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HomeMy Public PortalAbout5938 IVAR AVE_Building__ APPLICATION FOR BUILDING PER T 1 FOR APPLICANT TQ FILL IR (Print or type only) yJ/d�C BUILDING 'I r COUNTY OF LOS ANGELES CflY// A_"IEss DEPARTMENT OF COUNTY ENGINEER CITY ,�[ CIT ZIP G) BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT NOW ON LOT ADDRESS S TRACT BLOCK LOT NO.zX2 LOCALITY EL. n >> NEAREST n OWNER TIT i'��B- CROSS ST. ASSESSOR ADDRESS MAP BOOK PAGE PARCEL DISTRICT GROUP TYPE FIRE PR ESSED BY CITY = =Cf ZIP C U CONST.-it ZON 2 �i ARCH TECT OR TEL. �J[ os, .J ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS il TEL., CLASS NO. _DWELL.UNITS BK PG CONTRACTOR NO USE ZONE MAP O LIC. NO. ADDRESS NO, �� SPECIAL LIC. CONDI TIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES� NO [] . CONSTRUCTI N LENDER } NAME AND BRANCH BLDG.SETBACK FROM C FRONT PROP.LINE OF (STREET I C.; -ADDRESS CITY HIGHWAY } YARD - TOTAL SETBACK FROM TYPE OF EXISTING C SQ. FT �y NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE / STORIES / FAMILIES ONE L n' DES'CRIPTI N OF WORK NEW .[] z ( ADD 4 BLDG.SETBACK FROM 7� SIDE PROP. LINE OF (STREET) ALTER ❑ TOTAL ETBACK FROM TYPE OF EXISTING HIGHWAY + YARD = HIGHWAY WIDTH REPAIR SIDE OP. LINE USE DEMOL ❑ + EXISTING BLDG. APPLICANT TEL CORNER CUTOFF YES ❑ PRINT) U BY (SIGNATUR IN OPEN SPACE YES NO IN COASTAL ZONE YES NO VALUATIONc7 O - r �� CATEGORICAL EXEMPTION YES NO 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. I CERTIFY THAT IN DOING THEWORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFOR IN R LATI NG TO �+ +�/� N _ WORKMEN'S COMPENSATION INSURANCE. / -/ D'�oS IT . LAT hI it7 CA W/ SIGNATURE PERMITTEE /s3.1.Sh✓'���Drs:/h ADDRESSCz- pyo' r/T7 S, ,old/ er,�qQ6J FINAL rr j7p$ `7/, 1BY CITY NOL DATE i �� MA KF_ CIIF_CKS PAYAt3LC TU: P.c. r PMT'G FEE FEE V HARVEY T. BRANDT. COUNTY ENGINEER :3 , 6 PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH r =4rAY 22 1 © 3 5.2 5 A98 76A638A CE9803 7/73 _ _ F 76A538A CE#803-8-57 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 CASSATT D.GRIFFIN,SUPT OF BUILDING' CROSS ST. '� '�✓ . - DI�T�IC`TNO. .__..L--qi�uP TYPE ICON _�- SE R. MAI FOR APPLICANT TO FILL IN .,_.+1..-„ .11l---- -� C' BUILDING ��, ADDRESSg�j STATISTICAL CLASSIFICATION LOT N� / BLOCK CLASS.NO. DWELL. UNITS 0 MAP STATE NUMBER HWY. YES NO TRACT USE ZONE SPECIAL NO.OF SLDGS. CONDITIONS SIZE OF LOT / NOW ON LOT - USE OF _ EXISTING BLDG. BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER FRONT �.•oS., MAIL P.L: A-.6 ADDRESS jj SIDE TEL. P.L. CITY NO. INSPECTION RECORD ARCHITECT OR TEL. ENGINEER - NO. ` _ ` � e _.. ADDRESS � 5_z J3 _ /I Ta. , 4677 7i l ey4 c t-o O CONTRACTO N0. � 1 a♦ ZC h,-/ae r�5 T/ a — ADDRESS DESCRIPTION OF WORK ' �' ��' NEW4--ADD ALTER 'REPAIR DEMOLISH SQ.FT. .NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE OF /> APPROVALS APPLICANT �a .ADDRESS r DATE INSPECTOR'S SIGNATURE FOUNDATION: LOCATION _FORMS.MATERIALS $ FRAME: FIRE STOPS, FEE BRACING, BOLTS VALUATION �Cd $ FURNACE: LOCATION. /, ! 147 _ FEE GAS VENT.DUCTS fO / ,.•1 1 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 STATE LAWS REGULATING BUILDING CONSTRUCTION. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTJ-1. RECT AND POSTED ADDRESA,4�1­0'�� e-at2l��l FINAL JOHN A.LAM ,COUNTY ENGINEER. CLYDE N. DIRLAM, PRINCIPAL ST RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH K.PERMIT VALIDATION CM.O. CASH O OCT ®P WORKERS' COMPENSATION DECLARATION I he bafirm that f certificate � ent to einsureoracertifcate have WorkesCompeation Insurance, APPLICATION FOR. BUILDING PERMIT . ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY. I I R Policy N'. Company ❑. Certified copy is hereby furnished. . FOR APPLICANT TO FILL IN" ADDRESS bJ� ,;t 7. 