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HomeMy Public PortalAbout9167 FORTSON DR_Building__ ©s 76A638A _ • CE#803(REV 11/78) AJETLICATION FOR. BUI"LDING.:PERM1T _ COUNTY OF LOS ANGELES.'. . BUILDING AND SAFETY s _ P 'NT T .PLICAO FILL IN' BUILDING �• - •ADDRESS - � ✓j�. p''xi �•• ' BUILDING ADDRESS SON PW LOCALITY NEAREST / CITY (,F". C4 Tf ZIP CROSS ST 3y..��• OF BLDGS ASSESSOR.,, SIZE OF LOT IZU NOW ON LOT MAP BOOK t ' PAGE PARCEL. DISTRICT 'GROUP TYPE TRACT*' 6 BLOCK LOT NO / CONST ZONE - /$ Ar. / FIRE PROCE SED BY �` , OWNER M• NO y STATISTICAUCLASSIFICATION - ,{/SEWER MAP � ADDRESS CLASS NO DWELL UNITS, A BK f CITY ZIP ARCHITECT O TEL VALUATIONQDO ENGINEER NO ADDRES _ BLDG SETBACK FROM s% TEL p FRONT PROP LINE OF ��� STREETI CONTRACTOR L NO -{ TOTAL SETBACK FROM TYPE OF EXISTING ` , ` C HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH ADDRESSIIVI) a�/(��j O 7 ` LIC + ae) CITY CLASS BLDG SETBACK FROM CONSTRUCTION LENDER t ?„ SIDE PROP LINE OF STREET) NAME AND BRANCH 9^ HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING ' ADDRESS CITY SIDE PROP LINE . HIGHWAY WIDTH, SOF NO OF NO OF CHECK + _ SIZE STORIES FAMILIES ONE p® a USE ZONE/ NO tj DESCRIPTION OF WORK NEW d11L! 0 SPECIAL126 rjoJADD 111��� I` CONDITIONS y ALTER FINAL _ y BY REPAIR' ❑ DATE USE O ' .. " EXISTING BLDG pek_ L, DEMOL ❑ Z _ APPLICANT TEL C (PRINT) NO Q �Y(SIGNATURE) Q I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE Y ,• .THAT THE ABOVE IS CORRECT-AND AGREE TO COMPLY WITH-ALL ORDINANCES uVi AND LAWS REGULATING BUILDING CONSTRUCTION I ERTIFY THAT IN DOING THE S WORK AUTHORIZED HEREBY I WILL NOT EMPLOY PER ON IN VIOLATION OF V ;2 9 1. 9,3 A THE LABOR CODE OF THE S CALIFOR RELATI O WORKMEN S COM- - _ Z _ 1 PENSATION INSURANCE' s # 00000,1•'. SIGNATURE O 2 o o 977&Q', PERMITTEE ADDRESS` - Z to 0 0 97.0 0Z �! TEL _O CITY v NO Q 0 2,2 9`80 , . p PC Fee$ Permit Fee > Issuance Fee US _ Total Fee r APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRR��j� , I hereby affirm that I have a certificate of consent to self Insure, BUI IN "A SS N G� ora certificate of Workers' Compensation.Insurance,or a certified ,` copy thereof,(Sec:3800,Lab. LOCALITY Q S� ZIP p "�� 0 Ci I �' Policy Nal ,G/3 Comp �'�� SIZE OF LOT I NO OF BLDGS NOW ON LOT �❑ Certified copy Is 1iereby furnished NEAREST CROSS ST Cf Certified Copy IS filed with the county building inspection TRACT BLOCK LOT NO department . 4 , USE ZONE MAP NO Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FR WORKERS' o NER SEL COMPENSATION INSURANCE � lU—�r ITHIN 1000 FT-OF SCHOOL? YES NO (This section need not be completed If the•permit Is forone,hundred ADDRESS o t 1 � dollars ($100) or less,) DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY En I certify that In the performance of the work f which this permit ZIP i? &a Is Issued„I shall not employ any person In an manner s0 as t0 ARCHIT TOC� become subject to the Workers'Compensation Laws. R ENGINEER TEL NO - - STATISTICAL CLASSIFICATION APT 'CONDO Date Applicant 'ADDRESS - CLASS NO.i--? DWELL UNITS NOTICE' TO, APPLICANT.” --If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers! C jRA ` TEL NO' SET BACK YARD HWY PROP LINE WIDTH _ Compensation provisions of the Labor Code, you must forthwith, FRONT comply with such provisions or this