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HomeMy Public PortalAbout5216 GLICKMAN AVE_Building__ TEMPLE MP ITY 76A666A CE#808,1-61 APPLICATION F A OR BUILDING P ERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER F DDRESS r BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO., GROUP TYPE P SSED BY FOR APPLICANT TO FILL IN C' CONST. BUILDING �?p/ / STATISTICAL CLASSIFICATION I SEWER MAP c BK PG ADDRESSj4 CLASS.N_ O. �,, /DWELL.UNITS / LOT NO. BLOCK WATER NOT REQUIRED11„G RECEIVED �9 CERTIFICATE: TRACT 7-S 0/p 1 MAP HIGHWAY NO.OF BLDGS. NO - (CIRCLE) STATE MAJOR SECOND, CAL' SIZE OF LOTSO I NOW ON LOT USE ZONE SPECIAL USE OFCONDITIONS EXISTING BLDG. -” -- I TEL / OWNER c.✓- �.I�-.vC " .r7 fx'. NO.r'Jf' °LV.c'.�'. BUILDINGEXIST. - SETBACK YARD HWY REE NA E WIDTH ADDRESS c t 7. c: r Y + . FRONT ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P.L. �- ADDRESS TEL.CONTRACTORtI'/1�, 1�� 1%£L. f.:c NO./!I INSPECTION RECORD O '! ADDRESS ) O DESCRIPTION OF WORK v Lu CL t� NEW ADD ALTER REPAIR DEMOLISH Z SQ.FT. .;J NO.OF NO.OF �IZE /,: STORIES FAMILIES USE OF STRUCTURE a SIGNATURE OF APPLICANT VALUATION �- /�� ��� C1�� APPROVALS DATE : INSPECTOR'S SIGNATU E FOUNDATION: LOCATION P.C. PMT. FORMS,MATERIALS ' FEE $ FEE $ 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 ' t BUILDING CONSTRUCTION. I 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 O C FORNIA RELAT- ING TO WORKMEN'S CO NS ION SU N LATH,EXT. SIGNATURE OF / HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS S c / FINAL CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. . CASH PERMIT VALIDATION CK. M.O. CASH L' o66o6�; i-l`w 723 D 2 6.7 51 . L&O7 5 4 2 NOV28 1 D 5 7.00- WORKERS'COMPENSATION DECLARATION , _ I hereby affirm that. I have,a certificate of consent to self ynsure, or a,certificate of Workers'Compensation insurance, A P P L I CAT I O N F`O R BUILDING PERM IT or a ceftified copy thereof.(Sec. 3800, Lab. C.) l�=5tt COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy No.�Z�'i.-`��Company f,_r ' j5 " t14 ©/,Certified,copy is•.hereby furnished..' FOR APPLICANT TO FILL IN BUILDING Certified copy is filed with the county building inspec- BUILDING / -tion department ADDRESS `� + f__.l�- '\ �r;: - - Date-` - " /Appl icantCITY ZIP LOCALITY (r CERTIFICATE OF'EXEMPTION FROM,WORKERS': ' _ ' ' NO.-OF BLDGS. -; NEAREST COMPENSATION INSURANCE ' SIZE OF LOT i r�• `�f/-{.': NOW ON LOT «'_ CROSS.57. (This section"need not be completed if'the.permit.is•for-;oneASSESSOR hundred,dol.lars,($100)or less.) TRACT I BLOCK LOT NO. MAP BOOK PAGE PARCEL " _ _ OWNER ' _ T I certify that in the performance of the work for which this LAN t P�tFNO: r OP permit is issued,'I shall not employ any person m any,manner I SPECIAL d USE ONE '] so as to become sublecl'to the Workers`Compensation Laws. 'ADDRESS �l 1 Cly MTaf�t CONDITIONS V t i. Date' APPlicant" ZIP—.M !__ -G lT _ . NOTICE TO APPLICANT: Ifr, aftemaARCHITECT OR TEL. king this Certificate of DISTRICT G_OUP: TYPE FIRE PRO ESSED BY ENGINEER NO. 0 Exemption; you should _become subject to"the Workers'. CONST.. ZONE V Compensation`provisions of-the Labor Code "you,must forth- �� d ADDRESS with comply-with such provisions or this permit shall be . .