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Home My Public Portal About5719 KAUFFMAN AVE_Building__ s APPLICATION FOR BUILDING, PERMIT FOR APPLICANT TO FILL IN (Print r'ty'pe onlv) ' '15UILDING f. COUNTY OF LOS ANGELES ADDRESS DEPARTMENT OF COUNTY ENGINEER CITY zIP BUILDING AND SAFETY IVISION N(5.OF BLDGS BUILDING �^ - SIZE OF LOT �,y NOW ON LOT ADDRESS v` TRACT` BLOCK L NO`� 7 LOCALITYIeW, - �j EL i NEARES • OWNER /- N CROSS ST. ASSESSOR ADDRESS MAP. BOOK - PAGE PARCEL j� DISTRICT I G UPTY E FIRE ROC SSED BY CITY l�C!f+ IP C ST - ARCHITECT - - TEL. _ ' ENGINEER' O: STATISTICAL CLASSIFICATION SEWERA ADDRESS - CLASS NO.�_DWELL,UNITS BF�/ G: ��(� - - CONTRACTO TEL-. NO �C,�,j U ONE AP M ., _ LIC. NO. - G ADDRESS NO. (7t SPECML - - CITY- LIC. CONDITIONS - t CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES NO ❑ CONSTRUCTIONDER - } NAME AND BRANC - BL SETBACK FROM n FR NT PROP.LINE OF (STREET) C L ADDRESS CITY HI HWAY .}' YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING j SQ. FT NO. OF •NO..OF _CHECK - FRONT PROP. LINE HIGHWAY WIDTH SIZE ` IS FAMILIES ONE L; } CL = V- DESCRIPTION OF WORK j NEW BL Z i ADD �❑ SIDEPROP. LINEOF (STREET) TOTAL SETBACK F _ _TYPE OF EXISTING 7 ` ALTER ❑ HIGHWAY } YARD - = SIDE PROP. LINE IGHWAY WIDTH REPAIR❑ USE OF } _ EXISTING BLDG. _ DEMOL ❑ APPLICANT /1 TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) NO BY (SIGNATUR IN OPEN SPACE YES ❑• NO ❑ _ IN-COASTAL ZONE YES ❑ - NO ❑ _ w VALUATION$ CATEGORICAL EXEMPTION YES❑ NO ❑ I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND 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 THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT- EMPLOY ANY- PERSON IN VIOLATION OF THE LA BO DE OF THE,STATE OF CALIFORNIA IN RELATING TO y� /�! I - _/�1� r WORK N' OMPE NSURANCE '� ( (J� /VJ� 1 W SIGNATUR OF PERhlITT E ADDRESS FINAL BY _ - - TE L. ,.Jy /onw • - CITY NQ% DATE 77,r PMT MAKE CHECKS P,A Y'A BLE.TU' FEE $ FEE -F HARVEY T. BRANDY. COUNTY ENGINEER /l'�� 'r PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION EK O CASH 0.5 ea8 -. 7.3`"' .nJUN 27 1 D .5_2 5 Aa8 76A638A CE9803 7/73 - �� ' k• -. .- f 1 s��YY>t'��IYfr,t.�� Y T,y•- . t 76A638A CE 4803 2-63 APPLICATION FOR" BUILDING PER M IT. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER_ ADDRESS BUILDING AND SAFETY_DIVISION LOCALITY "�• JOHN A. LAMBIE, COUNTY'ENGINEER ti NEAREST ' WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST• tir _ DI ICT GRO _ TYPE P O B n' FOR. APPLICANT TO FILL IN, '{ CONS .' BUILDING _ _ STATISTI 'CL [CATION SEWER MAP ADDRESS:'S " - - BK P _ _ - - CLASS NO DWELL UNITS :LOT NO' (J O� �f� - _BLOCK ' � WATER ' " • - CERTIFICATE: 'NOT REQUIRED RECEIVED TRACT _ -MAP, HIGHWAY STATE MAJOR SECO D OCAL • NO OF`BLDGS NO (CIRCLE)" SIZE OF LOT �d NOW ON'LOT ` USE ZONE SPECIAL - • USE OF `CONDITIONS EXISTING BLDG �- OWNE_R J'1(f,/J •Q; ._}NO �t6 BUILDING EXIST. •SETBACK YARD HWY ,STREET NAME WIDTH ADDRESS �� • FRONT / ARCHITECT OR ( TEL - P L ENGINEER ,. NO - "' SIDE• P. L a ADDRESS- EL + V CONTRACTOR _ NO - ADDRESS DESCRIPTION OF-WORK Lu a NEW ADD ALTER REPAIR - DEMOLISH SQ FT- NO OF NO OF ---- SIZE STORIES FAMILIES ' USE OF `STRUCTURE , SIGNATU RE'O F' �'- APPLICANT'• VALUATION •� APPROVALS DATE *' INSPECTOR'S SIGNATURE P CPMT FOUNDATION. LOCATION FEE $ TFEE 5 ,FORMS, MATERIALS - FRAME- FIRE STOPS. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS 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 ' AUTHORIZED HEREBY I WILL NOT EMPLOY ANY. PERSON IN VIOLA- TION' IOLA- 'LATH. INT - TION'OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- , •ING-TO WORKMEN'S COMPENSAT40N INSURANCE ' I, - LATH. EXT. SIGNATURE OF HOUSE NUMBER COR- PERM OR- •�. PERMITTEE - RECT AND POSTED42 ADDRESS Sig ' _ '^' FINAL _ JOHN'F LEWIS. PRINCIPAL ST TURAL ENGINEER PLAN.CHECK VALIDATION CK ' M O CASH _ PERMIT VALIDATION -CK mo CASH 2 6 '21 • GDT18 1 D 4.0.0^' 17 WORKERS' COMPENSATION DECLARATION i / J-hereby affirm that I have a certificate of consent to self E RM I T nsure, ora certificate of Workers'Compenstion Insurance, or A P P L I CATION. FOR- BUILDING P a certified co y thereof (Sec. x,@00, L.A C )- COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N wpany �e ❑ CBUILDING ;C- ert Pied copy is hereby furnishe —' FOR14 APPLICANT TO,FILL IN" � ADDRESS U —7� Certified copy is filed w the �untybuilding in c- BUILDING _ ,tion department. ADDRESSAU jCJ4&A41' LOCALITY y NEAREST Date Applicant CITY ZIP CROSS ST CERTIFICATE OF EXEMPTI ROM WORKERS' NO OF-BLDGS ASSESSOR COMPENSATION INSURANCE SIZE OFAOT . :i NOW ON,LOT , •- MAP BOOK PAGE PARCEL (This section need not be'completed if the permit is for one USE ZONE--I MAP hundred'dollars ($100)or less.) TRACT BLOCK LOT NO 0 / NO TEL ' SPECIAL CLI certify that m the performance of the work for which this OWNER = NO. CONDITIONS O permit is issued, I shall not employ any person in any manner r DISTRICT GROUP TYPE FIRE PRO SSED BY U ADDRESS'' so as to become subject to the Workers"Compensation Laws ` ✓-�f/ CONST ZONEIIX -__ - d t �/ 3 O Date Applicant CITY ZIP STATISTICAL CLASSIFICATION • APT CONDO (~j NOTICETO-APPLICANT If, after making this Certificate' of ARCHITECT OR TEL•- 41 Exemption, you should become subject to the' Workers' ENGINEER NO CLASS NO �J / DWELL UNITS N Compensation provisions'of the Labor Code, you,must forth ADDRESS SEWER MAP with comply viith such .provisions"or this permit shall be . deemed revoked. r TEL BK G PG��I� VALIDATION CONTRACTOR Q � NO LICENSED CONTRACTORS DECLARATION LIC - I hereby affirm that'I am licensed under rovisians of-Chapter 9 . ADDRESS NO VALUATION (commenting with Section 7000)of Division 3 of,the Business and LIC � ) � � Professions Code, and my license is in full force and effect CITY = l CLASS. ! $ l!�/ ^ k� SFT NO'OF OF' CHECK -3.20 �S License NumberLic Class SIZE STOFAMILIES FAMILIES ' ONE - - NEW ❑ $ Contractor/ Date . 1 DESCRIPTION OF WORK. ❑ ADD K 'I am exemp from the licensing requirements as I am a FINA _ ALTER licensed architect or a registered professional engineer,.•, L 7 _ - . DATE acting in my professional capacity (Section 7051, 4 i REPAIR ❑ / Business and,Professions Code) USE OF FINAL t EXISTING BLDG .i DEMOL ❑ 13y o�►t.t,�,/ Lic or Reg. No Date APPLICANT . TE OWNER-BUILDER DECLARATION • ' - (PRINT) "t�.' �/ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and ADDRESS - p ✓ IAI Professions Code) PRE N - _ �/yd F-1 BUILDING.. .