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HomeMy Public PortalAbout5718 GOLDEN WEST AVE_Building__ 76AG38A CE q8032-63 APPLICATION FOR BUILDING PERMIT . COUNTY OF LOS ANGELES BUIL ISNs' DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF.BUILDING CROSS ST. 67 _1 DI T ICTO. P TYPE- R BY ol FOR APPLICANT' TO FILL-IN CONST. BUILDING STATISTICAL CLA (CATION' - SEWER MAP ADDRESS O� a ® (� - CLA$$. NO. UNITSK S �' LOT NO. "O o ,{s_ BLOCK WATER rJOT REQUIRED L;1'�ECEIVED / CERTIFICATE: {CJ�� TRACT- (r MAP �'J /y HIGHwAY STATE MAJOR SECOND LOCAL NO.OF BLDGS. NO. - / 6 URC LE) SIZE OF LOT X Cy .NOW ON LOT - USE ZONE SPECIAL USE OF j CONDITIONS- EXISTING BLDG. ,),LV e�.� / _ OWNER EL. V el- O Q .4 NO. BUILDING EXIST. / ' SETBACK YARD HWY STREET NAME WIDTH ADDRESS O A'do"J g- A FRONT Al - ARCHITECT OR - - TEL. - P. L. ENGINEER NO. SIDE ADDRESS CONTRACTOR,- !{G �_. E / }} yJO ADDRESS .Q `+ .h-11O V!A 0. H DESCRIPTION OF WORK ti w a . NEW A R REPAIR DEMOLISH - Z SQ. FT. � .NO. OF NO. OF - SIZE Ili STORIES FAMILIES USE OF. - - hl STIR UCTURE• - SIGNATURE O APPLICAN ' O VALUATI N L - - APPROVALS IDATO INSPECTOR.S%SIGNATURE P.C. PMT. f FOUNDATION: LOCATION FEE $ - FEE-$ �r� -FORMS, MATERfAL$ FRAME: FIRE-STOPS. i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _ BRACING. BOLTS t'J. AND ASTATE THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY FURNACE: LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT, DUCTS. / df •"'•" `�- r BUILDING CONSTRUCTION.'I CERTIFY THAT IN DOING THE WORK F AUTHORIZED HEREBY I -WILL NOT EMPLOY ANY PERSON.IN:VIOLA- LATH. INT. •/� TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- r,r ING TO WORI(MENASOMPFNSATI.ON INSURANCE. vV,J Vy' LATH,'EXT. , SIGNATURE OF HOUSE NUMBER CO.R- PERMITTEE RECT AND POSTED ADDRE$ FINAL ar `�a JOHN F. LEWIS. PRINCIPACSO-K AL ENG Ip EER. PLAN HECK' VALIDATION cK. M.O. cnsH _ PERMIT VALIDATION' M.O., CASH „kLA 936O'. AUGL I 76A638A CE 9803 12/69 F , APPLICATION FOR BUILDING PERMIT�7 ' I COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK- PAGE PARCEL BUILDING AND' SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY \ FORAPPLICANT TO FILL IN NEAREST Print or tyDe onl CROSS ST BUILDIST•j4CT NO GR TYPE PROC S JL �� CONST ADDRESS .5722 -Golden West I S (�� _ BLOCK STATISTICAL CLASSIFICATION SEWER MAA LOT NO CLASS NO­! /DWELL DWELL UNITS BK PG TRACT 15 USE•ZONE MAP NO.OF SLOGS NO SIZE OF LOT NOW ON LOT SPECIAL USE OF, 1 CONDITIONS EXISTING BLDG I I TEL. OWNER , Robert Cmpeland NO BLDG SETBACK FROM ADDRESS Same 1 IFRONTPROP LINEOF (STREET) 'TYPE OF EXISTING SETBACK HIGHWAY } YARD = TOTAL CITY Temple City (HIGHWAY WIDTH FROM C L ARCHITECT OR TEL. } _ ENGINEER NO BLDG SETBACK FRO ADDRESS ,SIDE PROP. LINE OF (STREET) TEL TYPE OF EXISTING SETBACK' HIGHWAY YARD = TOTAL CONTRACTOR ry0 _ HIGHWAY WIDTH FROM C.L. •• ADDRESS N� - 1 t _ d LIC. � CITY- San Gabriel 91776 CLASSC-39 CORNER CUTOFF YES ❑ NO ❑ U CONSTRUCTION LENDER NAME AND BRANCHSEE REVERSE SIDE FORISPECIAL APPROVALS ADDRESS - - - a SQ FT NO OF NO. OFryEN, ❑ ) _ - Z SIZE STORIES FAMILIES USE OF ADD ❑ STRUCTURE roof house '& ara a ALTER ❑ with #1 RC Shingles REPAIR© SIGNATURE OF' APPLICANT DEMOL ❑ r VALUATIONS - _ ©. APPROVALS DATE INSPECTOR'S SIGNATURE FEE S FEE 521.75 rOUNDATFORMS I MATERIIALSION 