——. _ _ _. ..___ �� "� /� _ -- I - - - y deemed revoked. . TEL. STATISTICAL CLASSIFI ATION ' APT. NDO.. Z "" CONTRACTOR LIGE"� 2 SC 5 co LICENSED CONTRACTORS DECLARATION: s - LIC - . CLASS NO. DWELL. UNITS 2 I-hereby affirm that Lam licensed under provisions of Chapter 9 ADDRESS; r, ey _ NO. ( l am- CLASS Section 7000)of Division'3 cf the Business•and_ ,. - _ _� .LIC.-- - EWER MAP Professions Code, and my license is m•fuil'force and effect. CITY -t[r'E - ��i� CLASS S SQ. FT. NO.OF NO. OF CHECK BK. PG. License Number ( ^- 1`f � Lic.Class SIZE �^ STORIES 1` FAMILIES f ONE (� ,,� ! VALUATION Contractor' i R 2'/G� C.�1Z p'af u� C� � DESCRIPTION OF WORK p �j Q NEW - ❑ �1� .j ADD a , 1 ❑ I am exempt under Sec. - S-C 1?`/ -' -, lam_, - - - `-" ' ALTER ❑ B.&P.C. for this reason REPAIR. ❑ �' ` to t,�. j EXISTUSE OING BLDG.'- fL't" 1 K_ DEMOL ❑ CE J 1_5 A = f Signature �Y �-w APPLICANT pp�� �^ TEL. ,y FINAL PRINT) /`\ 1(_ (_/ N 'i ® a o 0 0 1 OWNER- DER DECLARATION - . . __... .__... _... -DAT I hereby.affirm that I am exempt from the Contractor's License 5[�`+z�' Law for the following-reason (Section 7031.5, Business and ADDRESS 5 '7 �': L-(-i G, f LA KI 6 . F' ( a 1' 8 1. 1 3 Professions Code): " PRESENT - ___ y•-:. - BUILDING 1 81 1 3 5 ❑ 1,'as owner of the property, or my'employees with ADDRESS ® �` wages as their sole compensation,will do the work and the structure isnot intended or offered for sale(Section LOCALITY "' , O 1.0 9-�,8 7 7044, Business and Professions Code'). MOVING TEL. ❑ 1, as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors To construct-the'project (Sec- ADDRESS _ tion 7044, Business and Professions Code). CONSTRUCTION LENDING-AGENCY--" "' REQUIRED TOTAL SETBACK FROM:.... EXIST. SET BACK YARD HWY PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT the performance of the!work for which this-permit is issued - P.L. (Sec. 3097, Civ. C.). SIDE Q Lender's Name LDMA Ref. #' ^ P.C. Fee$ Permit Fee V/ _ Lender's Address � w //y ` , I certify that-1 have read this•application and.state that the ... _. ._- . _._ Issuance Fee- V t U- D LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee g 0 ordinances and State laws relating-to building construction, Total Fee - p- -- u and hereby authorize representatives of this County to enter LDMA Perm. # - up The above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent---° Date bOO TMLE CiTY 7YABSBAI:E UBOs•1-61 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST I WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTBIaT NO. GROUP TYPE 6, 09 WALL CONST. BUILDING / r STATISTICAL CLASSIFICATION I SEWER MAP ADDRESS I BK PG _ CLASS.NO.Z-2DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED ❑ 0 .�7 J'1 CERTIFICATE: TRACT C--/ J C MAP I HIGHWAY STATE MAJOR SECOND,'e CA NO.OF BLDGS. NO.. (CIRCLE) SIZEOFLOT.. 1,5­0. IN ON LOT USE`ZONE -SPECIAL - USE OFR_( CONDITIONS EXISTING BLDG. CY- ' � r TEL. OWNER NO. BUILDING EXIST. ' ,j' _ _ r YARD HWY STREET NAME .+r �le .