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Home My Public Portal About5758 GOLDEN WEST AVE_Building__ w' 1PAPPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS BUILDING DRESS-� I hereby affirm that I have a certificate of consent to self insure, 7 S or a certificate of Workers'Compensation Insurance,or a certified CIS zipLD COPY thereof(Sec 3800,Lab C) X LOCALITY Policy No Company SIZE OF LO � NO OF BL�NOW ON LOT NEAREST CR SSS ❑ Certified copy Is hereby furnished ❑ Certified Copy is filed with the county building Inspection TRACT RI CK, LOT NO USE ZONE MAP NO i department ' ASSESSOR MAP BOOK PAGE PARCEL Date Applicant SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' [ADDRhz�bq TEL NO YES No COMPENSATION INSURANCE WITHIN 1000 FT OF SCHOOL? (This Section need not be completed If the permit la for One hundred ( � DISTRICT G OUP TYPE CONST' FIRE ZONETkDdollars($100)or less) zIPI certify that In the performance of the work for which this permit �V J is issued, I shall not employ any person In any manner so as to ITECT OR NGINEER TEL NO become subject to the Workers'Compensation Laws I I STATISTICAL CLAS 11` ATION APT eNDO Date Applicant ADDRESS CLASS NO DWELL UNITS NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption,_ you should become Subject.to the Workers' CONTRACTOR TEL NO SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith A I FRONT comply with such provisions or this permit shall be deemed revoked ADDRESS LIC NO PL SIDE LICENSED CONTRACTORS DECLARATION CITY LIC CLASSp L a 0 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP v (commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORES NO OF FAMILIES Professions Code,and my license Is In full force and effect NEW ❑ BK PG DESCRIPTIO OF WOR ADD ❑ License Number Lic.Class ;^ C VALUATION Contractor Date ( ALTER ❑ I am exempt under Sec 0 REPAIR ❑ B&P C for this reason DEMOL ❑ LDMA P/C# Date US OF ISLNG DG /l URM ❑ nature AP ANT PRINT f` A TEL NO LDMA Penn# I as owner of theproperty, or m em to employees with wages as ,J ^ W, Z p l ,a Y P Y 9 O ti their sole compensation,will do the work and the structure is ADDR �� not Intended or offered for sale (Section 7044, Business and l FINALD I �/; C ,:307 ;17,l!II PFOfe9310r13 Code) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `7, i ❑ I, as owner of theproperty, em eXCIUSIV@I contractor with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN �' a 1 ITLEMS Y 9 THE AMOUNTS SPECIE ON THE HAZARDOUS MATERIALS INFORMATION GUIDE?+ FINAL B ht licensed contractors to construct the project (Section 7044, YES❑ NO �j1�ttL 8— Business and Professions Code) ��lll"` 2 00 WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CHECK CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMrrnNG CHECKLIST FOR GUIDELINES i CHANGE I hereby affirm that there is a construction lending agency for YEs❑ W' the performance of the work for which this permit Is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV.C) PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES _ COUNTY CODE,TITLE Z CHAPTER 220 SECTIONS 2 20 100 THROUGH 220140 CONCERNING i]i;i i -!I( 1 1 4/ 9/91) 721 Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD Lenders Address OWNER OA AGENT 9985 AM 7= 0 1 certify that I have read this application and state that the above - q Information is correct I agree'to comply with all county PC FEE PERMIT FEE , 1 • O G ordinances and State laws relating to building construction,and 1 hereb thonze represents es of is County to enter Upon _ _ ISSUANCE FEE O t o menti pro for In tion purposes INVESTIGATION FEE TOTAL FEE �j0 m js ,r mA��o.Ao.,v O.m SEE REVERSE FOR EXPLANATORY LANGUAGE, WORKERS' COMPENSATION DECLARATION ►: 4fiery-def irm that I hove a certificate of consent 'to self inure, or;p certificate of Workers' Compensation Insurance, APPLICATION FOR BUILDING PERMIT of a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS ❑ Certified copy is filed with the county building inspec- BUILDING �6-n 11m � J tion department. ADDRESS Date Applicant CITY ZIP LOCALITY NO. OF BLDGS.CERTIFICATE OF EXEMPTION FROM WORKERS' SPLE OF LOT �(� _ NOW ON LOT 3 NEAREST _ J 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.) J n C c t NO• USE Z NE MAP OWNER NO. �� (G+ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ADDRESS f r �' SPECIAL d CONDITIONS so as to become subject to the Workers' Compensation Laws. r� OO CITY ZIP Date > Applicant �E`�""" �" �` J ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE CESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. �E ` U Exemption, you should become subject to the Workers' � q - �_ , t j w Compensation provisions of the Labor Code, you must forth- ADDRESS ( v � �''r� a with comply with such provisions or this permit shall be T STATISTICAL CLASSI CATION APT. CONDO. v7 deemed revoked. CONTRACTOR O, Z LICENSED CONTRACTORS DECLARATION LIC.' CLASS NO. DWELL. UNITS I hereby affirm that lam licensed under provisions of Chapter 9 ADDRESS NO.\ LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business ,.., and Professions Code,and my license is in full force and effect. CITY CLAS BK PG. VALIDATION SQ. FT. O. OF NO. OF CHECK License Number Lic. Class SIZE STORIES FAMILIES ONE VALUATION Contractor Date DESCRIPTION OF WORK NEW ❑ ADD ❑ ❑I am exempt under Sec. (imaw ALTER B.&P.C. for this reason REPAIR ❑ $ Date: USE OF EXISTING BLDG. �`?r�C DEMOL ❑ Signature APPLICANT TEL. FINAL OWNER-BUILDER DECLARATION (PRINT) NO. DATE ..3 I hereby affirm that I am exempt from the Contractor's License _ Law for the following reason (Section 7031.5, Business and ADDRESS FINAL _ Professions Code): PRESENT By BUILDING +'•a._,; ,3 El 1, as owner of the property, or my employees with ADDRESS wages as their sole compensation.,will do the work and `?i t structure is not intended or offered for sale(Section LOCALITYf 044, Business and Professions Code.) MOVING TEL. T'Lt CONTRACTOR NO. z t F-1:= I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec- 11U.14L, f ADDRESS ''� en ��•"� tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. -:1C'.r-.. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH - t I hereby affirm that there is a construction lending agency for FRONT i_. )}-7)j}h the performance of the.work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P. l it li f _ Lender's Name. LDMA Ref. # 1 �)�� t' ' - P.C. Fee$ Permit Fee �+ fJ 'J f` 't•; Lender's Address poll. h•• _, a 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 0 ordinances and State laws relating to building construction, Total Fee i LDMA Perm. # and hereby authorize representatives of this County to enter upon the above-mentioned proerty for inspection purposes. a SEE REVERSE FOR EXPLANATORY LANGUAGE , Si nature- of-Applicant or Agent Date • COUNTY OF LUS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS-TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9704240053 PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS: TR: 6561 ._ LT: 454 SQ. FT STORIES TYPE OCCUP GROUP 5758 GOLDEN WEST AV STRUCTURE: 1573 1 V R3 TEMP CA 917802503 ASSESSOR INFORMATION NUMBER: GARAGE: 539 1 NEAREST CROSS'STREET: 8587-028-013 OTHER: 140 1 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: SE ONE: ISSUED ON: ROC SSE BY: EXPIRES N: EXIST OCC GRP: 06/18/97. TC 06/18/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY, DE: RICHARDS STEPHEN B;CORRIE J (818) 500-6728— 1 183,300 7 j 5758 GOLDEN WEST AV TEMP 917802503 FEES PAID DESCR PTI N OF WORK ADDITION OF 1573 SQ. FT.—GARAGE ITH WORKSHOP-539 SQ. FT. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW KITCHEN,MSTR. BEDROOM/BATH/CLOSET,FAMILY ROOM, LAUNDRY APPLICANT: TEL. NO: SAME AS OWNER — B1 PLANCHECK W/ENERGY 129300.00 VAL 1,390.29 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 183300.00 VAL 18.33 B1 PLANCHECK ,W/ENERGY '183300:00 VAL 333.23 B2 PERMIT W/ENERGY '183300.00-VAL 2,027.69 CONTRACTOR: TEL. NO: TOTAL FEES 3,797.29 APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO — - LOCATION AND SETBACKS SOILS E;dGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: OUNDATIO /TR NCH FORMS THE WREN GROUP (818) 564-2650 111 44 W. BELLUVUE DRIVE LIC. NO: SLAB/UNDER FLOOR SUITE 6 C21565 PASADENA, CA 91105 RAISED FLOOR FRAMING / MAP NO: SEWER MAP _BOOK: PAGE: FIRE ZONE: CMP: 3 Gi UNDERFLOOR INSULATION Z .. ST LEVEL FLOOR SHEATH _ NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH ool SCHOOL WITHIN HA ARDOUS ROOF SHEATHING p AIR QUALITY: 1000 FEET MATERIALS O 1z 47 _ NO NO NO FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT SET BACK .YARD: HWY: . PROP LINE: WIDTH: \ FRONT PL- _ SHEAR PANELS U SIDE PL— INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LAT LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL * ADDITIONAL DATA ON FILE REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS '9071 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 05.08 9705070002 PHONE: (818) 285-0488 EXT: LEGAL ID: NO. OF W CONST BUILDING ADDRESS:_ TR: 6561 LT: 454 SQ. FT STORIES .° 'TYPE' 5758 GOLDEN WEST AV STRUCTURE: 0 TEMP CA 917802503 ASSESSO INFORMATION NUMBER: NEAREST CROSS STREET: 8587-028-013 THOMAS PAGE: 597, GRID: A3- LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/07/97 TC 05/07/98 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL Y. CODE: RICHARDS STEPHEN B;CORRIE J (818) 286-4408- 10 � /► 5758 GOLDEN WEST AV ` —"6 TEMP 917802503 FEES PAID DESCRIPTION OF WORK �. DEMOLISH PORTION OF KITCHEN AND GARAGE IN PREPARATION FOR FEE DESCRIPTION: 1QUANT[TY LIOM AMOUNT: NEW ADDITION APPLICANT: TEL. N0: ��-� SAME AS OWNER AA BLDG PERMIT ISSUANCE - __ `�°27.75 02 DEMOLITION INSPECTN' , -;:` '163.50 SPECIAL CONDITIONS: TOTAL-FEES CONTRACTOR: TEL. NO: APPROVPLS DATE INSPECTOR SIGNATURE SAME AS OWNER - �'� LIC. NO PEDESTRIAN PROTECTION SEWER DISCONNECTION ARCHITECT OR ENGINEER: TEL. NO: ABANDON PRIVATE DISPOSAL LIC. NO: UNDERGRND STRUCT REMOVAL AND SOIL RECOMPACTION .MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: 150H269. 01 , NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: ✓ NO 23 SCHOOL WITHIN HAZARDOUS — AIR QUALITY: _ 1000 FEET MATERIALS NO NO NO ASSESM MORFICATM iWioatbn kVxr sant to AQW.or EPA Cox 86t1dt4 34at aot�dm6xra al.asb�sl� *emays#to mat tlfwrle ki a tee@. REPORT ID: DPR261 ROUTE TO: BS0508