14 ❑ Certified copy is filed with the county building inspec- BUILDING ! . - . . tion department. ADDRESS �; N Date Applicant CITY' ZIP i LOCALITY _ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SIZE OF L07 NO.OF BLDGS. NEAREST NOW ON LOT CROSS ST.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:) t TEL. 1 /� r ] USE ZONE MAP P. OWNER � U 1," � � 11 l,. �j NO 1 NO. ✓ �'/ !7 I certify that in the performance.of the work for which this SPECIAL >_ permit is issued, I shall not employ any person in any manner ADDRESS'/ - t/ 11/r f�� CONDITIONS a- soas to become subject to the Workers'Compensation'Laws. t ^ O CITY ZIP [f Date Applicant ARCHITECT OR VJ TEL. DISTRICT GROUP TYPE FI � NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. RE E PROCESSED BY 0 Exemption, you should beome subject t the. Workers' u .j7 ? L/ ,� Compensation provisions of.the Labor Code, you must forth ADDRESS' !10 J with comply with such provisions or this-permit shall beTEL. /- /j STATISTICAL CLASSIFICATION APTCONDO. N deemed revoked. ICONTRACTORi�- NO. . Z_ LICENSED CONTRACTORS'DECLARATION /� LIC. CLASS NO. / DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS • `"I` v/ t NO. (commencing with Section 7000)of Division 3 of the Business r ` LIC. SEWER MAP and-Professions Code,and my license is in full force and effect. CITY CLASS BIC PG VALIDATION SQ. FT.' NO. OF NO. OF CHECK License Number tic. Class SIZE STORIES FAMILIES ONE ❑ VALUATION v Contractor Date DESCRIPTION OF WORK NEW Z) Q ❑I am exempt under Sec.' A , $ ���� z ❑ ALTER X00, B.&P.C. for this reason �D �' REPAIR $ Dater USE OF EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL �j OWNER-BUILDER-DECLARATION (PRINT).' NO. DATE/��6/ 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 B ❑ I, as owner of theproperty, or m em to employees with BUILDING Y P Y ADDRESS wages as their sole compensation,will do the work and --.- the structure is not intended or offered for sole,(Section LOCALITY 7044, Business and Professions Code.) MOVING TEL. I, as owner of the property, am exclusively contracting CONTRACTOR NO. r with licensed contractors to construct the project (Sec- ADDRESS i.1t'€I_ x �, .,= _s tion 7044,.Business and Professions Code.) CONSTRUCTION LENDING AGENCYREQUIRED' TOTAL SETBACK FROM EXIST. _;ii_=;) si_Ie `; YARD 2. SET BACK HWY PROP. LINE WIDTH 1 hereby affirm that there is a construction lending agency for FRONT ;.H; {IJW ;1^;:3 the performance of the work for.which this.permit is issued P.L. - (Sec. 3097, Civ. C.). SIDE., P.L. Lender's Name ��� LDMA Ref. # P:C. Fee$ Permit Fee - •. , t r, Lender's Address __!_tt� 1 certify that I have read this application and state that the Issuance Fee 3' V MA'P/C# 8 above information is correct. I agree to comply with all County Investigation Fee �y d ordinances and State.laws relating to building construction, Total Fee (� e• LDMA Perm. # a and hereby authorize representatives of this County to enter m upon th above-m ti ed property fo inspection Dur ores. a SEE REVERSE FOR EXPLANATORY LANGUAGE ignatur f Applicant or Agent Date --F Y ~ APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS ADDR S I hereby affirm that I have a certificate of consent to self insure, BUILDING V �� or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) /' ZIP LOCALITY Policy No. Company SIZE OF LOT Gr NO.OF BLDGS.NOW ON LOT " PL ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county buildinginspection TRACT BLOCK LOT NO. I USE ZONE MAP NO. y1 � 50 department. . r ASSESSOR MAP BOOK PAGE PARCEL Date Applicant 0/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' owN N O. a� YES NO COMPENSATION INSURANCE w� TJ7 ADDRESS WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE P CESSE BY dollars($100)or less.) CITY6; ZIP 9-3 �'I certify that in the performance of the work for which this permit T, 3 is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. become