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HomeMy Public PortalAbout5304 GLICKMAN AVE_Building__ ADsa.9 11.55 APPLICATION FOR BUILDING PERMIT ], n.ss DIVISION OF BUILDING AND SAFETY ADDRESS 4 f Department of County Engineer County of Los Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT OF BUILDING CROSS ST. DISTR 0. GROUP TYPE SEWER MAP FOR APPLICANT TO FILL IN P B P BUILDING (/ /`/ ,A d rMadmST. ADDRESS O / (7 �^ �C_&r/AAl AV. NUMAP M ER STATE `yES O' HWY LOT NO. / BLOCK USE ZCINE SPECIAL 'y> CONDITIONS TRACT 1 O 14-~ NO.OF BLDGS. SIZE OF LOT I NOW ON LOT 9UILDING YARD HWY STREET NAME EXIST. USE OF _ SETBACK WIDTH EXISTING BLDG. G.` S /� CA"Lt FRONT OWNER V v ' ��,/�� //CIV AA SIDEMAIL ADDRESS J B,�/ GL�� /`fi7 d/ v P L / , O TRACT DWELL 1 UNIT T46/ 1.1-1 C/TV T 'G/ 7� 1 DWELL. 1 UNIT 5 INDUSTRIAL CITY 6 PUBLIC BLDG. ARCHITECT OR TEL. 2 DUPLEX 2 UNITS 7 p.DDN.,ALT., ETC. ENGINEER NO. 3 APT. UNITS 8 MISCEL. ADDRESS 4 COMMERCIAL CONTRACTOR V/41-< e K TC �L.'/4�7So33 INSPECTION RECORD ADDRESS OF e AJ_C.r 4 W1, L1,0- DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH SQ. F . NO. OF NO. OF STORIES FAMILIES USE OF STRUCTURE .1 T r` /� ` OO M FiC G / beC6 SIGNATURE OF , APPLICANT 7 APPROVALS ADDRESS DATE INSPECTOR'S SIGNATURE $ FOUNDATION: LOCATION PC QO P. C. $ FORMS.MATERIALS .�- FEE FRAME: FIRE STOPS. VALUATION $ O BRACING, BOLTS FEE FURNACE: LOCATION, _ 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS GAS VENT. DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CO ORDINANCES LATH, INT. AND STATE LAWS REGULATING BLJTLD7 CON RUC- TION. rLATH, EXT. SIGNATURE OF ,�K HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS2 01'F 4- X4 ' FINAL JOHN A.LAMBIE.COUNTY ENGIN ER VALIDATION CLYDE N. DIRLAM. CHIEF BLDG. INSPECTOR 4C.c� Mo CASH I6509U MAR 27 1 4.00 n k._: 76A638A CE 0803 12/69 ,C'r, APPLICATION FOR BUILDING PERMIT fl COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDIN JOHN A. LAMB]E, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITYs-r FOR APPLICANT TO FILL IN "FOREST Print ort a only) CROSS ST, �`'-� rEXISTING ` DISTRICT NO. GROUP TYPE ,�-- P SED BY V 3o �L�C '� � LI"S�- � CONST, J.A ��� STATISTICAL S I ATION _��- ER MAP BLOCK CLASS NO. LL,UNITS BK // U ZONE MAP p� T 25-Ki 3 AO NOWOONBLOT S ` SPECIAL ` CONDITIONS LDG. OWNER '`/ NPL ((/�1F.1-I is BLDG.SETBACK FROM ADDRESS 3Q� GLS FRONT PROP.LINE OF (STREET) r� TYPE OF EXISTING SETBACK HIGHWAY +' YARD = TOTAL CITYP JL It HIGHWAY WIDTH FROM C.L. ARCHITECT OR tTEL. / + -_ ENGINEER NO. BLDG.SETBACK FROM ADDRESS SIDE PROP.LINE OF (STREET) TEL. TYPE OF EXISTING SE CK HIGHWAY + YARD = TOTAL CONTRACTOR k-K-A-1NO. HIGHWAY WIDTH F M C.L. ADDRESS NO + = a LIC. O CITY CLASS CORNER CUTOFF YES ❑ NO ❑ CONSTRUCTION LEND NAME AND BRANCH E REVERSE SIDE FOR SPECIAL APPROVALS t ADDRESS d N SQ. FT."` NO. OF NO. OF ❑ Z SIZE ~- STORIES FAMILIES NEW USE OF l ADD STRUCTURE Q'L p ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ VALUATION $ �j � (� APPROVALS DATE INSPECTOR'S SIGNATURE P. PMT. FOUNDATION: LOCATION $ +: FEE FEE $� 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 FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTI ON. