HomeMy Public PortalAbout10649 FAIRHALL ST_Building__ CITY OF me
76A638A CE4803 8-64 APPLICATION FOR ,BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS ,--2
BUILDING AND SAFETY DIVISION LOCALITY U�Yc �7j
JOHN A LAMBIE COUNTY ENGINEER NEAREST, /
_ COLEMAN W JENKINS,SUP T OF BUILDING CROSS ST
DISTRICT NO GROUP?-TYPE P BY
FOR APPLICANT TO FILL IN G� coNsr �� : ,.v
BUILDING - STATISTICAL CJASSIFICATION_ �_ SEWER �,1AP '
-ADDRESS 10649 �Fairhall CLASS NO DWELL UNITS BK PG
LOT NO .- BLOCK USE ZONE:XMOA _ <
TRACT (,,//
_" SPECIAL
NO OF SLOGS _ CONDITIONS
SIZE OF LOT NOW ON-LOT
USE OF
EXISTING BLDG SETBACK FROM `�
TEL FRONT PROP LINE OF - �/ (STREET)
OWNEREd ar E• McLaren NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS 10649 Fairhall HIGHWAY WIDTH FROM C L
CITY Temple -City - - - +
ARCHITECT OR TEL BLDG SET ACK FROM
ENGINEER NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD - TOTAL
ADDRESS ��� HIGHWAY WIDTH FROM C L - - d
Mfg:id g• Compa TEL 263-5181 + _ - 0
ADDRES�3 S. Woods Avenu LI 169496 CORNER CUTOFF YES � NONO O
CITY Los Angeles CL
ASS C 39 SEE REVERSE SIDE FOR SPECIAL APPROVALS u
W
DESCRIPTION OF WORK °;
NEW ADD ALTER REPAIRX DEMOLISH I _
SQ FT _ NO OF NO OF -
SIZE STORIES FAMILIES _
x ,
USE OF
STRUCTURE reroof house & ara e
SIGNATURE OF
APPLICANT -
VALUATION$ 462.00 -
APPROVALS DATE _ INSPECTOR'S SIGNATURE
P C PMT9.00 �FOFO RMS I MATERIALS
a
FEE$ - FEE$-
FRAME, FIRE STOPS, ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
9UILDING CONSTRUCTION-] CERTIFY THAT IN DOING THE WORK
AUTHO ED HER I WILL NOT E LOY ANY PERSON IN VIOLA LATH INT
TION THE LABOR D OF TH F 1 AT
IN WORK N ATIO U ILATH EXT
S G A RE HOUSE NUMBER COR- '
PER TEE ¢u' RECT AND POSTED 99 _
ADDRESS FI NAL - _'�� '�' f
PLAN CHECK VALIDATION CK M o CASH JOHN F LEWIS PRINCIPAL ST RAL'ENGINEER ^
^ _ PERMIT VALIDATION CK M O CASH
LIi60 0 2 6 4% AlUG 2 4 ' ` 1 D 9.0,0-
t
�`:F?PLI? CATION FOR COUNTY OF LOS ANGELES
C� DEPARTMENT OF COUNTY ENGINEER
.>�- _ U I L D�`N G PERMIT BUILDING AND SAFETY DIVISION
BUILDING
FOR APPLICANT TO FILL IN ADDRESS
ADDF BUILEISS 10649 Fairhall -
LOCA L I T
s NEAREST
CITY Temple City ZIP 91780 CROSS ST
- NO OF SLOGS-- ASSESSOR
SIZE OF LOT NOW ON LOT MAP BOOK PAGE
DISTRICT 15,PQVP TYPE FIRE PROCE ED BY
TRACT77,, BLOCK LOT N- CONST ZONE
OWNERRobert S. Brodie
TEL STATISTICAL CLASSIFICATION
S
_ EWE AP
ADDRESS 10649 Fairhall- CLASS NO�_OWELL UNITS t BK PG
CITY Temple City _ ZIP91780 U ZONE MANO _(/PEI O
ARCHITECT OR TEL -�� SPECIAL -
ENGINEER none NO CONDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
Y
Amu r I all T U..L1uG1D TEp 97