• _ . j, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work•ond' the structure is not intended or offered for sale(Section ' LOCALITY- -" - - 3,0 2 2 A' 7044, Business and Professions Code). . MOVING- ( TEL , ❑' CONTRACTOR- .NO I, as owner of the property, am exclusively contracting # with licensed contractors to construct the project (Sec- tion 7044, Business and Professions Code) • _ ADDRESS " 2 •o to�7 9,0 0 REQUIRED TOTAL SETBACK FROM, EXIST' � .. CONSTRUCTION LENDING AGENCY SET BACK' YARD HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for- FRONT ' °ie -7 9, 0 0 c=.�' the performance of the,work for which this permit is issued P L ' (sec 3097, Civ' c ). SIDE.. - - - .- 02,2 2,—8.2 PL Lender's Name _ - $ •- P C Fee$ Permit Fee < U' - ', Lender's Address W I certify that I have read this application and state that theIssuance Fee aabove information is correct. I agree to comply with all County, Investigdrion Fee.. . ... _ 0 oran. te laws relating to'building construction, Total Fee ndze representatives of this County to enter aupoentioned property for i cti purposes SEE REVERSE FOR EXPLANATORY•LANGUAGE j pplicant or Agent Date s, - ,.r _ •. _ .- - �s • WO�KERS' COMPENSATION DECLARATION I hereby affirm that'I have'a certificate=of consen't'to•self A P P L I CAT I O N FOR BUILDING PERMIT insure, or a certificate of Workers' Corripensation Insurance, or a certified Cppy thereof (Sec. 3800, Lab. C.); -' COUNTY OF.LOS.ANGELES BUILDING..AND SAFETY Policy No.' Company Certified copy is hereby furnished., FOR APPLICANT;TO-FILL IN ADDRESS 'Certified copy is filed with the county,building inspec- BUILDING // e /r-• - tiondepartment. ADDRESS" T 9 ��TN :/�(I{% a LOCALITY NEAREST Date Applicant CITY 17,41P4£ ZIP !/ CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' - NO OF BLDGS" ASSESSOR COMPENSATION INSURANCE •SIZE OF LOT -"D 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 (� J'v/ r. BLOCK LOT NO- - O7 NO t. " ' TEL.,' I SPECIAL } I certify that in the performance of,thework for which this 'OWNER E� d jiheL 04,11AkNO� —33� �I CONDITIONS d permit is issued;.l shall not employ any person'in any manner DISTRICT GRO P ,TYPE • FIRE CESSED t Q so as to be me s bject to the WorW4, pe ti a DDRESS S A(4AFMA CONST . ZONE V �� CITY —�. ZIP �7Eld ` :QDate ' ApplicdnCSTATISTICAL CLASSIFICATION „• APT - CONDO. :,U NOTIC A LICANT- If; after making this Certificate of ARCHITECT•OR TEL lu Exemption, you' should become subject to the Workers' - ENGINEER NO CLASS NO. DWELL-UNITS •d Compensation provisions oftheLabor Code, .you,must forth= ADDRESS SEWER MAP � with�'comply with such pr6Visioris or this permit shall -be _ deemed revoked. CONTRACTOR. ; , :"NO. ,BK. PG, VALIDATION , LICENSED CONTRACTORS DECLARATION °i i LIC I herebyaffirm that I am licensed under provisions of Cho ter 9 ADDRESS " - P P a �'= SIC VALUATION (commencing with Section,7000)of DK ision 3 of the Business and LIC Professions Code, and my license is-in full force and-effect. CITY CLASS•' $ D SQ FT ' NO OF NO.OF CHECK ,- License Number c Lic.Class SIZE STORIES' FAMILIES ONE Contractor Date• - DESCRIPTION'OF WORK 1. NEW t 1',..