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILaN PLOY ANY PER ON IN VIOLATION OF THE LATH, INT. LABOR CODE STATE OF 'C I ORNIA IN RELATING TO WORKMEN'S COION R LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS. PRI&CIPAL STRU URAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH ^, O O 8 GcG11 1 3 8.2 S- I 76,A638A CE #803 4/70 APPLICATION FOR BUILDVIG ERM COUNTY OF LOS ANGELES ASSESSOR �. DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSC�4�Jr N COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY (�1 ,�LG_ 0 L•jill. FOR APPLICANT TO FILL IN NEAREST Print or tvoe only) CROSS ST. DISTRICTr I G TYPEBUILDING R S BY ADDRESS 5304 f�l��� �✓ CONST. 11 LOT NO. f BLOCK STATISTICAL CL//A��SSIFICATION SE R MAP CLASS NO.�L�.DWELL.UNITS BK A/ PG TRACT s;l USE ZONE[NO P NO.OF BLDGS. ✓� SIZE OF LOT NOW ON LOT CIAL USE OF NDITIONS EXISTING BLDG. - TEL. � OWNER �y y�y = NO. BLDG.SETBACK FROM ADDRESSC,-4,1f`�fm Ly FRONT PROP.LINE OF (STREET) /� TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL CITY T(y�'o/ �.G HIGHWAY WIDTH, FROM G.L. ARCHITECT OR TEL. + _ ENGINEER NO, BLDG.SET FROM ADDRESS SIDE PROP.LIN (STREET) TEL. TYPE OF EXISTING SETBACK HWAY + YARD = TOTAL CONTRACTOR 0 `` < , NO. HIGHWAY WIDTH FROM C.L. LIC. n- ADDRESS NO + = O U LIC. CITY CLASS CORNER CUTOFF YES ❑ ❑ O CONSTRUCTION LENDER NAME AND BRANCH SEE REVERSE SIDE FOR SPECIA APP OVAL a cn ADDRESS SQ. FT. NO. OF NO. OF NEW SIZE STORIES FAMILIES USE OF /f' ADD ❑ STRUCTURE /J ALTER ❑ REPAIR❑ SIGNATURE OF APPLICANT DEMOL ❑ VALUATION $ if s APPROVALS DATE INSPE OR'S SIGNATURE P FOUNDATION: LOCATION / FEE S FEE$ (. � FORMS, MATERIALS FRAME: FISTOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACIRE NG BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION.OF THE LATH, INT. LABOR CODE OF E STATE OF •CALIFORNIAA IN RELATING TO WORKMEN'S COM N TION INSURANCE. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 'Dip I � C FINAL Jw JOHN F. LEWIS. PRI CI AL STRUCTURAL E(N/GTNEEk- PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. (CASH .0 7� NOV 6 1D 9.00- v ~ 76A638A CE#803 9-68i��� AtPPLICATION FOR BUIL®I C PERMI COUNTY OF LOS ANGELES BUILDING c5-� 4 1 C � DEPARTMENT O?COUNTY ENGINEER ADDRESS CT-L BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST �✓ t COLEMAN W. JENKINS, SUPT OF BUILDING CROSS ST. 9' f+I6,l9W tG-vG FOR APPLICANT TO FILL IN DIST�CT NO • GR� TYPE PR D (Print or type only) CONST. FDDRESS STATISTICAL CL IFICATION SEW EMAP ', CLASS NO. DWELL.UNITS BK� PG . BLOCK USE ZONE NAAP ] TRACT 1 ;S 5 �) SPECIAL NO.OF BLOGS. �Q CONDITIONS SIZE OF LOT 3 147 INOWON LOT USE OF EXISTING BLDG. BLDG.SETBACK FROM TEL. FRONT PROP.LINE OF Lim —(STREET) OWNER NO. �-•�3 /' TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL G ADDRESS �?G / -44&<v w HIGH.W/�AY WIDTHFROM C.L. CITY 1_7�1Qi_L'�i ` 1Z UC'KF D } �0 _ � ARCHITECT OR BLDG.SETBACK FROM N� 7. TEL. SIDE PROP.LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. �y/, 1 } CONTRACTOR NO. LOC 44 + 1 0 = i (� O LIC. CU ADDRESS NO CORNER CUTOFF YES NO ❑ K LIC. O� CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS w CONSTRUCTION LENDER cl- C/)NAME AND BRANCH ADDRESS SIZE T STORIES t FAOMIOLFES NEW ❑ �- J USE OF ADD STRUCTURE �GL.0� -� ALTER ❑ SIGNATURE OF 1 ; REPAIR❑ APPLICANT V �" ` �` �� DEMOL ❑ VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION yG FEE $ FEE $ 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 FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE ODEN E STATE OF •CALIFORNI IN RELATING TO WORKMEN'S COMATION INSURANCE. HOUSE NUMBER CORSIGNATURE OF „ PERMITTEE RECT AND POSTED ADDRESS FINAL 1Ea, JOHN F. LEWIS, PRINCIPAL ST R URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH A/ 76A638A CE*803 9-07 ��'� ��✓ V.-APPLICATION FOR BUILDING PERMI I,, COUNTY OF LOS ANGELES BUILDING n DEPARTMENT 'OF.,COUNTY ENGINEER —ADDRESSCJ 'BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMB]E, COUNTY ENGINEER ~' COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST �/ CROSS ST. , DIST R T NO., RO TYPE PR C D BY FOR APPLICANT TO FILL IN CONST. (Print or type only) BUILDINGSTATISTICAL CLASSIFICATION SEWER MAP ADDRESS 5-3 �� � CLASS NO. DWELL,UNITS BK PG C LOT NO. BLOCK USE ZONE MAP .� NO. r71(/ 1 TRACT CONDSPECIAL TIONS �,,� / 3 NO.OF BLDGS. SIZE OF LOT � NOW ON LOT USE OF EXISTING BLDG, BLDG.SETBACK FROM f TEL.q ] ]] FRONT PROP.LINE OF (STREET) OWNER . L `>•, NO. I J TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL HI WAY WIDTH FROM C.L. ADDRESS T CITY - ,l fL BLDG.SETBACK ARCHITECT OR TEL. SIDE PROP.LINE OF (STREET) ENGINEER NO. TYPE OF EXISTING SETBACK I H rtNWZY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. TEL. + _ >_ CONTRACTOR NO. O ADDRESS NO CORNER CUTOFF YES ❑ NO U LIC. CDCD CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK CL_ C-1) z_ NEW ADD ALTER REPAIR DEMOLISH SQ. SIZE FT. STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT r VALUATIONS ° APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, FOUNDATION: LOCATION FEE 5 FEE S ,�: FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS ANO 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 1 WILL NOT EMPLOY ANY PERSON IN VIOLA. TION OF THE LABOR CODE OF THE STATE OF C IFORNIA RELAT• LATH, INT. ING TO WORKMEN'S TION IN RANCE LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- q PERMITTEE - RECT AND POSTED _ / ADDRESS FINAL I-. 10 JOHN F. LEWIS. PRIry IPAL STIR RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH L&O 5 0 1 5:: jUN 1 1 1 D 6.00- I �76A 638 A* -i �P'l, W. 1ON,FOR BUILDI G PERMIT S BUILDING ,,ff DEP�iRTIYI„ FG�OL Y Er`GINEER ADDRESS •�Cj"3(� 1G� -BUILSION LOCALITY JOHN'i4. A1VIBI-E, COUNTY ENGINEER COLEMAN W. JENK11 S, SUP-T OF BUILDING NEAREST CROSS ST. ry (L DISTRICT NO. GROUP TCONST �- YPE P DOSSED BY FOR APPLICANT TO<FILL IN (Print or type only) `a � BUILDING �+ > /yl STATISTICAL CLASSIFICATION SEWER MAPS ADDRESS\� j Com/ICC ss CLASS NO.—!.3—DWELL.UNITS BK PG C LOT NO. 31 BLOCK „JAS ZONE MAP V •�3 1` NO. L TRACT w CONDSPECIITIONS _ NO.OF BLDGS. SIZE OF LOT 7 S .�'C ( 3 6 NOW ON LOT USE OF EXISTING BLDG. �yL)9 ' — BLDG.SETBACK FROM (STREET) TEL FRONT PROP.LINE OF— OWNER FOWNER }� NO. '-I+ TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL L HIGHWAY WIDTH FROM G.L. ADDRESS 6 CITY _ LbGLLr 6,-) + = ZG3 t L” BLDG.SETBACK FROM ARCHITECT OR TEL. SIDE PROP.LINE OF !STREET) ENGINEER NO. TYPE OF EXISTING SETBACK HIGHWAY +_ YARD = TOTAL ADDRESS HIGHWAY t�WIDTH FROM C.L. TEL. LOCI— CONTRACTOR NO. / + �� l� CD O ADDRESS NO. CORNER CUTOFF YES NO ❑ � CITY CLASS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK NEW (;D 1) ALTER REPAIR DEMOLISH SQ. FT. NO. OF NO. OF L— SIZE STORIES FA LIES / � USE OF / 9'd' C(.