CONTRACTOR No� - BLDG SETBACK FROM
p 7 /'+LLIC- FRONT PROP LI NE OF (STREET)
ADDRESS5819k-Temple it NODlvd HIGHWAY } YARD _ TOTAL SETBACK FROM TYPE OF EXISTING
LIC r� -
CITY Temple- City. CLASS U�l J FRONT PROP LINE HIGHWAY WIDTH
CONSTRUCTION LENDER + -
NAME AND BRANCH 1 a
BLDG SETBACK FROM
ADDRESS CITY SIDE PROP LINE OF (STREET)~
SO FT NO I NO OF CHECK HIGHWAY + YARD -
TOTAL SETBACK FROM TYPE OF EXISTING �
SIZE STORIES FAMILIES ONE SIDE PROP LINE1 HIGHWAY WIDTH
DESCRIPTION-
OF WORK NEW ❑ + 1
Fn(-Io-,e Patio ADD ❑ - CORNER CUTOFF YES ❑ NO ❑ z
ALTER IN OPEN SPACE YES ❑ NO ❑
REPAIRUSE F ❑
EXISOT NG BLDG Dwelling DEMOL E] IN�COASTAL PERMIT ZONE YES ❑A' NO ❑
APPLICAN TAmeric Builder JE
(PRINT) `NO 7-9744
BY (SIGNATURE)V
- I HEREBY ACKNOWLEDGE THAT I HAVE READ IS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS-REGULATING BUILDING CON-
_ STRUCTIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN S COMPENSATION�INSURANCE --
Americ an huilderst
SIGNATURE OFFINALjj BY
PERMITTEE xT' DATE
ADDRESS 5819 Temple City Blvd. VV
s`
CITY Temple City - TE287-9744 PC Fee$ I Permit Fee
Issuance Fee
VALUATION$ j ��� , -
Total Fee
P Er.1- &rI, PERMIT VALIDATION CK M 0 CASH
POLICY . 9' B�kPK I ; 1 - 7 0.0 0
HOLIaER. _
FOLIC-MMUME : C3,91 VY 6
DEPARTMENT OF COUNTY ENGMEEEt
DIVISION OF
UUILDIN SAND SAFETY GELES BUILDING- - -
' WILLIAM J FOX, COUNTY ENGINEER I APPLICATION
CASSATT D GRIFFIN, SUPT OR BUILDING
FOR APPLICANT TO FILL IN r FOR OFFICE USE—ONLY
ADDRBU'LEING DISTRICT NO , PLANCK OR RE c No ,PERMIT NO
10(
LOCALITY ,MA LQ_ C I' RECEIVED BY DATE OF APPL DATE ISSUED
CNEAREST
ROSS BT , t Nae e r
ADDRESS IoG4"'1 Fa%t
LOCALITY
OWNER •MAIL /. , ---}-�
ADDRESS � a'` 7 �� J 1 1 1
STt
CITY,
Sa to (s TELNO CROSSNEARCR038 ST '_I c•�.1 �L-�
p
ARCHITECT OR TEL
FIRE NO OF T.Y�PT' GROUP
ZONE PLANS
ENGINEER NO I
s
ADDRESS BLDG
SETBACK LIN
u CONTRA OR �� TEL _ USE PPROVED ' �_,
ZONE BY i �� DA �1 J
ADDRESS Y S,Sa a r4 /J /uc/'S(
LEGAL MAH�OUSE/,NU NUMBERING
P NUMBER %//11!/ NO ASSIGNED BY
DESCRIPTION LOT NO I BLOCK
j ORRE�C`TIIONS" a
TRACT
SIZE OF LOT �7 X /00 NO OF i NOW ON LOTS
USE OF NO OF -- - w -
EXISTING BLDG FAMILIES
DESCRIPTION OF WORK ; oNW —
REP IR I—) DEMOLAITION TION �I ADDITION I s.. �
D
NO 0
S ZE T (� �n ROOMS STORIES
EXT WALL ROOF
COVERING �] to C C O COVERING ()VLI,D ,
USE OF STRUCTURE
APPROV�LS
INSPECTOR'S SI NATURE DATE
FOUNDATION
FOORMS, MATERIALS
ION
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME FIRE STOPS,
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS ,®
CORRECT
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION
i AND STATE LAWS REGULATING BUILDING CONSTRUCTION GAS VENT, DUCTS
