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HomeMy Public PortalAbout5405 GOLDEN WEST AVE_Building__ APPLICATION FOR BUILDING PERMIT FORP,PPLICANT TO FILL IN (Print o, type only) BUILDING COUNTY OF LOS ANGELES ADDRESS - DEPARTMENT OF COUNTY ENGINEER CITY -C., ZIP BUILDING AND SAFETY DIVISION NO.OF BLDGS` BUILDING SIZE OF LOT '7 NOW ON LOT ADDRESS _ �J c TRACT 3�), n BLOCK LOT NO ' '.� LOCALITY TEL. NEAREST OWNER * = Mf"C'p CROSS ST. tt p ASSESSOR ADDRESS .�JL.: i i[�+•a{ TM;t1 Cy' MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE I FIRE PROCESSED BY CITY ��� �IIi�j ZIP CONST. ZONE Aftj.�TR TEL. O E OGG,Id4F.F�R NO. 33'1"140 STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO. DWELL.UNITS BK PG CONTRACTOR Lµ {� NOL USE ZONE MAP LIC. NO. ADDRESS�-gj,... AS ­ 'licNO. SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED Y E 5 NO O CL- CONSTRUCTION LENDER U NAME AND BRANCH BLDG.SETBACK FROM LLJ FRONT PROP. LINE OF ISTREETI ADDRESS CITY V,,, HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXISTING SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWlZY WIDTH 7- SIZE STORIESI,4- . FAMILIES ,.j ONE Cr DESCRIPTION OF WORK NEW } a- BLDG.SETBACK FROM ISTREErfiI w C ..it.,, _.,ls`,' ADD ❑ SIDE PROP. 1 L, * ALTER ❑ HIGHWAY } YARD TOTAL SETBACK FROM TYPE OF EXIST NG Li' TIS 1 : REPAIR-i� ❑ = SIDE PROP. LINE HIGHWAY WI L USE OF DEMOL ❑ } EXISTING BLDG. APPLICANT t{'� TEL CORNER CUTOFF YES NO (PRINT) �.J4I-�e'�a T N0. s7• i',...`. E`ij BY (SIGNATURE) IN OPEN SPACE YES � NO ❑ Q, IN COASTAL ZONE YES NO ❑ VAL�ATION $ 481,025.00 CATEGORICAL EXEMPTION YES NO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE T,9AT THE ABOVE IS CORRECT AND AGREE 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) 1 WILL HEREBY NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATION INSURANCE. 1 SIGNATURE OF PERMITTEE ADDRESS TEL. FINAL BY -- &_/ CITY NO. DATE �'- , Q, MA KF_ CHECKS PAYABLE TU: PEE FEE HARVEY T. BRANDT. GOUIJTY,_gNG(NEER PLAN CHECK VALIDATION Ks M'o ASH _ PERMIT VALIDATION CK Mo CASH 76A638A CE4803 7/73 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT.•TO FILL IN BUILDING ADDRESS P-0 W�5 I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS A or a certificate of Workers' Compensation Insurance,or a certified 103- copy thereof (Sec.3800,}Leib.C.) CITY ZIP LOCALITY Policy No� �`3�7 5-7 fV�� TES Y ^ dT—�` �Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT El Certified copy is hereby furnished. NEAREST CROSS ST. qQ Certified copy is filed with the COu,Atyo,building ition TRACT BLOCK' LOT NO. department. USE ZONE MAP NO. Date 'LO f Applicant yy ASSESSOR MAP BOOK PA©�O PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER��� ����� rL NoB�_3 y7� COMPENSATION INSURANCE /Z WITHIN 1000 FT.of SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROC dollars ($100) or less.) I certify that in the performance of the work for which this permitCITY ZIP is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER '— TEL NO. 1 STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO. CQ I DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST ExemCompensation provision, you ions ofbecome the Laborubject to the Code, you must orrtthwith CONTRACTOR n �'���� TEL NO. OZZ SET BACK YARD HWY PROP LINE WIDTH l ,V �O / � FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC_.NO. PL LICENSED CONTRACTORS DECLARATION 761 SIDE CITY �i LE/S�D/9"G� ��- LIC.CLASS,23 PL I hereby affirm that I am licensed underprovisions Of Chapter 9 ,Y O SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES e } Professions Code,,and1�m/y Lice/rise is in full force and effect. 2.00 / NEW BK PG d License Number •� d's�X3 Lic. Class 6 DESCRIPTION OF WORK ADD ❑ VALUATION , Q y— fJ, 6-,I�� -_' Pao f��Toy ALTER 11 $ Contractor% ElI am exempt under Sec. REPAIR ❑ BAP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLD 1,imee- �/�y�Zs/ URM ❑ C0 Signature APPLICANT(PRINT) �7 TEL NO. LDMA Perm# 23 Z ❑ I, as owner of the property, or my employees with wages as ZO ,A P:! s , their sole compensation, will do the work and the structure is ADDRESS _ not intended or offered for sale (Section 7044, Business and FINAL DAT ' Q _:!I `tt j:=0 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 El 1, as owner Of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, MCC T p Business and Professions Code.) ves El No❑ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING 3^ 3 -_5f+ • OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ''1=13'•� -"'�°'�:1 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR O K z T T i-•r GUIDELINES. '•It 3'C I hereby affirm that there is a construction lending agency for YES El NO❑ j --31 a the performance of the work for which this permit is issued(Sec. n mss- 4 [HAVECHECKLIST, THE UNDERSHAZARDOUS MY INFORMATION GUIDE AND ANGELHE ES COUNTMCODE, 3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, (/ TITLE 2,CHAPTER 2.20 SECTIO2.20.100 THROUGH 2,20.140 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THEOSCAQMD.G HAZARDOUS a [=1 t i-00 I 6/22_r:z c_ o Lender's Address OWNER OR AGENT o 1097 aa t' 5g y.... o I certify that I have read this application and state under penalty i ; 1 !"