HomeMy Public PortalAbout5520 ENCINITA AVE_Building__ _.,DEPFiRTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMT
COUNTY OF LOS ANGELES U I L®I N G
'WM I.I. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDIN _ _ .\ / A , _ DISTRICT NO PLANCK NO �PyER/MIT NO
ADDRESS
LOCALITY � j;Ir, -^u- %;E C.a ) RECEIVED BY DATE OF APPL DATEISSUED
CROSS ST, B i� Q R V"'o f S
BUILDING
OWNER
0� 1 �Zer*�� � S6sk���, ADDRESS �
MAIL ` !!./ A, `1 LOCALITY
ADDRESS J �� N G 1� C'• i i •� NEAREST ,
CITY c-iv%j0L0 C:� • TEL NO �T CROSS ST
6/Gs'
'FIRE NO OF TYPE I GROUP
ARCHITECT OR TEL ZONE PLANS
ENGINEERS NO BLDG ORD NO
SETBACK LINE
ADDRESS l,���// ./� y ABy PPROVED
CONTRACTOR �� frl�. GpI/S�` NO jilt-
!1 USE AP ED DATE
ZONE DATE
ADDRESS �Z.ya s� -�/Qf-q� �; �.
HOUSE NUMBERING
LEGAL
DESCRIPTION LOT NO vv BLOCK MAP NUMBER FIELD CHECK BY
TRACT 0_ 4 Q NO ASSIGNED BY DATE
NO OF BLDGS - CORRECTIONS --
SIZE OF LOT NOW ON LOT
USE OF ,A �I NO OF
EXISTING BLDG, W CSL-�--- 1� FAMILI119
DESCRIPTION OF WORK _
,
NEW I I ALTERATION I I ADDITION
REPAIR I (.DEMOLITION I
' SQ FT NO OF _ 'n
SIZE ROOMS STORIES Z
EXT WALL ROOF ID'
COVERING I COVERING
USE OF STRUCTURE
im
FA
- APPROVALS
INSPECTOR'S SIGNATURE DATE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS]IS
FOUNDATION LOCATION
PLICATION AND STATE THAT THE INFORMATION GIVEFORMS, MATERIALSCORRECT
I AGREETO COMPLY WITH THE CORRECTIONS LIFRAME FIRESTOPS,
HEREON AND WITH ALL COUNTY ORDINANCES AND SBRACING, BOLTS
LAWS REGULATING BUILDING CONSTRUCTION
QFURNACE LOCATION,
SIGNATURE OF � Y �A1 Com' GAS VENT, DUCTS
PERMITTE y �+ ,,/ '
ADDRES6 f� 3O R j� (� L� _ LATH, INT
LATH, EXT ,
AUTHORIZED AGT
PLASTER, INT
76AC38A 0683 10-80 P C $
® , O FEE PLASTER, EXT I -
IVALUATION „!S FEE �.�. FINAL �,1�-^--r'�'4
I v v
V,;0RKWS'COMPENSATION DECLARATION
`J
I-.-,,sure,oroa certificate of Workersirtificate of' Compensat conon Insuranceelf APPLICATION FOR BUILDING PERMIT
or a certified copy thereof (Sec 3800, Lab C )
COUNTY OF LOS ANGELES BUILDING AND SAFETY ,
Policy No Company
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING t t
ADDRESS {) ft- r 6.
