HomeMy Public PortalAbout5725 KAUFFMAN AVE_Building__ TEMPLE CITY
,78A638A CE#803 9-67
APPLICATION FOR' BUILDING PERMIT
COUNTY OF LOS"ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 5 715 Kauffman , T . C .
BUILDING AND SAFETY DIVISION LOCALITY'
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST
'CROSS ST:
'DISTRICT NO. GR TYPE P OCES D BY
FOR-APPLICANT TO FILL IN t CONST•
(Print ort pe^only) �p
BUILDING STATISTICAL CL SIFICATION SEWER MAP
ADDRESS ,* CLAS.SNO. DWELL.UNITS BKPG
LOT NO. 1 � ' � BLOCK )USE ZONE MAP '
TRACT SPECIAL
NO.OF BLDGS. CONDITIONS
SIZE OF LOT NOW ON LOT
USE OF
EXISTING BLDG, BL G.SETBACK FROM
•- TEL. _FRO T PROP,LINEOF (STREET)
OWNER a TYPE OF ISTING SETBACK HIGHWAY } YARD = TOTAL
ADDRESS 5725 Ka U man HIGHWAY DTH FROM C.L.
} _
CITY ''BLDG.SETBACK F
ARCHITECT OR - TEL. - SIDE PROP.LINE OF (STREET)
ENGINEER NO. TYPE'OF EXISTING1 SETBACK WAY } YARD = TOTAL'
ADDRESS ,HIGHWAY, WIDTH FROM C.L.
} _
CONTRACTOR TEL.
HQiqard = O
A�DDkESS NO. CORNER CUTOFF YES E] N V
CITYSaCLASS _ SEE REVERSE SIDE FOR SPECIAL•APPROVALS o
DESCRIPTION;OF WORK _
,� z
I
NEW ADD ALTER REPAIR - DEMOLISH
SQ. FT. NO. OF NO. OF
SIZE STORIES FAMILIES
USE OF
STRUCTURE t
Re-roofin Compo
dtotv ��d^xi�( ASO
SIGNATURE OF � w+� 11'41 t
'APPLICANT I '
'VALUATION $ '450 - 00
APPROVALS DATE INSPECTOR'S SIGNATURE
PMT.FEE $ FEE $ 9 . 00 TION
)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 OF THE LABOR CODE OF THE ST OF CALIFORNIA RELAT. LATH, INT.
ING TO WORKMEN S CO P SA N IN UR NCE
- LATH, EXT,. '
SIGNATOR F HOUSE NUMBER COR-
PERMITTE - RECT AND POSTED
ADDRESS•,?9 € . a lesl , Sanb r_Tel FINAL /
JOHN F LEWIS PRINCIPAL ST RAL ENGINEER
PLAN CHECK VALIDATION CK M o GASH_ PERMIT VALIDATIONCK -0 CASH
'4; ._6':g, APR 2'9 I D 9.0 O N
APPLICATION FOR BUILDING PERMIT
. COUNTY OF LOS ANGELES,-' BUILDING AND SAFETY
' WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS �r7
BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, 3-2,2s-
or
a certificate of Workers'.Compensation Insurance,or a certified CITY ZIP p�
copy thereof Sec.3800,Lab.C. �rn P(k' C 17 y C)//2-d v
7 S'7ATE—Fasi hLOCALITY
,P�QIi/cY No. Companry�. ! SIZE OF LOT �i NO.OF BLDGS.NOW ON LOT
LJ Certified copy is hereby furnished. EZXP (� '1 7O 7C�a a NEAREST CROSS ST. / I
❑ Certified copy is filed with the ounty bulldin ' pection T CT rJ / - ( BLOCK LOT NO.
department �O USE ZONE MAP NO
�_ .2y- �7 ASSESSOR MAP BOOK PAGE PARCEL
Date pplicant SPECIAL CONDITIONS
CERTIFICATE OF E MPT N FROM WORKERS' . OW- J01 V e-S Co I ,rf_rR A-S TEL NO. 0 7�`i YES NO
COMPENS TIO INSURANCE a c�S WITHIN 1000 FT OF SCHOOL?
ADDRESS '
(This section need not be completed if the permit is for one hundred SA M F DISTRICT GROUP TYPE CONST.' FIRE ZONE PROCESSED BY
dollars($100)or less.)' CITY ZIP I-
1 certify that in the performance of the work for which this permit Q� t
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 LA71FICATION APT CONDO
Date Applicant ADDRESS CLASS NO. II DWELL UNITS
NOTICE TO APPLICANT. If, after making this Certificate of REQUIRED TOTAL SETBACK FROM EXIST
CO FACTOR TEL.NO.
Exemption, you should become subject to the Workers' Q ..,r1t�.� ����G� 1 SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of-the Labor Code, you must forthwith �M�S /� �V1 ? U eta FRONT
comply,with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L
6 d3c� s UC 771-AiA 's-)3693 SIDE >..
LICENSED CONTRACTORS DECLARATION CITY LIC.CLA p L CDpc e��` r,
I hereby affirm that I am licensed under provisions of Chapter 9 SEW :..� �
(commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES EgvAP
Professions Code,and my license is in full force and effect.
Z NEW ❑ BK C� PG
poll
License Number 3 G 0 Lic.Class Q DESCRIPTION OF WORK ADD VALUATION d
p
D iz ww g xI57-lav G 1
Contractor R UYc� CONST Date :2'-12'1- 10 G�RA-6� ALTER ❑� $ '� �` � Q'':�. .ACCT.
4Ek 7 3 t y T F19-MM ?,0Dr-\ — 7D 9,6'
❑ I am exempt under Sec. � REPAIR ❑ �$ _ _ .,:IL07 '
356.48
B.&P.C.for this reason R F'PL"C o:6 DEMOL LDMA P/C H { T
Date: USE OF EXISTING BLD . �' ITEMS
EMS
, AWI/.0 y. Dwe16 URM ❑ TE�7HL ' �
Signature APPLICANT(PRINT) TEL.NO. LDMA Perm Y
❑ I, as owner of the property, or my employees with wages as p CHECK 356.4','
their sole compensation, will do the work and the structure is ADDRESS Q CHANGE 00
not intended or offered for sale (Section 7044, Business and f' FINAL DATE
Professions Code.)
' WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL �•J
❑ Ir0 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER
, as owner of the THAN Q 1
property, am exclusively contracting with THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 1 " 1'>
t t 1 t ?f
vV—� �i 4/90
licensed contractors to construct the'project (Section 7044, YES❑ NO El
Business and Professions Code.) �']]i { (�J I�°i
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING I • iL 17 1 AM 1_°1.
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAGMD)SEE PERMITTING CHECKLIST
FOR GUIDELINES _
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. 1
3097,CIV.C.). I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCQMD
Q W
PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES y ,• i
Lender's Name �QN•— COUNTYCODE,TITLEZCHAPTER220SECTIDNS220100THRGH22014000NCERNING
HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAGMD. ,
Lenders AddressOWNER AGENT
0 1 certify that I have read this application and state that the above RC FEE Pt11T E
information is correct. I agree to comply with' all county '/
ordinances and State laws relating to building construction,and
hereby authorize representativ f this County to enter upon ISSUANCE FEE
th a ve-mentioned p rty or spection rposes.
INVESTIGATION FEE TOTALFEE�
not Appkr wAg� Dm
SEE REVERSE FOR EXPLANATORY LANGUAGE