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HomeMy Public PortalAbout10653 FAIRHALL ST_Building__ r DEPARTNMT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY COUNTY OF LOS ANGELES BUI A r ` _ WILLIAM J FOX, COUNTY ENGINEER APPLICATION CASSATT D GRIFFIN, SUPT OF BUILDING 4 FOR APPLICANT TO,FILL IN 1 FOR OFFICE USE ONLY BUILDING (( ti DISTRICT NO PLANCK OR REc No PERMIT NO J ADDRE68 �U ,� 5 1�C.] '� �� 38)41- -,LI LOCALITY G RECEIVED BY i DATE OF APPL ATE ISSUED NEAREST Ly ' CROSS ST Q/ -P_ OWNER �� () ADDREBUILDSS SG ©�.CS I-= , �C�Ir' �� g1 MAIL �/ LOCALITY c ADDRESS T NEAREST} CITY ITEL NO / e CROSSST �a ' � V FIRE p NO OF TYPE GROUP ENGINEER OR TEL ZONE I PLANS it �' BLDG ADDRESS SETBACK�LINF. CONTRA T OR r J TEL 7- 14 USE PRROVED / ZONE J BY �ir= DATE ADDRESS /�+./ , C/6 1 p, Q U�r <�f� HOUSENUMBERING LEGAL MAP NUMBER '�20 / e , NO ASSIGNED BY + DESCRIPTION LOTNO I BLOCK Y -:-- CORRECTIONS--T , n TRACT ,�, A 1 SIZE OF LOT N D U I NOW ON LOT USE OF I NO OF EXISTING BLDG FANILIKs DESCH IPTION OF WORK ; o — ALTERTION REP IR I-I DEMOLITION j_j ADDITION G1 � Z D SQ / r r S ZE T /OtD�J ROOMS STORIES I EXT WALL ! ROOF COVERING /�(jL I COVERING rO USE OF STRUCTURE - APPROV INSPECT 'S SIGNATURE DATE FOUNDATION LOCATION y FORMS MATERIALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME FIRE STOPS, 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 LAW/S�REGULATING BUILDING CONSTRUCTION SIGNATURE OF N ' �' LATH, INT PERMITTER r 111 e (T [[[ 1111 / ADDRESS + Z� ,d ` LATH EXT / PLASTER, INT 1 1� AUTHORIZED AGT PLASTER ,EXT S/ �Q� i FEE S '�� HOUSE NUMBER COR- !i RECT AND POSTED VALUATION FEE f 2� FINAL $ v 7GA"BA DHB 3 8-32 DEPARTMENT ENGII .DIVISION OF BUIUILDfNGNG, dEElt AND SAFETYBUILDING COUNTY OF LOS ANGELES _ 2 WILLIAM J FOX, COURTY ENGINEERAPPLICATION CASSATT•D GRIFFIN,' SUC T OF BUILDING FOR APPLICANT TO FILL SIN FOR OFFICE USE ONLY BUILDING {�! (+ r / (�•S DISTRICT NO P�pLAN C7rK�,OR R.-1NOO [PERMIT NO ADDRESS V Jf� (f(�/' ( J`P i f�i.� 1 Q — LOCALITY ( �LLI /4° +�.,_t' 1\ i. r RECEIVED BY DATE OF APP V ATE ISSUED r NEAREST. I►� U ! a Q r /, - V CROSS ST- C. �"� BUILDING ^� {�� 1 OWNER P« i m 161'J`� ADDRESS ����.5 3 � 1 Y—� I� ��1' D MAIL ADDRESS �I 6� Z c1 ,< [�fA t✓ t Gr (i&10 LOCALITYNEAREST 1 11F i 3 }' CROSS ST CITY /`ie r !�q"ARC �! IOR u NO ' PLANKS �TYP ENGINEER ZONE E� I GRO�p ADDRESS SBLDG ETBACK LIN CONTRACTOR i NO 7" 7-6/i USE ONE , BYPROVED""� DATE 9 / (� �( fi `n ; J� HOUSE NUM ERING ADDRESS .[ ! JCI/. G"l 6t' i r�IIIC LEGAL MAP NUMBER ,011a NO ASSIGNED BY DESCRIPTION I LOT NO I BLOCK j 9 r �,g CORRECTIONS TRACT S,�Ci 8 Q y NO OF BLDGS SIZE OF LOT �t I NOW ON LOT USE OF I NO OF ' EXISTING BLDG FAMILIES DESCRIPTION OF WORK v - C NEW `Iv I ALTERATION ...I ADDITION r REPAIR DEMOLITION I �i Di 811 FT //�! f" ROOMS (D STORIES m NO OF SIZE (iC'nJ . ?„ EXT WALLC�/ ROOF COVERING -) T P! A I COVERING USE OF STRUCTURE ' - a APPROVALS E INSPECTOR'S SIGNATURE DATE 'S FOUNDATION LOCATION FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ,,,THIS AP- FRAME FIRE STOPS,' PLICATION AND STATE THAT THE INFORMATION4 GIVEN IS BRACING, BOLTS CORRECT ' 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE LOCATION, , AND STATES LAWS REGULATING BUILDING CONSTRUCTION GAS VENT, DUCTS SIGNATURE OF P` ` /� �J LATH, INT PERMITTEE 6 r f� tl ` r/' f n �,r i LATH EXT ADDRESS✓ ( [ _ PLASTER, INT AUTHORIZED AGT` _ r ° PLASTER, EXT FE ''$ HOUSE NUMBER COR- E RECT AND POSTED j VALUATION c{ ,$ U O 'FEE 2� FINAL ' 76AG38A DHS 8 8-52 , 1 r L' 'APPLICATION FOR BUILDING PERMIT COUNTY,OF LOS AN BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN }BUILDING ADDRESS y� I hereby affirm that I have a certificate of consent to self Insure BUILDING ADDRESS or a certificate of Workers Compensation