HomeMy Public PortalAbout10062 GREEN ST_Building__ TEMPLE CITV.�
7YAe]e?CE#e03- 1-6, APPLICATION FOR BUILDING PERMIT (1
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. .g r
DISTRICT NO c GROUP TYPE PROCdSSgy
FOR APPLICANT TO FILL IN CONST.
BUILDING �ESTATISTICAL BK P
SSIFICATION SEW ER MAP
ADDRESS /I/�� (Q�` _G
CLASS.NO. DWELL. UNITS
LOTNO.W, �-r-�� WATER NOT REQUIRED RECEIVEDLi
TRACT�o 7"' -._�, ��' J MAP CERTIFICATE:ow
HIGHWAY
NO.OF BLDGS.
NO. (CIRCLE) STATE MAJOR SECOND, OCAL
SIZE OF LO I NOW ON LOT USF ZONE SPECIAL
USE OF ONDITIONSjEte
EXISTING BLDG.
4 , TEL. J � GL ..�..F•C b I � -�tIZ.
OWNER NO. BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
ADDRESS FRONT
ARCHITECT OR TEL. P. L.
ENGINEER NO. SIDE
P.L. �-
ADDRESS INSPECTION RECORD O
CONTRA V
ADDRESS .6 Cft+ d'
O
DESCRIPTION OF WORK .
W
a
NEW AD ALTER REPAIR DEMOLISH - N
SQ. FT. /� y(� NO.OF NO.OF
SIZE (J V STORIES FAMILIES
USE OF
STR CTURE
SIGNATURE OF
APPLICANT
VALUATION$ 'a 4 d�
APPROVALS DATE INSPECTOR'S SIGNATURE .
P.C. PMT. '- ig-tJ FOUNDATION: LOCAT,d -
FEE FEE FORMS,MATERIA
FRAME: FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
o..
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN LA- LATH, INT.
TION OF THE LABOR CODE OF THE ATE OF CALIFORNIA AT-
INC TO WORKME OMPEN SATI NSURANCE. - - -
LATH,EXT.
SIGNATUR HOUSE NUMBER COR-
PERMITTE R ECT AND POSTED
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGINEER
PLAN CHECK VALIDATION cK. M.O. H` PERMIT VALIDATION CK. M.O. "lH
5 4 l'uLq 2 1 5.0 0,
j
APPLICATION F;�O,R. BUILDING PERMIT
FOUNTY 6F LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLJCANT TO FILL IN BOILD6NG
r I hereby afflrm that I have a owttfloate of ooneecd to serf hsur% BIALDWG ADDRESS .$;–rtio �Bf/f/o�• .
or a cerdfloate of Workers' Compensation Vraunance,or a cent w ( L v
copy thereof (Sea 3800.Lab.C.) o 1c— MP
.Policy Na Company SZM OF LFUT N0.OF BLDGS NOW ON LOT
y ❑ Certtned copy fa hereby fumiahed. jrC L 1 NEAFEST CROSS ST.
❑ Certtfted copy Is Ned wtth the county bulldfnp htapection TRACT BLOCK LOT Na dapartrnL USE 3?Ff MAP NO.
DateAppkwt OWASSESSORRnMAP BOOF</5;6 PAGE`D`7 '02 9 SPECIAL CONW ONS
CERTIFICATE OF EXEMPTION FROM WORKERS' �j v ^'O
COMPENSATION INSURANCE wTnFUN 1OX FT.OF SCHOOL? YES NO
(This 9eotlon need not be Completed If the permit Is for one hundred `Q Z DISTRICT GROUP TYPE CONST. FE ZC*E PROCESSED BY
dollars($100) c 68a) peul�i
1 certffy that In the performance of the work for whloh this permffl� CllLIU G�
Is Issued, I shall not ernploy arty person In Ter so ae to becorne st-bled to the Q ARN7 Il EGT OR EFJGiiEFR TEL Na
Date IS I ApQlk�rrt SATtSTKlL AFT CONDO
1tK. ADpFtEgg CLASS NO ��* N
N0711l M APPLr-AMT• H, atterthis of �\ REOU6a£b TOTAL SETBA A FROM E IST
Exemptbn, You &'Quid become su to the Ylbrksre' J ��� TEL Na SET BACK Wo I W Y PROP LINE VST
Cortzpeneaffon prwleiom of the Labor Code, you must torthuvtth FROWr
co oy with auch provb1om or this permit&hall be deemed revoked. LIC.N%a P L
l
LICENSED CONTRACTORS DECLARATION 4 SIDE�� Lam. P L
I hereby affirm that I am Ik;ermed underprovWons of Chapter 9
Ig
(commencing wfth Section 7000)of Df4slon 3 of the Bualne&e and &Fr•SOW, NO.OF NO OF 8 SEWER MAP
Proteaabna Code,and my lbense 1&In furl force and effect. L� � NEW BK Fo a
LJcenee NLmuber �� +r� Lb.Claaa l DESORPTION OF WORK ADD WILCI N , Q
CormactorDate �'-1 -�� 2 1 ALTER ❑ $ V
Lad
❑ I am exempt under Seo. - `{U REPAIR ❑
B.dP.C.for thls reason DEMOL ❑ LDAM P/C r
Data QLLSE _ URM ❑
APPLICA T(PFMVT) TEL NO. LDAM Perm r i Z
E] 4 as owner d pro1P N
perty,operty, or my enpbyeee with wages as z
their Bole compermailon, wftl do the work and the adru&ure b ADDRESS O 3303
not Intended or offered for sale (Section 7044, Bustrreea and P1KAL DM1
Profeaabns Codas.) ALL nE AaQLFcwT oR rirruF�F■■n■ra OCG RWr {MLLE�wz�Faooue M4BML z-
❑ 4 as owner of the property, am exdLmVery contracting with oR"NCCIM COKNNNG A HAZAFDOUB NLUMAL EOLAL To oR 3FEATM THAN THE i
Iceneed contractors to conetr-uot theAAaoU>tNTs 8 E'C�ON THE�-wlaooUe M�4FJ�LE WORLA aN ouo[t F V L BY •I T.7
pro}eot (Section 7044, Yee El -1ZBusiness and Profeeabrm Code.
