HomeMy Public PortalAbout5841 GOLDEN WEST AVE_Building__ APPLICATION FOR,-BUILDING PERMIT,
FokAPPLICANT TO FILL IN (Print or type only)
BUILDING COUNTY OF,LOS ANGELES
ADDRESS DEPARTMENT OF COUNTY ENGINEER
CITY ZIP - - BUILDING AND SAFETY'DIVISION
NO OF BLDGS a BUILDING
SIZE OF LOT /i`���/ �JNOW ON•LOT ry ADDRESS -
TRACT 4BLOCK OO LOT NO 1 LOCALITY - C
TEL✓✓� NEAREST
OWNER NO iS 74 -CROSS ST _
ASSESSOR
ADDRESS ,5 MAP BOOK PAGE PARCEL
DISTRICT -GROUP TYPE FIR RRORSESSTO BY ,
CITY ZIP CONSSTTJ ZO
ARCHITECT O Fj TEL
ENGINEER NO
\ STATISTICAL CLASSIFICATION - - SEWER MAP
ADDRESS J, - CLASS NO. DWELL UNI- BK G
a
CONTRACTOR— EL USE f ONE NOP a
ADDRESS �. ��IP / �I CSPECAL
ONDIITIONS
CONSTRUCTION LENDER
CITY c% LIC
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES NO E]
NAME AND BRANCH BL G SETBACK FROM d
FR NT PROP LI NE OF (STREET) r C
G:
ADDRESS CITY — TOTAL SETBACK FROM TYPE OF EXISTING
HIG WAY } YARD — 'Cc
ESQ FT .NO OFNO OF- CHECK � - _ FRONT PROP LINE ., HIGHWAY WIDTH C
SIZE STORIES 'FAMILIES ONE CF-.
ILL
DESCRIPTION OF WORK NEW ❑ }
❑ BLDG SETBACK FROM - Z
ADD SIDEPROP LINEOF (STREET)
ALTER ❑ TOTAL SETBACK FRO PE OF EXISTING
HIGHWAY } YARD
RSIDE PROP LINE AHI Y WIDTH
EPAIR❑
USE O - } _
EXISTI BLDG DEMOL ❑
APPLICANT TEL _ CORNER CUTOFF YES ❑ NO ❑ _
(PRINT) NO
BY (SIGNATURE) IN OREN SPACE YES ❑� NO, ❑
QQ•• IN COASTAL ZONE YES ❑ NO
VALUATION$ 0 ��
� CATEGORICAL EXEMPTION YES� NO ❑
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL r
AND STATE THAT T.HE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE)
WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON-
STRUCTION 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE)
HEREBY I
WI NOT EMPLOY ANY-PERSON ' VIOLATION OF HE
LABOR CODE OF THE TE OF AL IF NIA IN RE LAT TO
WORKMEN'S COMPEN CE
SIGN4TURE OF -
PERMITTEE Ill it
ADDRESS
FINAL - BY
'- -' TEL _ - ,mss may' t
CITY NO DATE Z 7 "q
MAKF_ CHECKS PAYABLE TO P C, $ r PMT ,Q
HARVEY T. BRANOT. COUNTY ENGINEER FEE FEE P 76
PLAN CHECK VALIDATION CK _ MO CASH _ PERMIT VALIDATION CK M'O CASH
s
2 1.7.5
9: 1"mss :�
76A638A CE#803 7/73-
7SA638A GB#0G]2/4G, - APPLICA`fION: FOR BUILDING- PERMIT
COUNTY OF LOS'' ANGELES BUILDING
DEPARTMENT OF 'COUNTY-ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALI
JOHN-A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST
DISTRICT NO. GROUP TYPE PR CESSED BY
,FOR APPLICANT TO FILL IN CONST,
BUILDING ` STATIS CAL CLASSIFICATION SEWER MAP
`J Q !
