HomeMy Public PortalAbout9174 FORTSON DR_Building__ DEPARTMElit-OF BUILDING AND SAFETY ' _ APPLICATION,FOR PERMIT
__"COUNTY OF L_6S ANGELES
WM. J: FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING \1' - DISTRICT NO. PLAN CK.NO. PERMIT NO.
ADDRESS 6- "-gkI- -(,/. 6 30 4
LOCALITY toL/� , / RECEIVED BY �-/D/ATE OFF AP'PLL. DAAT/E ISSUED
NEAREST d L ,0- //�'CS 1"1�' / 74/7CROS9 9T:
BUILDING
OWN ER ,,' ,}R, ADDRESS
AMAILDDRESS �/ / �:na�%�% Ol' LOCALITY
�ldiWiy
- TE NEAREST
CROSS ST.
CITY - 6� NO NO.
FIRE NO.OF TYPE '/ I GROU
ARCHITECT OR � TEL. ZONE ' I PLANE I v
ENGINEER
BLDG. �/✓'�L /t/ORD'./NO.
ADDRESS SETBACK LINE .1e /
APPROVED
TEL '/ / DATE
CONTRACTOR ti• ,6'JNO.�d.I V,�J 7 13YY
J USE APPROVED
ADDRESS 1 ZONE ' BY DATE
LEGAL '/ - CORRECTIONS
DESCRIPTION I LOT NO.
�p�J/'� BLOCK
TRACT / -/,z 1
/ NO.OF BLDGS.
SIZE OF LOT (O X l �9 I NOW ON LOT
J USE OF NO.OF I NO.OF -
EXISTING BLDG. FAMILIES ROOMS -
DEE(SCRIPTION OF WORK
NEW L'TERATION ADDITION O -
REPAIR MOVING DEMOLISH O
NO OF Z
SIZE T� / ROOMS r STORIES D
r
WALL ROOF
COVERING I COVERING
USE OF NEW '
BUILDING uzx
L7- / Y v - oaq 9� y
lL7 U. Al,'
I HEREBY ACKNOWLEDGE THAT J.,HAVE READ THIS APPROVALS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION: LOCATION INSPECTOR DATE
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES .FORMS, MATERIALS
AND STATE LAWS RE ULATING BUILDING CONSTRUCTION.
FRAME: FIRE STOPS,
SIGNATURE OF 7- BRACING,BOLTS
OWNER �+ LATH,INT.:
AUTHORIZED AG . '0'Y�Aw LATH,EXT.: '
DBS-3 25M SETS 1-47(31// PC $ '� PLASTER. INT. '!
�O
FEE d .' -
PLASTER. EXT.
VALUATION 7FEE ' �`/++•® , FINAL �'•'1"���
BUILDING I ADD EIS S Y' -
_ APPLICATION LOCALITY / C�,
DIVISION OF BUILDING AND SAFETY NEAREST
CROBB 9T.
Department of County Engineer DISTRICT . RECEIPT NO. PERMIT NO.
County of Los Angeles _ (/)
WM. J. FOX, COUNTY ENGINEER GROUP DATE RECEIVED DATE ISS ED
CASSATT D. GRIFFIN, SUPIT OF BUILDING
9_ �s-s"
I
FOR APPLICANT TO FILL IN TYPE,,CONST. RECEIVED BY ISSUED BY
OWNER MAP
MAIL NUMBER a I/ D 3 ST
'
YES NO
ADDRESS Z
U E ZONE SPECIAL-
TEL. / CONDITIONS
CITY ND.
ARCHITECT OR TEL. D '
ENGINEER NO.
_ BUILDING YARD HWY STREET NAME - EXIST.
SETBACK WIDTH
ADDRESS _ FRONT � !
TEL. P.L.
CONTRACTOR NO. -
SIDE
P. L.
ADDRESS rj�,� •'
DATE CORRECTIONS INSPECTOR
BUILDING
ADDRESS
LOT NO. T BLOCK
' I
TRACT.
SIZE OF LOT
OF LOT j���-r� I NOW ON LOT
I NOW ON LOT9� - -
USE OF
FXI9TING BLDG.
DESCRIPTION OF WORK °a
NEW ADD ALTER! REPAIR DEMOLISH - - - Z
SO.FT. FOK I NO.OF ./ D
SIZE STORIES FAMILIES
USE OF 9T11CTURE .
NO.OF
EMPLOYEES
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP-
PLICATION AND STATE THAT THE INFORMATION GIVEN 19 APPROVALS INSPECTOR'S SIGNATURE DATE
CORRECT.
