The URL can be used to link to this page

Home My Public Portal About5133 GOLDEN WEST AVE_Building__ 1 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES u ®I G WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FELL IN FOR OFFICE USE ONLY BUILDING�t- j�r„� / DISTRICT O. PLAN CK. No. PERMIT NO. ADDRESS i a� ��• � S f'A ,�,� �! /i c � 2 4 t5i-O . 4 -7 LOCALITY •0-- ' RECEIVED BY DATE OF ADPL. DATE ISSUED ,�,,�_ �f. !��•+,�+ , NEARESTf;.. l � .. CROSS ST. �•,../� \ BUILDING ADDSS OWNER .� , 1%s MAIL LOCALITY I C ADDRESS NEAREST ` �.1✓ ^ - TEL. CROSS ST. L CITY NO. FIRE + NO. OF I TYPE r-h"�"I GROUP ZONE -----i-PLANS 1' ARCHITECT OR TEL. + ENGINEER •�+� -j,,, NO. BLDG., ORq NO SETBACK LINE Z V �f-q.� ADDRESS APPROVED .e,w 726 17; 76'#1 t.3�.{ice TEL. BY DATE CONTRACTOR NO. •Y' USE .� 1 J! APPROVED• ' ZONE BY DATE ADDRESS 1 ... 3 J.�, �`�.A�"s�e �+�� '! h.. HOUSE NUMBERING ' LEGAL ��V DESCRIPTION LOT NO. BLOCK MA/N .NE R FIELD CHECK BY NOED BY ❑AT TRACT 1 (�� NO. OF BLDGS. CORRECTIONS .- - SIZE OF LOT }?` , I NOW ON LOTS , USE OF NO. OF EXISTING BLDG, FAMILIHf3 DEgRIPTION OF WORK NEW I ' ALTERATION ,I I DDITION I / O REPAIR I I DEMOLITION I ) - SQ. FT. NO. OF _ D SIZE � ROOMS 1/1 R I ES _ D ' 'IALL XTWALL�� I ROOF C h r' COVERING + COVERING j/,,, �? - USE OF STRUCT RE APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS CORRECT. •' • ' 1 AGREE TO COMPLY WITH THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH A COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING ILD G MITTE /.f C NSTRUCTION. FURNACE: LOCATION, ,V/ �� SIGNATURE OF /� GAS VENT, DUCTS _Z PER - w LATH-INT. ADDRESS LATH, EXT\ ( U� , / /• AUTHORIZED AG T A + PLASTER, INT\ ' 7aAGSBA• DOSS f $ P C $ p , ® AA �J�jj. FEE r PLASTER, EXT. VALUATION L� --T $ p-'y FEE '�✓ FINAL �' Co'" r` ;SAF?P1:-1°CAT 1 O N FOR `w" = TY OF LOS ANGELES. Y DEPARTMENT OF COUNTY ENGINEER• -' B U ILD�I IN PERMIT; BUILDING AND SAFETY DIVISION - FOR APPLICANT TO FILL IN BUILDING- " ADDRESS ° BUILDINGr ADDRESS rj'� 3r 3':' i "GO =dc�_n W. LOCALITY 1 fix, NEAREST ; CITY Tempt.e City 4 ZIP CROSSST•• NO OF BLDGS ASSESSOR, SIZE OF LOT - 't_NOW ON LOT MAP BOOK" v PAGE PARCEL • ; DISTRICT GROUP 'TYPE FIRE OC ED BY,- TRACT- BLOCK L'OT NO qq CONST ZE3E TEL dU � V OWNER hO S'Uke Oksm t NO K" ,20 STATISTICAL CLASSIFICATION SEWER MAP ' ADDRESS 5133 N--" Gol d6ri W. J ''CLASS NO / "DWELL UNITS 4�7-BK u �'PG CITY" Temple City' ZIP USE ZONE MAP ;O / ARCHITECT OR TEL NO, ENGINEER NOSPECIAL /a NDITIONS ,ADDRESS' ROAD DEPARTMENT APPROVAL REQUIRED r,x YES NO TEL CONTRACTOR Mont eb ell O R f,,cr ra NO722-697 f BLDG SETBACK FROM ),pp c FRONT PROP LINE OF ' STREET)LIC ` 2 HIGHWAY' '+••r YARD` = TOTAL'SETBACK FROM TYPE OF EXISTING ADDRESS 808' TrUCkway N02`^YVV5 CITYM6htebell LIC ss -A FRONT PROP LINE HIGHWAY WIDTH I TRUCTION LENDER E AND BRANCH 0 •BLDG,SETBACK FROM i V ESS CITY SIDEPROP'LINEOF - - •-(STREET) . NO OF NO OF CHECK HIGHWAY + - YARD = ETBACK FROM TYPE OF EXISTING V STORIES G�FAMILIES 'ONE ; PROP LINE HIGHWAY WIDTH N RIPTIONOFWORK Rero"O1 EXistiri EW ❑ + _ Z dg• w/3-1- asphalt shin tS,'= CORNERCUTOFF• YES' a NO E] ALTER 0 IN OPEN SPACE' YES Q NO" Q REPAIR ` F IN COASTAL PERMIT-ZONE. YES .Q NO, ` NG BLDG dwelling. DEMOL Q - CANT TEL RINTn Monteb ell o Rf-g e ' NO - ' BY ISIGNATUREI " IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI(ZATIOWAND STATE- THAT JHE TATE-THAT,THE ABOVE IS CORRECT-AND AGREE TO,COMPLY WITH ALL ORDINANCES- AND LAWS REGULATING BUILDING CONSTRUCTION;1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY.PERSON IN VIOLATION OF THE LABOR CODE OFTHE STATE OF-CALIFORNIA IN RELATING TO WORKMEN S COM - PENSATION INSURANCE " SIGNATURE OF F NAL BY'? PERMITTEE ATE..O/ ADDRESS 878 V NO' 22' 6(a P C Fee,$ Permit Fee CITY Montebello Q Issuance Fee VALUATION$l?50 o OC Jotal Fee - PLAN CHECK VALIDATION -.