARCHITECT OR TEL
ENGINEER NO
ADDRESS 'ys `
CONTRACTORAi�rTN11L' NO
ADDRESS 5 u. f1411
1
DESCRIPTION OF WORK
NEW ADDA` ALTER' REPAIR DEMOLISH ,
SQ FT G NO OF NO OF
SIZESTORIES FAMILIES
cL OF STRUCTJJRE IRvtc
v e7 le PA f7c
APPROVALS
SIGNATURE OF
APPLICANT DATE INSPECTOR S SIGNATURE
ADDRESS SIL C D FOUNDATION LOCATION _
ism FORMS MATERIALS /1r,
P C $ FBRACING BOLTRAME FIRE S
S�
(�U FEE
$ FURNACE LOCATION.
VALUATION GAS VENT, DUCTS
mj FEE
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH, INT
PLICATION AND STATE THAT THE ABOVE-IS CORRECT AND
AGREE TO COMPLY WITH ALL COU TY ORDINANCES AND LATH. EXT
STATE LAWS REGULATING BUI G CONSTRUCTION
SIGNATURE OF - HOUSE NUMBER COR- tt
PERMITTEE RECT AND POSTED �7 A
ADDRESS` I2 " j(diet
116-" 2Y FINAL S
JOHN A LAMBIE, COUNTY ENGINEER, CLYDE N. DIRLAM, PR NCIPAL STRUCYURAL ENGINEER
PLAN CHECK VALIDATION CKwt o cAs PERMIT VALIDATION CK M o CASH
Cleo 0 1 7 5EL-r-) JUq- 12 1 - 100 10
DEPARTMENT OF BUILDING AND,'SAFETY APPLICATION FOR PERMIT
• _COUNTY OF LOS ANGELES y ® fXG
WM. J. FOX, CHIEF ENGINEER U L
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING / '} 1 DISTRICT NO. PLAN CK.NO., PERMIT NO.
ADDRESS (� C LIT ,�,�, 74110
ah l
LOCALITY R�E'C�EIIIVVE�b BY DATE OF APPL DATEISSUED
NEAREST-
CROSS ST
i
OWNER
P. BUILDING-'
. ADDRESS -4-/[�)x,-
MAIL LOCALITY T.C'/LA4 P, -E
ADDREB9 • J
NEAREST
CROSS ST.
FIRE NO.OF TYPE GROUP
ARCHITECT OR I TEL ZONE PLANS_ �� _�—
ENGIN6[R ! NO.
SLOG. / ORD.NO.
ADDRESS SETBACK LINE ,-7
v TEL APPROVED
CO R CT NO. BY DATE
�. USE APPROVED
A E 9 ZONE BY DATE t
CORRECTIONS
DESCRIPTION 'y BLOCK >� - o
CT
O OF BLDGS
SIZE OF LOT NOW ON LOT
USE OF 40 13F NO OF '
EXISTING BLDG AMILMS ROOMS
DESCRIPTIO OF WORK
NEW ALTERATION ADDITION ;�.. ,• ' '
0
REPAIR MOVING DEMOLISH
1311 FT /2G'ri .OF 45
SIZE OOM9 STORIES D
WALL ROOF
r
COVERING COVERIN 1
USE OF NEW • ,� 1 _
BUILDING / / 1 I r•'
-
/ i +
r r rta I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS- APPROVALS
APPLICATION'AND STATE THAT THE ABOVE IB CORRECT FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL„COUNTY ORDINANCEB FORMS, MATERIALS
AND STATE LAWS REGULATING BUILDING CONSTRUCTION
' FRAME: FIRE STOPS,
SIGNATURE OF BRACING,BOLTS
OWNER LATH,,INT.•
AUTHORIZED AGT ' LATH,EXT.:
D89-3 25M 9ET9 1-47 ,`_1 r� P.C;,41 PLASTER.INT.
FEE PLASTER,EXT. -
VALUATION �' ' l . U4
FEE SCJ FINALt/C(/�J!
J`
LAPPLI "ON FOR BUILDING PERMIT 647
COUNTY' OS` NGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDI�ADD ESS
I hereby affirm that I have a certificate of consent to self insure, 5 LL� G;o(w/
or a certificate of Workers' Compensation Insurance, or a certified 1
copy thereof (Sec. 3800,Lab.C.) CIT"�� ZI 7� LOCALITY .
Policy No. Company SIZE OF OT NO,OF BLDGS.NOW ON'LOT
❑ Certified copy is hereby furnished. S��( /P NEAREST CROSS ST.
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. �I`� p
department. - - USE ZONE MAP NO,
Date Applicant ASSESSOR MAP BOO JS.� PAGED '• PARC' '
CCS) CC/J SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWN Ri TEL NO. � L
COMPENSATION INSURANCE Cv>� ;° �y. Z7S`1'13+ WITHIN 1000 FT OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDRES v
`QW DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100) or less.) �'�?
