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Home My Public Portal About5217 GOLDEN WEST AVE_Building__ „ .-DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATION FOR APPLICANT- TO FILL 1N FOR OFFICE USE,ONLY DIBTRINCL; PLANCK. OR REc.NO. PERMIT NO. BUILDING CT ADDRESS J Z k RIECEIV -D BY DATE OF APPL. D E IS D ; _ LOCALITY /� 7 7 NEAREST ' ff CROSS BT BUILDING '�� ADDRESS OWNER 1 MAIL LOCALITY 00j ' ADDRE9 Z /`7 NEAREST TEL, CROB8 BT. CITY NO. FIRE NO.OF _TYPE I DPJWP ARC ECT OR ZONE ,-�� !,PLANS s ENGINEER N0. BLDD.� !�� D N•. SETBACK LINE ADDRESS USE APPROVED TELZONE BY DATE CONTRACTOR NO. / /fHOUSE NUMBIZRING j ) ADDREBB MAP NUMBER ��/�OI NO. ASSIGNED BY LEGAL CORRECTIONS ' DESCRIPTION LOT NO. BLOCK /.,� � � TRACT ��V 1 C F rj ✓ // A I 0. OF BLDGIL A 1 N .l e9 1• G�CGLS Cep✓��'isJ) .�f Q SIZE OF LOT G/1 !` I NlO�W.ON LOT /f -•• - /• ' USE OF � V��"G 'I NO. OF EXISTING BLDG. FAMILIES Z Z(m S� Ar: ,OA LIMA) , DESCRIPTION OF WORK Y ° A AR J6” /AA d /'dia-L0 A-14 'p NEW ALTERATION ADDITION A REPAIR' DEMOLITION '"� �I q FT. NO.OF B ZE �[�/ ROOMS 2—STORIES /� COV ROF RING J I COV'RING ®GsL� L•,� _ USE OF STRUCT R Z' dC= // INSPECTION FOR \ (AAPPROVALS/ OCCUPANCY AS INSPECTOR18•SIDNATURE DATE FOUNDATION: LOCATION 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FORMS, MATERIALS , G �� L PLICATION AND STATE THAT THE INFORMATION GIVEN 18 FRAME: FIRE STOPS, 7�y�/ CORRECT. BRACING, BOLTS / 1 AGREETO LY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, c/ j AND STATE S EDUCATING BUILDING CONSTRUCTION. GAS VENT, DUCTS AVG �YG� SIGNATURE O LATH, INT. PERMITTE / LATH, EXT. �� ADDRESS / AUTHORIZE ADTPLASTER, INT.. � PLASTER, EXT. FEES B ~— HOUSE NUMBER COR- RECT AND POSTED VALUATION FINAL 76A63BA DBS 3 1-82 / 76AS38A CE#803 8-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER AD°RESs 5217 Golden West BUILDING AND SAFETY DIVISION LOCALITY Temple City JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A JENSEN, SUPT OF BUILDING CROSS ST 0,4 DISTRICT N G TYPE E FOR APPLICANT TO FILL ,IN 1..CONST BUILDINGSTATISTICAL CL IFICATION S ER MAP ADDRESS - 21 Golden West T.C. BK PG 'CLASS NO DWELL UNITS - LOT NO ' BLOCK WATER ' CERTIFICATE NOT REQUIRED 0 RECEIVED ❑ TRACT %MAP., HIGHWAY STATE MAJOR SECON LOCAL NO OF BLDGS ' NO (.CIRC LE) SIZE OF LOT NOW ON LOT USE ZONE SPECIAL USE OF[ CONDITIONS EXISTING BLDG• ' TEL OWNER MP. .A7�llen Macka NO BU LDING YARD HWY STREET NAME EXIST SETBACK ADDRESS 521( Golden West, Temple City FRONTWIDTH ARCHITECT OR' TEL P L ENGINEER NO SIDE P L ADDRESS �7 a CONTRACTORVirgin Roof Co. NO 2 /-050 O ADDRESS 0 0 DESCRIPTION OF WORK t; CL NEW ADD ALTER REPAIR rOQfE_MOLISH N Z SQ FT NO OF 'NO OF SIZE STORIES FAMILIES USE OF' I STRUCTURE Reroof small,added rear porch SIGNATURE OF ' APPLICANT VIRGIN ROOF CO. VALUATION $ '00 00 _ _ _ - APPROVALS DATE INSPECTOR 5 SIGNATURE PC PMT FOUNDATION LOCATION FEE $ _ FEE $ 4.00 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 COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE WORK , AUTHORIZED HEREB I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH INT TION OF THE LABO CODE OF THE STATE OF CALIFORNIA RELAT , ING TO WORKMEN'S MPENSATION_INSUR NCE ' VIRGI R CO LATH EXT SIGNATURE OF HOUSE NUMBER COR- ' PERMITTEE QCT AND POSTED ADDRESS FINAL 3 - JOHN F LEWIS PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION CK M D , CASH PERMIT VALIDATION CK M o CASH Li`l,cj 4 8 g SEP 1 3 1 D 4.0 0 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print 0, type only) BUILDING • ' COUNTY-OF LOS ANGELES ADDRESS 5_.r - - .il �` - DEPARTMENT OF COUNTY ENGINEER CITY - / / j� ZIPf BUILDING AND SAFETY DIVISION NO'SIZE OF L �� 61% =%LOT , NOWOON LOTS- " "" ADDRESS TRACT ,�'� BLOCK '- LOT NO LOCALITY TEL NEAREST ' OWNER, - �.