permit shall be deemed revoked pD 1 S J ,It IC, PL LICENSED CONTRACTORS DECLARATION t ` VAC N�" SIDE Cl )I LA� P L I hereby affirm that I am-licensed underprovlsions of Chapter 9 SEWER MAP • "(commencing with Section 7000)of Division 3 of the Business and S NO OF RIES NO OF FAMILIES Professions Code,a my cense I full force eff t.' NEW BK PG , d License Num er Z j�.Cl 5S DE TION F WORK �� �� ADD ❑ ,VALUATION Q Contractor 1 [/ ALTER ❑ �S V /30 1 (Ul iia 4PAiR ❑ $ p ❑ I am exempt under Sec. B&PC for this reason L EMOL ElLDMAP/C# W Date USE OF EXISTING BLDG - .'1.URM- ❑ CO Signature AP ICA T(P T T L N LDMA Perm# ...._ _ ElI,"as owner, of the,property, o�'my employees with wages as a DR �l Z ACCT.■s their sole compensation, will do the work and the structure is _ not Intended or offered for sale (Section 7044, Business and ' FINAL DATE 1311■50 • Professions Code.) t WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL '• CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1ITEC�� El I; as owner of the property, am•exclusively contracting with OR A MIXTURE Q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE licensed Contractors to Construct the project (Section'7044, ves 0 No❑ FINAL BY �� > T1 if�� o �� Business and Professions Code) WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING rLL{{ { OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH p 1-HECK 133.50 R CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES li I hereby affirm that there Is•a construction lending agency for YES 1:1 No El CHANGE .00 a the performance of the work for which this permit Is issued(Sec 3097, CIV C. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING " N ) 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 �Yf•Y('If'S��'Y�'I i i 2/17/93 /i )�,�t 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD Vl.1S.V V 01 1 ! o Lender's Address Q� C". OWNER OR AGENT 324fj 1 AN11'•16 o : I certify that I have•read this application and state under penalty 0 of perjury that the above Information Is correct I agree to comply' ?C FEE PERMIT FEE N with all county, ordinances and State laws relating to building m construction, and hereby authorize representatives of this County ISSUANCE FEE � — , to ent upon the above-m to ed property for inspection purposes . INVESTIGATION FEE TOTAL FEE Sgnatu of Applicant or A: Date C•' SEE REVERSE FOR EXPLANATORY LANGUAGE 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 0707310034 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ITR: 14396 LT: 33 SQ. FT STORIES TYPE 9167 FORTSON DR I (STRUCTURE: VN I TEMP CA 917801323 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCINITAS IS382-016-013 THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl (TENANT: JEXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY: EXPIRES ON: I EXIST OCC GRP: 107/31/07 SR 01/27/08 OWNER: TEL. N0: 1BLDGS. NOW ON LOT: VALUATION: FINAL DAT FIN CODE: 1ERICKSON JOHN W;MARTY (626) 287-1779- 1 5,000 19167 FORTSON DR 1 I 1�� TEMP 917801323 FEES PAID ESCRIPTIO OF WORK I IREMOVE OLD ROOF & REROOF WITH COMPOSITION SHINGLES, OVER IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IHANG ON HOME REPLACING AWNINGS FRONT AND BACK DOORS (APPLICANT: TEL. NO: I I I (SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 1 I 1 IAC STRONG