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HomeMy Public PortalAbout5015 KAUFFMAN AVE_Building__ U. . • DEPARTMENN OF BUILDING AND SAFE APPLICATION FOR PERM COUNTY OF LOS ANGELES A R 1 195 WM.'J. FOX. CHIEF.ENGINEER FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING /�f A� Jy g, DISTRICT NO. PLAN CK. NO. PERMIT NO. ADDRESS :��i... i P� 'lo r.�i�-,,,®'N J! Z �- ° RECEIVED BY DATE OF APPLDATE ISSUED LOCALITY' P. / `CS „^,•-/ 'NEAREST r 11 � - J Q CROSS.ST, •,� �__. BLSf`LDING _ f ADDRESS /5 A OWNER /V��**''''�/ /�// 'CI�p�~ e.11 LOCALITYN7jaj.� L,44,-" MAIL J..�.. T• .�' /l-� IN `.tAl fI 'IIP 'i. NEAREST . ADDRESS ' A f 7 TEL. /� CROSS ST: CITY l mqQ (P•, r.A�f v: NO. / FIRE NO. OF TY E GSOUP ARCHITECT OR TEL. ZONE PLANS .Z ENGINEER •NO. _ BLDG. - ORD. NO. SETBACKLINE ADDRESS �{ ,•Pe ,1��-- APPROVED By CONTRACTOR I� NO. USE APPROVED DATE �' ' ZONE BY DATE ADDRESS - .HOUSE NUMBERING LEGAL DESCRIPTION I LOT NO. I.BLOCK MAP NUMBER Z / FIELD CHECK BY TRACT NO. ASSIGNED BATE nn NO. OF BLDG9. CORRECTIONS SIZE OF LOT 1! _ I NOW ON LOT A- A,USE OF - l.:/._.d I NO. OF EXISTING BLDG: � �l�r&mga,�=••:�, Fwrnate — �DESCRIPTION OFJWORg NEW I IKI ALTERATION I I ADDITION REPAIR I _ I DEMOLITION •I I I - ,(,,! /' - - A SQ. FT. NO. OF SIZE ROOMS STORIESZ EXT. WALL ROOF 'l 77_:r-.1✓-4 IrZ O GT-. Q fit/ > COVERING >> COVERING CO USE OF STRUCTURE / n APPROVALS INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS`AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS ' FORMS, MATERIALS CORRECT. 1 AGREE TO 'COMPLY WITH' THE CORRECTIONS LISTED FRAME: FIRE STOPS, HEREON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING; BOLTS LAWS -REGULATING.B ILDIIJN�ACONiSLjcyiO Tf/� /N. FURNACE: LOCATION, � yc6/ d" SIGNATURE OF GAS VENT, DUCTS PERMI T .JY' // / .I -��Ai ' �/ / E �014 i LATH, INT. A .V �y LATH, EXT. %Ce, AUTHORIZED AGT. PLASTER, INT. 7CABL8A• D888 10-80P. C. $ ® /© 7L 4j to FEE �+ �� PLASTER, EXT. VALUATION / O -u FEE $3 FINAL LrAPPUCAMON FOR BULUNG PERNT . .� COUNTY_OF OPS ANGELES BUILDING,AND SAFETY- WORKER'S COMPENSATION DECLARATION FOR-APPLIC40T TO FILL IN. BUILDING ADDRESS,� yr I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS or a certificate of Workers' Compensation Insurance,or a-certified J & i 11� -7x 0 copy thereof(Sec.3800,Lab.C.) CITY ZIP fy ZIP_ _ '1 LOCALITY o, ,Polity No. CompanySIZE OF LOT NO.OF BLOGS.NOW ON LOT ❑ Certified Copy is hereby furnished. - NEAREST CROSS S11" b ElCertified.copy is filed with the county building inspection TRACT BLOCK LOT NO. �tr\J1 ZAJ . b' department. - - USE ZONE - MAP NO. Date Applicant- ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. YES NO COMPENSATION INSURANCE J k1% -246 4 1 WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADD ESS `ti fir` DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP 1 I certify that in the performance of the work for which this permit CA!r ( -Ing d �O� is issued, I shall not employ any person in any manner so as t0 ARCHITECT ORENGINEER TEL NO. become Subject to the Workers'Compensation Laws. N STATISTICAL CL ATION APT CONDO Date Applicant - ADDRESS CLASS N L 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. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you.must forthwith FRONT comply with such provisions.or this permit shalt be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION PILE CITY - LIC.CLASS P L I`hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business andSQ.FT.317 NO.OF STORIES NO,OF FAMILIES , Professions Code,.and my license is in full force and effect. C/P e� NEW 1:1 BK PG D a License Number LiC.Class -DESCRIPTION OF WOR ADD VALUATION ho O Contractor ""bate ' i ALTER ❑ �— U 0 ❑ Lam exempt under Sec. REPAIR ❑ B.