HomeMy Public PortalAbout5007 GOLDEN WEST AVE_Building__ CF iA03(RId:l l/78) g
APPLI IO OFA B L NG PERMIT
COUNTY OF LOS ANGELESBUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS BUIL-0ING(jO,5 .
BUILDING
ADDRESS -VO CO ds/
Lv+L�t LOCALITY
NEAREST �Q
d .� ZIP ,v o CROSS ST. �'T
NO.OF BL.DGS. + ASSESSOR
SIZE OF LOTS x NOW ON LOT C;2 MAP BOOK PAGE PA
DISTRICT GROUP TYPE FIRE P BY
TRACE 0.3� BLOCK LOT NO.
TEL ELY C57 r0 �/ OON�j,�
OWIN E C,iAA NO.
STAT15T1CAL C/ TION
ADDRESS S e- CLASS NO DWEiL UNITS
--i;6,
aTY ZIP
ARCH nECT ENGINEER OR /� /✓I 1i11d NO. VALUATION $ /lO e
ADDRESS ^/t.fjJ'� FROM
-- FRONT PROP.LINE OF ST RE ETI
CONTRACT .-A ,VtA!!- a 61M/+ra�.la3o- TOTAL SETBACK FROM TYPE OF EXISTING .
LJC HIGHWAY + YA FRONT PROP.LINE PIGHAY WIDTH
ADDRESS /000,1V
� // DG +
a T-Y 4K(o %t til CLASS
CONSTRUCTION LENDER BLDG.SETBAIX FROM
NAME AND BRANCH �O!✓'e SJ DE PROP.LINA Of (STREET)
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF IXISTING
ADDRESS SIDE PROP.LINE HIGHWAY WIDTH'.
SIFT NO.OF NO.Of CHECK +
V
SIZE �O STORIES FAMILIES ONE LAE Z E h1AP
DESCPJRTK>N OF WORK Ad c,,, G�44 y� / 1 0
1` SPECIAL
ADD CONDITIONS y�
f J ALTER DATE BY _a
REPA1 R
FISTING BLDG. X DEMOL
APPLICANT TEL
(PRINT)��� ,It SOY� NO,s
BY(SIGNATU +rn ;
IHEREBY ACKNOWLEDGE I HAVE READ THIS APPLICATICN AND STATE ;9
0 2-7. 1 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES _
AND LAWS REGkkAn NG BULDING CONSfRU(TIOr1 I CERTIFY THAT IN DOING THE .
WORK AUTHORIZED HERESY I WILL NOT EMPLOY ANY PERSON IN VKXATK OF 0 0 0 • 0 1
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WOWOENS COM-
PEN&ASK)N INSURANCE. 2 ° 1 0 6 0 0
SIGNATURE ` ° ° 1 0 6 0 0.E
PERMITTEE
ADDRESS 7v o •� ; ral 0509-80
GTY��� .t.✓d 8ca.[ TEL
P.C.Fee$ Permk Fee
Issuance Fees
Total FeQ,/()
APPLICATION FOR BUILDING PERMIT
FOR APPLICANT TO FILL IN (print or type Only) Temple City
BUILDING5(yy7 Golden West
COUNTY OF LOS ANGELES
ADDRESS "'`"'�I DEPARTMENT OF COUNTY ENGINEER
CITY Te 1e Cit - zIP BUILDING AND SAFETY DIVISION
OF BLDGS. BUILDING
SIZE OF LOT�S . ON LOT ADDRESS
TRACT BL LOT NO. 2 Z LOCALITY
TEL. NEAREST
OWNER Josef Riemhofer NO. CROSS ST.
ASSESSOR
ADDRESS 5007 Golden West MAP BOOK PAGE PARCEL
DISTRICT I GROUP ITYPE FIRE SE BY
CITY Temple City- , ZIPCONST,_�r ZO
ARCHITECT OR TEL LJ� O r.��/�
ENGINEER NO.
STATISTICAL CLASSIFICATION SEWS MAP
ADDRESS CLASS NO.��.DWELL.UNITS BK �J
CONTRACTOR Rigid Mf . CO. T 263-5181 E ZONE MAP
ADDRESS 337 So- WOOds AVe4g;. 15I SPECIAL
CITY LOS Angeles LIC. - CONDITIONS
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONSTRUCTION LENDER
NAME AND BRANCH BLDG.SETBACK FROM
FRCVqT PROP.LINE OF (STREET) R
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF P>(ISTIt+G
SQ. FT. NO. OF NO. OF CHECK HI AY FRONT PROP. LINE HIGHWAY WIDTH pC
SIZE STORIES FAMILIES ONE O
DESCRIPTION OF WORK NEW I a
GO
Rerc>of With composition DD ❑ SIDE PROP.LINE OF BLDG.SETBACKOM (STREET) Z
ITER E HIGHWAY + YARD = OTAL SETSACK-NOMJ TYPE OF 1EXISTING
EPAIR❑
SIDE PROP. LINE HIGHWAY1 WIDTH
`ESXIISO +
T NG BLDG, Residence - EMOL ❑
APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) NO.
