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Home My Public Portal About5112 GLICKMAN AVE_Building__ f f �. i tt7a`,E I � l ��'ME CS1"![Y� "'I dF 76A688A CE#809260 APPLICATION FOR BUILDING PERMIT Z COUNTY OF LOS ANGELES BUD SING DEPARTMENT OF COUNTY ENGINEER 1 SS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. I GROUP I TYPE ,P ESSED BY FOR APPLICANT TO FILL IN j;U ' 7 ' CONST.. BUILDING L`" II STATISTICAL CLASSIFICATION SEBKR MAPF ADDRESS �7 A ' �&-w— CLASS.NO. ,D+WELL.UNITS-1—IS 0"' LOT NO. 7 BLOCK MAPSTATE NUMBER /® HWY. YES O TRACT 'ft USEZONE NO.OF BLDG SIZE OF LOT I NOW ON LOTS CONDITIONS USE OF EXISTINGBLDG. BUILDING YARD HWYTREE NAME EXIST. OWNER \,j-0�, TELN0E alp, SETBACK WIDTH �1 ��I7 ! FRONT ADDRESS�ee`� , P L r SIDE ARCHITECT Op TEL P.L. R ENGINEER I , [� NO. 4� INSPECTION RECORD ADDRESS CONTRACTOR NO /S(�D 04 O ADDRESS';L, DESCRIPTION OF WORK a0 NEW^ ADD ALTER REPAIR DEMOLISH SO.FT. NO.OF NO.OF r 04 SIZE6 STORIES )FAMILIES cn USE OF STRUCTURE s -4/. SIGNATURE OF "'eo t A.I APPLICANT VALUATION$ APPROVALS DATE INSPECTOR'S SIGNATURE P C. PMT. FOUNDATION: LOCATION F E $ \ FEE FORMS,MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- BRACING,BOLTS %A FRAME: FIRE STOPS, PLICATION AND STATE THAT THE ABOVE IS CORREES CT AND FURNACE: LOCATION, Iy AGREE TO COMPLY WITH ALL COUNTY ORDINANCAND GAS VENT DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOI E WORK AUTHORIZED I LATH, INT. WILL NOT EMP Y ANY E VIOLATION OF THE WORKMEN'S C TIO W O CALIFORNIA. LATH,EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTE RECT AND POSTED - r' J ADDRESS FINAL 1► CLYDE W. DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 3 9 1 4 ®e JUL :21 2 3 D 2 2.J 0 T s� U L'. .5 . w APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ! � j I hereby affirm that I have a certificate of consent to self insure, BUILDIN ADD E or a certificate of Workers' Compensation Insurance,ore ertified Copy thereof(Sec 3800,Lab.C.) �L nCITY ) ZIP -� O U!Jrff=m Oka c7 w LOCALITY //^ /!� POII No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT (ISG/�✓�� L �-z-C- Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. 'l�rr� B /p ASSESSOR MAP BOOK USE ZONE MAP NO. Date t� Applicant ] VS ♦ ` v PAGE PARCEL 41 SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' O NER TEL NO. 7 !s COMPENSATION INSURANCE �'�"OV ��/� WITHIN 1000 FT OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred AD) SS Al ocT /{/ DISTRICT GROUP TYPE CONST, FIRE ZONE PROCESSED BY dollars($100)or less.) �� CITY � ZIP I certify that in the performance of the work for which this permit7X01,0 ( is issued, I shall not employ any person in any manner so as to {�1 �l c become subject to the Workers'Compensation Laws. ARCHITECT R ENGINEER TEL NO. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.. --'/ DWELL UNITS NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED' TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' NTTO� a �•,_� TEL NO. M SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith j (\A�y s ?/ � 3 FRONT comply with such provisions or this permit shall be deemed revoked. A D S LIC.NO. PL LICENSED CONTRACTORS DECLARATION A-V0�3 � 0 SIDE CIT�f ! civ d LIC.CLA P L I hereby affirm that I am licensed underprovisions of Chapter 9 f [-��1i Q.I (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF ST RIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force and effect. NEW ❑ BK PG ® O s2 ba U ?� Lic.Class S P DSC TION OF WORK / ADD ❑ VALUATION License Num er ^� / dG�e CD Contractor Date ALTER El $ �� ~� El am exempt under Sec. REPAIR ❑ $ ti BAP.C.for this reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ Signature _ APPLICANT(PRINT) TEL NO. LDMA Perm# El 1,as owner of the property, or my employees with wages as Z _.•r __ their sole compensation, will do the work and the structure is ADDRESS O ;.-y• not intended or offered for sale (Section 7044, Business and FINAL DATE Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r1 El OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ••• •' , I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL licensed contractors to construct the project (Section 7044, R-YES 11 No❑ "°` Business and Professions Code.) _•..i.el•.ii WILL THE INTENDED USEOF THE BUIDLING BY THE APPLICANT OR FUTURE BUILD.— OC UILDIG •,i'tW:�'; .•�pne•..3 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUADTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR � j}y'j :_•`�' '^^ gj`i GUIDELINES L'Cr "(L. f�;('`'-'- I hereby affirm that there is a construction lending agency for YES 11NO❑ a the performance of the work for which this permit is issued(Sec. rn IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, // ft i i 5 If3E j° f.y{'+ TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS G[q1 '.J°_'.Si._ _. .