HomeMy Public PortalAbout5505 ENCINITA AVE_Miscellaneous__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 1012200003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
LEGAL ID NO OF CONST NEW I BUILDING ADDRESS I
ITR 9751 LT 262 SQ FT STORIES TYPE OCCUP GROUPI 5505 ENCINITA AV 1
I ISTRUCTURE 1 V-B U I TEMP CA 917802308 1
ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET BROADWAY I
15387-020-014 SEXIST BLDG USE I THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY I
I EXIST OCC GRP USE ZONE
ITENANT I (ISSUED ON PROCESSED BY 1
IBLDGS NOW ON LOT VALUATION 112/20/10 SR I
I ! 1,200 1 1
(OWNER TEL NO I IFINAL DATE FINAL BY CODE
ICHEN, SAM (626) 476-7593- !LIST ITEMS 1` I
15505 ENCINITA AV 1
ITEMP 917802308 FDESCf41PT ON OF WORK 1
I IREMOVE STORAGE ROOM BEHIND HOBBY ROOM ALSO REMOVE SHOWER
1 IOCCUP LOAD EXIST 1 I
(APPLICANT TEL NO ;OCCUP LOAD NEW I I
ISAME AS OWNER - I I I
I IPARKING SPACES REQUIRED ISPECIAL CONDITIONS 1
IPARKING SPACES PROVIDED
I
1 (EXIT HARDWARE
ICONTRACTOR TEL NO I I LIMITED TIME USE 1
ISAME AS OWNER - (NSR OF EXITS I FROM TO 1
LIC NO I I
1 I FEES PAID 1
I 1APPROJALS DATE INSPECTOR SIGNATURE
I (FEE DESCRIPTION QUANTITY UOM AMOUNT I I
(ARCHITECT OR ENGINEER TEL NO I ITRAILER USE 1 1 I
1 10A PERMIT ISSUANCE 27 80 1 I I I
LIC NO 101 R/M OCC/USE INSPECT 146 00 ISAFETY PERMIT I 1 I
1 I TOTAL FEES 173 80 1 I I I
ITEMP STRUCT APPROVED
I I I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP 1 ITEMP STRUCT REMOVED I I I
1147H265 I I I I
INO OF FAMILIES DWELLING UNITS APT/COND STAT CLASS I I I I
NO
SCHOOL WITHIN HAZARDOUS I I I
(AIR QUALITY 1000 FEET MATERIALS
NO NO NO I I
I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I i
(REPORT ID DPR267 ROUTE TO BS0508 1 I 1
WORKERS'COMPENSATION DECLARATION CE 8454(1 84) MISCELLANEOUS APPLICATION
I hereby affirm that I have a certificate of consent to self COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION
insurer or a certificate of Workers'Compensation Insurance,or
a certr ied copy thereof(Sec. 3800,Lab.C.).
PolicyNo._ ,� Company FOR APPLICANT TO FI LL IN BUILDING 5C5( �5 � !L k)f�;q
A ADDRESS l(/�J� t
Certified copy is hereby furnished. BUILDING t. v_-AJ �� r LOCALIr PLS
ADDRESS
❑ Certified copy is filed with the county building inspection LOCALITY NEAREST
department. CROSS ST.
Date Applicant NEAREST /) /► J� DIS RI,,YYO��Tr O� TYPE PRO SS
CROSS ST. /{J' ''T (,�l(�(® g t X CONST.
u
CERTIFICATE OF EXEMPTION FROM WORKERS' LEGAL
COMPENSATION INSURANCE DESCRIPTION LOT NO. BLOCK MAP HIGHWAY
NO. (CIRCLE) STATE MAJOR S 'GOND LOCAL
' 'NO. OF BLDGS.
(This section need not be completed if the work Involved TRACT q NOW ON LOT USE ZONE SPECIAL CONDITIONS
by the permit is for one hundred dollars ($100) or less.) / usE of I
SIZE OF LOT ClG {I EXISTING BLDG. }
I certify that in the performance of the work for which this V n ;= o
permit is issued, I shall not employ any person in any manner OWNER
so as to become subject to the Workers' Compensation Laws. MAIL �j I / OCCUPANCY GROUP o
ADDRESS ..7, v� L�•Li' u/� `rA .,� F—
Date Applicant w
NOTICE TO APPLICANT: If, after making this Certificate of CITY (�,'fi No� J P� OCCUPANT LOAD N
JS.. .. Z
Exemption, you should become subject to the Workers' APPLICATION FORS.,- I. EXIT HARDWARE:
Compensation provisions of the Labor Code, you must forth-
with comply with Such provisions or this permit shall be TRAILER USE ❑ GEOLOGY.INSPECTION ❑ No Spec. Knowl.
deemed revoked. -
LICENSED CONTRACTORS DECLARATION OCCUPANCYwsPEcnoN Panic Devices
I hereby affirm that I am licensed under provisions of Chapter SAFETY PERMIT, ❑ (LIST ITEMS BELOW)
9 (commencing with Section 7000) of Division 3 of the Busi-
ness and Professions Code, and my license is in full force and
effect. PARKING REQ'D PROVIDED ��
SPACES
License Number Lic. Class
LIMITED TIME USE
Contractor Date
DATE DATE
\ I FROM: TO:
❑ I am exempt from the licensing requirements as I am a
licensed architect or a registered professional engineer SIZE OF i /!, '�/ NO. OF INSPECTOR S
g 1> g SIGNATURE
acting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 5C � STORIES
iness and Professions Code). 2 m
PRESENT USE OF BUILDING FILIAL APPROVAL
Lic.or Reg.No. Date
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS
ON LOT AND USE
I hereby affirm that I am exempt from the Contractor's
License Law for the following reason (Section 7031.5, Busi-
ness and Professions Code): NO. PARKING
EJ1,
PROVIDED I, as owner of the property, will do the work and the ACCT.8
structure is not intended or offered for sale (Section
7044,Business and Professions Code). 3307
CONSTRUCTION LENDING AGENCY PROPOSED USE OF BUILDING (• �.L- ITEMS` `
I hereby affirm that there is a construction lending agency TOTAL
AL 1! 80 50
for the performance of the work for which this permit is ""�
issued(Sec. 3097,Civ.C.). CASH0.VJ
Lender's Name t
PROPOSED MAX. OCC. CHANGE oII
Lender's Address
PERMIT FEE V
I certify that I have read this application and state that the
above information is correct.I agree to comply with all County ISSUANCE FEE C'rye, i 1 I_0 1 �9
ordinances and State laws relating to building construction, / v tjlil� � '� 11f l�s�
a* hereby authorize representatives of this County to enter TOTAL FEE or7
u on thea ve-mentioned property for inspection purposes. 664 1 Ail 11 e;
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signat of Permittee Date