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Home My Public Portal About5221 KAUFFMAN AVE_Building__ 76A638A CE�803 2-63APPLICATION FOR` BUILDING PERM-IT. COUNTY OF LOS ANGELES -BOILOING- DEPARTMENT OF COUNTY ENGINEER - ADDRESS- h• BUILDING AND SAFETY DIVISION LOCALITY' JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST L/•� �' ' DISTRICT NO GROUP TTYPE PROCESSED BY FOR APPLICANT TO FILL IN c°" BUILDING / i. 'il 11 ST ISTICAL'CLASSIFICATION SEWER MAP - ADDRESS �., •/ /i �P�/jJ�Iw ��T I CLASS-NO DWELL UNITS BK PG LOT NO .- BLOCK WATER NOT REQUIRED ❑ RECEIVED - t �} CERTIFICATE , TRACT -lS G/r''- +J3 MAP NO '2 ({C GHWAY RCL'E) STATE MAJOR SECOND, OCA y NO OF BLDGS. SIZE OF LOT ^ NOW ON LOT USE ZONE SPECIAL -USE OF ` . 3 CONDITIONS - EXISTING.BLDG' TEL OWNER /t�C-.f A•%, /�Vp1(s�/�- NO 4 T'73/1 BUILDING •�` EXIST:/ I� SETBACK YARD HWY STREET NAME WIDTH ADORESS_l''�� - /-'A`` �"H1JFr//7 ft r% Trn Cel, FRONT .�•� ARCHITECT OR TEL. - P,L ENGINEER•• - - NO _ SIDE - - ADDRESS TEL i.-A ,( �G.��`Vd°� t�J O /t� � � On"I'+�� -� CONTRACTOR ,(��'ti ` NO A cum 411-1 . 411-1ADDRESS '-` _ - X,d DESCRIPTION OF WORg' � , r , ''�� , Lu NEW ADD ALTER REPAIR - DEMOLISH '' a N SQ FT //(( NO OF. NO OF �• '.' - .�✓°� .�. 4jzFP SIZE 'p( STORIES - ! 'FAMILIES , �— r /.I - .%•° - USE-OF fR'♦� J - fJ ,�,�-- -ay�5.� STRUCTURE rrl� - 4- Q SIGNATURE OF '• ,�,�� : �,�Gvs1 - - APPLICANT' VALUATION - •� APPROVALS ` f�DATE INSPECTOR'S SIGNATURE! PC PMTb' FOUNDATION FORMS. MATER ALS L FEE $ - FEE $ FRAME: FIRE.STO PS. 19126 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS �dS F� AND STATE THAT THE ABOVE,IS CORRECT AND AGREE TO COMPLY FURNACE LOCATION. r WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS,, BUILDING CONSTRUCTION. I CERTIFY' THAT'IN, DOING-THE WORK I AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN-VIOLA. LAT. INT TION OF THE LABOR CODE OF-THE,STATE OF CALIFORNIA RELAT. ING TO WORKMEN'S COMPENSATION INSURANCE EXTT/ SIGNATURE OF - J`,- HO SE NUMB R COR- J, ' PERMITTEE 7V`' 'L ' ' sOECT AND POSTED i ADDRESS �k- 1.tc...+ f•I I�//� FINAL ' JOHN F. LEWIS, PRINCIPAL ST R URAL ENGINEER PLAN CHECK VALIDATION' CK' -MO CASH _ PERMIT •VALIDATIO 'CK MO. . • CASH , LI uo. '9 6 JUL 1 � r) 7GA638A D08-3 a-65 APPLICATION FOR FOR BUIL®INC PERMIT 1 DIVISION OF BUILDING AND SAFETY BUILDING Deportment of County Engineer ADDRESS County of Los Angeles LOCALITY - WM.J. FOX, COUNTY ENGINEER NEAREST 'CASSATT D.GRIFFIN, SUPT OF BUILDING, CROSS ST., DISTRICT NO. GROVP I SEWER MAP FOR APPLICANT TO FILL IN ' TYPE. BK PG l ��.' BUILDING �� ' d., MAP . STATE ADDRESS 22 NUMBER ' HWY Y.F* O LOT NO. BLOCK USE ZONE SPECIAL ' CONDITIONS TRACT �J� �� 0 - - / NO. OF SLOGS. BUILDING _ EXIST. SIZE OF LOT J !d O I NOW ON LOT � ' SETBACK ;*DWY,'* STREETNAMfi WIDTH USEOF FRONTEXISTING BLDG. O SC 14, _ I { P. L. OWNER ✓/9/!7>C�"eS 5*14A)P7- SIDE - P.L. MAIL ADDRESS A6. m x /4 11E, O TRACT DWELL. .I UNIT 5 INDUSTRIAL TEL // I DWELL. I UNIT CITY TE LE NO. '(o_Do 6 PUBLIC BLDG., ARCHITECT OR TEL. 2 DUPLEX 1 UNIT ENGINEER �(3/GU/'✓.0 0�• NO. 7 ADDN.,ALT., ETC. 3 APT. -UNITS 8 MISCEL.' ADDRESS 4j COMMERCIAL TEL: INSPECTION RECORD CONTRACTOR LG E NO. - ADDRESS DESCRIPTION OF WORK low ( NEW ADD --" ALTER REPAIR' DEMOLISH ,,. Sq. FT. NO.OF NO.OF _ SIZE �� STORIES FAMILIES ' USE OF STRU TURfi 4,1 SIGNATURE OF APPLICANT _ APPROVALS ADDRESS Ja,]f //C, Q., Q•+... 