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HomeMy Public PortalAbout5347 GOLDEN WEST AVE_Building__ DEPARTMENT OF COUNTY ENGINEER DIVISION F BUILDING LSAFETY ANGELES WILLIAM J. FOX, COUNTY ENGINam APPLICATION CASSATT D. GRIFFIN, SUPT OF BUILDING FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING DISTRICT NO. PLAN CK.OR REc.No. PERMIT NO. ADDRESS '�^ I ,� (� /' Z/ 2- LOCALITY b LOCALITY ( E�.i !'L E v' RECEIVED DATE OF APPPPL. DATE ISSUED NEAREST OLIVE 7'7 c] � - 5^ CROSS T /� �+♦� p BUILDING OWNER �E PCO L-E p EL, 51(7NOP-E ADDRESS AMAILDDR 4 S I 0 R 10 NON D0 AVE LOCALITY - C— ADDRESS , CITY TEMPLE CITY To _ ' - CROSS ST. ARCHITECT OR TEL FIRE NO OF TYPE _ GROUPS ENGINEER �' PF-L S14'W0r a NO. ZONE PLANS LJ"'. =0 ADDRESS 8 J O RIO I=Dt4DO AVBLDG. i ORD.-NO 'II' SETBACK LINE_-_'�C::>_ TEL CONTRACT E • OF.L _E NO USE APPROVED ZONEBY DATE d ADDRESS b v O pL t 0 H W40 0 A Vr= HOUSE NUMBERING I LEGAL MAP NUMBER G� DESCRIPTION I, LOT NO. BLOCK NO. ASSIGNED BY- CORRECTIONS TRACT �� 3 SIZE OF LOT S O�SC IS-OSI NOW ON LOTS USE OF EXISTO EXISTING BLDG. F�V E L L��G FAMIL1Es ' _ - DESCRIPTION OF WORE .443 -�-Q i C�t ,J I , o - J NEW ALTERATION ADDITION / �y M `� �``'�� �I• DEMOLITION I�J�OV I N G I � / +G �' f. 1 .p+a- n D REPAIR SQ FT. , ", '/.7•O•,, 'ROOMS STORIESSIZE ROOMS EXT. WALL I ROOF A S p{JAL']' ' � T — GC.. �� COVERING -'' COVERING Fl /.l6L USE OF STRUCTURE 0VELL144 1�llti T:70 eu� SAI �� J it'-� ✓ � �-rn iu�s-✓ APPROV INSPECT S SIGNATURE D TE ,m 7-, �,.�f P�'� ��T FOUNDATION: LOCATION ,�„ ,.(, H �_. /\ FORMS, MATERIALS �eGo-,.tea _ Ic�r,.�•« 00, ` iEREBY'ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS; ' PLICATION AND STATE THAT THE INFORMATION GIVEN IS , BRACING, BOLTS CORRECT. •1 AGREE.TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDING CONSTRUCTION. GAS VENT, DUCTS SIGNATURE OF LATH, INT. PERMITTE ADDRESS 4 I/ D (VI/IJ n^,�p LATH. EXT. Q Ir'�Z �. PLASTER, INT. ' AUTHORIZED AGT. PLASTER, EXT. FEE $ HOUSE NUMBER COR- - /,� �✓ RECT AND POSTED j VALUATION - FEE $ OC FINAL ~ gL1,21S70 7GA63SA DOSS 9-82 _ - 78AS38A C 803 B-8 APPLICATION FOR BUIL NG PERNiI _ 'COUNTY OF LOS ANGELES BUILDING �—� DEPARTMENT OF COUNTY ENGINEER `ADDRESS BUILDING AND SAFETY DIVISION LOCALITY ` w JOHN A. LAMBIE. COUNTY ENGINEER NEAREST COLEMAN W JENKINSSUP'T OF BUILDING CROSS ST ' DISTRICT N TYPE C Y FOR APPLICANT TO FILL IN (� CONST BUILDING V11-7:2STATISTICA SSI FICA TION SE ER�MAP ADDRESS b?(,(�/'K BK PG CLASS NO DWELL UNITS /j LOT NO 56 BLOCKUSE ONEMAP ! J NO I TRACT �S' SPECIAL A NO OF SLOGS i7 CONDITIONS - SIZE OF LOT / NOW ON LOT USE OF EXISTING BLDG BLDG SETBACK FROM �r TEL_ FRONT PROP LINE OF (STREET) OWNER�orF • (�'C NO r TYPE OF EXISTING SETBACK "HIGHWAY `'F YARD = TOTAL ADDRESS HIGHWAY AIDTH FRQM C L CITYBLDG SETBACK FROM _ ARCH TECT O Ily TEL SIDE PROP LINE OF (STREET) ENGINEER NO TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C L ,a TEL + _ _ O CONTRACTOR _ O _� - V LIC CORNER�CUTOF-F YES NO ix O ADDRESS / ,/ O. CITY 'A LIc SEE REVERSE SIDE FOR SPECIAL APPROVALS u DESCRIPTION OF WORK y • ,.t , T`Z NEW ADD ALTER REPAIR DEMOLISH n A`&1-1— .