�.Ll-.f_.rLYYUW� I``` SETBACK i WIDTH ADDRESS ' ARCHITECT OR TEL. P. L. ENGINEER NO. SIDE P.L. ADDRESS INSPECTION RECORD a- CONTRACTOR _ = TNEOL U �// ADDRESS / ,3,)- w O DESCRIPTION OF WORK LLI r O a NEW ADD ALTER REPAIR DEMOLISH y SQ.FT. NO.OF NO.OF Z SIZE STORIES //�� 1FAMILIES USE OF W STRUCTURE {..Q �` A SIGNATURE OF APPLICANT VALUATION - av APPROVALS DATE INSPECTO 'S SIGNATURE PPMT. �,n FOUNDATION: LOCATION I FEE I FEE $ FORMS,MATERIALS / FRAME:FIRE STOPS, / ^ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS f AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE-LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT .DUCTS f BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. 6 li J/ t1 TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURAN LATH,EXT. 1 SIGNATURE OF HOUSE NUMBER CDR MI PERTTEE RECT AND POSTED t ADDRESS 14iI FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL I- ER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT -VALIDATION CK. M.O. CASH WORKER `COMPENSATION DECLARATION I hereb taffi m;th' t I have a certificate of consent toself insure, or,b ertificate of Workers'Compensation Insura,nce, APPLICATION 'F OR BUILDING PERMIT ora certified copy thereof (Sec 3800, Lab. C.) In) COUNTY OF LOS ANGELES BUILDING.•AND-SAFETY P01icy.No�y- G'1 !Company. 57 17' CIA.( -. - � 0- Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING. ; ADDRESS _ Certified copy'is filed with the county building inspec- BUILDING tion department. ADDRESS � i (� , �?�—lC /�t Date (ri- Applicant'• ('� v`_ CITY�� hLC . L�r�( ZIP LOCALITY - CERTIFICATE OF EXEMPTION FROM WORKERS' ..... 'j NOOF BLDGS:- NEAREST. COMPENSATION INSURANCE SIZE OF LOT _ X cF .-NOW ON LOT CROSS ST. (This section need not be completed-if the permit is for one ASSESSOR. - hundred dollars ($100)or less.). TRACT BLOCK LOT NO, MAP BOOK PAGE PARCEL _ ._ USEONE OP I certifythat in the pe'rfo�mance'of the work for which this OWNER r tk" C k 'IMEI� NO: Nn t7C permit is issued I shall not employ any person in any manner -� - -SPECIAL' so as to become subject to the Workers'Compensation Laws.. ADDRESS [ ( - 1_i. .•-1�lti-iL 1�J CONDITIONS Date' Applicant CITY __.�GA✓�r Lr~ -I Z' ZIP., NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL: O• ",DISTRICT:__ ,GROUP: TYPE, FIRE _ PROCESSBY I ~ Exemption, .you'should become subject-to the, Workers' ENGINEER NO. CONST./7 C E ZONE U Compensation provisions of the Labor-Code, you must forth- ADDRESS with comply with such..provisions.or this.permit shall be deemed revoked.'. TEL• STATISTICAL CLASSIFICATION APT. NDO. Z CONTRACTOR , (?i a`t` GNQ Lsx LICENSED CONTRACTORS DECLARATION _ LIC - CLASS NO. DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 3 C` I C l: NO. Z (commencing with Section.7000)of Division 3 of the Business and _ _.. LIC: E P SEWER MA Professions Code,"and my license is in full force and effect. CITY Q�6_& j eL j_ 1.�� CLASS; n BK PG �✓ 9 VALIDATION SQ. FT. NO._OF NO.OF CHECK License Number i G- Lic.Class-' i>'! SIZE e>Z5 STORIES r" FAMILIES ( ONE VALUATION Contractor yc CJ DESCRIPTION Date OF WORK STG�A — Po , iap_tc= " r' n—T,' i NEW _ ADD _ 0 1 am exempt under Sec. ; ALTER El B.