BY (SIGNATURE) IN OPEN SPACE YES ❑ NO ❑
IN COASTAL ZONE YES ❑ NO ❑
VALUATION / J CATEGORICAL QXEMPTION YES❑ NO ❑
I HERESY ACK NOW LED G[ THAT I HAVE READ THIS APPLICATION ENV IRO RAI[71T AL
AND STAT[ THAT'THE ABOVE IS CORRECT ANP AGR[[ TO COMPLY 'IMPACT EXEMPTION DECLARATION SIGNED DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
, STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HERESY 1 WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
LABOR CODE OF TME STAT[ OF CALIFORNIA IN RELATING TO
WORI(ME N'S COMPENSATION INS 'lJ'iPf�. 011DAlCf4
SIGNATURE OF MFG.11 11 77 r i''1L.CCtt11117711 p w
PERMITTEE
ADDRESS o• 2- 7'r
• BuzFINALS BY
CITY LOs Angeles NOL263-5 .DATE - 4
MAKE CNE(:1`5 PAYABLE TO: FEE.$ 15 X0
FEE +
HARVEY T. BRANDT, COUNTY ENGINEER PERMIT
PLAN CHECK VALIDATION CK. N.O. CABH rERMI.}. VALIDATIO �c- M.O. CASH
a , 24 3. .e 15,0 QA-46
78AB38A CEGBOD 12/72
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C A S S A T T D . G R I F F I N , S U F ' T O F B U I L D I M 4 C R O S S S T
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5 Q _ o G r 2 . 0 0
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" �� �������� o p t . " 9 - f i e _ S �� , / �� -
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76AGSOA CE#8052/80' APPLICATION FOR BUILbiN'G, PERMIT 1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
4
BUILDING AND SAFETY DIVISION LOCALI
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DI§�RICT N G UP`I TYPE ROCESSED Y
FOR APPLICANT TO FILL IN 5 „ p 4 CONST. to
BUILDING �r STATISTICAL C SSIFICATION SEWER AP
ADDRESS CJ(/
CLASS.N06-DWELL. UNITS
LOT NO. BLOCK MAP STATE
NUMBER l HWY. YES
TRACT / U$5.$0NE SPECIAL
NO.OF SLOGS. CO DITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG _ BUILDING EXIST.
TEL. SETBACK YARD HWY STREET NAME WIDTH
OWNE O. FRONT
P. L.
y J r
ADD RES SIDE
ARCHITE O TEL. P.L.
ENGINEER INSPECTION RECORD
ADDRESS
T &ZN a
CONTRACT .�
O
ADDRES V
DESCRIPTION OF WORK ` oq
O ,
E-
NEW A' ADD ALTER REPAIR DEMOLISH W
SQ.FT. ^ NO.OF NO.OF al
SIZE STORIES ===gAMILIES y
USE CTW,-
STRUCTURE 2La
c
SIGNATURE OF
APPLICA
VALUATIONS
APPROVALS DATE INSPECTOR'S SIGNATURE
I PMT. O� FOUNDATION: LOCATION
FEE $ FORMS MATERIALS
FEE $
FRAME: FIRE STOPS,
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- BRACING, BOLTS
PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION,
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT DUCTS
STATE LAWS REGULATING BUILDING CONSTRUCTION.
I CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH,INT.
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'S COMP SATION LAWS OF CAL ORNI H,EXT.
SIGNATURE OF E NUMBER COR-
PERMITTE oWg
T AND POSTED
ADD FINAL
CLYDE N. DIRLAM, 0RINCIPAL STR RAL ENGINEER
PLAN CHECK VALIDATION cK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
17 ®1,
I ' AQ 17 � U 12.00
tr.
rn
:J4ti.r:7 J�i`� ,
WbOYERS'COMPENSATION DECLARATION s Lee bo-472
~ lnsuri eby{affirm that I have a certificate of consent-to If
Insure, of a that
of Worker'Compe.nstlon lnsyranceror t A ��• �l O� , O � ��'���� ERMI�. ?
a c'Rrtlfled copy'thereo.f (Sic. 3800, Lab. C.) COUNFY OF iC�E ANG6LEf BUILDING ANP fAFEITY '
Polley N�Q-;F � CompanI'6II14I3CI+ ZI3E� �rY
tbrtlfied.co Is bereb furnish BUILDYJG.