�u�s•u� It SQ,FT NO OF f NO OF / aw SIZE IQ, STORIES ( FAMILIES USE OF STRUCTURE ol SIGNATURE OF APPLICANT ' -- le VALUATION.V ! APPROVALS / DATE INSPECTOR'S SIGNAr)RE P C PMT //,^, FOUNDATION, LOCATION FEE$ FEE�� C-F' 1^ FORMS,_MATERIALS FRAME, FIRE STOPS, n ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLT AND STATE THAT THE ABOVE IS CORRECT AND•AGREE TO COMPLY FURNACE. LOCATION WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,GAS VENT DUCTS 9UILDING 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 OF CALIFORNIA RELAT- ING TO WORKMEN S,(COy N ,A(T}(I,ONINSU NC I� '// n' � LATH EXT SIGNATURE OF HOUSE NUMBER COR- PERMITTEE RECT AND POSTED n �" ,A0DRESS FINAL JOHN F LEWIS PRINCIPAL STRAL ENGINEER PLAN CHECK VALIDATION CK M O CASH _ PERMIT VALIDATION STD M o CASH �' APP 14 1 D 4 .6.5 G WORKERS' COMPENSATION DECLARATION , a consent to B U LL D I N G PERMIT insure, or certificate of Workers' Compensation surn , APPLICATIONFOR _ or a,certified co f jc 3800, Lab .C ) COUNTY OF LOS"ANGELES- BUILDING AND SAFETY Policy No C1$5ompany N �I� , F ❑ Certified copy is hereby'furntshed. L`^ G��� FOR APPLICANT TO FILL IN ADDRESBUILDINS 3` ___ ADDRESS blal s� Certified copy is filed with the county-building inspec- BUILDING _ Y tiori department }� ,{pJl ADDRESS ('�. (� —1{� Date Applicant Of LMj�LfW 104160 CITY' f°V►1 l �1 ZIP 9 t LU fl LOCALITY - NO OF BLDGS NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 'NOW ON LOT ' �, CROSS ST - 6 "\V COMPENSATION INSURANCE. S 1� ASSESSOR L (This section need not be completed if the permit.is for one ' TRACT 142-1 b BLOCKLOT NO S MAP°BOOK: PAGE PARCEL hundred'dollars ($100).or dess ) TEL OWNER tWOCI e� N0.3O —9 -. USE ZONE'.. MAP ?, - •1 certify that m the performance of the work for which.this ) NO- permit.is issued, I shall not employ any-person in any-manner, ADDRESS ) �� _� K SPECIAL _r }• �. 1�• �+- � CONDITIONS so as to become subject to-the Workers'.Compensation Laws ' --�^ 'O �. C� + O CITY 1e1M `�l zIP [ 1�_� U -Date Applicant ARCHITECT OR I TEL 0 ENGINEER - NO DISTRICT-. GROUP TYPE FIRE PROCESSED-BY � O NOTICE TO APPLICANT If,- after,making this Certificate of CONST E Exemption, you should become subject to the Workers' t) Compensation provisions,of the Labor Code, you must forth- ADDRESS - -� ' '- d' with comply with 'such provisions or this permit shall be L; ey Qr\� Y OH TEL S7 I,4���� STATISTICAL CLASSIFICATION APT CONDO Z deemed revoked CONTRACTOR `, /�/. �n4�.NO LICENSED CONTRACTORS DECLARATION ` LICCLASS NO DWELL UNITS — I hereby affirm that)am licensed under provisions of Chapter 9 ADDRESS 11 o E W a NO 4i+kl— SEWER MAP (commencing with Section 7000)of Division 3 of the Business , LIC _ and ProfessionsIc _,Code,and my ense is in full force and effect CITY cad:: _ CLASS BK PG VALIDATION_ (� SQ ,FT NO OF NO OF ', CHECK' License Number Lc Classes SIZE' 30 STORIES FAMILIES �� ONE VA U ON `l f � a -� —' DESCRIPTION OF WORK Ih�ll� ��1h 1W��V�- .NEW ❑ r v`V Contract !:O/11 FYi4I Date f ❑I