SIGNATURE OF �. LATH, INT
= PER M ITTbe fiE_—r
. •f f LATH EXT
ADDRESS �a IA 60
V N • /
PLASTER, INT
AUTHORIZED AGT
6 PLASTER EXT
$ �/ FEE >s �— HRECT R
AND POSTED
VALUATION FEE
FINAL
76A888A 098 3 8-52 1
I
CITY OF
76A638ACE#8038-64 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS D i ! ,
BUILDING AND SAFETY DIVISION LOCALITY' - j��
JOHN A LAMBIE COUNTY ENGINEER NEAREST
COLEMAN W JENKINS SUPS OF BUILDING CROSS ST
DISTRICT NO GROUP,-TYPE ✓ P BY
FOR APPLICANT TO FILL IN Is", Qi coNsr 'n-BY G,
BUILDING STATISTICAL`CJ ASSIFICATION `l_ SEWER/MAP
ADDRESS 10649 .Fairhall CLASS NO DWELL UNITS _ SK /� PG
LOT NO Cg.1` BLOCK USE ZONE MA
NOP
TRACT � / i'I ' 4/SPECIAL
NO OF BLDGS CONDITIONS
SI ZE'OF LOT NOW ON LOT i
USE OF
EXISTING BLO. �C. �� ai�L� �_(�� BLDG SETBACK FROM
TEL FRONT PROP LINE OF - 4 - (STREET)- '
OWNEREd ar E. McLaren NO TYPE OF EXISTING SETBACK HIGHWAY _ + YARD = TOTAL
ADDRESS 10649 Fairhall HIGHWAY WIDTH FROM C L I
CITY Temple-City - + a _
ARCHITECT OR TEL BLDG SET ACK FROM '
ENGINEER NO SIDE PROP LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD '_ -TOTAL
ADDRESS ��r HIGHWAY WIDTH FROM C L -
CON TRA CT$Iag1d lYlig. ACOMPa TEL 263-5181 + _ 0
ADORES S. Woods AvenU LI 169496 CORNER CUTOFF YES NO NO O
CITY Los Angeles c�
"S C 39 SEE REVERSE SIDE FOR SPECIAL APPROVALS 'v
W
DESCRIPTION OF WORK °;
NEW ADD ALTER - REPAIRX DEMOLISH I
SQ FT _ NO OF _ NO OF
SIZE STORIES FAMILIF_S USE OF
STRUCTURE reroof house & garage
SIGNATURE OF T
APPLICANT
VALUATION$ 462.00 _ APPROVALS DATE INSPECTOR'S SIGNATURE
P C PMT 9.00 IFOFORMS,MA'TERIALSON
FEE$ FEE$-
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS `
13UILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHOED HER I WILL NOT E gLOY ANY PERSON IN VIOLA LATH INT
TION THE LABOR D- OF TH� iFy,i7F I AT
IN WORK NIATIO U +LATH EXT
SG A RE HOUSE NUMBER CCR-
PER EE RECT AND POSTED w'
ADDRESS FINAL
JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
--PLAN CHECK VALIDATION CK -M O CASH _ PERMIT VALIDATION CK M D CASH
JIL0 0 2 6 4 AUG 2 4 1 D 9.00-
�`:P'PL I SAT O N FOR COUNTY OF LOS ANGELES
" DEPARTMENT OF COUNTY ENGINEER
13 U 1 L D N G PERMIT BUILDING AND SAFETY DIVISION
BUILDING
FADDRESS
R APPLICANT TO FILL IN ADDRESSBUIL
0649 Fairhall - '
�+ LOCA LI T
ple Vit - ZIP 91780 CROSS ST
NO OF BLDGS-- - ASSESSOR `
SIZE OF LOT NOW ON LOTMAP BOOK PAGE
' DISTRICT P TYPE FIRE PROCE ED BY
TRACT BLOCK LOT N ~� CONST ZONE
oWNERRobert S. Brodie NEL 579-366 U� 3
STATISTICAL CLASSIFICATION SEWE AP
ADDRESS10649 Fairhall CLASS NOe��DWELL UNITS BK PG
CITY Temple City ZIP91780 U ZONE N
o
ARCHITECT OR TEL L