7, , I DATE IN'ShCTOR'S SIGNATURE P.C. $ FOUNDATION:FORMSMATERIIALSION -z Ila 6,eI FEE FRAME: FIRE STOPS. VALUATION $ =� BRACING,BOLTS FEE FURNACE: LOCATION. _ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT, DUCTS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH, INT. AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. ' /J LATH. EXT. - SIGNATURE OF /.'Au ///: /�j� ��L HOUSE NUMBER COR- PERMITTEE �•/Ay� _ w �[�j r RECT AND POSTED _ ADDRESS e1�7 ✓/d� FINAL WM.J. FOX,COUNTY ENGINEER VALIDATION C. N. DIRLAM,CHIEF BLDG. INSPECTOR 5 9 3 2 JUL'2 5 1 - 8.0.0 m r ' _ . APPLICATION FOR BUILDING PERMIT 1 COUNTY OF'LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION'DECLARATION FOR APPLICANT TO FILL IN BUILDNY�RE$S/ hereby affirm that I have a certificate of consent to §elf Insure, BUILDING ADDRESS o�f or a certificate ofmorkers' Compensation Insurance,or a certified 5221 KAUFFMAN copy thereof(Sec.3800,Lab..C.) CITTEMELE CITY ZIP 9,1780 `104614'0 STATE FUND - LOCAury Policy No. Company SIZE OF LOT NO OF BLDGS NOW ON-LOT - ❑ Certified copy is hereby furnished - NEAREST CROSS ST ® Certified copy Is filed with the county building in TRACT - BLOCK LOT NO department. USE ZONE MAP NO. , - Date 11-1=94 Applicant' RANDOL PROOFING ASSESSOR MAP BOOK PAGE PARCEL W SPECIAL CONDITIONS CERTIFICATE'OF EXEMPTION FROM WORKERS' OWNER _ TEL NO -- COMPENSATION INSURANCE DAVE 'CRIST. 286-4759 WITHIN 1000 FT OF SCHOOLS ves No (This "Section need not be completed if the permit Is for one hundred ADDRESS dollars($100)or less.) • '5221 KAUFFMAN. DISTRICT GROUP TYP CONST FIRE ZONE 'PROCESSED BY CITY _ ZIP I certify that In the performance of the work for which this permit TEMPLE CITY .9.1780 is Issued, I shall not employ any person in any manner so as to become subject to the Workers'Com ensation Laws ARCHITECT OR ENGINEER TEL NO. _ p STATISTICAL CLASSIFI ATION - APT CONDO Date Applicant ADDRESS CLASS NO- DWELL UNITS NOTICE STO APPLICANT. If,, after. making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject t0 the- Workers' CONTRACTOR - TEL NO SET BACK YARD HWY PROP LINE WIDTH Compensation-provisions of the Labor Code, you-must forthwith RANDOL ROOFING 288-4040 FRONT complywith such provisions or this permit shall be deemed revoked. ADDRESS LIC NO P L LICENSED CONTRACTORS DECLARATION 529 •E.. VALLEY 451SIDE CITY LIC CLASSSS 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 and SO FT SIZE NO O STORIES NO OF FAMILIES a Professions Code,and-my license is in full force and effect NEW ❑ BK PG °" U License Number '451937 Lic Class C-39 DESCRIPTION OF WORK ADD ❑ VALUATION 00 USE & GARAGE WITH Contracto�tANDOT. ROOFIN , Date 1-31'-96 ALTER ❑ $ 4,000.00 W CL ❑ I am exempt under Sec 30—YEAR -CLASS A FIBERGLAS REPAIR 1 'z B.