ADDRESS ' BK_ PG;cLASS.NO DWELL.UNITS J
LOT NO: BLOCK' _ NUMBER�� HWYMAP E YES NO'
TRACT ` US-4ZONE SPECIAL 4
�r 'NO:OF BLDGS. CONDITIONS,-
SIZE OF LOT a7 G� NOW ON LOT
USE OF
EXISTING BLDG. OiYJE BUILDING EXIST.
r. TEL. YARD HWY STREET NAME
SETBACK WIDTH
OWNER ry .y _ NO: FRONT
11 L
ADDRESS v �o rC t ,SIDEARCHITEC
-
ENG NEERT OR s S C NO4 fa - vl I' L.
r INSPECTION. RECORD
ADDRESS er /c!tI/T '.1 U T. • J 7
TEL y? ��-O 1 �� f�€C' r ff`/� a
CONTRALTO C I NO. / O
ADDRESS -
DESCRIPTION OF WORK ✓��'� _S.!. — f/�H UJED 0
NEW FT. ADD-` ALTER REPAIR DEMOLISH n r
SQ - NO OF NO OF r
• M7, Sf>LdjW;, -2,6 /Fio IVR GL
SIZE /1 S STORIES FAMILIES. -
SUSEOFTRUCTURE 7-,f)glt9-DRQ) ~���� FFFIII
-- J
d N M2/
SIGNATURE
SIGNATURE OF , /! �IE�� /► V1/p !SILL.
'APPLICANT
VALUATION
APPROVAL'S -DATE INSPECTOR'S SIGNATURE Y+,�
'P.C' PMT. FOUNDATION. LOCATION
FEE- �� FEE $ FORMS,MATERIALS
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- .-ID r �d7lt��i,' o
FRAME:FIRE STOPS, - fI r
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 1 LATH, INT. -2 no
WILL NOT EMPLOY ANY PERSON IN VIOLATION OF,THE
WORKMEWS COMPENSATION LAWS OF CALIFORNIA.
• _ LATH,EXT
SIGNATURE OF HOUSE'NUMBER COR-
PERMITTE RECT AND POSTED e ,
ADDRESS FINAL 1/-27-4/ 1
f
CLYDE N.`DIRLAM, PRINCIPAL STR T RAL E"NGINEER
PLAN CHECK VALIDATION cit H.O., CASH PERIM VALIDATION cK M.O., CASH
L�'.,c�5 .9 ? JSEP
7aAG38AC08o,VQo• .APPLICATION FOR BUILDI G PERMIT _
COUNTY.OF LOS ANGELES BUILDING n `
DEPARTMENT OF COUNTY ENGEER ADDREss
IN
BUILDING AND SAFETY DIVISION LOCALI . ,
JOHN A.LAMBIE, COUNTY ENGINEER - NEAREST
WILLIAM A. JENSEN SUPT oR BUILDING _ CROSS ST.
DISTRICT NO. GR P TYPE PR CESSED BY '
FOR APPLICANT TO FILL IN coNsr. _
BUILDING STATISTICAL CLASSIFICATION I SEWER MAP
ADDRESS ' B G
CLASS N WELL.UNITS
LOT-NO. % OO BLOCK MAP - Ut� 7 STATE NO
ER
NUMB
TRACT USE ZONE SPECIAL, '
NO.OF BLDGS. CONDITIONS -
SIZE OF LOT • NOW ON LOT ON�
USE'OF
EXISTING BLDG. _ BUILDING YARD HWY STREET NAME --EXIST.
' T
SETBACK' W,DTH
OWNER. _ NO . 9� FRONT.
P L -
ADDRESS o�Q .I Dry N� SIDE
ARCHITECT OR TEL fi`^�.�•••� -
ENGINEER S elC INSPECTION RECORD
ADDRESS
a
CONTRACTORk {VST ToLr, Y l 0-
ADDRESS- U /61 V
DESCRIPTION OF WORK' a
f r0'
NEW ADD ALTER REPAIR DEMOLISH
SQ FT., (,p NO OF NO OF
SIZE z O STORIES FAMILIES -
USE OF'
STRUCTURE 6144 A
SIGNATURE OF
APPLICAN MA /`r- C N, `
VALUATION$ ��
APPROVALS DATE INSPECTOR'S SIGNATURE
FOUNDATION LOCATION
PMT. - - '
FEE $ 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.