�; .. _. •i'I' 3 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. – • o Lender's Address 0 OWNER OR AGENT o I certify that I have read this application and state under penalty 0of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N G with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE t enter upon the a Dv entio d property for inspection purposes. a (pINVESTIGATION FEE TOTAL FEE /e �./ n tit Applican r ge Date � /,";2 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 0708270012 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE I SQ. FT STORIES TYPE 1 (STRUCTURE: VN 5112 CA 91780 AV 1 ASSESSOR INFORMATION NUMBER: I TEMP CA 917803362 1 8585-006-033 � NEAREST CROSS STREET: THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, CI (TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: 1 EXIST OCC GRP: 108/27/07 SR 02/23/08 1 1 OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: F D TE FI CODE: 1 THOMAS MAYEDA (626) 337-4949- 1 15112 GLICKMAN AV i 5,300 i ��j 1 (TEMP 917803362 I FEES PAID IDE CRIPTION OF WORK 1 I I (REPLACE (1) WINDOW DUAL G ZED 10 X 4 AND TEAR OFF AND RE- 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IROOF WITH COMPOSITION SHINGLES 1 (APPLICANT: TEL. NO: I (MARY MCCONNELL (818) 703-0482- JAA BLDG PERMIT ISSUANCE 27.75 1 1 120644 COHASSET JAC STRONG MOTION RESID 5300.00 VAL 0.53 (SPECIAL CONDITIONS: 1 ICANOGA PARK CA 91306 ID2 PERMIT W/O EN-HC 5300.00 VAL 149.40 1 TOTAL FEES 177.68 1 1 1CONTRACTOR: TEL. N0: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IK-B CONSTRUCTION (626) 932-1249- 1 1126 W POMONA AVE LIC. NO I (LOCATION AND SETBACKS 1 1 I (MONROVIA, CA 91016 B/L357406 1 (SOILS ENGINEER APPROVAL I I ARCHITECT OR ENGINEER: TEL. NO: - i (FOUNDATION/TRENCH FORMS 1 I 1 LIC. NO: i (SLAB/UNDER FLOOR I I I I I I (RAISED FLOOR FRAMING 1 I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 1 JUNDERFLOOR INSULATION 1 I 1147H273 3 011 I I (FLOOR SHEATHING 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I NO 21 i (ROOF SHEATHING I 1 1 1 SCHOOL WITHIN HAZARDOUS 1 (SHEAR PANELS I I I (AIR QUALITY: 1000 FEET MATERIALS I 1 1 1 NO NO NO i (FRAME INSPECTION I I I (REQUIRED TOTAL SETBACK FROM EXIST I (FIRE SPRINKLER HANGERS 1 1 1 ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 (FRONT PL- I (INSULATION/WEATHER STRIPI I 1 I SIDE PL- 1 1 1 (INTERIOR LATH/DRYWALL 1 1 1 I I (EXTERIOR LATH 1 I 1 (RATED FLOOR/CEIL ASSEM. 1 1 1 1 (RATED WALL ASSEMBLIES 1 I I I (RATED SHAFTS/OPENINGS 1 1 1 I 1 1* 1T-BAR CEILINGS ADDITIONAL DATA ON FILE I 1 1 I I I1 1 1 1LOT DRAINAGE I I I (REPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I I I t 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 0708170008 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: 1 ON FILE SQ. FT STORIES TYPE 5112 GLICKMAN AV I STRUCTURE: VN I TEMP CA 917803362 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18585-006-033 1 1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl I 1 I 1 TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 IEXIST OCC GRP: 108/17/07 SR 02/13/08 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: , CODE: ALE -4949-THOMAS MAYEDA (626) 337 7,500 1 15112 GLICKMAN AV I I 1 ITEMP 917803362 I FEES PAID 1DE CRIPTION OF WORK 1 I I IFIRE DAMAGE ROOF OVER HANY STARTER BOARD REPLACED & PLASTER 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( I (APPLICANT: TEL. NO: I IMARY MCCONNELL (818) 703-0482- IAA BLDG PERMIT ISSUANCE 27.75 I I 120644 COHASSET IAC STRONG MOTION RESID 7500.00 VAL 0.75 ]SPECIAL CONDITIONS: I ICANOGA PARK CA 91306 ID2 PERMIT W/0 EN-HC 7500.00 VAL 183.00 1 1 TOTAL FEES 211.50 I I I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IK-B CONSTRUCTION (626) 932-1249- 1 1 I 1126 W POMONA AVE LIC. NO IILOCATION AND SETBACKS I 1 IMONROVIA, CA 91016 B/L35740G * I I 1 1 1 I ISOILS ENGINEER APPROVAL I 1 I I I I I I (ARCHITECT OR ENGINEER: TEL. NO: 1 IFOUNDATION/TRENCH FORMS I I LIC. NO: I ISLAB/UNDER FLOOR I I I I I I I I I IRAISED FLOOR FRAMING I 1 I I I I I I IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1147H273 3 011 I L 1 1 1 1 IFLOOR SHEATHING I INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: Il I I 1 NO 21 1 IROOF SHEATHING 1 1 I I I I I I 1 SCHOOL WITHIN HAZARDOUS 1 ISHFAR PANELS 1 1AIR QUALITY: 1000 FEET MATERIALS 1 1 1 1 1 NO NO NO (FRAME INSPECTION 1 1 I I I I I I IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I I I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I 1 1 1 IFRONT PL- I (INSULATION/WEATHER STRIPI I 1 I SIDE PL- I 1 11 1 1 1 11NTERIOR LATH/DRYWALL I 1 1 I I I I I I 1 I (EXTERIOR LATH I 1 I I I I I I IRATED FLOOR/CEIL ASSEM. I _ I IRATED WALL ASSEMBLIES I 1 1 IRATED SHAFTS/OPENINGS 1 1 1 1 1 IT-BAR CEILINGS 1 1 * ADDITIONAL DATA ON FILE I 1 1 ILOT DRAINAGE I I 1 1 IREPORT ID: DPR261 ROUTE TO: BS0508 I 1 1 1 I I I I I I