The URL can be used to link to this page

Home My Public Portal About10665 FAIRHALL ST_Building__ TEMPLE CITY 76A638A CE u6o3 z-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENQINEER ADDRESS (/ BUILDING AND SAFETY DIVISION LocALlr�' i t JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. �J�C DISTRI N G OU. TYPE � PR B FOR APPLICANT TO FILL,.-IN ® ONST. BUILDING / r �A/ p '` �' STATISTICAL CLA SIFICATION SEWER MAP ADDRESS �O (�J 'j/��J` /�x___� / CLASS. NO_2/_ DWELL. UNITS BK PG LOT NO. /P 9 BLOCK �"� WATER NOT REQUIRED RECEIVED ❑ TRA�fCQT�/ ]�/ / 7 CMAPERTIFICATE: /-� SIZE�O�F LOOT r • / NOW ON LOTS 2 NO. "�jL L% HIGHWAY STATE MAJOR SECOND, CAC USE ZONE SPECIAL USE OF n ` r .CONDITIONS EXISTING BLDG. RA O t W 4 ([S�JC' G / OWNER we S-0 � dclemA ,l/PbUC//NO• �0 X10 ;N� BUILD NG tL� { SETBACK YARD HWY STREET NAME EXIST. WIDTH ADDRESS FRONT `t ARCHITECT OR TEL. ENGINEER N SIDE P. L. d ADDRESS O TEL. V CONTRACTOR NO. ADDRESS -'� _21 LA " O DESCRIPTION OF WORK w (1AIL N NEW ADD ' ALTER REPAIR DEMOLISH Z SO. FT /t yt0. OF NO; OF -- _ SIZE ¢JI z_c rCNeCTORIES FAMILIES USE OF /r STRUCTURE �� 7 f . /54 SIGNATURE F APPLICANT -tel VALUA O APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEFEE $ FORMS. MATERIALS 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. WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS BUILDING CONSTRUCTION.'I CERTIFY THAT IN,DOING THE WORK AUTHORIZED HEREBY IWILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. TION OF THE LABOR CCDC OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S CO PEN SATION INSJtU^�RANCE. LATH. EXT. SIGNATURE OF� / HOUSE NUMBER COR- PERMITTEE i RECT AND POSTED n ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STRUCTURAL EN P AN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK.f 1 M.U. CASH LLO2 8 9 2:fl AUG 2Q 1 D 1.00Nckl r I 1, DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY COUNTY OF LOS ANGELES BUILDIN,G .k WILLIAM J. FOX, COUNTY ENGINEER APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING /f�/ r �� B / DISTRICT NO. PLANCK.OR REc.No. PERMIT NO. ADDRESS V l7 b 8 57 LOCALITY d' RECEIVED BY DATE OF APPL. DATE ISSUED NEAREST �I e any., CROSS ST /'� BUILDING OWNERy / (G` (V''IJ ADDRESS MAIL ADDRESS y tl� J , J a d ItLNEAREST OCALITY TEL P®� ! CROSS ST. y CITY GS8 O r 6 ARCHITECT OR TEL. FIRE NO. OF TY GROUP ENGINEER NO. ZONE PLANS ADDRESS BLDG. � RD. ADDRESS SETBACK LINE - nA TEL. ' �J ]f"j' USE ",__By OVED /,,. CONTRA Oen D e r� gV"�C 1 N ZONE .. ABY' Ci4 .�i-�/� AT x ADDRESS f��' y� 5� /y`�� -j r�HOU E NUMBERING d LEGAL MAP NUMBER �CJ.1e!�) NO. ASSIGNED BY----!::— DESCRIPTION LOT NO. I BLOCKl9l ` CORRECTIONS TRACT I As �I NO. OF BLDGS. SIZE OF LOT ,� Q NO ON LOT USE OF I NO. OF EXISTING BLDG. FAMILIES DESPIEMON OF WORK o - REP IR 11/1 DEMOLITION H--&D—E)ITION I O D SQ. FT. ,+� NO. OF /^+ SIZE /Pro '3 ROOMS In STORIES EXT. WALL ROOF COVERING S t(JG�A I COVERING E e USE OF STRUCTURE APPROV LS INSPECTOR'S SIGNATURE DRLTE FOUNDATION: LOCATION J y FORMS, MATERIALS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, �r PLICATION AND STATE THAT THE INFORMATION GIVEN IS BRACING, BOLTS 4 s" CORRECT. FURNACE: LOCATION. 