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76A :!EM80910-58 APPLICATION FOR BUILDINPWITCOUNTY OF LOS ANGELES BULDITIm
DEPARTMENT OF COUNTY ENGINEER ADDREss
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A.LAMBIE,COUNTY ENGINEER NEAREST
CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST.
DISTRIC f10. GROUP TYPE Wvt
D BY
FOR APPLICANT TO FILL IN TYPE
BUILDING �. 1, C STATISTICAL CLASSIFICATION
ADDRESS � , U � (W�y,� �.� I P
/ SK PG
�- I I CLASS.NO. DWELL. UNITS
LOT NO. BLOCK MAP STATE YES NO
NUMBER HWY.
TRAC USE ZONE SPECIAL 17)4 �5�
X �r+�� NO.OF BLDGS. CONDITIONS `-/
_SIZE OF T 71 F 5 ^ V NOW ON LOT A
USE OF
EXISTING BLDG. BUILDING EXIST.
/` SETBACK YARD HWY T T NAME WIDTH
OWNER /iq f
FRONT
ADDRESS W 4G I '� xJ�-4 .I SIDE
CIT j NoWTE ZL�'I P.L,
ARCHITECT TE J
INSPECTION RECORD
ENGINEERt. NO �G
ADDRESS �A/1CL
TEL `
CONTRACTOR - 11� NO J
ADDRESS�✓+DESCRIPTION OF WORK
//
NEW L ADD ALTER REPAIR DEMOLISH
SQ.FT. NO.OF NO.OF
SIZE I 1 G G STORIES FAMILkES �C
USE OF STRUCTURE /� >
SIGNATURE OF . APPROVALS
APPLICANT-
DATE INSPECTOR'S SIGNATURE
FOUNDATION: LOCATION
FORMS.MATERIALS --_--_
P. FRAME: FIRE,STOPS,
J FEE C2BRACING, BOLTS A `,c
$ FURNACE: LOCATION.
VALUATION FEE GAS VENT, DUCTS ;�O �•• -1•y! c-r'✓titi"'
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. �^
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL TY DINANCES AND LATH, EXT.
STATE LAWS RE L NG IL 1 C TRUCTION.
SIGNATURE OF HOUSE NUMBER COR.
PERMIT' RECT AND POSTED Q
ADDRESS FINAL •'� J �:':� ,'
CLYDE N.DIRLAM, PRINCIPAL ST URAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION �' M.O. CASH
2 1 .0 0 u
' tri /, ®F
L�tt p 7 4 8 J ' 4 1 h 4 2.0 � e
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
t DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1303140073
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BUILDING ADDRESS:
ON FILE I SQ. FT STORIES TYPE 1 5101 GLICKMAN AV I
(STRUCTURE: V-B I TEMP CA 917803325
(ASSESSOR INFORMATION NUMBER: 1 NEAREST CROSS STREET: GREEN
18585-006-026 1 I THOMAS PAGE: 597 GRID: B� LOCALITY: TEMPLE CITY CAI
I I I I
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 TISSUED ON: PROCESSED BY: I
IEXIST OCC GRP: 103/14/13 SR 1
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE `FIN?. ' BY: CODE:IVANA1
5101 CLICK CHAD - i - 5,000 i
5101 GLICKNAN AV / l\
ITEMP 917803325 I FEES PAID WORK. j I
I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:i BATHROOM REMODEI +�
(APPLICANT: TEL. NO:
1HERNANDEZ, FRANCISCO (626) 232-9865- IAA BLDG PERMIT ISSUANCE 27.80 1 I
112700 ELLIOTT AVE IAB STATE GREEN BLDG FEE 5000.00 VAL 1.00 ISPECIAL CONDITIONS:
TEL MONTE CA 91732 IAC STRONG MOTION RESID 5000.00 VAL 0.50 1
1 IB2 PERMIT W/ENERGY 5000.00 VAL 145.90 1
IFR INV WORK W/O PERMIT 339.60 DOL 339.60 1
(CONTRACTOR: TEL. NO: TOTAL FEES 514.80 1APPROVALS DATE INSPECTOR SIGNATURE 1
IFH CONSTRUCTION (626) 232-9865- 1_ 1
112700 ELLIOTT AVE SP 25 LIC. NO 1 (LOCATION AND SETBACKS I I
