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Home My Public Portal About5222 KAUFFMAN AVE_Building__ = TEMPLE- llr 76A638A CE#803 2-63 APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES ADDRESS O� DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST. DISTRICT 1710 G U TYPE RO BY FOR APPLICANT TO FILL IN U CONST. BUILDING !` STATISTICAL CLA ICATION , WER MAP. ADDRESS Q BK PG CLASS. NO. DWELL. UNITS LOT NO. r!/ BLOCK WATER (� CERTIFICATE: NOT REQUIRED1. RECEIVED TRACT �3 MAPHIGHWAY STATE MAJOR SECON . LOCAL NO. OF BLOGS. / NO. (CIRCLE) SIZE OF LOT NOW ON LOT Z E SPECIAL USE OF" �%� I�`J CONDITIONS EXISTING BLDG. J TEL. OWNER N BUILDING YARD HWY STREET NAME . EXIST. ADDRESS /� ,/ SETBACK WIDTH Q !� P FRROINT - ARCHITECT OR TEL. ENGINEER '. NO. SIDE r P. L. D. ADDRESS - O V CONTRACTOR TEL.. NO.. I � ADDRESS - FO DESCRIPTION OF WORK w a NEW ADD • ALTE REPAIR DEMOLISH Z SQ. FT. NO. OF NO. OF -- SIZESTORIES FAMILIES USE OF STRUCTU SIGNATURE OF APPLICANT VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE P.C.' PMT. FOUNDATION: LOCATION FEE $ FEE $ ("J-• FORMS. MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS �/! !/��1'7r J.'.%,clz_ 7�Yli 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. I CERTIFY THAT IN DOING THE 'WORK E AUTHORIZD HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CLIFORREIAT-ING TO WORKMEN'S COMP NSATION I NCEi` LATH. EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTEE �Q ` /fop RECT AND POSTED ADDRESS FINAL JOHN F. LEWIS, PRINCIPAL STR URAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH o"o '7 3 4- JM 1 1 D 1 1,50- • vn/ - WORKERS'COMPENSATION DECLARATION ! �' hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING PERMIT insure, or a certificate of Workers' Compensation Insurance, or a certified cop thereof (Seca 3800, Lab:C.) c c� 2 0 4 2 4-1 6 6 3 2 7 Argonaut. Ins . COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILDING Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS L a 2 2 at ® Certified copy is filed with the county building inspec- BUILDING 20f— tion department. ADDRESS 5222 -Kauffman LOCALITY NEAREST Date 1 1 —_1 —R d Applicant Ran rl n 1 R n n f i ng CITY T will 1 e Cit ZIP 91780 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO. OF BLDGS. ASSESSOR 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 �- certify that in the performance of the work fon which this OWNER NO. 8 — 7 CONDITIONS DilitRICT GROUP TYPE FIRE PRO ESSED BY O permit is issued, 1 shall not employ any person in any manner _ CONST. ZONE so as to become subject to the Workers'Compensation Laws. ADDRESS 5222 Kauffman Ave . Y I P rt�0 �., CITY Temple Cit ZIP 91780 Date �—'�R d Applicant �2a3"Id91 R89 f i}'1g STATISTICAL CLASSIFICATION � APT. CONDO. ARCHITECT OR TEL. U NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CLASS NO. DWELL. UNITS Exemption, you should become subject to the Workers' eat 9L Compensation provisions of the.Labor Code, you must forth- MAP with comply with such provisions or this permit ADDRESS SEWER shall be TEL. � deemed revoked. CONTRACTOR Ra h d O 1 Roofing NO. 2 8 8-4 0 4 0 BK.// PG,/3� VALIDATION LICENSED CONTRACTORS DECLARATION z. LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 5 2 9. E . Val 1 e B 1 No. 4 519 3'7 VALUATION (commencing with Section 7000)of Division'3 of the Business and - LIC. Professions Code, and my license is in full force and effect. CITY SaQ Gabriel CLASS C-39 $ 4699 . 00 PoolSQ.*FT. NO.OF NO. OF CHECK License Number 4 5 19 3 7 Lit.Class C-39 SIZE STORIES FAMILIES ONE $ Contractor R a n d o l RO o f i n mate -7-8 4 DESCRIPTION OF WORK Re-roof house NEW E] ADD ❑ ❑ I am exempt under Sec. and gar I age with ALTER ❑ FINAL L(. A B.BP.C. for this reason REPAIR DATE '0 o 0,0 0 0 "K� 1 D Date: USE OF BLDG. F FINA DEMOL BY 2'o I o718,0 . Signature APPLICANT TEL. OWNER-BUILDER DECLARATION PRINT NO. _ / s./ �,3 o o t o;7 i�,Q C1 u I hereby affirm that I am exempt from the Contractor's License ADDRESS 2 9 E V a 11 e B 1 . San Gab A .0611 1 -84 Law for the following reason (Section 7031.5, Business and Professions Code): PRESENT ❑ BUILDING — I, as owner of the property, or my employees with ADDRESS 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. U ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HW( PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for .FRONT , the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE FO P:L. Q Lender's Name .9 P.C. Fee$ Permit Fee 67 . 50 Lender's Address I certify that I have read this application and state that the Issuance Fee 10 . 5 0 above information is correct. I agree to comply with.all County Investigation Fee g ordinances and State laws relating to building construction, Total Fee 78 . 00 u and hereby authorize representatives of this County to enter m upon th a ve-m nti ned property for inspection purposes. upon t7hPve-yJt' ne a � ^ A. 1SEE REVERSE FOR EXPLANATORY LANGUAGE ignature of Applicant or Agent Date ®s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUI TNG P RMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RES D AL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0 08 0410270029 PHONE: (626) 285-0488 EXT: LEGAL ID: - NO. OF CONST NEW BUILDING ADDRESS: TR: 15683 LT: 26 SQ. FT STORIES TYPE OCCUP GROUP 5222 KAUFFMAN AV STRUCTURE: 444 1 VN R3 TEMP CA 917803947 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: BLACKLEY 8589-010-026 OTHER: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 01/04/05 JK 12/30/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI 2DA� JU, KIM/ISABEL (626) 285-6212- 36,670 &-- 5222 5222 KAUFFMAN AV An�� TEMP 917803947 FEES PAID DESCRIPTION OF WORK ADD FAMILY ROOM & BATHROOM. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - B1 PLANCHECK W/ENERGY 36670.00 VAL 587.22 AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS: AC STRONG MOTION RESID 36670.00 VAL 3.67 82 PERMIT W/ENERGY 36670.00 VAL 690.86 TOTAL FEES 1,309.50 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: - FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION L 3 01 1ST LEVEL FLOOR SHEAT NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 21 2ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO FIRE DEPT. FRAME INSPE REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPEC SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- SHEAR PANELS SIDE PL- INSULATION/WEATHER STR - -- INTERIOR LATH/DRYWALL 2 EXTERIOR LATH -- LOT DRAINAGE 1 SMOKE DETECTION DEVICES- FIRE E ICESFIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508