1 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES GAS VENT, DUCTS AND STATE LAWS REGULATING BUILDING CONSTRUCTION. SIGNATURE OF LATH, INT. PERMITTE V - r 1 LATH. EXT. S ADDRES CPr g PLASTER, INT. AUTHORIZED AGT. PLASTER, EXT. C I�Y/V '1 / $ /p FEE $ HOUSE NUMBER COR- ,/ H RECT AND POSTEDQ VALUATION 61�. FEE $ 2 Z `/ FINAL 76AG36A DRS 3 5-198 " APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS 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 10665 E. FAIRHALL .ST. Copy thereof (Sec.3800,Lab.C.) CITY ZIP Policy No. 1.046140 Company STATE FUND TEMPLE CITY .91780 LOCAL SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. NEAREST CR06S ST. Certified Copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 11-1-94pplicant RANDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL / SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. COMPENSATION INSURANCE NORMA CROUCH 448-0666 WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars ($too)or less.) 1.0665 E. FAIRHILL DISTRICT GROUP TYP CONST. FIRE ZONE PROCESSED BY CITY I certify that in the performance of the work for which this permit TEMPLE CITY ZIP 917804 , is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFI ATION APT CONDO Date Applicant ADDRESS CLASS NO.- 24 DWELL UNITS • NOTICE TO APPLICANT If, after making this Certificate of REQUIRED" TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION 529 E. VALLEY 451937 SIDE CITY LIC.,CLASS PL I hereby affirm that I am licensed underprovisions of Chapters C-39. SEWER MAP c- (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES NO,OF FAMILIES c- Professions Code,and my license is in full force and effect. NEW ❑ BK PG ® O License Number 451.937 Lic.Class C-39. DESCRIPTION OF WORK VALUATION U ADD ❑ � Contractor RANDOL ROOFINGAte. 1-31-96 REBOOF T40ITSF & CAR E WITH ALTER ❑ $ 3'0001.00 0 25—YEAR CLASS "A" FIBERGLAS REPAIR] W ❑ 1 am exempt under Sec. $ CL BAP.C. for this reason SHINGLES OVER EXISTING COMP DEMOL ❑ z LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ f ` Signature ArPT(CANT(PRINT) T LDMA Perm# RANDOL ROOFING Wg-4040 � �E ❑.I,as owner of the property, or my employees with wages as — Z _`�._,.- •-,v their sole compensation, will do the work and the structure is ADDRESS O I` `"`� not intended or offered for sale (Section 7044, Business and 529 E. VALLEY SAN GABRIEL, CA FINAL DATE Q r^:^"'*4 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r - 6 lL' ' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 10� T J ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY i.?••�f�I _ Is') licensed contractors to construct the project (Section 7044, _ __ YES❑ NO❑ _ j�i ij it g--j kl�j_i '{'` _• Business and Professions Code.) _• fir`` WILL THE INTENDED USE*OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDINGOCCUP _; COAST ANT AIB OUQALI TV A PERMIT MANAGEMENTRDCSOTR CT 1(SCAOMDCTION RSEOEDPERMTOT NG C ECKLISTN FROM THE OFOR !'� 'I'UTH '•"i /:50 CONSTRUCTION LENDING AGENCY GUIDELINES. - I hereby affirm that there is a construction lending agency for YES❑ No❑ N the performance of the work for which this permit is issued(Sec. p1 I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 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 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. o Lender's Address 0 OWNER OR AGENT o I certify that I have read this application and state under penalty O of perjury that the above information is correct. I agree to comply P.C.FEE PERMIT FEE N with all county ord' ances and State laws relating o building 94.95 construction, r by authorize re resentatives of s Co ty ISSUANCE FEE co to enter upon a e-mention r erty for inspe i ur o26.40 INVESTIGATION FEE TOTAL FEE G4naWra.o1 a,�. 121..35 SEE REVERSE FOR EXPLANATORY LANGUAGE