`�� _==•tea' o of perjury that the above information is correct.I agree to comply P.C.FEE ' 0 PERMIT FEE yCtt'all county ordinances a State laws rel ting to building !!// <•. �constructfon, and hereby r representa s of this County ISSUANCE FEE ��jj " to on thea ned property f inspection purposes. vt-� o � INVESTIGATION FEE TOTAL FEE a�4 gnat a of Applicant or or. SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers'Compenstion Insurance, or tif• pp ter of (Sec. 3800, Lab. �� COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDI P i N Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING t,b,p�deiment. ADDRESS LOCALITY i i` o NEAREST Date Spplicant 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 one USE ZONE MAP hundred dollars ($100)or less.) TRA T BLOCK LOT NO. NO. TEL. SPECIAL I certify that in the performance.of the work for which this OWNER NO. CONDITIONS permit is issued, I shall not em to an person in an manner DISTRICT GROUP TYPE FIRE PROC SSED BY p p Y Y p y ADDRESS CONST. ZONE De so as to become subject to the Workers'Compensation Laws. e ` e Date Applicant CITY ZIP STATISTICAL CLASSI ATION Y APT. CONDO. NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. � !! 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 M with comply with such provisions or this permit shall be deemed revoked. CONTRAC R . N BK. PG, / VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESNO. VALUATION (commencing with,Sectio 7000)of Division 3 of the Business and LIC. ` 11 1N Professions Cod and m license is in full force and effect. CITY CLASS $ / SQ. NO. OF NO. OF CHECK License Numb r Lic.Class SIZ U STORIES FAMILIES ONE C iracto Date DESCRIPTION OF WORK NEW $ I C am exempt from the licensing requirements as I am a ADD licensed architect or a registered professional engineer ALTER EJ FINAL ?� acting in my p ofessional capacity (Section 7051, REPAIR DATE Oi Business d oode). USE OF FINAL Lic. or Reg. No.� Date-1 D_ 1 APPLICANEXISTING T ' / DEMOL By OWNER-BUILDER DECLARATION (PRINT) j 1 ,5 0 8 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS J& .2, �# a0aa21 Professions Code): PRESENT ❑ BUILDING 2 0 0 6 0,48 I, as owner of the property, or my employees-with ADDRESS wages as their sole compensation, will do the work and b 0 8= the structure is not intended or offered for sale(Section LOCALITY o o o � .7044, Business and Professions Code). MOVING TEL. I, as owner_of the property, am exclusively contracting CONTRACTOR NO. i 01 .3—8 1 with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and,Professions Code): REQUIRED TOTAL SETBACK FROM EXIST. 2 1 5 0.9 A CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT o:0 0 0 0 1 the performance of the work for which this permit is issued P.I. (Sec. 3097, Civ. C.). SIDE 2 a 1 1 SO 0 P.I. Lender's Name .o 0 1 1 SO 05 Lender's Address P.C. Fee$ 6 i Permit Fee (J / 1013-81 w I certify that I hove read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee odinances and State laws relating to building construction, Total Fee J a d hewby,authorize representatives of this County to enter U n 0k e ab ve-mentioned property for inspectiio�n purposes. / c _.6 SEE REVERSE FOR EXPLANATORY LANGUAGE Sig e of Applicant or Agent F Doe i ©s -COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0105110047 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS.: TR: 35012 LT: 2 SQ. FT STORIES TYPE 5405 GOLDEN WEST AV STRUCTURE: 0 VN TEMP CA 917803219 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OLIVE 8588-020-023 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY- TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC;GRP: 05/11/01 JK 11/07/01 OWNER: TEL. NO: BLDGS. NOW ON'LOT: VALUATION: FINAL DATE FI L CODE: EVANS JAMES R;ROBIN B (626) 285-3470- 1' 5,800 5405 GOLDEN WEST AV TEMP 917803219 FEES PAID DESC I TION OF WORK T/0 ROOF; REPLACE SHEAT ING AND INSTALL 20YR CERTANTEED FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: FIBERGLASS SHINGLE TO HO SE AND GARAGE APPLICANT: TEL. NO: GREG GAROFOLO (818) 652-9870- AA BLDG PERMIT ISSUANCE 27.75 11333 MOORPARK ST AC STRONG MOTION RESID 5800.00 VAL 0.58 SPECIAL CONDITIONS: TOLUCA LAKE, CA D2 PERMIT W/0 EN-HC 5800.00 VAL 149.40 TOTAL FEES 177.73 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE EXPRESS REMODELING (800) 471-3950- 22148 SHERMAN WAY LIC. NO ���� LOCATION AND SETBACKS CONOGA PARK, CA 91303 B 512240 ` SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS - � LIC. NO: - - SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 147H269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS �i SHEAR PANELS r AIR QUALITY: 1000 FEET MATERIALS NO NO NO i,� FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 • a