*' {{J f11 _ NO � ",��o � CROSS ST ASSESSOR AODRESS,J� ` ,.>c 'MAP BOOK PAGE 1 PARCEL DISTRICT GROUP TYPEST FIRE SED BY CITY - ,�„�' /� '1` ZIP q// �� Q.O -' /J�' - CON -ZONE ARCHITECT OR TEL /KJJ/T 3 ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP , ADDRESS CLASS NOi_DWE/LL UNITS K CONTRACTOR / -� ,NEOL G' ,USE ZONE MA NOP D! ADDRESqZ�P/ �' NO E rt, .,.-I SPECIAL /LIC CONDITIONS CITY � 4 � CLASS ' ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG SETBACK FROM -- C FRON PROP LI NE OF (STREE-T), ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING SQ F NO OF NO. OF _ CHECK HIGH Y } YARD. - FRONT PROP LINE HIGHWAY WIDTH H SIZE STORIES FAMILIES ONE C: } - U. DESCRIPTION OF WORK NEW ❑ 1 Z ADD SLOG. BACK FROM SI �cA�"f/•� SIDE PRO INE OF (STREET) ALTER ❑ HIGHWAY } YARD TAL SETBACK FROM TYPE OF EXISTING lie - REPAIR SIDE P E HIGHWAY WIDTH USE EXISTING'NG' BLDG. .4�fI�_`I� DEMOL ❑ APPLICANT//� ^ /��} _p CORNER CUTOFF YES ❑ N_O ❑ (PRINT) G-�+-y'�il� /'��i �/� N 0 13 7� BY (SIGNA E) IN OPEN SPACE YES ❑ NO ❑ IN,COASTAL ZONE YES ❑ NO ❑ VALUATION. - CATEGORICAL EXEMPTION 'YES❑ NO ❑ 1 HEREBY ACKNOWL G THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACTr EXEMPTION DECLARATION SIGNED (DATE) WITHALL ORDINANCES AND LAWS REGULATING BUILDING CON- S T RUC TI ON I CERTIFY THAT IN DO WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I'WILL NOT EMPLOY ANY RSON IN VIOLATION OF THE , LABOR CODE OF THE TATE 0 ALIFOR NIA IN RELATING TO WORKMEN'S COM ENS ON INS N E SIGNATUR _C PERMIT E ADDRESS C ITYg;:/ NODA (�J rye%,G,c i� TEL TE Q ' MAKE CHECKS PAYABLE TO FE $ FEE HARVEY T. BRANDT. COUNTY ENGINEER . JJ PLAN'CHECK VALIDATION CK M o CASH PERMIT V DATION (.K M'0 CASH 2 8 JUN o `5 5.5 0 ,6% 76A638A CE#803 7/73 / 5"5LTMENT OF BUILDING AND SAFETY. - I APPLICATION FOR PERMIT -:COUNTY OF LOS ANGELES Jut 9l-. 2 9 t9 4 U WM. J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE-ONLY /`/ DISTRICT NO. PLAN CK.NO. - PERMIT NOr UILDINGADDRESS 4 [�- 'e(/V If /�► wp/e� f (O �! t o ,� t Z LOCALITY mL�t �P I / O ry/ RECEIVED BY DATE OFF�APPL. DATE ISSUED NEAREST CROSS ST. ( BUILDING nn�� OWNER , a ADDRESS MAIL !] �'� �� 4\ LOCALITY _ p ADDRESS ` !I NEAREST ( C1_fK X 1 TEL. (► � CROBB BT. : CITY tf.� Q Q tG- N O. l5� G ..e ARCHITECTOR - V TEL ZONE PLANE TYPE GROUP ENGINEER NO. _ BLDG. s�l+ / �' �P ORD.NO. ADDRESS _ SETBACK LINE APPROVEDTEL - CONTRACTOR NO.. BY --w-� DATE USE APPROVED ADDRESS '} ZONE, "/ BY DATE `- LEGAL CORRECTIONS DESCRIPTION J LOT NO. ^3 - BLOCK TRACT - r� NO.OF SLOGS. /p�� p/ SIZE OF LOT�� ' - I NOW ON LOT E Lt fY USE OF NO.OF . II- NO.OF� EXISTING BLDG. I FAMIUEB 1 ROOld6 - DESCRIPTION OF�WORK NEW ALTERATION ADDITION O A -.REPAIR.*, - _ MOVING DEMOLISH L] 5q.FT.