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HomeMy Public PortalAbout10246 FREER ST_Building__ .r• TEMPLE CITY ` 76AS38A CE#003. 1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES pDDR E1SS DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST �y WILLIAM A. JENSEN SUPT OP BUILm NO CROSS ST. /�• F,!97� DISTRyT NO. GROUP ITYPE PgJCLrESSED BY FOR APPLICANT TO FILL,IN ` CONST. BUILDING ({ STATISTICALCLASSIFICATION SEWER MAP ADDRESS / ���G- BK PG CLASS.NO.�DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED CERTIFICATE: El TRACT MAP Jl/ HIGiRc EI STATE MAJOR SECOND, LOCAL NO OF BLDGS. NOf. SIZE OF LOT �O I NOW ON LOT (i M USE ZONE SPECIAL USE OF CONDITIONS - EXISTING BLDQ1^G. W� n r OWNER f�..IJG C✓ •jJ/C V.-/NEO 41]" . sfs BUILDING RD HWY STREET EXIST. ADDRESS;5'�/'2�-- Tecs,o/ f l y `�j„,�, SETBACK YARD NAME WIDTH FRONT ARCHITECT OR EL. P. L. ENGINEER NO. SIDE ADDRESS �^�- - P L � TEL. INSPECTION RECORD O CONTRACTOR - - NO. ADDRESS O DESCRIPTION OF WORK S �� � S LU rLv a fn NEW ADD ALTER REPAIR DEMOLISH - Z SQ FT. NO OF NO OF IZE STORIES FAMILIES - USE OF STRUCTURE V- SIGNATURE OF 1 -APPLICANT .f / l•y/� VALUATION •�� /• / /. L!L!-�- - - --- -- -`-_'--- - - - - - --- - - - - - - _• - - - - - ,/ APPROVALS DATE INSPECT R'S SIGNATURE P.C. PMT.I FEE $ / �-' FO FORMS, MATER ALSON -L5�iAT FEE � FRAME: FIRE STOPS, / ///� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS LAG .�/f a AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION." U WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION'1CERTIFY THAT IN DOING THE WORK 0AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. / —7/�. /1 TION OF THE LABOR CODE OF THE STATE OF CALIF NIA RELAT- ��V v, �w�� TNG TO WORKMEN'S COM NSATION IN6U RAN E LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE - RECT AND POSTED r v ADDRESS G'J� FINAL / w v� / CLYDE N. DIRLAM, PRINCIPAL STR T AL ENGINEER PLAN CHECK VALIDATION cK M.o. CASH PERMIT VALIDATION IcK. M.O. CASH LI It,o b 3 3 2 2 3 D 3'0.2 5 tv L;Lc� 7'7 7 3\-0 �If'I'I 1 D 6 4.0 0N 76A638A CE*803 3-66 APPLICATION- FOR BUILDING PERM I.J "'7 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS fl// BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST- _ COLEMAN W. JENKINS.SUP'T OF BUILDING CROSS ST DISj_RIICT N GR - TYPE E BY FOR APPLICANT TO FILL IN CONST. , BUILDING STATISTICAL C, IFICATION SEWER MAP ADDRESS 2 - BK PG CLASS NO. DWELL UNITS LOT NO. BLOCK USE ZONE MAP jJ / SPECIAL- C/ TRACT SPECIAL ' NO. OF BLDOS. CONDITIONS SIZE OF LOT NOW ON LOT USE OF Y N • `T �/V BLDG. SETBACK FROM CSNOL FRONT PROP. LINE OR (STREET) OWNER `Q TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS J/J M/ icy HIGHWAY WIDTH FROM C.L CITY - / ,; i BLDG. SETBACK FROM + - ENGINEER OR - L� - NEOL. 7 SIDE PROP. LINE OF (STREET) / TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS nS, $V� HIGHWAY WIDTH FROM C L CONTRACTOR J /�, 5J✓T ,,,,�(LLOLhiVg 1 + - �. ADDRESS SO,S if'/hLA) No I70lay CORNER CUTOFF YES NO E] CD clrY L cic SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK IiJ a NEW ADD ALTER REPAIR DEMOLISH Z SQ.FT. 3 NO OF NO. OF / SIZE STORIES FAMILIES USE OF / Y STRUCTURE L � � —_e I A X07 SIGNATURE VALUATIO Q !j, .00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION, LOCATION FEE$ FEE$ � FORMS, MATERIALS FRAME, FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS 9UILDI NG CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH. INT. ' TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. ING TO WORK n N'S MPENSATION INSURANCE. LATH. EXT. SIGNATURE HOUSE NUMBER COR- PERMITTE - RE T AND POSTED - ADDRES6 FINAL j 7 �j� JOHN F. LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK. M.C. CASH _ PERMIT VALIDATION CK. M.O CASH LA- 7 .1 8 81 FES 1 cj 1 D X3.0 WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a'certificate of consent to self insure, & a certificate of Workers' Compensation Insurbhce, • A PPL I CAT I O NT O R B U I L D I N G' -PERMIT . or a certified cop/y�thereof'(Sec. 3800,�La+b.sC�:) ��p� : COUNTY OF,LOS ANGELES BUILDING-AND SAFETY Policy NQt T© Company�o7J ING 'Certified copy is hereby furnished. FOR APPLICANT TO FILL IN-' BUILDADDRESS f� 7 ❑ Certified copy is filed with the county building inspec- BUILDING �7 tion department. ADDRESSQor q. -Date 4's�Q Applicant -"""y -�eG:JCJ1 —��7' ZIP 'l / Q LOCALITY (� ` NO OF BLDGS. NEAREST- CERTIFICATE OF EXEMPTION F06M WORKERS' SIZE OF LOT NOW ON LOT CROSS ST, -COMPENSATION,INSURANCE ASSESSOR (This section.need not be corripleted'tf the permit is for one TRACT BLOCK, LOT NO. MAP BOOK PAGE. PARCEL hundred dollars ($100).or less.) TEL OWNER rcolv7keyUSNO. USE ZONE MAP I certify that in the performance of the.work fog which this NO permit is issued, I shall not employ any person in any manner ADDRESSa CONDITIONS SPECIAL } so,as to become subject to the Workers'CompensaTion•Laws. dO CITY C ZIP Date Applicant„ ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE OCESSE BY ix NOTICE TO APPLICANT: If, after,making.this•Certificate of- ENGINEER-.• Exemption, you should become,subject to the'-Workers' NO CONST. 1 U Compensation provisions of`the Labor'Code; you`must_forth- ADDRESS.= - _ _ _ ' t.- _ �J ___ - = � with comply with such provisions or this permit shall be 'TEL to STATISTICAL CLA SIFICATION T APT. CONDO deemed revoked. ' ;_ CONTRACTOR NO "•-t7 y.. Z LICENSED.CONTRACTORS DECLARATION". LIC.. CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of•Chapter 9 ADDRESS 4,d1J, 72E&J10LjE- Clr;oNO LIC. SEWER MAP (commencing with.Sec(ion 7000)'of Division 3 of the Business CLASS CITY _- � G �9 ' and Professions Code,and my license is in full force.and effect. BK PG VALIDATION' SQ FT d NO. OF NO OF CHECK .License Number 4t�T3lZ � _Lic. Class C-3? SIZE �� STORIES FAMILIES ONE VALUATION Contractor �l�A/ X1%, l�'L�ate c�^JO DESCRIPTION OF WORK NEW ❑ �0 D ` Li ADD ❑I am exempt under Sec. AAACC ALTER ❑ - ►- B.&P.C. for this reason LC REPAIR $ - 'Date: USE OF, _ EXISTING BLDG. DE MOL ❑ Signature ��r.' r APPLICANT TEL. (PRINT), NO FINAL OWNFirBUILDER DECLARATION DATE ✓ I hereby affirm that I am exempt from th_e Contractor's License -Law for the following reason (Section,7031.5, Business'and ADDRESS 'T FINAL / 307151.`7.- ' Professions Code): PRESENT - By Ar ❑ I, as owner of the property, or-my employees with ADDRESS 1 ILDING 'i i!EMS ' wages as their sole compensation;will do the work and the structure-is not intended or offered for sale(Section, LOCALITY , TIJT{�� 195. m 7044, Business and Professions,Code.) MOVING TEL II,, El 1, as owner of the property, am exclusively contracting CONTRACTOR NO. CHECK -1_-C 1.95 with licensed contractors to construct-the project (Sec- ADDRESS CNANGUG ,Ii1:I tion 7044,_Business and Professions Code.) REQUIREDTOTAL SETBACK FROM- EXIST CONSTRUCTION LENDING AGENCY' SET BACK YARD`` HWY PROP. LINE -WIDTH' I hereby affirm that there is a construction lending agency for FRONT ''`ij the performance of the work for.which this'permit is issued P L " " (Sec. 3097, Civ. C.). SIDE _ 997 1 AM 10:41 Lender's Name LDMA Ref # Lender's Address P.C. Fee$ Permit Fee • o I certify-that 1.have read this application'and state that the Issuance Fee . LDMA P/C# ► . 