Certified copy is filed with the county building inspec- BUILDING_
tion department ADDRESS (� F y t >
Date Applicant CITY Tiivll ZIP LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' O OF BLDGS NEAREST
COMPENSATION INSURANCE SIZE OF LOT /0 OW ON LOT CROSS ST /)411:11_4_& C_1 Cf
(This section need not be completed if the permit is for one TRACT [ BLOCK LOT NO ASSESSOR '
hundred dollars ($100)or less ) r MAP BOOK GE PARCEL
OWNER ` �{ NO USE Z NE MAP
1 certify that in the performance of the work for which this NO
per is issued, I shall not employ any person in any manner ' -f _ ' SPECIAL
so as to become subject to the Workers'Compensation Laws ADDRESS CONDITIONS 4
' , V i
Date — y Applicant y CITY yl ZIP - ♦il-
i ARCHITEC OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTI T APPLIC T If, afte king s e icate of ENGINEER NO CONST ZONE Q
Exemption, you ould beco subject t th Workers' �i /)}(� V
Compensation provisions of th Labor Code, you must forth- ADDRESS J(JcJ �� ✓ 3 W
with complyl,with such provisions or this permit shall be --
deemed revoked �/� TEL STATISTICAL CLASSIFICATION APT ONDO N
CONTRACTOR NO Z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ` f NO
(commencing with Section 7000)of Division 3 of the Business and 1 ,LIC SEWER MAP
Professions Code, and my license is in full force and effect CITY f i CLASS VALIDATION
SQFT NO OF NO OF CHECK BK PG
License Number Lc Class SIZE STORIES lY FAMILIES ONE
VALUATION
NEW G
Contractor Date DESCRIPTION OF WORK /� s /6
�� ADD
D I am exempt under Sec
pool
ALTER
B 8P C for this reason REPAIR $
USE OF
Date EXISTING BLDG DEMOL
APPLICANT TEL
Signature ✓ A (�� NO - FINAL f -
OWNER-BUILDER DECLARATION PRINT DATE 6 -
I hereby affirm that I am exempt from the Contractor's License t
Law for the following reason (Section 7031 5, Business and ADDRESS ��� C` 1 r FI 7 4 7 5 A
Professions Code) E #
BUILDING ' t) - 21 a 6 3
I, as owner of the property, or my employees with ADDRESS e u 2 1 &63'
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY 7, 1 5-870
7044, Business and Professions Code) MOVING TEL
1, as owner of the property, am exclusively contracting CONTRACTOR NO
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code)
REQUIRED YARD ' HWY TOTAL ROPSETBACK
FRnrlo
CONSTRUCTION LENDING AGENCY
SET BACK PROP LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P L
(Sec 3097, Civ C ) SIDE
PL _
Lender's Name
LDMA Ref k
m Lender's Address PC Fee S Permit Fee (/U
1 certify that I have read'this application and state that the Issuance Fee /0, JOU LDMA P/C#
above information is correct I agree to comply with all County Investigation Fee
S ordinances and State jaws relating to building construction, Total Fee LDMA Perm q '
R and hereby authorize representatives of this County to enter
upon the above-mentoned property for inspection purposes
a / SEE REVERSE FOR EXPLANATORY LANGUAGE
m
gnature of Y
I ICGo Agent Date
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 0308280028
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING
TR: 12410 LT: 20 SQ. FT STORIES TYPE 5520 ENCINITA AV:
STRUCTURE: VN TEMP CA 917802307
ASSESSOR NEAREST CROSS STREET: BROADWAY
8588-002-020 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG USE. RESID TISE - D BY EXPIRES ON:
EXIST OCC GRP: 08/28/03 JK 08/22/04
OWNER: TEL. 0: BLDGS NOW ON LOT: VALUATION. :/�D OD :
JENNY/JEFFREY (626) 795-8162- 9,900 5520 ENCINITA AVE �' v
TEMPLE CITY 91780 FEES PAID DESCRIPTION
T/0 EXISTING WOOD SHAKE, INSTALL 7/160SB & 30#FELT & MONIER
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: LIGHT WEIGHT TILE (590#/SQ)
APPLICANT. TEL. NO:
CHARLIE WANG (714) 961-1266- AA BLDG PERMIT ISSUANCE 27.75
1955 BROOKHAVEN AVE AC STRONG MOTION RESID 9900.00 VAL 0.99 SPECIAL CONDITIONS:
PLACENTIA D2 PERMIT W/O EN-HC 9900 00 VAL 216.60
TOTAL FEES 245.34
CONTRACTOR: TEL NO: APPROVALS DATE INSPECTOR SIGNATURE
CHARLIE THOMAS WANG (714) 961-1266-
1955 BROOKHAVEN LIC. NO LOCATION AND
PLACENTIA, CA 92870 C39
SOILS ENGINEER
APPROVAL-
GI TFOUNDATION/TRENCH
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP O: SEWER MAP BOOK: PAGE: FIRE ZONE- CM UNDERFLOOR INSULATION
147H265 3 01
L R SHEATHING
0. OF FAMIL15S DWELLING UNITS APT/COND:
NO 21 ROOF SHEATHING
SCHOOLPANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAME INSPECTIO
REQUIREDTOTALRS
SET BACK YARD- HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR
EXTERIOR LATH
7/7-/0 3 A.dv-7" �'ZA�y �,?�
9/?/U 3 - �IPOZ 7 OA'eel Z 01 RATED WALL B I S
CEILINGS
* ADDITIONAL DATA ON FILE LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508