HomeMy Public PortalAbout5214 HALLOWELL AVE_Building__ APPLICATION FOR -BUILDINGPERMIT,
FOR APPLICANT TO FILL IN (Print or type only)
_ '• COUNTY OF LOS ANGELES
BUILDING -+• /
ADDRESS / moi 6«c z e DEPARTMENT OF COUNTY ENGINEER'
clry ZIP BUILDING AND SAFETY DIVISION
- - - NO OF BLDGS BUILDING
SIZE OF LOT/ NOW ON LOT -ADDRESS J
TRACT�J�O� BLOCK��,9 LOT NO �.� LOCALITY r `
OWNER jfiL ,�d�NL TEL NEAREST-
NO CROSS ST-
1 ®® ASSESSOR1-1
ADDRESS / �C �V MAP BOOK PAGE, PARCEL
DISTRICT , [,GROUP TYPE ' FIRE ESSED BY
-CITY' /� C ZIP o" CONST• ZON
ARCHIT OR TEL �.•%a 9� .�_- T
ENGINEER NO STATISTICAL CLASSIFICATION SEWER<A P
ADDRESS - CLASS NO �� DWELL UNITS BK PG
CONTRACTOR N TEL
LIC' U ONE NMOAP
ADDRE ` No/-. J, CONDITIONS
CITY C ASS
CONSTRUCTION LENDER / ` ROAD DEPARTMENT APPROVAL REQUIRED YES ❑" NO'❑-
NAME AND BRANCH BLDG.,SETBACK FROM
FR ON PROP'LINE OF (STREET)
ADDRESS CITY _ TOTAL SETBACK FROM TYPE OF EXISTING
HIGHW Y + YARD
SO,FT NO OF NO OF CHECK r FRONT PROP LINE HIGHWAY WIDTH
SIZE STORIES FAMILIES ONE }
DESCR TION OF WORK NEW ❑ O
BLDG:SETBACK FROM �
ADD SIDE PROP.LINE OF ISTREET) O
ALTER ❑ TOTAL TYPE OF EXISTING S
HIGHWAY + YARD = SIDE PROP LINE AY WIDTH
SE OF '// REPAIR ❑ Z !
EXISTING BLDG �J t-��• DEMOL ❑ +
APPRINT PLICArfT t TO� u7� CORNER CUTOFF •• YES ❑ NO E]>t+� '7� IN OPEN SPACE . YES ❑ NO ❑
BY(SIGNATU I l
Q /• IN COASTAL PERMIT ZONE YES ❑ NO E]0
VALUATION $ ( C7 /217
•I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ` 7�� � C /��_
u THAT THE ABOVE IS CORRECT,AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION,I CERTIFY THAT IN DOING THE
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABO DE OF THE STATE OF CALIFORNIA IN REL ING TO WORKMEN S COM-
PENSATIIOO, NCE
SIGNATU Q E
PERMITTEE'
AD E
gg FINAL �/ BY
CI eAJ
TEL
G DATE
MAKE CHECKS-PAYABLE TO: FEE FET
HARVEY T.BRANDT,COUNTY ENGINEER `•
PLAN CHECK"VALIDATION CK M.O. CASH _ PERMIT VALIDATION cK MO. 'CASH,
8 7 '14'-APR'. 25 -:1 A 9 6,.0.0 A9.8
.®f 76A638A CE#803 3.75
APPLICATIOI .r.FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
r•.�:
r WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
I hereby affirm that I hake a certificate of consent to self insure, BUILDING ADDREsy$��
or a certificate of Workers' Compensation Insurance, or a certified T-)14 L d l.? LL ! V F-
copy thereof ( 800, L b.C.) CITFPLE C iT ZIP �, 7r
A l^ t� LOCALITY
POterItified
Company ✓v/� SIZE OF-LOT �,-= NO.OF BLDGS.NOW ON LOT
copy is hereby furnished. ' NEARES CROS ST.
❑ Certified copy is filed with the co y ildm insp ction TRACT BLOCK LOT NO.
dep en. USE ZONE MAP NO.
Date Applicant
ASSESSOR MAP BOOK PAGE. PARCEL
.41 f ��!,�� ` SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER i p C ur-^,� TEL NO. YES NO
COMPENSATION INSURANCE L 1 1 1 WITHIN 1000 FT.OF SCHOOL?
ADDRESS
(This section need not be completed if the permit is for one hundred ,�?/q 1E AX A ft p(I rz DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY
dollars ($100)or less.)
CITY ZIP
I certify that in the performance of the work for which this permitT.t
is issued, I shall not employ any person in any manner so as to VV41 �T7EL 1\10. G
become subject to the Workers'Compensation Laws. i�N YoY �,,..66 �� STATISTICAL CLA SFICATION APT CONDO
Date. Applicant ADDRESS / CLASS NO. DWELL UNITS
�-
NOTICE TO APPLICANT.' If, after making this Certificate Of \ -I-,,T`F i Go L LF-Cir F-W dc� bBZ WAU 61 T REQUIRED TOTAL SETBAN FROM EXIST'
Exemption, you should become subject to the Workers' \ CON ACTOR xuE O. -SET BACK YARD HWY PROP''NE WIDTH -
Compensation provisions of the Labor Code, you must- forthwith /UC O/ ���v FRONT
comply with such provisions or this permit shall be deemed revoked. AD 1 LIC.NO. P L _y,_
LICENSED CONTRACTORS DECLARATION
SIDE !?_ y';'
CITY 2 LIC. P L � �•,- 4,�.