&P.C.for thisreason DEMOL ❑ ` LDMA P/C# ... W Date: - USE OF EXISTING BLDG. URM ❑ .. - CL 0 Signature .gS owner Of the APPLICANT(PRINT) TEL NOLDMA Perm# z _ Si nature � F e,property,'or my employees with wages as Z 1 .a their sole compensation, will do the work and the structure-is ADDRESSFINAL DATE yl f _I0.50 ' not intended or offered for sale (Section 7044, Business and Professions Code.) WILL THE APPLICANT-OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL LL Ll ❑ I, as owner of theproperty, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES "FINAL BY/ j T•8 licensed contractors to construct the project (Section 7044,' Ir YES❑ NO❑ �_ . Business and Professions Code. / i{{� ` WILL THE INTENDED USE OF THE BUIDLING BY.THE APPLICANT OR FUTURE BUILDING -- 3 s 0 .. 14Tit e i L OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR y+ ITEMS - GUIDEJNES. I hereby affirm that there is a construction,lending agency for YES❑ NO❑ �. m the performance Of the Work for which this permit IS ISSUed(Sec. IHAVEREADTHE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING - ••_ ---• - r, "--' {5,J w 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE,LOS ANGELES COUNTY CODE, - i,HECK y t 4.f j N TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS _ Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. CHANGE .Qi l IL Lender's Address - — OWNER OR AGENT o I certify that I have read.this application and state under penalty Q / p y g p y P.C.FEE .. PERMIT FEE �/U � fm.,, 'IT: 2 97 of perjury that the above information is correct 1 agree to comply 013013-130001 o with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE `r 3909 1 AM 11:13 Cl) to enter upon the above-menti ned property for inspect n purposeS. J - 4 � . O� INVESTIGATION FEE TOTAL FEE. Synalure pi Applicant w A nT G_ / ' SEE REVERSE FOR EXPLANATORY LANGUAGE Jf COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0712180050 PHONE: (626) 285-0488 EXT: ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: ITR: 14632 LT: 6 SQ. FT STORIES TYPE OCCUP GROUPI 5015 KAUFFMAN AV I I (STRUCTURE: 263 1 VN R3 I TEMP CA 917803944 IASSESSOR(INFORMATION NUMBER: I GARAGE: ,. NEAREST CROSS STREET: LOWER-AZUSA 18589-017-007 1 OTHER: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl I � 1(TENANT: (EXIST BLDG USE: USE ZONE: (ISSUED ON: PROCESSED BY: EXPIRES ON: I (EXIST OCC GRP: 101/31/08 SR 07/29/08 (OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFNNAT FIN CODE: I (LAI AN MING;KUEI J (626) 286-4184- I 93,800 I I5015.KAUFFMAN AV ITEMP 917803944 I - FEES PAID IDESCRILPTION OF WORK I I I 11-STORY HOME ADDITION FAMIL RM & EXPAND (E) MASTER BATH I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: IREPliACE ALL 10 (E) WINDOWS, KITCHEN REMODEL, REROOF (E) HOUSI (APPLICANT: TEL. NO: I I I IKAO (626) 839-9385- IB1 PLANCHECK W/ENERGY 41480.00 VAL 648.22 12321 FALLEN DRIVE IAA BLDG PERMIT ISSUANCE 27.75 (SPECIAL CONDITIONS: I IROWLAND HTS CA 91748 IAC STRONG MOTION RESID 93800.00 VAL 9.38 I IB2 PERMIT W/ENERGY 93800.00 VAL 1,360.10 TOTAL FEES 2,045.45 I (CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INS ECTOR SIGNATURE 1 (INF BUILDERS, INC. (626) 526-9840- fiI 1120 W. CAMINO REAL AVE - LIC. NO ILOCATION AND SETBACKS I IARCADIA, CA 91007 490547 B ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: IFOUNDATION/TRENCH FORMS I IKAO, PEN (626) 839-9385- - I 12321 FALLEN DR. LIC. NO: 1 (SLAB/UNDER FLOOR 1 I - IROWLAND HEIGHTS, CA 91748 C22022 I I IRAISED FLOOR, FRAMING I I i IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:( (UNDERFLOOR INSULATION I I 1 3 011 11ST LEVEL FLOOR SHEATH INO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: I I I I NO 21 I 12ND LEVEL FLOOR SHEATH - I I I SCHOOL WITHIN HAZARDOUS IROOF SHEATHING I P (AIR QUALITY: 1000 FEET MATERIALS ' 1 NO NO NO I IFIRE DEPT. FRAME INSPECT�( I I IREQUIRED TOTAL SETBACK FROM EXIST 1 - (BLDG DEPT. FRAME INSPE 1 I ISET BACK YARD: HWY: PROP LINE: WIDTH: I I I IFRONT PL- ISHEAR PANELS LI SIDE PL- I I I I (INSULATION/WEATHER STRI }� I l I (INTERIOR LATH/DRYWALL I" I I . (EXTERIOR LATH I �//I I I• 4f ILOT DRAINAGE I I I I I ISMOKE DETECTION DEVICES IFIRE DEPARTMENT APPROVAL( I I 1 I* ADDITIONAL DATA ON FILE I I I I I I I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I I I