- e i G Q- STRUCTURE SIGNATURE OF APPLICANT VALUATION $ 1 APPROVALS DATE, N P CTOR'S SIGNA TU RE P.C. PMT. - FOUNDATION: LOCATION • \ FEE S FEE S FORMS, MATERIALS - a FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING, BOLTS ,� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, N WITH ALL COUTY 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 LABOR ,E OF THE STATE OF CALIFORNIA RELAT. LATH, INT. INC TO WORKMEN'S C MP NSATION INSURANCE. LATH, EXT. ' SIGNATURE OF '�_ HOUSE NUMBER COR- , PERMITTEE - COR- RECT AND POSTED I ADDRESS IL FINAL ` JOHN F. LEWIS. PRINCIPAL STIR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH Lfil c 5 0 1 4'1'44 JU'11 1 D 1 2.0 0 rr �eDi APPLICATION FOR BUILDING PERMIT �� TM°" COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUILDI G ADDRES 11i.��lU or a certificate of Workers' Compensation Insurance,or a certified ?J� J Copy thereof(Sec.3800,Lab.C.) CITY ZIP, ne �ITO •�J? e u LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT C�L� ElCertified copy is hereby furnished. NEAREST CROSS ❑ Certified copy is filed with the county building inspection BLOCK LOT S department. ' C USE ZONE.. MAP NO. Date Applicant 6 AOK P PBRCEL-9 lr �, SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' NK e1401 ,a COMPENSATION INSURANCE P-OA � (Its '���� WITHIN 1000 FT.OF SCHOOL? YES —NO / (This section need not be completed if the permit is for one hundred ADDR S dollars ($100)or less.) -1) !�l<M Air✓ DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED QY I certify that in the performance the work for which this permit �( � L /-y � !� is issued, I shall not employ any, rson in any ma ner so as'to ("�' O �"�9 become subject to the Workers' O pens ARCHITECT ORENGTEL NO. STATISTICADate/'�4-�✓.S ApphCant / � � ,044G ADDRESS CLASS NO. DWELL CLASSIFICAT DWELL UNITS/ APT CONDO NOTICE TO APPLICANT.' If, after making this Certificate of REQUIRED /L 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 comply with such provisions,or this permit shall be deemed revoked. ADDREFRONT SS LIC. F L r LICENSED CONTRACTORS DECLARATIONSIDDE EL CITY LIC.CLASS O 1 hereby affirm that I am licensed underprovisions of Chapter 9 U (commencing with Section 7000)Of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force and effect. NEW ❑ BK PG O F- License Number Lia D RIPTIO OF WORK Class y� ADD E] VALUATION W Contractor Date f" ALTER ❑ $ ®• O- 0 I am exempt under Sec. -x- 6[,- ��� "cam REPAIR. Ur $ Z_ B.&P.C.for this reason � DEMOL ElLOMA P/C# E OF Date: USG ByL�t�G ll-Z_ URM El IgnatUre APPLICgNT1JPRINT) .- TEL NO. LDMA Perm# Xit;teir gDDRESSOas owner of the property, or my employees with wages as �I Zr t-f I n Ur sole compensation, will do the work and the structure is , not intended or offered for sale (Section 7044, Business and FINAL DATE Q =1 I `r.16-1 Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE I % J i ?#CIT ❑ 1, as Owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? - t a licensed contractors to construct the project (Section 7044, FINAL BY > >- # --�50 Business and Professions Code.) �'Es❑ No #!