HomeMy Public PortalAbout5210 GLICKMAN AVE_Building__ TEMPLE CITY -1
7iA999A CEri�/
809- 1-61 APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING �.
DEPARTMENT OF COUNTY ENGINEER ADDRESS _ z
BUILDING AND SAFETY DIVISION LOCALITY y
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. L
DISTRICT NO. GROUP TYPE PROCESSED BY
FOR APPLICANT TO FILL IN
t5-"' (r CONST.
BUILDING STATISTICAL CLASSIFICATION SEWr.RMAP
ADDRESS - ����'i�1 is /,f-'H� 1r% � / BK PG
CLASS.NO.�DWELL. UNITS--j
LOT NO. BLOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED
t
y -) 4 MAP q - HIGHWAY
TRACT
'y � NO.OF BLDGS. NO. <�L-' (CIRCLE) STATE MAJOR SECOND(C CAL
SIZE OF LOT /-2j I NOW ON LOT - USE ZONE SPECIAL
USE OF (7)
EXISTING BLDG. \ I "
// / TEL. ,r
OWNER 1-4 �- uE E �L'!f le"". NO. /j,.-its:">, BUILDING EXIST.
SETBACK YARD HWY .S REETAME WIDTH
ADDRESS �%�J f. iFJJ01"eF 1-:1714' f?i Vl' FRONT
ARCHITECT OR TEL. P.L. ! '
ENGINEER NO. SIDE
P.L.
ADDRESS O_
J/ L.�, INSPECTION RECORD , O
TE
CONTRACTOR ,/.is'lfat LS .E� G L"G�. NCL""'/b6J r j'. L)
}�1 �G- /L/,/i%LF- fr-may 4����' 0
ADDRESS
DESCRIPTION OF WORK w
CL
N
r&%W ADD_ ALTER REPAIR DEMOLISH Z
SQ. FT. NO.OF NO.OF
IZE ,✓�� `.P STORIES FAMILIES
USE OF
STRUCTURE �T/ 617_4
el
SIGNATURE OF
APPLICANT -VALUATIONS
APPROVALS DATE INSPECTOR'S SIG AT RE
. PMT. FOUNDATION: LOCATION
PC. '
FEE $, FEE $ FORMS, MATERIALS /"-
III 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 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 P SON IN VIOLA- LATH, INT.
TION OF THE!LABORACOD F THE STATE IFORNIA R LAT-
INO TO WORKEN'S C N IO NS ALATH,EXT.
SIGNATURE F HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS G f FINAL
CLYDE N. DIRLAM, PRINCIPAL STRC RAL ENGINEER
PLAN CHECK VALIDATIONCK. M.O. CASH PERMIT VALIDATION (!q M.O. CASH
LtA,UO 6 6 0 5:a NOV 7 2 3 D 2 3 2 5 e v
LJI,a 7 5 4 1-0 NOV 2 8 1 D 5 0.00- Q
i
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN( BUILDING ADDRESS
ADD S
I hereby affirm that I have a certificate of consent to self insure, BUILDING �w /�', -�
or a certificate of Workers'Compensation Insurance,or a certified _ ��y �7
coy 4�2of Sec.3800,Lab.C.)�`y`�� � `� c CITY G � ZIP `7 1/6 ® LOCALI ��
PO o. uzm � ® COrhpany a'�(�'•/� �U� SI E OF LOT NO.OF BLDGS.NOW ON LOT zy
❑ Certified copy is hereby furnished. NEAREST CROSS ST.
Certified Copy is filed with the County building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO.
departm nt.
DateAppllCant /i �1�//�9 ��iC�7� ASSESSOR MAP BOOK PAGE PARCEL
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWN _ TE . WITHIN 1000 FT OF SCHOOL? . YES NO
COMPENSATION INSURANCE
ADD �y �
(This section need not be completed if the permit is for one hundred L I C I. DISTRICT GROUP TYPE CONST.' FIRE ZONE CESSED Y
dollars($100)or less.) ^ ti
ZIP /`-�',rt�/ 3 /�
1 certify that in the performance of the work for which this permit bq-Pd c- 6.__ ti 0 d 0 ��ll U9✓)( �T
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO.
become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate of F REQUIRED TOTAL SETBACK FROM EXIST
Exemption, you should become subject to the Workers' CO TOR ,ZE NO._ �� SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith f T 19 s FRONT
comply with such provisions or this permit shall be deemed revoked. SS LIC f� PL
,L L SIDE
LICENSED CONTRACTORS DECLARATIONclyr LI LASS, PL O
I hereby affirm that I am licensed under provisions of Chapter 9 L-., 3 SEWER MAP U
(commencing with Section 7000)of Division 3 of the Business and S E NO.OF TORES NO.OF AMILIES
Professions Code,and my license is in full force and elle t. NEW ❑ BK PG , CD
CRIP ION OF WORK ADD ❑,
. License N b r ic_.Class — _ ® ! VALUATION �Lu
75
Contract r oN ) r 90 _❑ E]ALTER
G d� z I am exempt under Sec.