subject to the Workers'Compensation Laws. STATISTICAL ICATION APT C NDO 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' C TOR T SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code,you must forthwith l N& FRONT comply with such provisions or this permit shall be deemed revoked. A 0 A ,�A 0 1�/_ P L LICENSED CONTRACTORS DECLARATION I� J 1!r' LIC. LASS /� SIDE °�- I hereby affirm that I am licensed under provisions of Chapter 9SEWERAP v FT SIZE NO.OF ORES NO.O FAMILIES[:* CD (commencing with Section 7000)of Division 3 of the Business and � NEW ❑ BK PG � CD Professions Code,and my license i in full force and effect. v w. DES RIPTION OF WORK ADD. VALUATION W License Number LitfassA&2C2 OF J y Contractor N RICAate ^ ALTER 11 $ ❑ I am exempt under Sec. • REPAIR ❑ $ B.BP.C.for this reason DEMOL ❑ LDMA P/C# Date: SE OF gXIPTING • URM ❑ I� • ' Signature APP.LIC PIN E N LDMA Perm# .. ❑ I, as owner of the property, or my employees with wages as O '- their sole compensation,will do the work and the structure is AD p , F-0.- --- - V FINAL DATE✓�j Q I_ a •`_i=' ;.' not intended or offered for sale (Section 7044, Business and G -- - Professions Code. WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT ANDLE A HAZARDOUS MATERIAL _ ( D J s ❑ I, as owner of theproperty, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN - Y 9 THE AMOUNTS SP CIFIED O THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL B > i licensed contractors to construct the project.(Section 7044, YES .� 3! ( i� ��=g VES❑ NO Business and.Professions Code.) -.1iWILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING - -, E1.� OCCUPANT REQUIRE PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. // L•i-i('iE`'I.1� - I hereby affirm that there is a construction lending agency for YES❑ NO the performance of the work for which this permit is issued(Sec. I HAVF.AEAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD 3097,CIV.C.). LR IN CHECKLIST.I ERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES );Siiiii_i �j'i I. CODE,TITLE 2, ER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING `jS Lender's Name S MATERIAL ORTING AND FOR OBTAINING A PE ROM THE SCAQMD. a Lender's Address o 1 certify that I have read this application and state that the aboveFEE PERMIT FEE'P.C.information is correct. I agree to comply with all countyO 5cs�� ordinances and State laws relating to building construction,and ¢. h eby authorize re resentatives of this County to enter upon ISSUANCE FEE ©o e above-menti property for inspection purpose INVESTIGATION FEE TOTAL FEE '1 n � noun m kem a Ayem SEE REVERSE FOR EXPLANATORY LANGUAGE 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 0210250026 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST- BUILDING ADDRESS: TR: 5904 LT: 127 SQ. FT STORIES TYPE 5942 IVAR AV STRUCTURE: VN TEMP CA 917801519 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA 5384-018-014 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 10/25/02 JK 04/23/03 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL D TE FINABY: CODE: HUANGROSEMEAD BL #A (626) 237-2137- 1,000 , , SAN GABRIEL 91776 FEES PAID DES RIPT NOF WORK SE L SID DOOR & RELOCATE CLOSET WALL TO MAKE CLOSET SMALLER FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 1000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 1000.00 VAL 65.40 .TOTAL FEES 93.65 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO 4" LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT'OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS , , 1 LIC. N0: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 15OH261 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: 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- INSL".ATION/WEAT.HER STRIP SIDE PL- INTERIO LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BSO5O8