IAGREE TO COMPLY WITH ALL COUNTY ORDINANCES FOUNDATION: LOCATION
AND STATE LAWS REGULATING BUILDING CONSTRUCTION. FORMS, MATERIALS
FRAME: FIRE STOPS,
SIGNATURE OF BRACING,BOLTS
PERMITTEE FURNACE: LOCATION, -
GAS VENT,DUCTS
ADDRESS '
LATH, INT.
AUTHORIZED AST. - "-
LATH, EXT.
$ P. C.$ HOUSE NUMBER COR-
D Qf� FEE RECT AND POSTED n 1
VALUATION $
FEE V� FINAL
76A638A D85 3 Crab 5-54
TE
76A636ACEb8032-63.APPLICATI'0N� FORBUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF-COUNTY ENGINEER ' ADDRESS �l
BUILDING AND 'SAFETY DIVISION LOCALITY
JOHN A.L'AMBIE:COUNTY ENGINEER NEAREST
WILLIAM A.. JENSEN, SUP T OF BUILDINGCROSS ST'
_ DISTRICTN G TYPE D
FOR 'APPLICANT TO FILL IN . ., coNsr. "
BUILDING STATISTICAL CLA ATION S ER MAP
ADDRESS 'i. SEAER
CLASS. NO 'DWELL UNITS
LOT NO BLOCK WATER ; NOT RE QU IR ED ED
ECEIV
CERTIFICATE: �LJ�LJ
TRACT - MAP HIGHWAY
NO OF BL
DGS NO -2-c)03 ,(CIRCLE) STATE MAJOR SECOND, OCAL
SIZE OF LOT NOW ON LOT USE ZONE SPECIAL -
USE OF :.i CONDITIONS '
EXISTING BLDG •• .61
OWNER NO B L ING' EXIST. _
SETBACK' YARD HWY STREET NAME - WIDTH
ADDRESS - FRONT - •i� T
ARCHITECT OR TEL P. L.
ENGINEER NO }. SIDE
a
ADDRESS O
-:TEL
CONTRACTOR NO - -
ADDRESS O
DESCRIPTION OF WORK a
NEW ADD ALTER REPAIR DEMOLISH -
SQ FNO' OF NO OF --
SIZE �77STORIES 2• FAMILIES - - -
USE OF
STRUCTUR
S IGNAT U R E O
APPLICANT
-
VALUATION'$
APPROVALS DATE, INSPECTOR'S SIGNATURE
PC - PMT //'' ;FOUNDATION LOCATION
FEE.-5 FEE $ l 'FORMS: MATERIALS '
FRAME FIRE S_T.OFPS.
"I HEREBY ACKNOWLEDGE THAT I HAVE'READ THIS APPLICATION'.- BRAC ING',BOLTS
AND•STATE THAT'THE ABOVE IS'CORRECT AND AGREE TO COMPLY FURNACE LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS'REG ULAT INGr
GAS VENT, DUCTS
BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY'ANY PERSON IN-VIOLA- LATH.•INT
TION OF THE LABOR CODC OF THE STATE OF CALIFORNIA RELAT. ,
ING TO WORKMEN' MPEN SATION INSURANCE '
LATH. EXT
SIGNATURE O — HOUSE NUMBER COR-
PERMITTEE— RECT AND POSTED ( rpt p\Jj i,� i'/,7 �•�
ADDRESS FINAL
" JOHN F LEWIS.'PRINCIPAL STRUCTUF2AL•E" ER
AN CHECK VALIDATION •CK MO CASH ' _ PERMIT VALIDATION cK: MID. cns
ob 9s'2=�6Q, J"1,5� i o 4.00 . E
76A888A CE 980870-88 APPLICATION- F'Ok BUILD[NG PERMIT , •.1 �"
COUNTY OF LOS "ANGELES BUILDING
ADDRESS /2
DEPARTMENT 'OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION LOCALITY 'Tt lJ j
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST- /
CASSATT D. GRIFFIN, SUPT OF BUILDING - CROSS ST. -f...cd
DISTRICT NO. GROUP TYpE PROCESSED BY
FOR APPLICANT TO FILL IN cONST.y I
BUILDING / J7(/ STATISTICAL"C SSIFICATION SEWER MAP
ADDRESS 0� G+'S t - ,` `a B ,
CLASS.NO.�DWELL.UNITS ' I
LOT NO. BLOCK MAP STATE YES O
NUMBER �• N'td �f' HWY.