ENGINEER none NO NDITIONS
ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑
L MP- 1C a J:ILl.L.LLL-_.L,->A TE
CONTRACTOR N05g7_97
R - 44BLDG SETBACK FROM
p 7 LIC- FRONTPROP LINEOF (STREET)
ADDRESS5819y Temple Clt N011lvd HIGHWAY } YARD = TOTAL SETBACK FROM TYPE OF EXISTING
LIC J FRONT PROP LINE HIGHWAY WIDTH
CITY Temple City CLASS -D_l _
CONSTRUCTION LENDER }
NAME AND BRANCH a
_ BLDG SETBACK FROM O
ADDRESS CITY SIDE PROP LINEOF (STREET) G�
SQ FT- NO OF NO OF CHECK HIGHWAY } YARD
TOTAL SETBACK FROM TYPE OF EXISTING
SIZE STORIES FAMILIES ONE SIDE PROP LINE HIGHWAY WIDTH O�
DESCRIPTION OF WORK NEW El } - -
'Rnolose yPatio ADD ❑ - CORNER CUTOFF YES ❑ NO ❑ z
ALTER
"! /'� REPA R❑ IN OPEN SPACE YES ❑ NO ❑
EUSE FXISOT NG BLDG Dwelling DEMOL [:1 IN COASTAL PERMIT ZONE YES ❑ NO ❑
APPLICANT Amer ii n$ui lder�OL S' �2' -eAf j� �id,�,V C.A• �"��-�-�
(PRINT) "'NO 7-9744 ,
BY (SIGNATURE)p '
I HEREBY ACKNOWLEDGE THAT I HAVE READ VHIS APPLICATION =
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL ORDINANCES AND LAWS,REGULATING BUILDING CON-
STRUCTIONI CERTIFY THAT IN DOING THE WORK AUTHORIZED - --
HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO
WORKMEN'S CO
SIGNATURE OF E -- -
American Auilders FINAL BY
PERMITTEE IF* DATEU/
ADDRESS-5819,39, Temple City Blvd,
CITY Temple City - TE287-9744 P C Fee$ Permit Fee '
Q Issuance Fee
VALUATION$ �;ad - /)
Total Fee v
p E_W5A T 1_ _ - PERMIT=VALIDATION—cK.=M o�cASH
f 958u2APK 17 {1 1) 70.00 ®°
POLICY HOLDER; -
_POLICY-AJMHB.R: Cad
I
DEPARTWIENT OF COUNTY ENGINEER
DIVISIO OF UnMM SAND SAFETY BUILDING -
WILLIAM J. FOX, CouNTY ENGINEER ! APPLICATION -„u
CASSATT D GRIFFIN, SUP'T OF BUILDING s
FOR APPLICANT TO FILL IN I FOR OFFICE USE,ONLY
DISTRICT NO PLAN
�CKK"�OR REc No' PERMIT NO
Lb
ADDRESSG � D l' S 11 "r7S J� � ' 3 V4 1
LOCALITY Q RECEIVED BY DATE OF APPL / DATE ISSUED
NEAREST
CROSS ST
BUILDING ,` ((^�,�
OWNER ADDRESS, 10064 'I �o—LA-
r
ADDRESS �, �L� S -� �� �• _ LOCALITY J 1 1 i
MAILOOR�� NEAREST
CITY Q Gr ' TEL CROSS ST ,
p. N O
ARCHITECT OR - TEL FIRE NO OF TY�PT' GROUP{
ENGINEER NO ZONE PLANS
BLDG
ADDRESS SETBACKLIN �lJ 1 t t ,
-- =-CONTRA O _ /`,J /A�L,'t
TEL L _` USE a PPROVED
_ _ _ ZONE BY I � � ,DAT J
ADDRESS ` y gl s; a �4T fi\!!a, �uGf,S� 1�I HOUSENUM1f�ERIN6 t/
LEGAL MAP NUMBER /�Z4;/� NO ASSIGNED BY ``
DESCRIPTION I LOT NO I BLOCK s ORRECTIONS""'
TRACT / \t ���
NO OF BLDGS
SIZE OF LOT NOW ON LOT
USE OF NO OF
EXISTING BLDG FAMILIES
D TION OF WORK t - 0 -
REP IR —I ALTERATION �I ADDITION
Z
DEMOLITION // /NEWr
NO OF
SIZE SQ FT ' ROOMS C STORIES �(
EXT WALL (� ROOF
COVERING Gl C C O COVERING vv_o.