-r w�',ti,_'• •ADD' Li a I am exempt under Sec. 0dxr — O - ;r ALTER FINAL B.BP.C. for this reason - 0 DATE REPAIR USE OF DEMOL '❑ Date: T EXISTING BLDG • G BIN Signature APPLICANT r,> TEL \, 'OWNER-BUILDER DECLARATION PRINTpv I / .NO. I hereby affirm that I:am exempt from the Contractor's License ADDRESS / /T� Law for the following reason (Section 7031.5, •Busiriess and - ' -=Professions Code):-,- ' ° - - - , FREbENT 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 oP offered.for'sale•(Section LOCALITY' 7044,-Business and Professions Code). MOVING TEL. - "I, as ownei of the property, am exclusively contracting, CONTRACTOR NO. , with licensed contractors to construct the project (Sec= ADDRESS < ~ tion 7044, Business and'Professions,Code). 5 4 53'A REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY,' SET BACK YARD HWY PROP LIN WIDTH hereby affirm that there is a construction lending agency for;" ,' FRONT - - # 0 0 0 0 • the performance of the work-for which this permit is•issued• 'P L (Sec. 3097, Civ. C.): SIDE 3 z3.G 0 ., pt w o 0 0 33��.c=�' Q Lender's Name L'ender's Address P C. Fee$ Permit Fee 5� 0 9 -2'-8 b I certify that I have,iead this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee g ordinances and State jaws relating to building construction, Total Fee' ��.• a r U and hereby authorize representatives of this County to enter up o a ove- a tione rop ty for inspection p rpos ' a t L SEE REVERSE FOR.EXPLANATORY LANGUAGE ig at f Applicant or Agent- Date ®s APPLICA1 . � OR BUILDING PERMIT � COUNTY OF LO!'1 ANG. BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD RESS. BUILD1 ADDR SS sit I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITY Temp ZIP LOCALITY C, Policy No. Company SIZE OF LOT NO.OF BLDG OW ON LOT ❑ Certified copy is hereby furnished. — NEAREST CROSS ST. ❑ Certified copy is filed with the county building Inspection TRACT BLOCK LOT NNO� USE ZONE MAP NO. department. Date Applicant ASSESSOR P BQO PAG PARCEL/ _/ SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' c TEL NO. . �Z 1 YES NO COMPENSATION INSURANCE J WITHIN 1000 FT.OF SCHOOL? ADDRESS (This section need not be completed if the permit is for one hundred DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY dollars($100)or less.) C( ' er-i ZI I certify that in the performance of the work for which this permit tv_w'l q l" is Issued, I shall not employ any person in any mann r so to ARCHITECTO NGINEER TEL NO. become subject t0 the Workers'Co pen On STATISTICAL CLASSIFICATION APT CONDO Date Applicantxtt, ADDRESS CLASS NO. / DWELL UNITS NOTICE TO APPLICANT. If, after m ing this Certificate of CONTRACTOR TEL.NO. REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' SETBACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith �� Gt=�`� �' FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO., PL LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS- PIL U I hereby affirm that I am licensed under provisions of Chapter 9 SQ.FT SIZE NO.OF STORES NO.OF FAMILIES SEWER MAP (commencing with Section 7000)of Division 3 of the Business and NEW El PG Professions Code,and my license is in full force and effect. ® Iv' DES RIPTION OF WORK ADD ❑ VALUATION License Number Lic.Class _j� /1 .; y f 1 Cn Contractor 0 Date ALTER U ❑ I am exempt under Sec. ` REPAIR ❑ $ B.