am exempt under Sec *AC �� Y '��(�� ADD ❑ ALTER - B&P C for,this reason .3 REPAIR ; a USE OF _ EXISTING BLDG �� S Si natureciv - ICANT •� g OWNER-BUILD R DECLARATION APP(PRI T) QIjQJ E NO FINAL [y I /� n DATE J@� J r I hereby affirm that I am exempt from the Contractor's License ADDRESS�3 T �`�f►�ia�SCS >�/� --T ��l� Law for the`followirig reason (Section-7031 5, Business and FI Professions,Code). , PRESENT l By- �✓ (�^f"� ❑ I, as owner of the ro ert or m employees with BUILDINGR�4 rJl 'er►I,� Ave T (, ! A'�t•T,Ba P P Y. YADDRESS ''' 190.50 wages as their sole compensation,,will do the work and �. .3307 1�0• the structure isrnot intended or offered for sale(Section LOCALITY © �. r 7044, Business and Professions Code ) MOVING TEL ITE�I ,`+ _ C E] 1, as owner of the propertyam exclusively contracting CONTRACTOR NO', TOTAL' 190 ®5101'. with licensed-contractors to construct the projecf (Sec- ADDRESS t� tion 7044, Business and Professions Code.) CHECK 1413■:,Il REQUIREDTOTAL SETBACK.FROM EXIST 1.ilAf�t}r� rr�t•I CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE 'WIDTH •�1 , I 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 - P L ' 130013-0001 . 11/30/39 Lender's Name ' - 07163: —4.1� AN 11 010 � PC~Fee$ Permit Fee LOMA Ref # Lender's'Address Y o 1 certify that-I have read this application and state that the Issuance Fee ' -O LOMA P/C# 0 8 above information is correct Lagree to comply with all County Investigation Fee Iq ordinances and State laws relating to building construction, Total Fee LOMA Perm # a and hereby'out orize representatives of his County to enter up ` the above- nt n d props r,i spection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE } azure of Applicant or 99ent Date ' « _ - ,ri+ WORKERS' COMPENSATION DECLARATION aG•I hereby affirm that i have a certificate'of consent to self insure, or a certificate of Workers' Compensation Insurance, APPLICATION FOR, BUIMING P E RIVE I T oral certified copy thereof (Sec 3800, Lab C ) 11 ' ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No, - Company ❑ Certified copy-is hereby furnished FOR APPLICANT O FILL IN VNEARE /-3 y , (96 r� £�'w,-SCertified copy is filed with the county build ng mspec BUILDING "tion department ADDRESS ' 11 Date Applicant CITY C! ZIP. ?8 CERTIFICATE OF'EXEMPTIONFROM WORKERS' NO OF BLDGS1 COMPENSATION INSURANCE SIZE'OF LOT S �Sb • NOW ON LOT i', (This section need not'be completed if the permit is for oneASSESSOR hundred dollars ($100)or less ) TRACT BLOCK LOT NO MAP'BOOK4- PAGE PARCEL ," TEL S/s USE ZONE ' MAP,, ' r IBcertify that an the performance.of the `work for which this OWNER' . - NO NO permit is issued, I shall not employ any person in a y`manner ADDRESS _ —/ _ 'SPECIAL _ • so as to become subject to the,Workers;,Com n ion L ws [ CONDITIONS O 7 7U Date S. I/ APPlicarii CITY - ZIP NOTICE JO APPLICANT If, after ma ng `this• tificate of ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE PROCESSED BY O ENGINEER NO CONST , ZONE Exemption, you' should become subject'-to,the Workers' ?