I certify that in the performance of the work for which this permitCITY/ f2A1 ZIP +�/
is issued, I shall not employ any person in any manner so.as to� ARCHITECT OR ENGINEER TEL NO. �e—&
/V/
become subject to the Workers'Compensation Laws. STATISTICAL CLAS FI ATION ':`-*`"A1'i_• CONDO
Date Applicant ADDRESS .•;} —y
CLASS NO. DWELL UNITS
NOTICE TO APPLICANT.' If, after making this Certificate of � REQUIRED TOTAL SETBACK FROM''j»
' ,•;:::EXIST '
Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE` °'w WIDTH
Compensation provisions of the Labor Code, you must forthwith FRONT
FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L -
SIDE
LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS P L —:
I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the BusinessAand. SQ.FT.SIZ NO.OF STORIES NO.OF FAMILIESNEW `Professions Code,and my license is in full force and effect. 1?O BK PG , 1j;'•f)=''-- ; ;L'
License Number Lic.Class DESC��ION OF' / ADD VALUATION ��a • E-L7
Contractor Date ALTER ❑
REPAIR ❑
❑ I am exempt under Sec. y 0
BAP.C.for this reason DEMOL ❑ LDMA P/C# V
W
Date: `[ADDRESS
UcX�;�pl`�XX)yp�TING BLDG. URM ❑
Signature A,pP�LICANT(PRINT) TEL NO. ;J LDMA Perm# I: z
V/ �(J61: J. y�IEY+�b�i. :tI'.)/Ji 71 Z +; 1_ .9.
fG I, as owner of the.property, or my employees with wages as� :
their sole compensation, will do the work and the structure is "`Ill _ ` —
�'�:",/.l /i.+?i,v' f�• /1ic%:Yr' AL DATE .
not intended or offered for sale (Section 7044, Business and l/�/�' __ ..,...
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
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? V44AL kY
licensed contractors to construct the project (Section 7044, YES El NO❑ I E;w€ 'a a
Business and Professions Code.) :
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING _
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK
�..
-
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES.
I hereby affirm that there is a construction lending agency for YES ElNO❑
w the performance Of the work for which this permit Is issued(Sec. HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING
3097, CIV.C.) HECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, —
0000-1
I�.,33�._ _
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS �•�J'J•' i_!I_LI.:. _.,, •_}
.Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD,
o Lender's Address
OWNER OR AGENT
O
o I certify that 1 have read this application and state under penalty
C of perjury that the above information is correct.I agree to comply P.C.FEE �/� f,J� PERMIT FEE
o with all county ordinances and State laws relating to building
nstruction, an�hereb� au nz �representatve of this County ISSUANCE FEE
co nter upon theenti dction purposes.m INVESTIGATION FEE TOTAL FEE �Js a�,e Appuc o, ce oC
�'\\ SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1006170054
PHONE (626) 285-0488 EXT
(LEGAL ID NO OF CONST NEW 1 BUILDING ADDRESS 1
1 ON FILE SQ FT STORIES TYPE OCCUP GROUPI 5432 ENCINITA AV 1
I ISTRUCTURE 264 1 V-B R-3 I TEMP CA 917803116 1
(ASSESSOR INFORMATION NUMBER GARAGE I NEAREST CROSS STREET BROADWAY 1
18588-031-018 1 OTHER 328 1 V-B R-3 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl
(TENANT (EXIST BLDG USE USE ZONE (ISSUED ON PROCESSED BY 1
1 IEXIST OCC GRP 107/08/10 SR 1
10WNER TEL NO JBLDGS NOW ON LOT VALUATION F IIIALIDATE FIN CODE
1EDEN, DEAN & SANDRA (626) 309-9991- 1 65,370 LD
15432 ENCINITA AV I 1 � I
(TEMP 917803116 1 FEES PAID DESCRIPTION OF WORK 1
I 1 IBEDROOM ADDITION (264 SQ FT ) AND INTERIOR REMODEL (328 SQ 1