REPAIR
BARC.for this reason �� DEMOL ❑
LDMA P/C#
Date: USE OF EXISTING BLDG. URM 1:1
Signature A L NT(PR T¢ `TF/ LDMA Perm#
El 1, as owner of the property, or my employees with wages as Q ` p
their sole compensation,will do the work and the structure is ADDRESS F - '£r•L•! n a
DATE
not intended or offered for sale (Section 7044, Business and FINAL CG
PrOfeSS10r1S Code.) WILLTHE APPLICANT OR FUTURE BUILDIN OCCUPANT HANDLE A HAZARDOUS MATERIAL❑
I, as owner of the property, am exclusively contracting with ��.�'r
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ! a E tTHE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FlNdit
"M
licensed 'contractors to construct the project.(Section 7044, YES ElNO 11 ';I TAI
Business and Professions Code.)
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING x,c; ) i•1
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 3�j_i
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST
FOR GUIDELINES. 1 v/1/, ( 3 L�Zirr r'3.
�
I hereby affirm that there is a construction lending agency for ves El No El '� :f t(`i56 rl_ n `s
D• (t
the performance of the work for which this permit IS issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD
3097,Civ.C.). PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES
- COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 220.140 CONCERNING n[--100-�gi( ",•�j, re'�I'�i,
Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. 0 0
So ;
IL Lenders Address
OWNER OA AGENT 11ice; )h, Win:».
o I have re s-apptt�3ibfra state that the above
information rrect. I agree to compl with all County RC.FEE PERMIT FEE
a ordinances a d State laws relating to build i construction,and
a. hereby auth r e re esent 'v s o thi Ounty to ente upon ISSUANCE FEE,
the boo o d pro or' n >� e On
a
toINVESTIGATION FEE TOTAL FEE
a
ieaaareor �rarn �: Dara
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 1002170082
PHONE: (626) 285-0488 EXT: `
LEGAL ID: I NO. OF CONST BUILDING ADDRESS:
ITR: 27309 LT: 2 1 SQ. FT STORIES TYPE 1 5210 GLICKMAN AV I
STRUCTURE: 2600 V-B I TEMP CA 917803326
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18585-005-002 1 1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
I I I 1
TENANT: JEXIST BLDG USE: RESID USE ZONE: R-1 TISSUED ON: PROCESSED BY: 1
EXIST OCC GRP: 102/17/10 SR
� 1 � I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE:
IPEREZ, CARMEN (626) 443-7238- 1 6,000 I
15210 GLICKMAN AV I 1.1 1
ITEMP 917803326 1 FEES PAID IDESCRIPTION OF WORK 1
IT/O REROOF 30 YR CLASS A SHINGLES
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: (
(APPLICANT: TEL. NO: I I I
IGUY (626) 679-1284- IAA BLDG PERMIT ISSUANCE 27.75 1 1
16252 TEMPLE CITY BL. IAB STATE GREEN BLDG FEE 6000.00 VAL 1.00 ISPECIAL CONDITIONS: 1
ITEMPLE CITY CA 91780 IAC STRONG MOTION RESID 6000.00 VAL 0.60 1 I
ID2 PERMIT W/O EN-HC 6000.00 VAL 149.40 1
1 1 TOTAL FEES 178.75 I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IB AND G ROOFING (626) 679-1284- 1 1 1
16252 TEMPLE CITY BLVD. LIC. NO 1 ILOCATION AND SETBACKS 1
ITEMPLE CITY, CA 91780 903492 C39 1 -1-1
1 ISOILS ENGINEER APPROVAL 1
I I I I I I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I
1 LIC. NO: I (SLAB/UNDER FLOOR 1 I
I I I I I I
I IRAISED FLOOR FRAMING I I
I I I I I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 (UNDERFLOOR INSULATION I I
1147H273 3 001 1 1
I I IFLOOR SHEATHING 1 I 1
INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I
1 NO 21 1 IROOF SHEATHING I
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS
1AIR QUALITY: 1000 FEET MATERIALS I I 1
1 NO NO NO 1 1FRAME INSPECTION I 1
I I I I I I
IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I I
ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I
IFRONT PL- I (INSULATION/WEATHER STRIPI I I
I SIDE PL- 1 11 1
1 (INTERIOR LATH/DRYWALL I 1
I I I I I I
1 1 IEXTERIOR LATH 1 1
I I I I I I
I 1 IRATED FLOOR/CEIL ASSEM. 1 1
I I I I I I
I IRATED WALL ASSEMBLIES 1 I 1
I I I I I I I
1 I IRATED SHAFTS/OPENINGS 1 I 1
I I I I I I
1 IT-BAR CEILINGS 1 1 1
I I I I I I
1 ILOT DRAINAGE I 1 1
I I I I I I
I IREPORT ID: DPR261 ROUTE TO: BS0508 1 I 1
I I I I I I