� Compensation provisions of the Labor'Code, you must forth- s ADDRESS with comply with such provisions or this permit shall be ( deemed revoked �N TEL- STATISTICAL CLASSIFICATION APT CONDO.,- CONTRACTOR Nb_' Z LICENSED CONTRACTORS DECLARATION, LIC CLASS NO`- DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �NO (commencing with-Section 7000);of Drvision 3 of the Business and _ LIC -_ SEWER MAP Professions Code,•and my license is in full force and effect, CITY CLASS BK VALIDATION ' ` PG SQ FT O OF / NO OF / CHECK License'Number`' Lic.Class,- SIZE STORIES (' FAMILIES 'ONE ' y ❑ VALUATION^' Contractor Date DESCRIPTION OF WORK NEW $ Q ADD ❑ I am exempt under Sec ALTER • B.BP.C,'for•this reason REPAIR ❑ s Date: i USE OF DEMOL EXISTING BLDG ❑ - Signature APPLICANT ` `a TEL P Q OWNER-BUILDER DECLARATION PRINT FINAL NO DATE, 7- -291 8:4 A' I hereby affirm that I am exempt from the Contractor's License ° "•c r r '#.a o,e o a 1 Law for the following-,reason (Section 7031 5, Business and ADDRESS FINAL ' M,i za'So Professions Code) ; • P BY e o 1 BUILDING 1, as owner of the-property, or'my employees with ADDRESS, e,iatro. wages as thieir sole compensation,will do the work and = « 2 8 5,0 v ' the'structure is not intended or offered for sale(Section [ADDR LITY + e `;7044, Business and Professions,Code) NG,' ;+'. -TEL ° �.3 1 7. ,8 8 ' RACTOR NO` t • ❑' I, as owner of the property, am exclusively contracting , ,',r'• _ with licensed contractors to'construct-the project (Sec- ' - �-' tion 7044, Business and Professions Code)- ESS a _.. ,• _ UIRED TOTAL SETBACK CONSTRUCTION LENDING'AGENCY BACK -YARD HW Y # PROP LINE ' WIDTH �- hereby affirm that there is a construction lending agency for NT the performance of-the work for which this permit is issued Y (Sec 3097,.Civ C ) E t .. E _ Lender's Name f O LDMA Ref # Lender's Address ee S f Perm,tFee liI certify that I have read this application and state,that the ' Issuance Fee CJr LDMA,P/C.#. above information is correct 'I agree to comply with ol1 County igation Fee Q `c�( � 9 ordinances and State jaws relating to building construction, Total Fee •J ` LDMA Perm, #-' and hereby authorize representatives of is County to enter uPon the above:m coned perty inspection purposes r `o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ofplicant or Agent `Date JVciR;ERS'COMf�it15ATIOfJ DECLARATION :Ir'>, l xclie~ r; hgr a c ticcz!e#laWoir ,ce'Come of consent, ranelf' YAPPLICi4TION FOR �U,IL'DING PERMIT insure;,or a certificate of'Workers' Compensation Insurance, a or a certified copy thereof (Sec 3800, Lab'C ); '' - r COUNMOF LOS-ANGELES } y 'BUIUJI NG,AND'SAF,ETY Policy No Company - - - D 'Certified:copytis,hereby furnished,'. T.;.. '. FOR APPLICANT O FILL IN BUILDING ADDRESS ❑'' Certified copy is filed with the county building inspeo - BUILDING "tion'department 7• ADDRESS �,�Y A/c'T Date ` Applicant. .3 CITY ZIP- {O O LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' " - ^' '"' -NO OF BLDGS NEAREST' r J r COMPENSATION INSURANCE" - SIZE OF LOT NOW ON LOT CROSS (This section need not be completed if the permit is for one - _. ASSESSOR,, r, TRACT BLOCK LOT NO hundred dollars ($100)or less ) , MAP BOOK ' i PAGE, PARCEL 'c � , " " - • - G -IT. ;.NO..' _ a S USE ONE P -..