-!iL .. .. S WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH '-' CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR s ! !#�S GUIDELINES. ':i it,I•i•1r„-' e no I hereby affirm that there is a construction lending agency for YES 11No1 the performance of the work for which this permit is issued(Sec. 3097,CIV.C.) I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING q CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, (II II,fI I--f�j##{I 7 rn Lender's Name TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD.� 4408; c t Lender's Address e f Q OWNER OR AGENT I certify that I have read this application and state under penalty p of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE. 1nwit�, all county ordinances and State laws relating to building L� m uction, and hereby* uthorize representatives of this County ISSUANCE FEE O �!O�!,t rupon ab e- entity for iN �' ""1' INVESTIGATION FEE TOTAL FEE ofApPlicn1 or Agenl SEE REVERSE FOR EXPLANATORY LANGUAGE WORy,ERS''COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT q, est � insure, or certificate'of Workers'Compenstion Insurance, or i 1, �y th re�ec. 3800, 1, COUNTY OF LOS ANGELES BUILDING AND SAFETY cy No. ompany copy y FOR APPLICANT TO FILL IN ADDRESS �� r Certified co is hereby furnished. BUILDINU Certified copy is filed with the county building inspec- BUILDING n r ent. ` ADDRESS LOCALITY Date Applica t ` NEAREST CITY ZIP CROSS ST. '_ CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for oneUSE ZONE MAP TRACT BLOCK UOT NO.hundred dollars ($100)or less.) NO. EL SPECIAL _ I certify that in the performance of the work for which this " OWNER r— CONDITIONS permit is issued, I shall not employ any person in"any manner DISTRICT GROUP [YPE FIRE PROCESSED BY so as to beco subject to the Workers'Comn'a ' Laws. ADDRESS PONSTG` / Z'�E Date Applicant CITY ZIP STATISTICAL CLASSIFICATION f APT. CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. W Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply'with such provisions or this permit shall be TEL. G VALIDATION CONTRAC NO. /�J BK. deemed revoked. PG, LICENSED CONTRACTORS DECLARATION C. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRES O. \/ VALUATION (commencing with Sectio 7000)of Division 3 of the Business and LIC. Professions license is in full force and effect. CITY CLASS $ t111 SQ. F NO. OF NO. OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE lLJ $ Contract o � \ ate � DESCRIPTION QF WORK NEW Elam exempt from the licensing requirements s I am a ADD z 1 .3 1, 1 ,A licensed architect or a registered professional engineer / i ALTER ❑ FINAL �•-� . acting in my professional capacity (Section 7051, 5!w- E]REPAIR DATE � # 0 0 0 0 2 1 Business d P sio Code). USE OF FINAL DEMOL 5 0. 