T E WENDED USE OF Tf a c m aur TLI
-E APPLICANT OR FUTL FE BUILDING 331.K-
OCCIlF'AlrT FeOUM A FSdd
T FOR CTRON UCTOR N006=rJ DN FROM THE SOUTH
CONSTRUCTION LENDING AGENCY �T An QTY�� ' SEE� ��
T mTrvcT McAaaTTm T FoFl 2 ITEMS
rat EE W&
I hereby affirm fhaf there la a �Uciion kwn !.ng aoenoy for YE8❑ No TOTAL 382 _ 15
a the periormarwe d the work for wNc'thrs permit to lasued(Sec.
3097, CN.C) i HAE FCAD Ti FI&LAPECUS aLiDE AND THE&cwao PE Rhc-nml3 +.15
THE LOS,&3ELES COUP"CODE,
2.2oLerTCiera t�tame FELT F�oii�TTHE
ecrN>wa
r .00Lenders Address C
OR AQWT
I certify that I have reed thle applloabon and shale under penefty
d perjury that the above trrtormetion Is correct I spree to comply D �S
v with all ordlnan aas State lam raWng to bulmnp P C FEE PER1,�T FEE L ISI]--I�IJ 1 8/17/94
represerrrawe& of this Canty *8UANCE FEE 5&54`7 1 AM 9:44
ICY InepeDria,rxrpoeee
NVESTnAATICN FEE T0T1L FEE
SEE REVERSE FOR EXPLANATORY LAN43UAGE
. 4 �
COUNTY OF LOS ANGELES TEMPLE= CITY `��i150$ BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0505 9612020051
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CONST ---TM-nNG ADDRESS'
ON FILE SG. FT STORIES TYPE 1OD62 GREEN ST
STRUCTURE: 0 VN TEMP CA 917803331
ASSESSOR INFORMATION NUM1BER: NEAREST CROSS STREET: BALDWIN
8585-007-029 THOMAS PAGE: 597 GRID: 94 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG RESID 09t ZWr:- ISSMPROCESSED BY: EXPIRES ON:
EXIST OCC GRP:: 12/02. • UT 12/02/99
06M ER TEL. NO: BLDGS. NOW ON LOT: VALLJAnN-- FINAL �ATE FINAL E:
HOGGATT JERRY E II-I;LINDA E (626) 448-1492- 1 6,650
10062 GREEN ST 1 (7- /VA7 15;7
TEMP 917803331 FEES PAID OF WORK
TER OFF AND RECOVER WITH TIMBERL E 25YR COMP. SHINGLE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
AFIPLICANT: TEL. NO:
RANDOL ROOFING (626) 2.88-4040- BLDG PERMIT ISSUANCE 27.75
529 E. VALLEY BL !►C STRONG MOTION R .00 VAL 0.67
SAN GABRIEL, CA . 2 PERMIT W/O �1N VAL 166.20
- H GEL /� 194.62
CONTRACTOR: TEL. NO: INSPECTOR SIGN.ATOWE--
5
U
RAADOL ROOFING (626) 288-4040- �rO
529 E VALLEY BLVD LIC. NO LOCATION AND SETBACKS
SAN GABRIEL, CA 91776 B
SOILS ENGINEER APPROVAL
ARCHITECT TEL. W:
LIC. NO: 111111
14TH273 3 ❑• �� L C V V / 'kl Ll`J
MO 21 8 FLOM tHF-ATHIgr--
W. OF FAMILIES: D61ELLING UNITS: APT/COND: STAT Cf ROOF $HEATHING
SCHOOL WITHIN
AIR QUALITY: 1000 FEET MATERIALS
�` ❑
NG Ito NO FRAMEiNSPECTION
cl
REQUIRED TOTEl SET BACK YARD: ffYT: PROP LINE: WIDTH: \4\C t O� $
FRONT PL- sOrvice
SIDE PL-
INTERIOR LATF/5ff7WlT--
EMBLIES
* JIDDITIONAL DATA ON FILE
REPORT ID: DPR261 ROUTE TO: BS0508
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