I hereby affirm that I am licensed underprovisions of Chapter 9 o DST �� 1.3 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE - NO.OF ST IES NO.OF FAMILIES
NEW ❑ BK L. PG
Professions Code,and my lice e is in full force and e fect.
DESCRIPTION OF WORK VALUATION , CHECKi_.
License Number ft�,t A-b-DI i6� d-r-L,�y ADD �C7o
Contractor r7l� ate I`;i I'- ;€;
�l ^- B R �'" (�A � .' lA(lAIa7R ALTER ❑ 'i�€d. _� ,
❑ I am exempt under Sec. REPAIR ❑ -
B.&P.C, for this reason coVmR M7100 IV>rW ' gA DEMOL El
Date; USE OF EXISTING BLDG. 11RM ❑ !i';:=.'
��SJhJ��tIT
Signature APPLICANT(PRINT EL NO. ` LDMA Perm# s'�• '� Z
❑ I, as owner of the property, or my employees with wages as froqrq� - .-�•.t;
their sole compensation, will do the work and the structure is ADDRESS L 0 ---- i-6,
not intended or offered for sale (Section 7044, Business and J6 74 1 Com`LLQ'¢E(wuD� /�' C4AJ,,UW FINAL DATE
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL of 7 y z
OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J TO
€F+F` i";•'•:
❑ I, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B `'I r.,•.}'r.} j .. s�hsL
licensed contractors to construct the project (Section 7044,
_ . . 'i "••:j -'f t'' =C:
Business and Professions Code.) YES NO 11 '-L` t•�_ �•*=°i=_•_�:'
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING a l,-
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ` 1 t - i�`r iZGE a f f3€
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDELINES. ,.
I hereby affirm that there is a construction lending agency for YES❑ No❑
the performance of the work for which this permit is issued(Sea AND THE SCAOMD PERITTING ;'i f f
3097, CIV.C.) HECKLIST..I UNDERSTA DUMI HAVE READ THE YI REQUIREMENATERIALST SMATION UNDDER THDE LOS ANGELES COUNTY CODE, ' �_�� -
/� TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS e ;]
Lender's Name /✓ N MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. t :
o Lender's Address
0 OWNER OR AGENT
o I certify that I have read this application and state under penalty
P.C. E
�• PERMIT'
of perjury that the above information is correct.I agree to comply y� v� � FEE
with all county ordinances and State laws relating to building G Q cG
CD construction, d hereby authorize representatives of this County ISSUANCE FEE
to enter construction,
I ve-me Coned roper y for inspection urp es. 7
a
� INVESTIGATION FEE TOTAL�&
sre�amre Ar,P"_ A._ o� - / / �}
SEE REVERSE FOR EXPLANATORY LANGUAGE
C -
I
1 -
G, � « �� oB ���Y APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
I hereby affirm that I'have a certificate of consent to self in BUILDING ADDRESS �/ W.-e_
or a certificate of Workers' Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C) CIT //' / ZIP d LOCA ITy
(,o /�Policy NO Company- SI OF.LOT NO OF BLDGS NOW ON LOT l
❑ Certified copy Is.hereby furnished / x 3j_ NEA ST CROSS
❑ Certified copy Is filed with the county building inspection TRACT BLOCK LOT NO
department. USE ZONE MAP NO
Date Applicant ASSESSOR AP BOOK PAGE PARCEL
SPECIAL CONDITIONS
'CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL N
COMPENSATION INSURANCE �-� " "O'` WITHIN 1000 FT OF SCHOOLS YES NO x
(This section need not be completed if the permit is for one hundred ADDRESS ! 0
DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY
dollars($100)or less.) _
I certify that In the.performance of w k for which this permit, C /t l ZIP
IS Issued, I Shall not employ any erson an manner SO t0- ARCHITECT ENGINEER TEL NO' �J
become subject to the Workertomp atl STATISTICAL CLA SIFICATION APT CONDO '
-Date 1?=944pplicant ADDRESS CLASS NO- DWELL UNITS
NOTICE TO'APPLIG4NT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
Exemption, y0U should become Subject t0 the Workers' C ACTO - TEL NO�s ,[ SET BACK YARD HWY PROP LINE
Compensation provisions of the Labor Code, you must forthwith G 3 1z FRONT
comply with such provisions or this permit shall be deemed revoked ADDRESS UC NOP L
` G _
LICENSED CONTRACTORS DECLARATION 155�`ry ` O SIDE
CITY // LIC CLASS P L
I hereby affirm that I am licensed'underprovisions of Chapter 9 f-Q�CL•4 Com- .Qrv SEWER MAP >
(commencing with Section 7000)of Division 3 of the Business and SO FT SIZE NO OF STORIES NO OF FAMILIEFS