� OWNER i I,certify_that m the performance of`the work for' which this / NO permit'is issuedI shall not employ any person in any manner = /- SPECIAL '- " •- - - c t ' ADDRESS` fN!✓E`S` II�. -' f CONDITIONS t ,1 t O so'os to become subject to the Workers'Co136 rrie atio nn f Date 'APPlicant' t CITY. W - ;ZIP ��V:i " ._- _ _ , '09 NOTICE TO'APPLICANT'-If, after' king'th Certificate ARCHITECT R TEL DISTRICT GROUP' TYPE FIRE'- PRO S D,BY ENGINEER NO " _ Z i ' Exemption, .you*should become' subject •to,the Workers' CONST Z E ,G Compensation provisions of the labor Code,ryou-must forth- ADDRESS t, ''J' ,• _ d 'with comply-with,such, provisions or. this•permit shall be -• :. _ _ _ / •N TEL I STATISTICAL CLASSIFICATION- APT C DO :deemed revoked; 1 ct t' CONTRACTOR Gi NS 2UG /ON NO J I _ _ LICENSED CONTRACTORS DECLARATION-• -- _ LIC_ CLA55 NO--Z{ DWELL UNITS ` I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS f !t! NO 7 ?3 QQ _ SEWER MAP (commenang with Section 7000)of Division 3 of the Business and LIC- _ � ,- ..,. '. - -•----•i - Professions Code, and my,license'is in full force and effect CITY /J C9 /L(rt' CLASS BK PG �Z -r - I VALIDATION 1 _ SQ FT _ NO OF_ NO OF _ _ CHECK ; License,Number �` Lic Classy SIZE STORIES FAMILIES y ON . I •r . , ., a ., VALUATION • (�-• 1.. Date DESCRIPTION OF WORK N� NEW ---a ; Contractor U ADD , 1 exempt under Sec •,a - ALTER - - � •. B&P C for-this reason -- REPAIR_ $ - - - - • ---. _ Date - USE OF DEMOL z EXISTING BLDG O S _ APPLICANT Signature FINAg OWNER-BUILDER DECLARATION-� F PRINT NO 30? 51 DATEL - --;9•6 3 4 0 A •1 hereby affirm that.Lam exempt from the Contractors License Law for the following,redson"(Section 7031 5, Business and ADDRESS 7 WF 1 FINAL" - # a •''° i e Professions-Code) PRESENT- - r. gY - - BUILDING' - 1 °-° 4,,9.8'8' , ? -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 ®^ ° ° •_4 9 8.8 c)q '' -7044, Business and Professions-Code) - ^ r MOVING' Y' '- `` JEL ` - - �,' 01. 1 4=8-7 CONTRACTOR NO { , I, as owner of the property, am exclusively contracting - , - , °• -:with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) _-REQUIRED TOTAL.SETBACK_ _ ti'. CONSTRUCTION LENDING AGENCY" SET BACK "YARD c HWY, " PROP LINE WIDTH ; 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 r - - PL o Lender's Name'' LDMA Ref #, P C Fee$ -. -- Permit Fee Lender's Address - - I certifythat I have read this application and state.that.the _ _ PP - - Issuance Fee-•- - i�° LDMA P/C# - a above information is correct I agree to comply with all County Investigation Fee } S ordinances and State laws relating to building construction, __•-� _ Q �( �{ a ^' Total Fee --( p-1/• -LDMA Perm #- u and hereby authorize representativ s of this County to enter - ! m upon the above entio prop for inspection purposes any-� SEE REVERSE FOR EXPLANATORY LANGUAGE 1 Signatu a f-Applicant or Agent Date _ - _ -,