J IFEE DESCRIPTION QUANTITY UOM AMOUNT IFT ADD BATHROOM & CLOSET SPACE 1
(APPLICANT TEL NO I I 1
INYBORG, SCOTT (626) 614-4874- JB1 PLANCHECK W/ENERGY 65370 00 VAL 896 90 1
14499 VIA MARISOL 116 JAA BLDG PERMIT ISSUANCE 27 80 (SPECIAL CONDITIONS \ 1
1LOS ANGELES CA 90042 JAB STATE GREEN BLDG FEE 65370 00 VAL 3 00 1 \\1
JAC STRONG MOTION RESID 65370 00 VAL 6 50 1 1
1 JB2 PERMIT W/ENERGY 65370 00 VAL 1,054 20 1 1
(CONTRACTOR TEL NO 1 TOTAL FEES 1,988 40 JAPPROVALS DATE INSPECTOR SIGNATURE 1
JEDEN, DEAN & SANDRA (626) 309-9991- 1 1 _ 1
15432 ENCINITA AVENUE LIC NO 1 (LOCATION AND SETBACKS
(TEMPLE CITY, CA 91780 NONE 1 I I
1 I (SOILS ENGINEER APPROVAL 1 1
JARCHITECT OR ENGINEER TEL NO I IFOUNDATION/TRENCH FORMS I I
1 LIC NO 1 JSLAB/UNDER FLOOR I 1
1 1 1RAISED FLOOR FRAMING I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I 1UNDERFLOOR INSULATION I I
1 3 001 1 �I I
I I 11ST LEVEL FLOOR SHEATH I 1
INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I I I
1 NO 21 1 12ND LEVEL FLOOR SHEATH I I I
1 SCHOOL WITHIN HAZARDOUS 1 (ROOF SHEATHING I
1AIR QUALITY 1000 FEET MATERIALS 1 I I 1 I
1 NO NO NO I (FIRE DEPT FRAME INSPECTI I I
I I II I
I I (BLDG DEPT FRAME INSPECT I
I - ISHEAR PANELS I I
1 I INSULATION/WEATHER STRI
1 I 11NTERIOR LATH/DRYWALL I I
I 1 1EXTERIOR LATH I
I 1 ILOT DRAINAGE I 1 1
I 1 ISMOKE DETECTION DEVICES 1 1 1
I I JFIRE DEPARTMENT APPROVALI I I
I I 1 1-1 1
I (REPORT ID DPR261 ROUTE TO BS0508 1 I 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 0801280026
PHONE (626) 285-0488 EXT
ILEGAL ID I NO OF CONST I BUILDING ADDRESS I
ON FILE I SQ FT STORIES TYPE I 5432 ENCINITA AV
(ASSESSOR INFORMATION NUMBER ISTRUCTURE 580 VN I TEMP CA 917803116 1
NEAREST CROSS STREET OLIVE
18588-031-018 I I THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl
ITENANT 1EXIST BLDG USE RESID USE ZONE R-1 (ISSUED ON PROCESSED BY EXPIRES ON I
I (EXIST OCC GRP 101/28/08 SR 07/26/08 I
(OWNER TEL NO IBLDGS NOW ON LOT VALUATION IFI�VATE FIN CODE
ISTANTON KEVIN J,SANDRA (626) 309-9991- I 1,500
15432 ENCINITA AV I
ITEMP 917803116 I FEES PAID IDESCRIPTION OF WORK
I I ITEAR OFF & REFOOF METERIALS 6 ROLLS NAIL ON 3 ROLLS SA BASE I
1 IFEE DESCRIPTION QUANTITY DOM AMOUNT IWHITE MOLE HIDE 5 GAL APOC 133 100 FT 4X4 STRAIGHT 90 DEGRESI
(APPLICANT TEL NO I I
ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 75 1 1
IAC STRONG MOTION RESID 1500 00 VAL 0 50 ISPECIAL CONDITIONS
1 I D2 PERMIT W/O EN-HC 1500 00 VAL 82 20
TOTAL FEES 110 45
ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1
ISAME AS OWNER - I I
I LIC NO I ILOCATION AND SETBACKS
I I ISOILS ENGINEER APPROVAL I 1
(ARCHITECT OR ENGINEER TEL NO 1 IFOUNDATION/TRENCH FORMS I I I
1 LIC NO ISLAB/UNDER FLOOR I I
(RAISED FLOOR FRAMING I I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP (UNDERFLOOR INSULATION I
I I I
1147H65 3 Oil I I I I
I I IFLOOR SHEATHING I
INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I I I I
NO 21 i IROOF SHEATHING 1 -
SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I I
(AIR QUALITY 1000 FEET MATERIALS I I I I I
1 NO NO NO I IFRAME INSPECTION
I I I
IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I I I
ISET BACK YARD HWY PROP LINE WIDTH I I
IFRONT PL- I IINSULATION/WEATHER STRIPI I
I SIDE PL- I I I I I
I (INTERIOR LATH/DRYWALL I I I
I I 1EXTERIOR LATH I I
I I IRATED FLOOR/CEIL ASSEM
I I I
I (RATED WALL ASSEMBLIES I I I
I I I
IRATED SHAFTS/OPENINGS
I I I
I IT-BAR CEILINGS I I
I• ADDITIONAL DATA ON FILE I
I I
I ILOT DRAINAGE I I I
I I I
IREPORT ID DPR261 ROUTE TO BS0508 I I
I I I I I I