I CERTIFY THAT IN DOING THE WORK AUTHORIZED 1 LATH, INT.
WILL,NOTEMPLOY ANY PERSON IN VIOLATION OF THE
WORKMEN'S COMPENSATION LAWS OF CALIFORNIA. LATH,_EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTEE RECT AND'POSTED A
ADDRESS FINAL —LJ �(8 Y® '
CLYDE N. DIRLAM, PRINCIPAL- ST RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK M.o.K cAsx
Ir1U G G 5 0 SEP, 0
WORKERS' COM@ENSATION DECLARATION L
APPLICATION FOR BUILDING .
I hereby affirm that I-have a certificate of consent to self PERMIT
insure, or a certificate of Workers' Compensation Insurance, - -or acertified copy thereof (Sec 3800, Lab C ) - COUNTY OF LOS ANGELES, BUILDING AND SAFETY
Policy No Company BUILDING
®�rtified,copy is hereby`furnished . FOR APPLICANT TO FILL INADDRESS go Lj)E7L)
❑ Certified copy is filed with the county building inspec- BUILDING
ion department. ADDRESS o 7
� ��,,,���jj//�� CIN
ZIP, LOCALITY
'fX
Date's Applicant
NO OF BLDGS NEAREST
CERTIFICATE OF EXEMPTION-FROM W KERS'- SIZE OF LOT 'NOW ON LOT CROSS Si
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 a NO USE ZONE ' MAP
I certify that in the,performancec;of the work for which this < NO
permit is issued, I shall not employ aiS
iy,person in any manner ADDRESS _ _ SPECIAL - ate.
CONDITION
so as to become subject to the Workers'Compensation Laws J O
CITY / ZIP - U
Date Applicant ARCHITECT OR TEL
ENGINEER NO DISTRICT. GROUP TYPE FIRE PRO SED BY Q
NOTICE TO APPLICANT If„after making this Certificate of CONST Z E Exemption, you should become subject to the, Workers' U-
Compensationprovisions of the Labor Code, you must forth- ADDRESS �✓'' V �, a
with comply with such_provisions-or this permit shall be TEL ��("�/- STATISTICAL CLASSIFICATION APT' CONDO Z
deemed revoked CONTRACTORagN v t�
LICE' All LIC Sr/ CLASS NO DWELL UNITS +°
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE 6 �"! NO (J D SEWER MAP
(commencing with Section 7000)of Division 3 of;the Business s LIC �-?-1• i
and'Professions Code,and my license is in full fort nd effect CITY CLASS; j BK VALIDATION
Cd SQ' FT NO OF - NO OF CHECK
License Number v �4 Lac Classes SIZE STORIES FAMILIES ONE
VALUATION �y
Contractor lee -Date /•v DESCRIPTION OF WORK NEW ❑ _ $
ADD ❑ J O
❑I am exempt under ec ►
ALTER ❑
B&P C. for this reason Ow a�� $
Date USE OF _ .