TEL MONTE CA 91732 968550 1 1 I I
ISOILS ENGINEER APPROVAL 1 1
(ARCHITECT OR ENGINEER: TEL. NO: � (FOUNDATION/TRENCH FORMS I I
I - I
LIC. NO: (SLAB/UNDER FLOOR I
1 1 IRAISED FLOOR FRAMING 1
I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I I
I I I
1 3 001 IFLOOR SHEATHING 1 I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I_ I I I
1 NO 21 1 IRCOF SHEATHING 1 I I
SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I
(AIR QUALITY: 1000 FEET MATERIALS 1 I 1 I I
NO NO NO IFR.TUME INSPECTION
I I I
IFIRE SPRINKLER HANGERS I 1
(INSULATION/WEATHER STRIP
I I I
1 1 (INTERIOR LATH/DRYWALL 1 1 1
I I I
1 1EXTERIOR LATH I 1
I I I
1 (RATED FLOOR/CEIL ASSEM. 1 1
I IRATED WALL ASSEMBLIES
I I
I I I I
I_ I I I
I I IRATED SHAFTS/OPENINGS
I I I
1 1 IT-BAR CEILINGS 1 I 1
I I I
1 1 ILOT DRAINAGE I I
I I I
1 IREPORT ID: DPR261 ROUTE TO: BS0508 1 1
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 1303.140068
PHONE: (626) 285-0488 EXT:
ILEGAL ID: NO. OF CONST I BUILDING ADDRESS:
ON FILE I SQ. FT STORIES TYPE ,I.jPOr ===:@"GLICKMAN AV 1
ISTRUCTURE: V-B I TEMP CA 917803362
(ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET:
18585-006-038 I THOMAS PAGE: 597 . GRID: B4 LOCALITY: TEMPLE CITY CAI
I I I I
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 11SSUED ON: PROCESSED BY: 1
1 (EXIST OCC GRP: 103/14/13 SR 1
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE:
1T N PAINTING - 1 5,500
15130 GLICKMAN AV
I I
ITEMP 917803362 I __FEES PAID IDFISCRIPTIOn�OF WORK
I IREMOVE EXISTING SHINGLES RE ROOF WITH 30 YR COMPOSITION 1
_IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ISHINGLES I
(APPLICANT: TEL. NO: I I I
IRUIZ, GERARDO C (714) 317-4700- IAA BLDG PERMIT ISSUANCE 27.80 1 1
11714 W CHALET AVE IAB STATE GREEN BLDG FEE 5500.00 VAL 1.00 ISPECIAL CONDITIONS: I
(ANAHEIM CA 92804 IAC STRONG MOTION RESID 5500.00 VAL 0.60 1 1
1 ID2 PERMIT W/O EN-HC 5500.00 VAI, 149.40 1 I
1 TOTAL FEES 178.80 1
(CONTRACTOR: - TEL. NO: I IAPPROVALS DATE INSPECTOR SIGNATURE 1
IG C R ROOFING _ (714)x317-4700- .J 1 1
11714 W CHALET AVENUE LSC:-NO' 1 ILOCATION AND SETBACKS I I
1ANAHEIM CA 92804 979959 1 1 1 I
1 ISOILS ENGINEER APPROVAL I I
1ARCHITECT OR ENGINEER: TEL. NO: I (FOUNDATION/TRENCH FORMS I I I
1 LIC. NO: 1 t ISLAB/UNDER FLOOR I
I I I
I IRAISED FLOOR FRAMING I I
I I I
IMAP NO: SEWER MAP BOOK: PAGE: F=_ _ZONE: cmP: 1 1UNDERFLOOR INSULATION
I I I
1 3 001 IFLOOR SHEATHING I
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I
1 NO 21 I I ROOF SHEATHING
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I
1AIR QUALITY: 1000 FEET MATERIALS I I I 1
1 NO NO NO IFRAME INSPECTION
I 1 1
I IFIRE SPRINKLER HANGERS 1 1
1 I (INSULATION/WEATHER STRIPI I I
11NTERIOR LATH/DRYWALL
I 1 1EXTERIOR LATH � I
I I I
IRATED FLOOR/CEIL ASSEM. 1 1
I IRATED WALL ASSEMBLIES I I I
I I I
IRATED SHAFTS/OPENINGS I I I
I I I
I - IT-BAR CEILINGS I I I
I I I
I 1 ILOT DRAINAGE I I
1 IREPORT ID: DPR261 ROUTE TO: BS0508 I I I