50 above information is correct I agree to comply with'all County Investigbhon.Fee - 0 ordinances and'State laws relating to building construction, I Total Fee r ✓ LDMA Perm. # a and hereby authorize representatives of this County,to enter up-'the above-mentioned property for inspection purposes. oy�'✓r,(� (p'IB/i 4"=.J �g� ' - SEE-REVERSE FOR EXPLANATORY LANGUAGE 411--jut re of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION I hereb'y'affirm that I have a certificate of consent to'self insure, or-a certificate of•Work rs' Compensation Insurance, APPLICATION FOR B U I L D•I N G PERMIT or a certifie c py the of (S 3800, La��b((,C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No o any�C 7ni/U bd BUILDING ❑� Certified copy .s hereby furnished. FOR AP LICANT TO F LL IN ADDRESS Certified copy is filed,with the county building inspec- BUILDING tion'de rime t ADDRESS 01; k'j Date' � L j�ppl+canH ���� CITY ZIP LOCALITY CE TIFICATE OF EXEMPTION FROM WORKERS' INO OF BLDGS. NEAREST " COMPENSATION INSURANCE'� SIZE OF LOT NOW ON LOT CROSS ST (This section need,not be completed if the permit is for one TRACT BLOCK LOT NO'. ASSESSOR,'' • hundred dollars ($100)or less.) - MAP BOOK PAGE PARCEL TEL USE ZONE MAP I certify that in the performance of the work for which this OWNER NO' 3 NO permit is issued, I shall not employ any person in any manner ADDRESS / SPECIAL so as to become subject to'the Workers'Compensation Laws. CONDITIONS 0 0 Date Applicant CITY_ ZIP ; C� NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY 0 Exemption, you should become sublet; to. the Workers' ENGINEER NO. CON ZONE 1—' Compensation.provisions of the Labor-Code,youu,.must.forth- - .- _ i ADDRESS- --- - - - = '--`�� . ---- -� --�V-- LL.I with comply with 'such provisions or this permit shall be TEL L deemed revoked.- CONTRACTOR NO ;,,77 STATISTICAL CLASS[FICATI APT. CONDO. (f) . Z LICENSED CONTRACTORS DECLARATIONLIC ,J �� CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS f NO (commencing with,Section 7000)of Division 3 of the Business and LIC SEWER MAP Profess ions'Code, and my license is in full'force and effect. CITY C/' CLASS VALIDATION SQ. FT. NO. OF _ NO. OF CHECK BK' PC' License Numb r � ' �� Lic.Class SIZE STORIES FAMILIES ONE / NEW 0 VALUATION Contractor Date Q 'fo DESCRIPTION OF WORK L 0 A1 ADD ❑ $ ❑ I am exempt under c. wf4 t ALTER B.BP.C. for this reason IR '❑ s Date: USE OF EXISTING BLDG. t��l> (/�I -DEMOL ❑ Signature APPLICANT T • FINAL OWNER-BUILDER DECLARATION PRINT DATE I hereby affirm that I am exempt from the.Controctor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS Q z�9 2 J�,4 A wages as their sole compensation,will do the work and LOCALITYC Q �l the structure is not intended or offered for sale(Section i 7044, Business and Professions Code). MOVING TEL. # °`.'. •;•'°'� ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS L ° •-7 a;O 0 tion 7044, Business and Professions Code). °a _ s" REQUIRED TOTAL SETBACK �r j 'ti '+ s tl4; 1 0;e�e 7 a 0 U CONSTRUCTION'LENDING AGENCY ' SET BACK YARD HWY PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT �•• •, 0 3.2 8-8 8 the performance of the work for which this permit is issued P L. (Sec. 3097, Civ. C.•). _ SIDE P.L Lender's Name LDMA Ref. # Lender's Address PC Fee$ PermitFee v g I certify that I have read this application and state.that the Issuance Fee Ov LD MA P%C# - 3 above information is correct. I agree to comply with all County Investigation Fee 0 ordinances arid State laws relating to building construction, `.`�.r', +, s -i` l• s •�� R Total Fee CDMA P and hereby authorize representatives of this County to enter 4J " ermr upon t above-me tioned pr perty for inspection purposes. — a, / y ✓— G1 SEE REVERSE FOR EXPLANATORY LANGUAGE S+g at re of Applica or ent Date