Insurance or a certified 10653 E. FAIRHALL copythereof(Sec 3800 Lab C) ` CITY ZIP " Pol,cy No 1046140 STATE FUND TEMPLE CITY 91780 LOCALIT Company SIZE OF LOT NO OF BLDGS NOW ON LOT ❑ Certified copy is hereby furnished NEAREST CROSSOOST Mertlfled copy Is filed with the county building Inspection ' TRACT BLOCK ' LOT NO - department USE ZONE MAP NO Date ` 11-1-96Appl,cant RANDOL ROOFING ASSESSOR MAP BOOK PAGE - PARCEL - I ' r SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER - TEL NO � COMPENSATION INSURANCE JEAN DOLAN 444-0981 WITHIN 1000 FT OF SCHOOLS i YES No DRESS (This section need not be completed,f the permit,s for one hundred AD 10653 E. FAIRHALL - DISTRICT GROUP TY `ONST FIRE ZONE PRO ESSED BY dollars ($100) or less) I certify'that,n the performance of the work for which this permit CITTEMPLE `CITY, CA ZIP 91780 e� �� Is Issued I shall not employ any person In any manner so as to become subject to the Workers Compensation Laws ARCHITECT OR ENGINEER TEL NO STATISTICAL CLA�SJ,,SIFICATION APT CONDO -- Date Applicant ADDRESS f CLASS NO � DWELL UNITS NOTICE TO APPLICANT If after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption you should become subject t0 the Workers CONTRACTOR TE p SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code you must forthwith RANDOL ROOFING 9%-4040 FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS, LIC NO PL LICENSED CONTRACTORS DECLARATION 529 E. VALLEY BLVD. 451937 SIDE CITY LIC CLASS P L I hereby,affirm that I am licensed underprovlslons of Chapter 9 RAN CARRTFT, CA C-39 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ FT SIZE NO O STORIES I NO OF FAMILIES ` Professions Code and my license Is In Will force and effect NEW ElBK PG ® } License Number 451937 L,c Class C-39 DESCRIPTION OF WORK ADD ❑ VALUATION a contractor RANDOL ROOFINGte 1-31-96 ALTER ❑E WITH $ 3,000.00 OV , 20—YEAR CLASS A FIBERGLAS REPAIR L F-1I am,exempt under Sec $ O BBPC for this reason SHINGLES. TEAR OFF ONE` LAYER w - - I— ~ USE OF EXISTING BLDG DEMOL ❑ LDMA P/C#, W Date URM ❑ I J m - U) Signature App T(PRINT) TEL NO LDMA Perm# Z ❑ I as owner of the property or my employees with wages as RANDOL ROOFING 288-4040 Z their sole compensation will do the work and the structure ,s ADDRESS - O not Intended or offered for sale (Section 7044, Business and 529 E. VALLEY BLVD., SAN GABRIEL FINAL DATE Q 1 � Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL l ❑ I as owner Of the property am exclusively contracting,With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY licensed contractors to construct the project (Sect,on_7044 VES El No E3 � { Business and Professions Code) > WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGr/, OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH .,C���•_�/ �� + CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)D)SEE PERMITTING CHECKLIST FOR GUIDELINES 1 I hereby affirm that there ,s a construction lending agency for VES❑ No❑ a the performance of the work for which this permit Is Issued(Sec rnIHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 1 3097 CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE TITLE 2 CHAPTER 2 20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS Lender s Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD W oLenders Address O OWNER OR AGENT , o I certify that I have read this application and state under penalty 0 of perjury at the above Information Is correct 1 agree to Comply PC FEE PERMIT FEE 98.25 w with all C n ord, nces and State laws relating to building _ 00 con t,o y authonz rep sentatives of iJ11s CountyISSUANCE FEE' Cl) to ente U e e e n rty for In ectl p rposes 27.30 m INVESTIGATION FEE - TOTAL FEE sg�m�re Ao - 125.55 ' SEE REVERSE FOR EXPLANATORY LANGUAGE i