TRACT _ �� US;ZO SPECIAL
NO.OF.BLDGS /L I _ ''CONDITIONS
S
'SIZE OF LOT: I NOW ON LOT
USE OF - BUILDING EXIST. ~
EXISTING BLDG. .` N. YARD HWY ' ' . STREET NAME
SETBACK WIDTH_-
..OWNER /�• - ._ ,-'FRONT" _
MAIL P.,Li O Ga 12 T"S► G w �U
ADDRESS /— /"�SC7 Y- �.` "SIDE - - -
TEL. - P.-L.
CITY NO 'SI
ARCHITECT OR TEL._ INSPECTION RECORD
ENGINEER NO. -• '
ADDRESS
TEL. it 41
j'
CONTRACTOR �: NO.
fi3
ADDRESS D l�'C_-' /,',�?N 11F ISI
DESCRIPTION OF.WORg - l�igA>S!/t/3' IS -rb /35-
NEW DD ALTER REPAIR DEMOLISH
SQS. T - j NO.OF STOES NO.OIF. �- -� 6/1!/'� — lf����'II•�[/
USE OF j �Gd'IT Y/�_T• /_L i�/��6�"�L�®
—STRUCTURE �i+'ta'E:
SIGNATURE OFor
APPLICANTCl
` APPROVALS DATE INSPECTOR'S SIGNATURE
S
ADDRES �( i �`✓ a -FOUNDATION:LOCATION
VALUATION C/lI119/
I FORMS,MATERIALS
F 7.
" FRAME:FIRE STOPS.
BRACING,BOLTS
FURNACE:LOCATION. ] e
FEE' $�— • FEE $ •; GAS VENT,-DUCTS �[yo���--(�-�►q% ��� t,("('i�,r/ -
_ I HERESY-ACKNOWLEDGE/THAT I HAVE READ THIS AP- LATH.INT. •• '77 �i1';!` �G
PLICATION AND STATE_THAT THE ABOVE IS CORRECT AND -
AGREE TO'COMPLY WITH-ALL COUNTY ORDIN ES AND
STATE LAWS RE UL ING BUILDING CO�UCTION. LATH;EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE it .•�/� RECT AND POSTED
ADDRESS ��=�l 'y="• FINAL -
CLYDE N,.DIRLAM', PRINCIPAL STC RAL ENGINEER
PLAN/CHECS VALIDATION CK. M O. CASH _ PERMIT VALIDATION- 'CK. M.o. CASH
APPLICATION FOUR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self Insure, AeZka-w Plf
or a certificate of Workers' Compensation Insurance,or a certified
copy thereof (Sec.3800,Lab.C) CITY
• ZIPC/� �/�ef�
t, LOCALITY ,
Policy No. Company
• SIZE-OF LOT NO OF BLDGS NOW ON LOT
❑ Certified copy Is hereby furnished l��B NEAREST CROSS ST
❑ Certified copy Is filed with the county building Inspection TRACT BLOCK LOT NO
USE ZONE MAP NO
department.
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL-
Date SPECIAL CONDITIONS G/
CERTIFICATE OF,EXEMPTION FROM WORKERS' OWNER. TEL NO YES NO
COMPENSATION INSURANCE � - ���`� �oWN L �fi �/ '�� �� WITHIN 1000 FT OF SCHOOL
ADDRESS
(This section need not be completed If the permit is for one hundred Ff+jJp,�O p DISTRICT GROUP TYPE CONST FIRE ZONE ' PROCESSED BY
dollars'($100)or less) I CITY ,\ ZIP q
I certify,that in the performance of,the work for which this permit
is Issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER 6TEL NO J
become subject�tor the Workers'Compensation Laws STATISTICAL CL SrFICATION APT CONDO
`7f % CLASS t DWELL UNITS
Date Applicant
ADDRESS
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 FRONT
comply with such provisions or this permit-shall be deemed revoked ADDRESS LIC NO P L
'
LICENSED CONTRACTORS DECLARATION SIDE
CITY- LIC CLASS 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 SQ FT.SIZE NO OF STORIES NO OF FAMILIES
Professions Code,and my license Is in full force and effect NEW BK PG , a
License Number LIC Class DESCRIPTION OF WORK ADD ❑ VALUATION.