USE'OF STRUCTURE
APPROV.I.S
INSPECTOR'S SI NATURE DATE
FOUNDATION LOCATION _ / J/��g
FORMS, MATERIALS yC/
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS, ol
PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS
CORRECT FURNACE LOCATION
1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS ,
• AND STATE LAWS
pyREGULATING� BUILDING CONSTRUCTION
ol
SIGNATURE OF yi,� 1 /►,/� �J U. LATH, INT
z PERMITTfifi I ' % ( lPP1J (�
LATH EXT
ADDRESS �! '�� •� V� n
^ AUTHORIZED AGT PLASTER, INT ^�I' /
7 PLASTER, EXT A W ! ),0"/
FFEE OUSE NUMBER COR- �yy,�/� •a
���� o
RECT AND POSTED
F A
VALUATIO S r„
HFINAL , J b
78AS88A 01119 3 8-82 ® '
WORKERS COMPENSATION DECLARATION
APPLICATION FOR BUILDING PERMIT
I hereby affirm that I have a certificate of consent to self
msu,T, or a certificate of Workers Compensation Insurance, s
,or b certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY t
,Policy No Company
Certified copy is hereby furnished FOR APPLICANT TO FILL IN" BUILDING
1:1
ADDRESS
❑ Certified copy is filed with the county building inspec- BUILDING _ _
i- tion department ADDRESS f(� V
Date - Applicant CITY /%' ' 7 ZIP 91LOCALITYTEM
p OF BLDGS NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT S7�" O OW ON LOT Z } CROSS ST
COMPENSATION INSURANCE k ASSESSOR
(This section need not be completed if the permit is foi one TRACT / �d�7 BLOCK LOT NO MAP BOOK PAGE PARCEL '
hundred dollars $100 or less - TEL
( )a r, ) 5• OWNER �f d/SI ,LLQ NO rO0 USE ZONE MAP - 4
NO
I certify that in-the performance of the work for which this c� SPECIAL-, - r >-
permit is issued, I shall not employ any person in any manner ADDRESS !jJ �r l-Ip �/F + CONDITIONS 4 O
so as to become subject to,the Workers' mpensation Laws
CIU
- TY LZIP/ ,�M /¢ U
Date d�` ��Applicant ARCHITECT OR TEL _ DISTRICT GROUP TYPES" _ : FIRE PROCESSED BY 0
" NOTICE TO APPLIC NT If, afteibor
king is Certificate-of ENGINEER - NO = CONST i ' ZONE ``
Exemption, ou,should becomub ect to the Workers' U
Compensation provisions of the Code, you must forth- ADDRESS �iv � - I � a
with comply with such provisions or this permit shall be TEL STATISTICAL CLASSIFICATION APT CONDO N
deemed revoked CONTRACTOR NO Z
{ LICENSED CONTRACTORS DECLARATION - LIC, CLASS NO DWELL UNITS -
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO
(commencing with Section 7000)of Division 3 of the Business LIC SEWER MAP
and Professions Code,and my license is in full force and effect [APPLICANT
CLASS BK PG VALIDATION e
T NO OF / NO OF CHECK _
License Number Lic Class Q STORIES ( FAMILIES / ONE }
_ T VALUATION
Contractor Date ^ RIPTION OF WORKetcT P/9SS 1`I�,ev 'NEw ❑ ;
❑I am exempt under Sec P /S 1 1 t ADD ❑ ,
ALTER ® -
B 8P C for this reason (9 P,44G P'1/Z1/V4 REPAIR ❑r V $ _
Date F DEMOL ❑
ING BLDG QST iv�C� i
_ TEL 1 )'Y Signature OWNER-BUILDER DECLARATION RINT)eJ O !V' ` I'm NOg OOQ.3,S FINAL ^ a
DATE ,v
I hereby affirm that I am exempt from the Contractor s License
Law for the fode) PRESENT llowing reason (Section 7031 5, Business and ADDRESS - FINAL
' Pfessions Co _ BY x - A
BUILDING HC4 1 •a
1, as owner of the property, or my employees with ADDRESS
wages as'their,sole compensation,will do the work and `(`I�r �, Wer• 1'Lt