-CK,"'WO CASH PERMIT_VALIDATION_ CK ` ',M 0 cnsrl UG @)3 76A638A CE d803A 8/77 - , _ 40 ` �,rs ?gig' D TION DECLARATION ` ( � e wrrt that I have a certComie of consent to.seIt lf - APPLICATION P P L'CATION F® BUILDING � `,®I N G P� M ri:�re, ertificate of Workers' Comjiensahon.lnsurance, or a_certifie �opy,rhereof (Sec 3800,--Lab C ) COUNTY OF LOS ANGELES i BUILDING AND SAFETY Policy No� r S(5)Company'•--' i�L� 5�'' Certified co is hereby furnished BUILDING SL'' Py r FOR APPLICANT'TO FILL IN r / ADDRESS �,� �j � ! t { QG I/i) Certified copy is filed with the county building inspec- BUILDING ; , A tion department -ADDRESS E ° C__ ut CA j DateJ/4-6L Applican��.� < , ,trC• CITY• r✓� ZIP , . LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT (o Z Zf� ? NOW ONLOTif ) a CROSS ,L' oeA COMPENSATION,INSURANCE •� . • (This section nee($100) be completed if the permit is for one �] t ASSESSOR hundred dollars ($100)or less ) - TRACT J(Q BLOCKY t LOT NO NSP BOOK PAGE PAREL CEL OWNER Q'SiE NO ;443-`5 l USE NE MAP I certify that in'the performance of the work for'which this i J NO SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS !� GYJ_ • 'I CONDITIONS so as to become subject to the Workers'Compensation'Laws - Q Date Applicant CITY1EMPZIP NOTICE TO APPLICANT If, after making this Certificate of ENGARCINEER OR TEL DISTRICT GROUP TYPE FIRE PR SSED BY O / ENGINEER `" NO CONST ZONE V / Exemption, you should become subject to the Workers' ® 't Compensation provisions of the Labor Code,,you must forth- ADDRESS tr�[ W with comply with such provisions or this permit shall be �t STATISTICAL CLASSIFICATION APT NDO (n deemed revoked CONTRACTOR n �� TEL -NO U � Z LICENSED CONTRACTORS DECLARATION LIC•. CLASS NO DWELL UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS' `7 A (.. NO (commencing with Section 7000)of Division 3 of'the Business and ,/� � LIC SEWER MAP Professions Code,-and my license is in full force and effect CITY '� Ae CLASS BK -L VALIDATION PG 77 A SQ FT NO OF NO OF i CHECK License Number e45 LEE Lic.Class �' SIZE , STORIES FAMILIES L t 'ONE _ !/► V _ ; ALUATI _ .ON Contractor 9� 3 Date 3'1�i ) DESCRIPTION OF WORK —AM)J>f NEW ❑ $ t) • 1 am exempt under Sec f d'4 '. �o J �_ ADD ALTER B 8P C. for this reason Oyj u N REPAIR ❑ $ USE dF Date' EXISTING BLDG . j N DEMOL F1 �2 9,1 6:0 A, ( Signature ' " APPLICANT ' TEL -" FINAL (/ 0; OWNER-BUILDER DECLARATION- PRINT NO �3 �� # 0 0 e to 31DATE / „I hereby affirm that I am exempt from the Contractor's License Law for the following reason-(Section 7031'5, Business and ADDRESS- PIGd L FINA , I I o;1 99..88 Professions Code): By ❑ BUILDING /r •a o,1 9 9,•8 8 5 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will'do the work and the structuFe is not intended or offered'for sale(Section LOCALITY` ;•u. p 3. 1 4 r=8$ 7044, Business and Professions Code)- - MOVING. TEL ® i I, as owner of the property, am exclusively contracting CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS - 1,1 " tion 7044, Business and Professions Code) \ ', aw REQUIRED TOTAL SETBACK ` CONSTRUCTION LENDING AGENCY YARD HWY SET BACK" PROP 'LINE WIDTH. I hereby affirm that there is a construction lending agency for FRONT the performance of the work for whichthis•perm it is issued P L (Sec 3097, Civ C ) SIDE i� PL • ti ` { yid-�y� Lender's Name LDMA Ref #` �a c m Lender's Address P C Fee$ Permit Fee J J - I certify that I have read this application and state that the Issuance Fee G"� LDMA P/C# above information is correct I agree to comply with all County• Investigation Fee q ordinances and State laws relating to building construction,' Total Fee LDMA Perm # $ and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. , , m q � 'x 14: '�t SEE REVERSE FOR EXPLANATORY LANGUAGE iag— • Signature of Applicant or Agent Dote• '- -