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HomeMy Public PortalAbout5743 GOLDEN WEST AVE_Building__ APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDINGCOUNTY OF LOS ANGELES 573 Golden West - ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY em le C-i-t-y ZIP BUILDING AND.SAFETY DIVISION NO.OF.BLDGS. BUILDING 57�Z i SIZE OF LOT NOW ON LOT l ADDRESS TRACT BLOCK I LOT NO. LOCALITY TEL, NEAREST OWNER NO. CROSS ST. ASSESSOR ADDRESS 57-43 Golden West MAP BOOK PAGE PARCEL t Q DISTRICT GROUP TYPE FIR,,4E PROCESSED BY CITY ZIP -1, SO / CONS ZON ARCHITECT OR TEL. �+• 0� ENGINEER NO. STATISTICAL IEWER MAP ADDRESS - CLASS NO.--2J—DWELL.UNITS BK PG CONTRACTOg. TEL. – 'USE ZONE MAP D I NO. ADDRESS O• goods Ave,NO �' SPECIAL CITY Californ1wS`' LIC.S C-39 CONDITIONS 48 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION L NDER NAME AND BRANCH BLDG. OM FRONT PROP.LINE (STREET) ADDRESS CITY Re-roof __ HIGHWAY + YARD � OTAL SETBACK FROM TYPE OF. EXISTING SQ. FT. NO. OF NO. OF .CHECK RONT PROP. LINE HIGHWAY1 WIDTH SIZE STORIES FAMILIES 'ONE DESCRIPTION OF WORKNEW ❑ + O ❑ BLOG.SETBACK FRO V 'Rigid eared lass tt C n ADD SIDE PROP.LINE OF (STREET) roofing. ALTER ElHIGHWAY + YA Fp _ T TA ET FROM HTYPE OF IGHWAY EW DTHG O b SIDE ROP. E U REPAIR❑ W a OF NG BLDG. Itesenne O. DEML [:] + _ EXISTING Z APPLICANT TEL CORNER CUTOFF Y ks ❑ NO ❑ .(PRINT) NO. BY (SIGNATURE) IN OPEN SPACE YES NO ❑ IN COASTAL PERMIT ZONE YES ❑ O ❑ VALUATION;$ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT-AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE ST,4TE OF CALIFORNIA IN RELATING*�TpO WORKMEN'S COMPENSATION INSURANCE.M M CO . SIGNATURE O PERMITTEE -- ADDRESS337 scl —jj W4ods Aye TEL FINAL 'A-Y CITY NO. – DATE MAKE CHECKS PA17ABLE TO: FEE'5 Y✓ ! FEE $L6•0MO EHARVEYT. BRANDT, COUNTY ENGINEER PLAN'CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION !A,M.,O. CASH 5 2 811-'SEP 8 1 0 6.0 0 ♦�d 76A638A CE 4803 5/74 °`SPL .CIT 70A008A CE#8082100 APPLICATION FOR BUILDING PERMIT - 1 COUNTY OF LOS ANGELES BUILDING fi � DEPARTMENT OF COUNTY ENGINEER A°DREss� BUILDING AND SAFETY DIVISION LocALI JOHN A. LAMBIE, COUNTY ENGINEER NEAREST /J WILLIAM A. JENSEN SUP'T OF BUILDING CROSS ST. LGA _ DISTRICT NO. GROUP TYPE ' PR CESSED BY FOR APPLICANT TO FILL IN �� ` CONST BUILDING °�} .STATISTICAL CLASSIFICATION SEWER MAP " ADDRES{��+ �/ U/ CLASS.NO.J� DWELL.UNITS C� (f SK PG LOT Ngt�2-_ 1 G'- BLOCK MAP '" -STATE TRACT NUMBER d 7 HWY. YES ,mss, USE ZONE SPECIAL SIZE OF LOTy ?S- I NOW ON LOTS CONDITIONS - - - USE OF EXISTING BLDG. BUILDING EXIST. TEL. SETBACK YARD HWY STREET NAME WIPTH OWNER -NO. FRONT ADDRESS 7 / SIDE ARCHITECT OR TEL. P.L. ENGINEER No: INSPECTION RECORD ADDRESS TEL. a CONTRACTOR NO. O ADDRESS. .. V DESCRIPTION" OF WORK a O NEW ADD ALTER REPAIR _DEMOLISH SO.FT. NO.OF NO.OF a SIZE ,;L 3CrZb STORIES FAMILIES � USE OF STRUCTURE SIGNATURE OF APPLICANT �SQ1'I✓et. /"7`l/T�. c-at*-.,a VALUATION$ // o -�� APPROVALS DATE INSPECTOR'S SIGNATURE FEE '$ I I ` - FOUNDATION: LOCATION FEE FORMS,MATERIALS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FRAME: FIRE STOPS, _ BRACING, BOLTS PLICATION AND STATE THAT THE ABOVE IS CORRECT AND FURNACE: LOCATION, AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND GAS VENT;DUCTS STATE LAWS REGULATING BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED I LATH, INT. WILL.NOT EMPLOY ANY PERSON IN VIOLATION OF THE - WORKMEN'S COMPE TION F LIFORNIA. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL •CLYD.E N. DIRLAM, PRINCIPAL STRUCTURAL ECASH R PLAN CHECK VALIDATION cK. m.o. CASH PERMIT VALIDATION CK. M.O. OF 78A888A CF#80970-88 APPLICATION FOR BUILDING. PERMIT _ • 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER A°°REss� BUILDING AND SAFETY DIVISION LOCALI JOHN A.