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 ORDINANCES AND LAWS' REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED _ HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT - LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COMPENSATAN INSURANCE t n� I LATH, EXT SIGNATURE OF C/��) HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS - FINAL Z PLAN CHECK VALIDATION GK MO CASH JOHN F LEWIS PRI CIPAL STRU ENGINEER PERMIT VALIDATION CK ASH NOV 1,7_ 1 D '2 1.75- _ WORKERS' COMPENSATION DECLARATION insure,oraafcertif cafirm thatte of Workers' CompensatioI have a certificate of n Insuran elent to f A P P L I CA \I O f FO R +lJ'I L DING PERMIT or a certified copy thereof (Sec. 3800, Lab. C.) Poli N��`/.2'`f0 COUNTY OFIOS ANGELES BUILDING AND SAFETY Company r . • BUILDING Certified copy is hereby furnished._ FOR APPLICANT TO-FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 7 �S 9/ ,�om ��� CITY' ZIP /� a LOCALITY G 4 Date Applicant NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL'OWNER NO. c USE ZONE MAP / �J �6C� c?�ef•��/Q I certify that in the performance of the work for which this NO.SPECIAL permit is issued, I shall not employ any person in any manner ADDRESS s� .2 ,fJ /C -J CONDITIONS n so as to become subject to the Workers' Compensation Laws. O CITY /77 ZIP 70p-l: U Date Applicant ARCHITECT OR TEL. Q� ENGINEER NO. DISTRICT PGOUP TYPEFIRE PROCESSED BYNOTICE TO APPLICANT:.If, after making'this Certificate of CONST. Z NE Exemption, you should become subject to the Workers' ? t / UCompensationprovisions of the Labor Code, you must forth- ADDRESSJ V "' a with comply with such provisions or this permit.shall be �1 TEL. STATISTICAL CLASSIFICATION APT. CONDO. z deemed revoked. CONTRACTOR /7 /t/ NO. 9-V Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 6/%« /(],T1//glt' /kJ� NO.L/ �3� LIC. SEWER MAP (commencing with Section 7000)of Division 3.of the Business CITY •%Eh1f�L€ Tl CLASS C�� and Professions Code,and my license is.in full force and effect. p BK PG. VALIDATION r' C� SEESTORIESS OROS / MILLIIES l ONE K License Number `�- ��� 'Lic. Class -7 4 VALUATION Contractor /�� �.-�1f1�-at, e /—�s /� DESCRIPTION OF WORK /`� EW ❑ $ ❑I am exempt under Sec. ADD ❑ Q/ , ALTER ❑ BAP.C. for this reason REPAIR ❑ $ Date: USE OF �i EXISTING BLDG OL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) /� j NO. �.� DATE C' 1/Q 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS / :��IpZ' � T . FINAL Professions Code): PRESENT By BUILDING ❑ I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and "' I the structure is not intended or offered for sale(SectionOpp, LOCALITY 7044, Business and Professions Code.) MOVING TEL. _ _ rlj» -' El 1, NO. I, as owner of the property, am_exclusively contracting .-..,,.-- with licensed contractors to construct the project (Sec- I_l _ =6 ADDRESS tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY .SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT CRR the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE Lender's Name m /D _ LDMA Ref. # P.C. Fee$ Permit Fee `i i' _ v 1 3 Lender's Address o poll- 1 certify that I have read this application and state that the Issuance Fee / � LDMA P/C# 8 above information is correct. I agree to comply with all County Investigation Fee d ordinances and State laws relating to building construction, Total Fee !!