MOTION RESID 5000.00 VAL 0.50 (SPECIAL CONDITIONS: I 1 ID2 PERMIT W/O EN-HC 5000.00 VAL 132.60 I 1 1 1 TOTAL FEES 160.85 I 1 (CONTRACTOR: TEL NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 (SAME AS OWNER - I I I I LIC. NO 1 (LOCATION AND SETBACKS I I I I (SOILS ENGINEER APPROVAL I I I ARCHITECT OR ENGINEER: TEL NO: 1 (FOUNDATION/TRENCH FORMS I I I LIC. NO: 1 1SLAB/UNDER FLOOR I I I (RAISED FLOOR FRAMING I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE. CMP: ( (UNDERFLOOR INSULATION I I I 1153H265 3 011 I I I I I IFLOOR SHEATHING 1 I 1 INC. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I NO 21 IROOF SHEATHING I 1 SCHOOL WITHIN HAZARDOUS ISHEAR PANELS 1 (AIR QUALITY: 1000 FEET MATERIALS 1 I I I I NO NO NO 1 (FRAME INSPECTION I I 1 REQUIRED TOTAL SETBACK FROM EXIST 1 (FIRE SPRINKLER HANGERS I 1 SET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I I FRONT PL- I (INSULATION/WEATHER STRIPI I I I SIDE PL- I I 11 1 I I (INTERIOR LATH/DRYWALL 1 I - (EXTERIOR LATH I I 1 (RATED FLOOR/CEIL ASSEM. I 1 1 (RATED WALL ASSEMBLIES I I 1 RATED SHAFTS/OPENINGS 1 1 I 1 IT-BAR CEILINGS 1 1 ILOT DRAINAGE 1 1 I I I (REPORT ID: DPR261 ROUTE TO: BS0508 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 0707170010 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS: 1 ITR: 14396 LT: 33 1 SQ. FT STORIES TYPE 1 9167 FORTSON DR 1 I (STRUCTURE: VN I TEMP CA 917801323 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ENCINITAS I 15382-016-013 I I THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 (EXIST OCC GRP: 107/17/07 SR 01/13/08 I I I I (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL D TE FIN CODE: I IERICKSON JOHN W;MARTY (626) 287-1779- I 20,000 I�• I 19167 FORTSON DR I '�. I I ITEMP 917801323 I FEES PAID 1 ESCRIPTION OF WORK 1 I I IREPLACING 8 WINDOWS, WALL I SOLATION, WOOD FRAMING INCLUDINGI I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IEXTENSION OF OVERHAND NEW FRONT PORCH ROOF, REPLACING 2DOORSI (APPLICANT: TEL. NO: I I I ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.75 1 1 1 IAC STRONG MOTION RESID 20000.00 VAL 2.00 ISPECIAL CONDITIONS: I ID2 PERMIT W/O EN-HC 20000.00 VAL 384.60 1 I I I TOTAL FEES 414.35 I 1 I I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I I 1 I LIC. NO I ILOCATION AND SETBACKS I I I I I I I I I 1 ISOILS ENGINEER APPROVAL I I 1 I I I I I I 1ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I 1 LIC. NO: I (SLAB/UNDER FLOOR I I I I b I I I I IRAISED FLOOR FRAMING 1 1 1 I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ( (UNDERFLOOR INSULATION I I I I153H265 3 Oil 1 11 I I IFLOOR SHEATHING I I 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I NO 21 1 IROOF SHEATHING 1 SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I I (AIR QUALITY: 1000 FEET MATERIALS NO NO NO I IFRAME INSPECTION I I I I I I I 1REQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I ISET BACK YARD: HWY: PROP LINE: WIDTH: I 1 IFRONT PL- I (INSULATION/WEATHER STRIP 1 SIDE PL- I I I (INTERIOR LATH/DRYWALL I I I I I (EXTERIOR LATH I 1_4V I IRATED FLOOR/CEIL ASSEM. I 1 I I I I I I I I I IRATED WALL ASSEMBLIES I 1 I I I I I I 1 I IRATED SHAFTS/OPENINGS I I I I I I I I 1 IT-BAR CEILINGS I I I I I I I I I I I ILOT DRAINAGE I I I I I I I I I I IREPORT ID: DPR261 ROUTE TO: 2S0508 I 1 1 I I I I I I I