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Home My Public Portal About10764 FREER ST_Building__ 76A638A CE;+t803 9-67 ••/ '` i .APPLICATION FOR BUILDIN PERMIT COUNTY OF LOS ANGELES BUILDING O DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMB]E, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST y0 CROSS ST. !/ FBNG OR APPLICANT TO FILL IN DISTRICT NO GR TYPE O B CONST. (Print or type only) /� ING t STATISTICAL C SIFICATION SEWER MAP SS - CLASS NO. OWELL,UNITS BIS PG . BLOCK USE ZONE MAP NO. SPECIAL NO.OF BLDGS. CONDITIONS F LOT NOW ON LOT NG BLDG, BLDG.SETBACK.FROM air TEL. FRONT PROP.LINE OF (STREET) C � NO. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL SS CHIGHWAY WIDTH FROM C.L. }DG.SETBACKFROM TECT OR TEL. SIDE PROP.LINEOF (STREET) EER NO.. TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL ADDRESS HIGHWAY WI-DTH FROM C.L. N O. } o_ CONTRACT IJ O. ' LIC.��/ U ADDkESS��(J O.y(�/ CORNER CUTOFF YES ❑ NO ❑ CITY LC SEE REVERSE SIDE FOR SPECIAL,APPROVALS, c D SCRIPTION F WORK" N Qz NEW ADD ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF IA 1A SIZE STORIES FAMILIES USE OF �., .. /Y C L '-._ /YD/t' c-'/ nI STRUCTURE Ile .0 SIGNATURE c%rcDkl G w / O �G� I APPLICAN �' t VALUATION' j� 1 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, ' FOUNDATION: LOCATION FEE S FEE $ . v 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 a FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS BUILDING CONSTRUCTION, I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. TION OF THE OR CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT. ING TO WO ME 'S COMPENS TION INSURANCE, LATH, EXT. SIGNATU HOUSE NUMBER COR- PERMITS - RECT AND POSTED ADDRESS 1 N�A L _ JOHN F. LEWIS. PRI CIPAL STRU RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ J PERMIT VALIDATION CK. M.O. CASH ._ ,, 0..34,2l'Sa IW . 4 1 D 17.25- APPLICATION FOR BUILDING PERMIT o COUNTY OF LOS ANGELES BUILDING AND SAFETY �' WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS /Q 7G'SS I hereby affirm that I have a certificate of consent to self insure, BUILDING ADD,i!�•-7,/_ r0� or a certificate of Workers' Compensation Insurance,or a certified IY ll copy thereof(Sec.3800,Lab.C.) c �Y71 G�� ZIP Q��O D X71 U 1 LOCALITY Policy No. Company SIZE OF LOI NO.OF E12f.NOW ON LOT El Certified copy is hereby furnished. L NEAREST CROSS T. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. LUSEONE MAP NO. ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' R /(��, Nu YEs No WITHIN 1000 FT.OF SCHOOL? COMPENSATION INSURANCE �V� r o� (This section need not be completed if the permit is for one hundred ADDRESS dollars ($100)Or less.) 7 � • DISTRICT GROUP TYP ONST. FIRE ZONE PROCESSED BY S',LFY ]n ZIP �� I certify that in the performance of the work for which this permit 1L 0L) is issued, I shall not employ any person in any manner so as to ARCHIT CT OR ENGINE TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS No. � 7 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 FRONT comply with such provisions or this permit shall be deemed.revoked. ADDRESS LIC.NO. P L SIDE LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF AMILIES Professions Code,and my license is in full force and effect. NEW BK PG , a License Number Lic.Class DESCRIPTION OF ORK ADD ❑ VALUATION O Contractor Date rwf - ALTER ❑ $- �' O V ElI am exempt under Sec. El $ BAP.C.for this reason p�Q,�,� f DEMOL ❑ LDMA P/C# U W Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) TEL NO. LDMA Perm# A Z t i i•'•:? a S I, as owner of the property, or my employees with wages as Z heir sole compensation, will do the work and the structure is ADDRESS 0!7 'S Eti not intended or offered for sale (Section 7044, Business and FINAL DATE _ !2, � _ E-M Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r'''S ❑ I, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q ht Y, y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY �� '5 {1-1 1 fez,» EF c 4 i � licensed contractors to construct the project (Section 7044, YES❑ NO❑ f [ - `• Business and Professions Code.) ,.;-IECKL�' WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH [ W ail_i CONSTRUCTION LENDING AGENCY COAST AIR QUAJTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR _HHW3 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. i 3 ; HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, 01000-000 N 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. I"2 ; I 1 a=f 1 CL Lender's Address OWNER OR AGENT O 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 with all county ordinances and State laws relating to building O M constructio and hereby authorize representatives of this County ISSUANCE FEE to e r e abov men'oned prpKerty for inspec n purpose a �(� 6 �j INVESTIGATION FEE TOTAL FEE o / O r Sgnamre of Apolaam o,A �c oma ' 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 0608140060 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 13384 LT: 17 SQ. FT STORIES TYPE 10764 FREER ST STRUCTURE: 1000 VN TEMP CA 917803534 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: SANTA ANITA 8574-004-001 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/14/06 JK 08/09/07 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINA DATE FINAL BY: CODE: MENDEZ, ALBERT/MICHELL E (626) 836-6755- 5,000 2� 10764 FREER ST /k TEMP 917803534 FEES PAID DESCRIPTION OF WORK TEAR OFF AND REROOF 30 YEAR COMPOSITION FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 'AC STRONG MOTION RESID 5000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 5000.00 VAL 132.60 ' TOTAL FEES 160.85 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 147H277 3 01 _ FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: + NO 21 ROOF SHEATHING a W 6 SCHOOL WITHIN HAZARDOUS SHEAR PANELS d LO AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS . SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-DAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508