&PC.for this reason SHINGLES. TEAR OFF' 2 'LAYERS. DEMOL, ❑ LOMA P/C# Date- USE OF EXISTING BLDG. URM ❑ ' Signature SFD 9 - _ APPLICANT(PRINT). TEL NO LDMA Perm ❑,,I,as owner of the property, or m employees with wages as O OFING 288-4040 0 i•;T y g ADDRESS _ cg - their.sole compensation, wlll.do the work and the structure Is - not Intended or offered for sale (Section 7044, Business and LEY {., SAN GABRIEL' FINAL DATE a �1[I E j,'_°!.4•{( Professions Code.) �7 G i - WILL THE URE CANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL `L.`�—� J E- L, 777 ❑ 1, as Owner of the r0 ORA MIXTURE CONTAINING A'HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE UU property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES; FINAL BY P licensed contractors to construct the project (Section 7044, TOT AL �..,� � � '£e_-0 Business and Professions Code) YES El- No 1:1 re f WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING t•["IEvi'•. [ 'til _ OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ _ j�y;, _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR l_y 1L' e)Ij E GUIDELINES i f�l GE •• I hereby affirm that there Is a construction lending agency for YES❑ No❑ a the performance of the work for which this permit is Issued(Sec I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING N 3097,CIV C) --CCHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, i fl10001— - 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 SCAOMD65i:7 i �ri i9 0 Lender's Address i! 7 0 OWNER OR AGENT - o I certify that I have read this application and state under penalty 0 of perjury that the above Information is correct.I agree to comply PC FEE PERMIT FEE 111.00 $ with all county ordinances and State laws relating to budding m constr i n, reby But nz eprese,ntatives oft Cou y ISSUANCE FEE - "' to en r o e-men roperty for insp p r o 26.40 co INVESTIGATION FEE TOTAL FEE - �. G� �' C .40 SEE REVERSE FOR EXPLANATORY LANGUAGE .WORKERS'COMPENSATION DECLARATION L hereby affirm that I have a certific6te of consent to self, APPLICATION:. FOR U I L D I N G' 'PERMIT- insure, or a certificate of Workers'Compenstion Insurance, or a certified copy there f (Sec 3800, Lab C ) 1%,, n y COUNTY OF LOS ANGE ES BUILDING AND SAFETY. . Poy lic N �� Certified co is hereby furnished BUILDING ❑ PY Y, `�.—Z—�/" FOR'APPLICANT TO, FILL' IN ADDRESS Certified'copy isfiled with the county building inspec- BUILDING Tion department ADDRESS Z Z L u vyL LOCALITY i NEAREST Date ' Applicant CITY - -ZIP-,- CROSS ST.; ` t' NO OF BI_6GS• 'ASSESSOR" - -CERTIFICATE OF EXEMPTION FROM WORKERS' • - COMPENSATION INSURANCE SIZE,OF LOT NOW ON LOT MAP BOOK ' PAGE PARCEL. (This.secTion need not'be,completed if-the permit is for one, USE ZONE MAP hundred dollars,($100) or less•)- TRACT BLOCK. - LOT NO ! NO - } TEL +� SPECIAL I certify that in the performance of-the-work for'which this OWNER`. �+rz 'NOG • CONDITIONS " O DISTRICT GROUP, TYPE FIRE' PR• SSED BY U permit is issued, I-shall hot employ any person in any manner ADDRESS 5�z I '' CONST so as-tb•become subject to the Work sE Compensation Laws. 