O
Contractor Date ALTER ❑ $ -15 �� U
ElI am exempt under Sec REPAIR ❑ $
B.BPC for this reason ��d0 J4. Z-r DEMOL ❑ w
LDMA P/C#
Date USE OF EXISTING BLDG URM ❑ 77t[[t�,,t"4
Signature APPLICANT(PRINT) TEL NO LDMA Perm# �iti �f 1jJ'=1L.+Z,
❑ I, as owner of the property, or my employees with wages'as' Z _
O �ri�-�,
their sole compensation, will do the work and the structure,is, ADDRESS _ � i ('ti�L �i�..�:+Za� _ ��-
not Intended or offered for sale (Section 7044, Business and FINAL DATE ^ Q 'yy_
Professions Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL /, _� �;H t.K SS3 .LL'•
❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE !v
Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY
licensed contractors to construct the project (Section 7044, YES❑ NO❑' 1K/`,/ l(l�i a;_j 1
Business and Professions Code) - l.r A•'+G=•
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING • ,
OCCUPANT REQUIRE A.PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ _ -
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES _ t- :fir
Y 9 agency YES❑ No El
(�� i ,I r,_Z f.f!_'! r•_
I hereby affirm that there Is a construction lendin a enc forIrl.0is�
N the performance of the work for which this permit Is Issued(Sec IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMDPERMITTING29Fi hl �?°C;
3097,CIV C) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER-THE LOS ANGELES COUNTY CODE, � i I
'' rI
N 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 SCAQMD
o Lender's Address
OWNER OR AGENT
O ,
o I certify that I have read this application and state under penalty
of perjury that the above information Is correct I agree to comply PC FEE PERMIT FEE
oN with all county ordinances and State laws relating to building
m construction, and hereby authorize representatives of this County ISSUANCE FEE
to a ter on t bove-mentioned property for Inspection purposes �j a
a /�� '+',f � INVESTIGATION FEE - TOTAL FEE '
Sg ture of Applicant ,Agent /wale D , / O
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 1201090023
PHONE: (626) 285-0488 EXT
ILEGAL ID: 1 NO. OF -CONST I BUILDING ADDRESS: 1
ITR: 14396 LT: 43 I SQ. FT STORIES TYPE 1 9174 FORTSON DR - I
I (STRUCTURE: 2000 V-B 1. TEMP CA 917801322 1
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET: 1
15382-016-023 1 I" THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl
(TENANT: (EXIST BLDG USE- RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: 1
(EXIST OCC GRP: 101/09/12 SR 1
I I I I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: (FINAL DATE FI BY: CODE: I
1LAMSAM JOHN S;DIANA Y (213) 785-4108- I 6,500 1� 1
119174 FORTSON DR I �f .% I
(TEMP 917801322 - I FEES PAID S RIPTION OF WORK _
IRE-ROOF REMOVE OLD WOOD SHAKE & SHINGLES, NEW PLYWOOD 30 LB I
I IFEE DESCRIPTION: QUANTITY: UOM• AMOUNT: IFELT AND NEW SHINGLES 30 YR. AND REMODEL 1 BATHROOM I
(APPLICANT: TEL. NO: I I 1
(SAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27 80 1 - 1
IAB STATE GREEN BLDG FEE 6500.00 VAL 1.00 (SPECIAL CONDITIONS:
IAC STRONG MOTION RESID 6500.00 VAL 0 70 _
1 ID2 PERMIT W/0 EN-HC 6500.00 VAL 166.60 I 1
' IFR INV WORK W/O PERMIT 257.00 DOL 257.00
(CONTRACTOR: TEL. NO: I TOTAL FEES 453.10 (APPROVALS DATE INSPECTOR SIGNATURE
(SAME AS OWNER - 1 _ 1__ '
I LIC NO I ILOCATION AND SETBACKS
I I I I I I
ISOILS ENGINEER APPROVAL
I I I I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I
I LIC. NO: I IST_,�B/UNDER FLOOR I I
I I 1_ I I
IRAISED FLOOR FRAMING I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION 1 1
1153H265 3 001
1 1 , IFLOOR SHEATHING 1 1 I
INO OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS. I I
I 0 NO 21 1 I ROO:' SHEATHING
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS
1AIR QUALITY 1000 FEET MATERIALS I - I_ 1
1 NO NO NO 1 IFRAME INSPECTION I 1 1
1 (FIRE SPRINKLER HANGERS 1 I I
(INSULATION/WEATHER STRIPI I I
I I I
1 _I (INTERIOR LATH/DRYWALL 1 1 1
I I 1EXTERIOR LATH 1 1
I I IRATED FLOOR/CEIL ASSEM I 1 1
I I I I I I
1 1 IRATED WALL ASSEMBLIES 1 1
1 I (RATED SHAFTS/OPENINGS
1 I IT-BAR CEILINGS 1 1 I
1
1 t'1 ILOT DRAINAGE 1 1
I 41 I I I I
1 (REPORT ID DPR261 ROUTE TO- BSO508 I I
I I I I I I