]. copy r FOR APPLICANT TO Flit 1 . ADDRE d
Certlfled tbpy 1rflled wllh the oounty'h611d(nq Ins
pec- BUILDING
' tion department. - ADDRESS' L r
NEAJZEST
/ Date Appllcd'rit tj 0 4 Ufa ("_1l�� G1TY_ ZIP CROW ST:
(€_ T FICATh QF EXEMPTION FROM WORKERS' NO. OF BLDGASSESSOR
COMPENSATION IN$UF)Af�CE SIZE OF LbT NOW LLOTNO. MAP BOOK P PARCII
(This section need not be cqm letbd'If thb permit is for one Z
ktundred dollars•{51.00}6r tdu.� TRAC
B
jo
sgph �h NO. !,1. COND 0.
r certify that. In,the performance of the Work for which this l Ct
permit Is.Issue& I sha4l not ernployany�erson In'any manner �� ��. (#oleo West DISIRIa, � RE r B• V
to as to become sebjecl tb the Workers ✓ompensdflon Laws. - - (..' C ��+ ?«� O
atY �e
City- iIP
Date Appllcont" TISfK C1�.SSIF TION - AFF: IG
.NOTICE TO,APPLICANT: if after making.thls Certlfltbte of IE Grp:� _ � qASSNO. DwEU- UNITS I d
Exemption,' you should beeome .subject ,to. the Workers' '.
Compensatloh provisions of the Labor Code, you-must forth-.
with.comply:with; such prpvli on& or ihls pw"t .shall be AbDRESS
coNTRcrMfg. SEWER
deemed revoced. d " ��5 l 1CJ 1M1APG, { VAUDA11ON
NO.
_
LICENSED COtJTRACTORS QE CLARATIONLIC ��
1 hereby affirm that l am licensed under Wovlslons of Chapter 9 ADDkESS O..Box 2-: _ 190.1594-96. - VA(.11LIAT}6N
(commencing w4 Section 7000)of DlvJsion 3 of the Buslnem-c } )
Profe"I,gns Code, and my-11denie Is 1n fulI if ce and.effect. '' CITY S .CLASS f 1700•00 .� A
1 SQ. . NO. OF:.. NO.OF `ECK
License Number Lic.ciao - S17E STOkIES F-'�.ULES ONE',
p DESCR1PTIONOF WORK f V-StII NEW,
r y ¢ 1
' Contrecror2�B��SfS'••�,,,; (• tJ - - •- . '. :. - •
I am exelnpt fromYhe.4Jcenslnq requirements as I arb a' 88 tx n`IDAterixtl
Ifcensedarch[ted or-ar'siglstbredgmfeimloho I engineer _ _ ALTER Q -FINAL 1•
REPAIR �D �•_ � t
yactlnq •In my professlohgl',capacity (Segtlon 7051, 'H g11TE
BuslhM4-'arid Professlons Code). UL�tEE _ l
. y y Ex15TING"�. ,reBide�Ce DE/i40L l+INAL
Lic.or Req. No. rate
• APPLICANT TEL
bVg4ER-BUILQ-5R DECLARATION. '- PRINT
I hereby affirrn that F arrrexempt from the Con tractors LIggnae
Law for.the folFowing reoion (Section 7031:5, Buslneu and ADDRESS'
Prcfes}lons Code): u..
' BUILDINGS
1, as owner"of the property, or my emp�oyeei with . . ' ADQRf55'
wageaas their sole oomperisatlon,will do the work•and
thb jrh ure Is not fgtended or offered for sale(Section LOGALTFI .
7QAA,.tuilpqu pna PSofeulpns.Code). MOVING TE1
..4, q;owner of the,prop.", am excrwlvely'cgntradlnd. - -
wlth Ilcensed contractors To construc4 the project{Sec- ADDRESS T ap 3 5 A j,
tion 71X44;$uslnesi and ProfeuIons.Code). - — - - ,
I TOTAL FROM 1 EXIST. # 0 6 o o
CQNSfRUCTI6N LENDING AGENCY SET CK YARp FiVJY PROP.LINE MD
I-herebyofflrm-ti at.thero I;_a'coMtrodlbn'leoding agency for ;f
the performpn.Ce,of the,work-for which thts permit Is Iuued P �, 2 ° b I4,0 0 t.
/� 1{
( - 30¢7,•CLV. C.).- _ ;O O OBJ a, 0'U
Len4ibrs Ngmd ). pp pp •4
$ .. P Fee f' .. Pei rn It Fee ` - - U V�" _
LendeF i Addreu �. <
I'Gertl at I have read this applltptlon and state-that the lawance Fee 7•�' f - r•��
(I
o .I rrK flon Is correct.I agree to comply wllh.alLCounh tnwdlgatton Fs•
or ncf es a'nd State laws relating to building constructlon,
h eby aythorize,repr Ives of,this County to enter Total Fee
ypo a obave-rnentlo pr rty for.rnipectlgn purposes:-
'SH REV1 9f!FO*K)TLAHATQRY L.A WAGE
n �}
Ignqture.of Applicant or Agent_ Date