� �/ t1 LDMA Perm. # e and h aut on representatives of this County to enter u th ove- "fioneroperty for inspection purposes. j�fr 9� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date WORKERS' COMPENSATION DECLARATION, r insure,hereby aa certificate of Worke srlComtpennsat on eInsuran to of APPLICATION FOR BUILDING PERMIT cq a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company BUILDING ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS /Z,// � Date Applicant CI `— ZIP LOCALITY pP NO. OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100) or less.) TEL. OWNER d� d NO. 3 USE ZONE OP 1 certify that in the performance of the work for which this / v-� permit is issued, I shall not employ any person in any manner ADDRESS Jr / CONDITIONS a- so as to b ome subject to the Workers'Com nsaty n Laws. O CITY L(j ZIP } t Date Applicant - ARCHITECT OR TEL. DISTRICT WOUP TYPE FIRE PROCESSED BY NOTIC TO PLICANT: If, after making this Certif' ate of ENGINEER NO. C Z NE 0 Exemption, you should become subject to the Workers' n i� U Compensation provisions of the Labor Code, you must forth- ADDRESS W ✓ 0- with with comply with such provisions or this permit shall be TE 1f p STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. -CONTRACTOR) r 8 ? LICENSED CONTRACTORS DECLARATIONLIC. p CLASS NO.cDWELL. UNITS — I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS L /"te�Q d NO'l ,C"' SEWER MAP (commencing with Section 7000)of Division 3 of the Business LIC. and Professions Code,and my license is in full force and effect. CITY ,� - CLASS 6' BK PG. VALIDATION / ff ss SQ:FT. NO. OF NO. OF CHECK License Numberh )/ 92 / 9 Lic. Class S I STORIES FAMILIES ONE �.,,/ ❑ VALUATION Contractor] • 9 mate DESCRIPTION OF NEW $ ❑I am exempt under Sec. � �N�i IADD ❑ , ALTER ❑ B.BP.C. for this reason REPAIR $ Te: USE OF EXISTING BLDG. DEMOL Signature v APPLICANT(PR NT) NO. ';� FINAL / O ER-BU LDER DECLA ION DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS G?�A � Law for the following reason (Section 7031.5, Business and FINAL Professions Code): PRESENT BUILDING _ ❑ I, as owner of the property, or my employees with ADDRESS s wages as their sole compensation,will do the work and ' the structure is not intended or offered for sale(Section LOCALITY ' ► L 7044, Business and Professions Code.) MOVING TEL. - ' - --O CONTRACTOR NO. ❑ I, as owner of the property, am exclusively contracting i 1>Gt 3 Y with licensed contractors to construct the project (Sec- ADDRESS ? -I I Ai 2—s�� =,—,1 tion 7044, Business and Professions Code.) '- REQUIRED YARD HWY TOTAL SETBACK FROM EXIST. LLii CONSTRUCTION LENDING AGENCY SET BACK PROP. LINE WIDTH `-`�?ECIE' '- tii `'• ! 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. Lender's Name. 1 3 3�1 IE i LDMA Ref. # -t''�` P.C. Fee$ Permit Fee e t• 3 Lender's Address I certify that I have read this application and state that the Issuance Fee LDMA P/C# above information is correct.I agree to comply with all County Investigation Fee �7 8 ordinances and State laws relating to building construction, Total Fee O� LDMA Perm. # a and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. o SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date