the structure is not intended or offered for sale(Section LOCALITY � i 7Tr -
7044, Business and Professions Code ) MOVING TEL _, - , - 1 T t a�ti - -
-
❑ I, as owner of the property, am exclusively contracting CONTRACTOR NOTOTAL 0
with licensed contractors to construct the project (Sec- - - t ®'
ADDRESS ,.HEC K 33.CO
n -�-,
tion 7044, Business and Professions Code ) �` 4 ei
REQUIRED TOTAL SETBACK FROM EXIST tw y' ' C
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH Frti = 9 •LILT
I hereby affirm that there is a construction lending agency for, FRONT (7G
the"perfofm6nce of the work,for which this permit is issued » P L
(Sec 3097, Civ C ) SIDE } y i
P L - e - i jllilJ�(i111y�i 1i f 1tf
Lender's Name °
t P C Fee$ _ Permit Fee V < LDMA Ref #i (LL/ 1 AM 8.'71
i
Lender's Address' Oil.
z p
o I certify,that I have read this application and state that the Issuance Fee 0*5n LDMA P/C# "
8 •above information is correct I agree to comply with all County Investigation Fee y -
R ordinances and State laws relating to building construction, Total Fee I LDMA Perm #
and hereby authorize representatives of this County to enter -
upon the ob e-me tw e�property for inspection purposes
` (� SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign re ofp scant or Agent Date
- * s
G
WORKERS'COMPENSATION DECLARATION Y
hereby affirm that I havecertificate of consent to self _ APPLICATION' FOR BUILDING PERMIT �
insure, or a certificate of Workers' Compensation Insurance, , '
or a certified copy thereof(Sec 3800, Lab C )
,,- COUNTY OF LOS ANGELES. BUILDING AND SAFETY
Policy No Company BUILDINGe�
Certified copy is hereby<furnished, FOR APPLICANT TO FILL IN ADDRESS 9
Certified copy is filed with the county building-inspec- BUILDING
tion department ADDRESS Q LOCALITY
NEAREST r N
Date Applicant CITY F ! r ZIP CROSS ST
r CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR_,-'
COMPENSATION INSURANCESIZE OF LOT NOW ON LOT MAP BOOK I PAGE PARCEL a
(This section need not be completed if the permit is for one USE ZONE MAP
hundred dollars($100)or less ) TRACT BLOCK LOT NO
NO }
OWNER O C NO J �6 S /J SPECIAL i
CONDITIONS,
I certify that in the performance of the work fo�`which this ISTRICT GROUP TYPE r FIREAP SSED BY O
"permit is issued, I shall not employ any person in any,manner r CONST ZONE U
so as to become subject to the Workers'Compensation Laws ADDRESS�� / L /t0 _ - i
Date ApplicanT����v CITYr� GE 1 ZIP STATISTICAL CCA SIFICATION APT CONDO � ,
—'-7 ARCHITECT OR TEL U
NOTICE TO APPLICANT If, of nakmg this rhficate of _ ENGINEER NO` _ CLASS NO DWELL UNITS r W
Exemption, you should become subject to the Workers CL
Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP - N
with comply with such provisions or this permit shall be Z
deemed revoked CONTRACTOR( Co O BK PG VALIDATION
LICENSED CONTRACTORS DECLARATION / I LIC
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 14j O /1 p 0` NO3VALUATION L
(commencing with Section 7000)of Division 3 of the Business and LIC B .� r
Professions Code, and my license is in full force and'effect CITY �- CLASS 0 VV �0�? ►
U SQ FT NO OF „ NO OF C ECK
License Number Lic Clas CJ "C7 y SIZE STORIES FAMILIES ONE '
DESCRIPTION OF WORK L'iY F NEW El "� _ +