&P.C. for this reason l %T� f REPAIR $ — pR�1 USE OF ;2631.4A D e: EXISTING BLDG. tXL L ❑ DEMO . Signature APPLICANT TEL. FINAL �. # o 0 0 0 1 OWNER-BUILDER DECLARATION (PRINT) NO. DATE_q ]:hereby affirm that I.am exempt from=the Contractor's License 7-8.0 d. . Low for the following reason (Section 7031.5, Business and ADDRESS FINAL' U -Professions Code):. PRESENT - -— By _T&.0_0 ❑ BUILDING I, as owner of the property, or my employees with ADDRESS �_1,.d 9 8 7 wages as their sole compensation,will clothe work and the structure is not intended or offered for sale(Section LOCALITY L 7944; Business and Professions Code), MOVING — TEL. a I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct,the project (Sec- tion 7044, Business and Professions Code). . ADDRESS REQUIRED, TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD ' ' HWY PROP. LINE. WIDTH I hereby affirm that there is a construction lending agency forFRONT the performance of the work for which this permit is-issued - P.L. ----- - (Sec. 3097,.Civ. C.)., SIDE P.L. Lender's Name o �) LDMA Ref..# ' Lend '-er's Address P.C. Fee$ .. ... _ ._ ,Permit Fee . - I Certify that Ihave-read this application and.state that the _ Issuance Fee (- t•J LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee ordinances,and State laws relating to building construction, _ -- Total Fee ; (� LDMA Perm. # - and hereby authorize representatives of this County to enter. upon the above-me coned property for inspection purposes. '� s1 � � SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Applicant or Agent Date 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 1101310012 PHONE: (626) 285-0488 EXT: LEGAL ID: I NO. OF CONST BUILDING ADDRESS: ITR: 27309 IT: 3 SQ. FT STORIES TYPE I 5216 GLICKMAN AV I I (STRUCTURE: 3300 V-B I TEMP CA 917803326 I ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: GREEN I 18585-005-003 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: I EXIST OCC GRP: 101/31/11 SR I JOWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE: 1 -ISHAFER, SAM (626) 840-1648- I 4,800 I _7115216 GLICKMAN AV I I TEMP 917803326 I FEES PAID IDRSCR-IPTIO14 OF WORK I I ITEAR OFF AND REROOF WITH IMPOSITION SHINGLES I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 APPLICANT: TEL. NO: 1 1 14 SEASONS ROOFING INC. (323) 726-9615- JAA BLDG PERMIT ISSUANCE 27.80 I I 11300 W. COLEGROVE JAB STATE GREEN BLDG FEE 4800.00 VAL 1.00 (SPECIAL CONDITIONS: I IMONTEBELLO, CA 90640 JAC STRONG MOTION RESID 4800.00 VAL 0.50 I 1D2 PERMIT W/O EN-HC 4800.00 VAL 132.80 J J TOTAL FEES 162.10 J JCONTRACTOR: TEL. NO: I JAPPROVALS DATE INSPECTOR SIGNATURE I 14 SEASONS ROOFING INC. (323) 726-9615- I 1 11300 W. COLEGROVE AVENUE LIC. NO I 1LOCATION AND SETBACKS I 1MONTEBELLO, CA 90640 857018 C39 1 I ISOILS ENGINEER APPROVAL (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I I - I LIC. NO: I 1SLAB/UNDER FLOOR I I I I I I IRAISED FLOOR FRAMING I I I I I I 1MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I I 1147H273 3 001 1- I I 1 1FLOOR SHEATHING INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 1 I NO 21 1 1ROOF SHEATHING SCHOOL WITHIN HAZARDOUS ISHEAR PANELI I (AIR QUALITY: 1000 FEET MATERIALS I I I J I J NO NO NO I (FRAME INSPECTION I J I J 1FIRE SPRINKLER HANGERS I J I I IINSULATION/WEATHER STRIPI 1 I (INTERIOR LATH/DRYWALL 1-1 I I I I 1EXTERIOR LATH J I I I I I IRATED FLOOR/CEIL ASSEM. IRATED WALL ASSEMBLIES I I I I RATED SHAFTS/OPENINGS I I I I I I 1T-BAR CEILINGS I I I I I I ILOT DRAINAGE I IREPORT ID: DPR261 ROUTE TO: BS0508 I I J I I I