&P.C.forth is reason DEMOL ❑ LDMA P/C# Date: USE OF EXISTING BLDG. URM ❑ j�" / Signature AP 6A (PRINT) �/' TEL 7 LOMA Perm M Z I, as owner of the property, or my employees with wages as / Q25J/ O their sole compensation,will do t( —e work and the structure is A CFINAL DATE Q / �� } not intended or offered for sale Section 7044, Business and „ D Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLEAHAZARDOUSMATERIAL Z`�—4v 7' El I, as owner of the r0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN property, am exclusively contracting with THE AMOUNTSIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY z � �', > -• ' licensed contractors to construct the project (Section 7044, YES 11NO3CIFI`Y^ Business and Professions Code.) WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH _ CONSTRUCTION LENDING AGENCY COAST AIR.QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES 1-1No the performance of the work for which this permit is issued(Sec. I HAVE READ AAE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD 3097,CIV,C.). PERMITTING CHECKLIST.1 UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,TITLE 2 CHAPTER 2 20 SECTIONS 220.100 THROUGH 22(1.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. Lender's Address ER ORw MT o I certify that I have read this application and state that the above information is correct. I agree to comply with all county P.C.FEE PERMIT FEE �S.ordinances and State laws relating to building construction,and hereby authorize representative Of thj j County to enter upon ISSUANCE FEE 7 the— ove-4mentioned prnge n� ctio purposes. / � . / / g_J z _9 z INVESTIGATION FEE TOTAL FEE r` nen..al or Agent Oeb 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 9910050014 PHONE: (626) 285-0488 EXT: LEGAL D: NO. OF CONST BUILDI SS: TR: 6561 LT: 507 SQ. FT STORIES TYPE 5719 KAUFFMAN AV STRUCTURE: 0 VN TEMP CA 917802506 ASSESSOR INFORMATION NUMBER• NEAREST CROSS STREET: LIVE OAK 8587-022-005 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY TENANT: E STB G : RESID USE ZO : - ISSUED 0 BY: EXPIRES EXIST OCC GRP: 10/05/99 UT 04/02/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MOLNAR BENJAMIN A;SALLY (626) 285-3314- 1 2,570 r��/ _ 5719 KAUFFMAN AV TEMP 917802506 ID D-ESCR ORK T/0 ROOFING, RE-ROOF WITH CLASS A COMP SHINGLE (ELK) FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: AP EL. NO: CHAMPION ROOFS (323) 251-9451- AA BLDG PERMIT ISSUANCE 27.75 3257 VERDUGO DR. AC STRONG MOTION RESID 2570.00 VAL 0.50 SPECIAL CONDITIONS: LOS ANGELES, CA D2 PERMIT W/O EN=HC�25,70.00 VAL 99.00 GEL S OT�`AL FEES 127.25 CONTRACTOR: TEL. NO: �y �/� APPROVALS DATE INSPECTOR SIGNATURE CHAMPION ROOF, INC. (323) 248-0803- 3257 VERDUGO RD LIC. NO LOCATION AND SETBACKS LOS ANGELES CA 90065 429481/C39 1 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: T 0: y OU D NCH FORMS LIC. N0:/-� 1111111 SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: - CMP,::, D �� UNDERFLOO INSULATIO 150H269 3 1 FU � V ��n�G�K3 FLOOR SHEATHING N0. OF FAMILIES: D S: PT/ CLASS: I NO 21 V .1 . ROOF SHEATHING o-,� AIR QUALITY: 1000 FEET SCHOOL IN MATERIALS HAZARDOUS O ' SHEAR S NO NO NO ®� FRAME INSPECTION R50UIRED SETBACK FROM C/� D �oQ`� RE SPR ANGERS SET FRONT PL- YARD: HWY: PROP LINE: WIDTH: /�, 8ervice"Th � INSULATION/WEATH R STRIP SIDE PL- TERIORLATH/DRYWALL EXTERIOR LATH RATED OOR L ASSEM. RATED WALL ASSEMBLIES TED SHAFTS/OPENINGS T T-BAR CEILINGS LO AG REPORT ID: DPR261 ROUTE TO: BS0508