'Date Applicant CITY j ZIP STATISTICAL CLASSIFICATION s A T. CONDO (J NOTICE TO APPLICANT If, after maing kthis Certi to of ARCHITECT OR TEL ,Exemption,- you' should 'become sublect to the Workers' ENGINEER NO CLASS NO DWELL UNITS H Compensation provisions of the Labor Code, you must forth- "i ,ADDRESS SEWER MAP Z with comply with such provisions or,'this' permit shall,be //)) - _ . deemed revoked CO R q Iq NO d BK PG.m' 'VALIDATION l ` -LICENSED CONTRACTORS DECLARATION;,- :' - ss I .. hereby affirm that I am licensed under provisions of Chapter 9.,, A -d' 3 VALUATION �Zj0010 (commencing with Section 7000)of Division 3-of the Business and LIC Professions Code, and rn{ license is in full force and effect - CITY ]'9�/. CLASS I N6 License,Nu" er t6I� Lic Class a-� SIIZEFT 0 f� TORIIEES' MILES CONEK + DESCRIPTION OF WORK ' NEW ❑ $, Contractor �Date�� 8�� K_ - �••- ' �J DD • ❑• I am exempt from the licensing requirements as I,am a - ' licensed architect ' a registered pro fessional-engineer ALTER ❑ FINAL acting m my professional capacity (Section 7051, DATE 3 Business and Professions,Code).' " , , REPAIR - USE OF FINAL EXISTING BLDG DEMOL ❑ Lic. or Reg No. Date 'APPLICANT t TEL 1 OWNER-BUILDER DECLARATION---, PRINT - NO I hereby affifm that I am exempt from the Contractors License `Y7J�0i ,Law for'the following reason•(Section 7031 5,'-Bosiness,and ADDRESS- J3 2 - 'O •• 1� ProfessionsCode},, ` PRESENT 1, 'as owrier'of the property, 'or my employees with ` ADDR SS ❑ wages as their sole.compensation,will do the work and the structure is not intended or offered'for sale(Section- LOCALITY 7044•, Business and Professions Code). MOVING% TEL ✓ p ❑ I, as owner of the-'property, am exclusively contracting ' - CONTRACTOR NO �b with licensed contractors to'construct the project (Sec- ADDRESS Tion 7044, Business and Professions Code)', r 610 '� �L O 0 U REQUIRED TOTAL-SETBACK FROM EXIST _ CONSTRUCTION LENDING AGENCY i SET BACK% YARD HWY PROP LINE WIDTH -1 hereby affirm that there is a'construction'lending agency for FRONT 11,2 0 8_8 0' the performance of the.work for which this permit s issued P L (Sec 3097,:Civ 'C ) SIDE. Lender's Name m P C Fee$ Permit Fee Lender's Address - w I certify that,I have read this application and state that the Issuance•Fee above information i-s correct. I agree to comply with all County, Investigation-Fee- o -ordinances-and State laws relating to building construction, m Total Fee �— and - re'by authorize �epresentafives of this County to enter Q' up e hove-mennoned property for mspechon purposes _ a _ Os SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Ap licant or Dote - of