- A - NO:OF Z SIZE - /Q�j� ROOMS STORIES _ r WALL ROOF COVERING I COVERING USE OF NEW BUILDING a Qn f 11 _z_ - 7 1,Ve �J I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPROVALS APPLICATION AND STATE THAT THE ABOVE IS CORRECT FOUNDATION:LOCATION INSPECTOR DATE �^ AND AGREE TO COMPLY WITH'°ALL COUNTY ORDINANCES ' FORMS,MATERIALS V.A1L_5 AND STATE L REGULATING BUILDING CONSTRUCTION. FRAME: FIRE STOPS, SIGNATURE O BRACING,BOLTS 7 / PERMITTEE LATH,INT.: AUTHORIZED /SGT LATH,EXT.: OBS-3 50M SETS 1-4e $ 79 d�pQ o-� PLASTER, INT. P7 9 fl-0 FEE / PLASTER,EXT. VALUATION ,. I/J1 FEE FINAL � V WORKERS, COMPENSATION DECLARATION ► hereby affirm that I have a certificate of consent toself APPLICATION F O �B U I L"D I�N -PERMIT E insure, or•a certificate of Workers'Compenshon Insurance,'or � o certifie o 3 , lab C�� COUNTY OF LOS ANGE ES 2 (_ ; BUILDING AND SAFETY Policy N CompanyBUILDING_ rtified copy is hereby furnished ��—� FOR APPLICANT TO FILL IN ADDRESS�� Certified copy is filed with the coun uilding i ec- BUILDING. A�/ter t o department ADDRESS Z ��T /��/. LOCALLY a NEAREST Date Appli 1 CITY ZIP pD CROSS ST CERTIFICATE OF EXE M FRO KERS: - O �fq�o OF LOT AS COMPENSATION 11 SUR SIZE OF LOT . OW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if t e permit is for one T� USE ZONE MAP hundred dollars ($100)or less ) TRACT 0.S' 4f _ BLOCK LOT NO NO TEL �� SPECIAL ' d I certify that in the performance of the work for which this OWNER . // NO- CONDITIONS :Q ,permit is issued, I shall not employ any person to any manner DISTRICT GROUP CONST FIRE P C ED BY �U so as to become subject to the Workers'Compensation Laws ADDRESSITYPE CITY ZIP �Q , 6� �� O Date Applicant STATISTICAL CLASS CATION APT CONDO LU NOTICE TO APPLICANT If, after making this Certificate of ARCHITECT OR TEL M ENGINEER NO CLASS NO DWELL UNITS Exemption,- you -should-become subject to the Workers' Z Compensation provisions of the Labor Code, you must forth- ADDRESS -SEWER MAP• _ with comply with such provisions or this permit shall be deemed revoked CONT NO Z1579W BK PG, VALIDATION LICENSED CONTRACTORS DECLARATION ''C b 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRES NO O VALUATION (commencing with Section 7000)of Division 3 of the Business and LICA Professions Code, and my license is in full force and effect CITY ?14& /41C.01* 4171CLASS 41110 $ NO OF SQ FT NO OF CHECK License Number_ �v Lic Class SIZE STORIES FAMILIES ONE , ®GTj >✓D - NEW $ �.n Contractor Date pa DESCRIPTION OF WORK ❑ ADD a I am exempt from the licensing requirements as am a D .... licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity.(Section 7051, REPAIR DATE9:21 Business and Professions Code) USE OF ��yy��l� FINAL B EXISTING BLD . �jiiDEMOL By Lic or Reg No _Date APPLICANTTEL' " OWNER-BUILDER DECLARATION (PRINT �NO I hereby affirm that j am exempt from the Contractor's License ADDRESS 44r. •1`911/ `�O _ Law for the following reason (Section 7031 5, Business and , Professions Code) PRESENT BUILDING 1,1 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 sdle(Section LOCALITY 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 2 2 5 7.4 A tion 7044, Business and Professions Code) REQUIRED TOTAL SETBACK FROM EXIST o o'0 0 0 CONSTRUCTION LENDING AGENCY 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 2 o o 6A 0 0 (Sec 3097, Civ C ) SIDE PL / > 0 0 0,6 1,0050, Lender's Name $ P C Fee$ Permit Fee Q.'110-8 0 Lender's Address w I certify that I'have read this application and state that the Issuance Fee / above information is correct I a amply with all County Investigation Fee < ordinanc and State jaws citing to ilding construction, d he y outhorize sentatives this County to-enter Total Fee ao e above-m ti ed pro or inspection purposes r tit D9� SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Applicant or Age Date ®s