EXISTING BLDG ° -1
Signature APPLICANT TEL _ FINAL
OWNER-BUILDER DECLARATION (PRINT) "NO „DATEe V M
I hereby affirm that I am exempt from the Contractor's License _ I(
Law for the following reason (Section' 7031 5, Business and ADDRESS FINAL)
Professions Code) PRESENT By • [•rvTva
BUILDING r
❑ I, as owner of the property, or,my employees with ADDRESS l 3307 ,� - •140.2
wages as their sole compensation,will do the work and - - (} 1 y
the structure is not intended or offered for sale Section LOCALITY -( T
MOVING'.:. . » _• _ ._TEL , r ' ITEMS••
' -7044; BusmessFand-•Professions Code ) ";• �• _ -
•0 I, as owner of thePrope'rty,am exclusively contracting TOTAL
CONTRACTONO �V AL 140.22
with licensed contractors to constructthe project (Sec- - - �• r
tion 7044, Business and Professions Code ) ADDRESS- G 4� '1 i-t•1.22
REQUIRED, TOTAL SETBACK FROM EXIST Y 4f�1Gt, ` 1�V.�
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH4f7tR1VL
I hereby affirm that there is a construction lending agency for rFNthe performance of.the wofk for which this permit is issued(Sec 3097, Civ. C )•Lender's Name -} �tDMA Ref # -v!1E 1 PM1206
Permit Fee t
,Lender's Address /)
1 certify that I have read this application•and state that the Issuance Fee , V LDN1A P/C#
8 above information is correct I agree to'comply wrth all County Investigation Fee
ordinances and•State jaws relating to building construction, Total Fee 14 0 raLDMA Perm #
a and hereb uthonze rep sentatives of this County to enter
upon t abov- ti d property for inspe=tiori purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Si nature of Ap c t Date
�- 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 1202220023
PHONE (626) 285-0488 EXT
i
LEGAL ID I NO. OF CONST I BUILDING ADDRESS I
ITR 6561 LT 474 I SQ FT STORIES TYPE I 5841 GOLDEN WEST AV I
STRUCTURE. 3000 V-B I TEMP CA 917802202 - I
(ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET. LAS TUNAS I
IB587-024-009 I I THOMAS PAGE 597 GRID A3 LOCALITY. TEMPLE CITY, Cl
ITENANT (EXIST BLDG USE RESID USE ZONE. R-1 (ISSUED ON: PROCESSED BY: 1
I (EXIST OCC GRP- 102/22/12 SR
I I I I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT VALUATION IFINAL,DATE F NAL BY: CODE
FLORENCE PROPERTIES (626) 447-3228- 1 6,400 'LL7/'J�r •�
• I FEES PAID ID SCR PTION OF WORK
IREMOVE ONE LAYER COMP INSTALL 30 YR CLASS A FIRE RATED 1
IFEE DESCRIPTION- QUANTITY DOM: AMOUNT- ISHINGLE OVER EXISTING 1X6 SHEATING I
(APPLICANT TEL. NO I
IKEEFER, BRIAN (909) 608-0622- IAA BLDG PERMIT ISSUANCE _ 27 80 1 I
1 - IAB STATE GREEN BLDG FEE 6400 00 VAL 1.00 (SPECIAL CONDITIONS 1
I IAC STRONG MOTION RESID 6400.00 VAL 0.60 I
ID2 PERMIT W/O EN-HC 6400 00 VAL 166 60 I
TOTAL FEES 196 00
(CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE
IKEEFER'S ROOFING (909) 608-0622-
11216 BEGONIA COURT LIC NO I ILOCATION AND SETBACKS
UPLAND CA 91784 760903 C39 I 1 -1-1
ISOILS ENGINEER APPROVAL I I
I I I
1ARCHITECT OR ENGINEER- TEL. NO 1 (FOUNDATION/TRENCH FORMS
1 LIC NO 1 (SLAB/UNDER FLOOR I I 1
I I I
1 I IRAISED FLOOR FRAMING I I 1
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDERFLOOR"INSULATION I I
1150H269 3 001 1 I 1
I I IFLOOR SHEATHING I I I
INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I I I I I
I 0 NO 21 1 IROOF' SHEATHING 1 I 1
SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I 1
(AIR QUALITY 1000 FEET MATERIALS i _ 1 ' I I I
NO NO NO 1 IFRAKE INSPECTION I I I
IFIRE'SPRINKLER HANGERS' I I I
1 I 1 I I I
(INSULATION/WEATHER STRIPI I I
I (INTERIOR LATH/DRYWALL I I I
I I 1EXTERIOR LATH I 1 I
I I I I I I
IRATED FLOOR/CEIL ASSEM
I I IRATED WALL ASSEMBLIES I I I
` I IRATED SHAFTS/OPENINGS I I I
I I I I 1 I
. I IT-BAR CEILINGS I I I
I ILOT DRAINAGE I I I
I I I I 1 I
REPORT ID DPR261 -ROUTE TO BS0508 I I I I