Contractor Dare ADD ❑ '
I am exempt under Sec Q G
SAF �iy�L G'Y�� ALTER" O DA EFINAL /D "(J�
B 8P C for this reason REPAIR }
Date l USE OF FINAL
EXISTING BLDG �� DEMOL ❑ FI r�" ,
Signature APPLICANT TEL _
WNER-BUILDER DE ATION PRINT O No 3 r
+ I hereby affirm that I am exempt from the Contractor s License r
Law for the following reason (Section 7031 5, Business and ADDRESS
Professions Code) PRESENT r
BUa 5 3 6 A
WING " y
1, as owner of the property, or my employees with ADDRESS ,
wages as their sole compensation,will do the work and t o o o o 0•1 �+
the structure is not intended or offered for sale(Section I LOCALITY i ,
7044, Business and Professions Code) - [AD
ING TEL } 2 a a 32 50
TRACTOR NO
I, as owner of the property,'am exclusively contracting � -
with licensed contractors to construct the project (Sec- RESS o; a 3 2.50 c='
tion 7044, Business and Professions Code)
UIRED TOTAL SETBACK FROM EXIST ' t � "'� ro +� !,'O 9, 1 9—8'3
CONSTRUCTION LENDING AGENCY BACK YARD HWY PROP LINE WIDTH 1
I hereby affirm that there'is a construction lending agency for ONT
the performance of the work for which This permit is issued
(Sec 3097, Civ C ) E a.a
m Lender s Name
" - Fee E Permit Fee
Lender s Address -
I certify that I have read this,application and state that the Issuance Fee `
above information is correct I agree to comply with all County Investigation Fee -
$ ordinance's and State jaws relating to,building construction, Total Feem
d -and hereby authorize representatives of this County to enter
upon the above-mentioned property for inspection purposes f '
Q r '
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of App 1 or 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 0606010005
PHONE (626) 285-0488 EXT
LEGAL ID NO OF CONST BUILDING ADDRESS
TR 19189 LT 26 SQ FT STORIES TYPE 10649 FAIRHALL ST
STRUCTURE 775 VN TEMP CA 917804121
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET PAL MAL
8585-027-012 THOMAS PAGE 597 GRID C4 LOCALITY TEMPLE CITY C
TENANT EXIST BLDG USE RESID USE ZONE R-1 ISSUED ON PROCESSED BY EXPIRES ON
EXIST OCC GRP 06/01/06 JK 05/27/07
OWNER TEL NO BLDGS NOW ON LOT VALUATION FINAL DATE FINlAkBY CODE
BALLADARES, MARIO (626) 616-6381- 7,000 77 /'O
10649 FAIRRALL ST / /
TEMP 917804121 FEES PAID DESCRIPTION OF WORK
RE-ROOF CHANGE PITCH 30 YR SHINGLES 2 X 18 RAFFEERS 25' SPAN
FEE DESCRIPTION QUANTITY UOM AMOUNT
APPLICANT TEL NO
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27 75
AC STRONG MOTION RESID 7000 00 VAL 0 70 SPECIAL CONDITIONS
AX BUILDING REVIEW FEE 54 70
D2 PERMIT W/0 EN-HC 7000 00 VAL 166 20
TOTAL FEES 249 35
CONTRACTOR TEL NO APPIOVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC NO LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER TEL NO FOUNDATION/TRENCH FORMS
LIC NO SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP UNDERFLOOR INSULATION
144H273 3 01
FLOOR SHEATHING
NO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHETp PANELS
AIR QUALITY 1000 FEET MATERIALS
NO NO NO FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD HWY PROP LINE WIDTH
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTFRIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID DPR261 ROUTE TO BS0508
1