4 0 EXISTING BLDG.. ❑ + _ Lic.or Reg.No. Date ' APPLICANT L. By '" 0 0 0 50,IL0U OWNER-BUILDER DECLARATION (PRINT) 1 hereby affirm that I am exempt from the Contractor's License 9, 2 3 — 1 Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT ❑ BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. El 1, NO. 1 3 1.2 A I, as owner of the property, am exclusively contracting �\ with licensed contractors to construct the project (Sec- ADDRESS 0 0 0 0 0 1 tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 2.0 a 9,7, Q 0 :I hereby affirm that there is a construction lending agency for FRONT he performance of the work for which this permit is issued P.L. 0 0 0 97. Q 0 (Sec. 3097, Civ. C.). SIDE P.L. 09, 23-81 Lender's Name /� C n P.C. Fee$ �— Permit Fee D ' Lender's Address w I certify that I have read this application and state that the Issuance Fee aabove information is correct. I agree to comply with all County Investigation Fee a 0 ordinances and State laws relating to building,construction, Total Fee and her authorize representatives of this County to enter m on tbe,a ove-mentioned property for inspe ion qb a Q. SEE REVERSE FOR EXPLANATORY LANGUAGE �\ Signature of Applicant or Agent Date ©s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0804040008 PHONE: (626) 285-0488 EXT: (LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: ITR: 10558 LT: 31 SQ. FT STORIES TYPE OCCUP GROUP 5304 GLICKMAN AV - STRUCTURE: 326 1 V-B R-3 I TEMP CA 917803328 (ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: OLIVE 18585-004-023 OTHER: THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl TENANT: 1EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: EXPIRES ON: 1 EXIST OCC GRP: 104/29/08 SR 10/26/08 OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DAT FINAL Y: CODE: ITHOMAS DARYL G (626) 579-9065- I 48,320 1' e 15304 GLICKMAN AV 1 ITEMP 917803328 I FEES PAID rLDEScr1pfj:Oj OF WORK 1 1 ICON/,VkT EXI TING PATIO TO N AND BATHROOM 326 S.F. IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 / 1 1APPLICANT: TEL. NO: I I 1WU (626) 912-3289- IBI PLANCHECK W/ENERGY 48320.00 VAL 733.65 1 118403 VILLA CLARA ST IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: 1 IROWLAND HEIGHTS 1AC STRONG MOTION RESID 48320.00 VAL 4.83 I I B2 PERMIT W/ENERGY 48320.00 VAL 863.12 1 1 IFR INV WORK W/O PERMIT 128.50 DOL 128.50 ICONTRACTOR: TEL. NO: I TOTAL FEES 1,757.85 (APPROVALS DATE INSPECTOR SIGNATURE I ITHAMAS SURACHAI (626) 579-9065- 1 1 15305 GLICKMAN AVENUE LIC. NO ILOCATION AND SETBACKS 1 1 ITEMPLE CITY, CA 91780 NONE I 1 I 1 1 ISOILS ENGINEER APPROVAL 1 1 (ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS 1 I 1WU, STEVE C Y (626) 912-3289- 1 1 1 1 118403 VILLA CLARA ST. LIC. NO: 1 ISLAB/UNDER FLOOR 1 1 1 IROWLAND HEIGHTS, CA 91748 26073 C 1 1 1 1 1 IRAISED FLOOR FRAMING 1 1 IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:1 1UNDERFLOOR INSULATION I I I 1 3 011 I I I 11ST LEVEL FLOOR SHEATH I 1 1 INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: 1 I I I I 1 NO 21 I 12ND LEVEL FLOOR SHEATH 1 1 SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING I I I (AIR QUALITY: 1000 FEET MATERIALS 1 1 I 1 NO NO NO I IFIRE DEPT. FRAME INSPECTI I I IREQUIRED TOTAL SETBACK FROM EXIST I 1BLDG DEPT. FRAME INSPEC 1 - / 1 1 ISET BACK YARD: HWY: PROP LINE: WIDTH: 1 I I IFRONT PL- I ISHEAR PANELS SIDE PL- i 11NSULATION/WEATHER STRIP 1 11NTERIOR LATH/DRYWALL 1 1EXTERIOR LATH ILOT DRAINAGE 1 ISMOKE DETECTION DEVICES 1 1 1 1 1 IFIRE DEPARTMENT APPROVALI I I (REPORT ID: DPR261 ROUTE TO: BS0508 1 I 1 I I I I I I