Professions Code, nd my license is In full•force and effect / NEW BK PG - O
ev"2 - DESCRIP ON OF RK � VALUATION
License Nu er f Lic Class �S� � ' /!N ADD' ❑ — ® �
Contractor Nli ate �%� '! ALTER ❑ $
LU
Aol REPAIR ❑ a
I] I am exempt under SEC $ N
B.&P.C-for this reason -P/V S -st- T f c Cr L(///r DEMOL ❑ LDMA P_/C.# Z
D tR USE OF EXIST INGDG PURM 1:1- '
Signature LIC T PRINT �- TEL NO LDMA•Perm#
❑.I,as-'owner of the property, or my employees with wages as v �f -Z
their sole compensation, will do the work and the structure is DDRESS '// Q nti •I z s
not Intended or offered for sale (Section 7044, Business ,and u, 4 !/ �� L FINAL DATE Q . 5
OR
! -=) 'll °""'j'
WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL _- �j�/ - - J _ -
❑ 1, as owner of the property, am exclusively contracting with OR I MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q
AMOUNTS SPECIFI ON THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BV� �
licensed contractors to construct the project (Section 7044,
YES❑ NO y
Business and Professions Code) ,� 1_ a'
WILL THE INT NDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -7"0� _
• OCCUPANT,REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH X71 ry/ --• - �� n�E
CONSTRUCTION LENDING AGENCY COAST AIR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR U P ate = -'
OH
i..L 1_-
I hereby affirm that there Is a construction lending agency for
N the performance of the work for which this permit is Issued(Sec ,�,.
°D 3097,CIV C. ARDOUS MATERIALS INFORMAT ON GUIDE AND ESCAOMD PERMITTING TOTA _C_H•m �p
N ) D DMV REQUIREMENTS ER THE LO A GELES COUNTY CODE,
I ECTIO S 2 20 100 T GH 2 20 14 C CERNING HAZARDOUS f'• i a—Lender's.Name AND FO PE MIT FR :1 iv(? L•1 n L{I
Lender's Address
CHANGE
O I 0,_J0
KT'1 OR NT "
oI certify that I have read this application and state under penalty'
O of perjur at the above Information is correct I agree to comply PC FEE —7% PERMIT FEE
N with c ty ordinances and State laws relating to building log
) �I jj i I:r°°9.i-00
m COOS tru , and hereby authori� representatives of this County ISSUANCE FEE r - L '
CID en u the rope for Inspection purposes. y �` 5:5-'i
fp 2 5 INVESTIGATION FEE TOTAL FEE
^ SV� a PkCwt«,yea o-..
SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # � BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA SL 0508 9804060021
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CON T BUILDING
TR: 14053 LT: 25 SQ. FT STORIES TYPE 5214 HALLOWELL AV
STRUCTURE: 0 VN TEMP CA 917803460
ASSESSOR ION NEAREST CROSS STREET: FREER
8585-019-038 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY
TENANT: E DG USE: RESID USE ZONE: R-1 ISSUED 0 .
EXIST OCC GRP: 04/06/98 UT 04/06/99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
CHEN L-ILY;TANIES JACKIE- - - -(626)-448-2922-- - 1 700 -
5214 HALLOWELL AV 11 77
TEMP 917803460 FEES PAID UNNUPTIUN
REMOVE APPROXIMATELY 5!.-OF CARPOR ROOF TO CONFORM WITH THE
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: WITH LINE OF GARAGECODE ENFORCEMENT 30 DAYS TO COMPLY
AP TEL. NO:
SAME AS OWNER AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION RESID 700.00 VAL 0.50 SPECIAL CONDITIONS:
AX BUILDING REVI-EQ-FEE��\ 54.70
D2 PERMIT W/O EN--HC GF- E S W7,000 VAL 43.50
J TOTA'L'I(FEES 126.45
CONTRACTOR:
TOWNER L• NO: - ®� �1��� APPROVALS DATE INSPECTOR SIGNATURE
SAME A
LIC. NO UOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
ARCHITECT 0 TEL. NO: \f` FOUNDATION/TRENCHFORMS
LIC. NO.: _ i ' ylllllilLAS AB/UNDER FLOOR _
- - - - - -- ----- - --- R7mD FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIR ZONE: CMP: ��I (�,�� ;�� � �� UNDERFLOOR INSULATION
147H273 3 0,1 �'��i7�� _ ��> � ��� ����'-�i'���' LFLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: 0 D: STAT CLASS..
NO 21 t'�� I C /�j ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS
SHEAR
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO ;� �i �,� ;;i� �� ;i/ FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM rlKt
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL INSULATION/WEATHER S� _ , T
SIDE PL-
INTERIOR
1
EXTERIOR LATH
RATED L ASSEM.
Rib WALL AS L
SHAFTS/OPENINGSRATED
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508