-LAMBIE, COUNTY ENGINEER NEAREST > CASSATT D. GRIFFIN, SUPT OF BUILDING CROSS DISTRICT NO. GROUP rypE PR CESSED BY FORAPPLICANT, TO'-FILL IN' , e <� I CONST, � I BUILDINGry/ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS 5743 43. Golden West CLASS_NO.-Z--DWELL' LIM T _I gK PG J / LOT`MI�O� 464 BLOCK NUMB ER (/ STATE HWY. YES N TRACT 6561" USE ZONE SPECIAL . _ __ _ NO.OF.BLDGS p CONDITIO. - SIZE OF LOT 50X200 -' I NOW ON LOT -L 1// USE OF •1 - EXISTING BLDG. Dwelling BUILDINGYARD HWY STREET NAME - EXIST. SETBACK WIDTH OWNER Leo 1' --• FRONTMAIL " ADDRESS 43 Golden West SIDE' © -QITY Temple- City NOLAT 7231 �P.L. ARCHITECT OR TEL, INSPECTION RECORD�- - ENGINEER none NO. ADDRESS -` _ 11­2,q­ o /moi S /)-ri4 I&lKh A, — ZAP CONTRACTOR Santa ,..Anita OonSti},E AT- 79744 A ADDRESS 0717 Las Tunas f San Gabriel M 11ST 'ER '51y DESCRIPTION OF WORK F571YeE A/,3D/ T _& ���EF , 14, `!v D'F ' NE1N� 'ADD •-1.�ALTER REPAIR '. DEMOLISH � � �i . _ SQ.FT V o .- -NO.OF-- -• -� NO.OF �• 1 ;�. SIZE GA rn STORIES 1 FAMILIESUSE OF STRUCTURE De ached Garage - _ b Y• 3 Pr SIGNATURE OF .APPLICANT APPROVALS ' DATE INSPECTOR'S -gSIGNATURE 'ADDRESS [j�,s' [IJ[ FOUNDATION:LOCATION FORMS,MATERIALS^ VALUATION FRAME:F IRE BRACING,BOLOTSS, - �- ?4a �._ FURNACE:LOCATION. FEE P.C. E. $ +I FEE $ / �, I _GAS VENT;.DUCTS - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- PCICATION AND STATE THAT THE ABOVE IS CORRECT AND LATH. INT. AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REG UL � 4G CONSTRUCTION: LATH,EXT. Z/2i,•/ � lil�.. SIGNATURE OF HOUSE NUMBER COR- PERMITTEE- - 66L��� _RECT AND POSTED ADDRESS / FINAL ` ' Z-24 IG"/ CLYDE N. DIRLAM, PRINCIPALS UCT. RAL ENGINEER PLAN CHECK VALIDATION CK: M.O. CASH PERMIT VALIDATION ('CK/M.O. CASH i_.u3 76A3 Ait CE#809.7.56 APPLICATION FORBUILDING PERMIT 1 BUILDING AND SAFETY DIVISION BUILDING / ? `C n, ADDRESS <13 7 J •/�sr „3/.�.�+�/� Department of County Engineer County of Los Angeles LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN, SUPT of BUILDING CROSS ST.'--'-- DIS RICT T.'DIST NO. GROUP ITYPEI SEWER MAP FOR APPLICANT TO FILL IN B PG CONST. BUILDING ADDRESS �t7LA � ��,� STATISTICA - LASSIFICATION I �/ / LOT'NO. ��, i�A U F�aT `/1� p BLOCK -CLASS. NO. DWELL. UNITS MAP pj' �• STATE. .YES O , J / NUMBER dso HWY TRACT /P 6 •1USE ZO E SPECT L _ .�-• NO. OF BLDGS. CONDITIONS SIZE OF LOTCJ iD ,p?r/3,(� I NOW ON LOT GG'l1 USE OF _EXISTING BLDG. n USCF BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER LMAIL ,y / >�/9 NO FRONT I_v w ADDRESS .S75 ,3 OL ",�/b+' NOSY_ SIDE P. L /O" 4eJ Q� /� y�y/ A.¢. ry �j CITY /-��• 4 �/ X NO /'1/ Zp,31� P. L. INSPECTION RECORD ARCHITECT OR9y''�� TEL. ENGINEER (.� �(z- /C NO. ADDRESS TEL. CONTRACTOR. NO. v. ADDRESS _ - e DESCRIPTION OF WORK NEW ADD- LTE L(REPAIR DEMOLISH SO. FT:/-73O OF NO. OF SIZE K STORIES FAMILIES USE OF STRUCTURE ��� APPROVALS ASIGNATURE OF PPLICAN Try gg- g ADDRESS �I DATEry INSP TO/RS SIGNATURE �/�,7 X�k' �d�%/ s _H7f� ''''' e FOUNDATION: LOCATION FORMS, MATERIALS �,./�•—_,.� S . P.l,C. $ ` FRAME: FIRE STOPS. FEE BRACING. BOLTS VALUATION �`�' $ FURNACE: LOCATION, U FEE d GAS VENT, DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH. INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND LATH. EXT. STATE LAWS REGULATING RJILDING CONSTRUCTION. — SIGNATURE OF i HOUSE NUMBER COR- PERMITTEEffffE��///���///�66,,'��� 1 / n RECT AND POSTED ADDRESS—,5 7A-3 FINAL JOHN A. LAMBIE, COUNTY ENGINEER, CLYDE N. DIRLAM, PRI CIPAL STR TURAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH Io6694 RR 2 1 2 .00 WORKERS'COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT � insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Sec. 3600, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. BUILDING PolCompany — Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS < �s.�T LOCALITY .�'� Q NEAREST Date Applicant CITY / ZIP 7 v 0 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT 5D X�D O NOW ON LOT 3 MAP BOOK PAGE PARCEL (This section need not be completed,if.the Permit is for one• USE ZONE EMAP ,hundred dollars.($100)or less.) �.. BLOCK LOT NO. 4 TEL /�I certify that in the performance of the work#or which this OWNER TR/�,i NO:��6�68 / NS @. permit is issued, I shall not employ any person in any manner /'/ DISTRICT. GROUP TYPE FIRE PROCESSED BY O ADDRESS �Ll�CAJ W E� 'T' CONST.eC24 ZONE Im so as to become subject to the Workers' pensatio aws. � � _ ,a Date �. �pplic'ant �• CITY l_ ZIP STATISTICAL CLASSIFICATION APT. CONDO. Q NOTICE TO APPLICANT: If, after making this Certate of ARCHITECT OR TEL. ' 'Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. _DWELL. UNITS IL Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or, this permit shall be /p TEL. // QQ deemed revoked. CONTRACTOR ` / '�pp NO. BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATIONLIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS q(p tij aSe, 67 NO. VALU ION (commencing with Section 7000)of Division 3 of the Business and i- LIC. Professions Code, and my license is in full force and effect. CITY Se, L Mp 76- CLASS $ a� SO. FT. NO.OF NO.OF CHECK ► License Number � J—'Lic.Class 6_/ SIZE STORIES FAMILIES ONE r�• Contractor Date e DESCRIPTION OF WORK NEW ❑ $ �'— ADD Q I am exempt under Sec. t U'41 lq_r /D ALTER FINAL 7� B.&P.C. for this reason REPAIR � DATE Date: USE OF DEMOL FINAL EXISTING BLDG. By Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. I hereby affirm that I am exempt from the Contractor's License , Law for the following reason (Section 7031.5, Business and ADDRESS Professions Code): PRESENT BUILDING 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 7044, Business and Professions Code). MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. �216 0 5 4.A with licensed contractors to construct the project (Sec- LADDR #'0'0 0 0 0 tion 7044, Business and Professions Code). TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY YARD HWY PROP. LINE WIDTH *0 0 2 2350 I hereby affirm that there is a construction lending agency for ' the performance of the work for which this permit is issued ► o.0 0 2�J 5 O.cs� (Sec. 3097, Civ. C.). FD 0903-82 -Q Lender's Name � Lender's Address Permit Fee I certify that I have read'this application and state that theIssuance Feeabove information is correct. I agree to comply with.all County n Fee g ordinances and State la��t. ting to building construction, Total Fee c� and her uthorize retives of this County to enter upon eZ61 -mentionper for inspection purposes. 0 U SEE REVERSE FOR EXPLANATORY LANGUAGE ^ Signature of Applicant Agent Date - es 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 0701120009 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 464 UN: .002 - SQ. FT STORIES TYPE 5743 GOLDEN WEST AV STRUCTURE: VN TEMP CA 917802504 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8587-023-010 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/12/07 JK 01/07/08 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: RICCELLI ANDREW JON (626) 287-1815- 10,000 -- 5743 GOLDEN WEST AV / TEMP 917802504 FEES PAID DESCRIPTION OF WORK REPAIR EXISTING DEN AND REROOF WITH COMPOSITION SHINGLES FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 10000.00 VAL 1.00 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 10000.00 VAL 216.60 TOTAL FEES 245.35 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO LOCATION AND SETBACKS 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 150H269 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO 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