HomeMy Public PortalAbout6013 KAUFFMAN AVE_Building__ .� APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR.APPLICANT TO FILL IN BUILpINDG
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ADDRESS
I hereb affirm that I have a certificate of consent to self insure, BUILD G ADORNS
or,a certificate of Workers' Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.) CITY G v ZIP / 1
9• / LOCALITY
Policy No. Company SIZE OF LOT NO.OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. .Z NEAREST CROSS S ._
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO.
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS' owrR_ TEL NO. p/
COMPENSATION INSURANCE /'T�`Xb'6 /Oy WITHIN 1000 FT.of SCHOOL? YES No
(This section need not be completed if the permit is for one hundred ADN S
(� /3 `��//�.'��"y�/ DISTRICT GROUP T E CONST. FIRE ZONE PROCESSED BY
dollars ($100)or less.)
I certify that in the performance of the work for which this permit CITY 7-1 /= G ,rY ZIP '/
is issued, I shall not employ any person in any manner so as to O d
become subject to the Workers'Compensation Laws. ARCHITECT OR ENGINEER TEL NO.
P STATISTICAL CLASSIFICATION APT CONDO
Date Applicant ADDRESS CLASS NO. � DWELL 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 shall be deemed revoked. ADDRESS LIC.NO. P L
LICENSED CONTRACTORS DECLARATION SIDE
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 and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES
Professions Code,and my license is in'full force and effect. �.� / NEW BK PG a
License Number Lia Class
DESCRIPTION OF WORK ADD ❑ VALUATION , O
�/` /?c90/•/�,� $ � � l•�
Contractor Date ALTER El
REPAIR ❑ O
❑ I am exempt under Sec. $ I—
B.BP.C. for this reason -14 P cr!/INGa p,� DEMOL ❑ LDMA P/C# V
W
Date: USE OF EXISTING BLDG. URM ❑ I'
Signature APPLI NIJPRINT)„� T Le�Nl .�/ LDMA Perm#
El 1, as owner of the property, or my employees with wages as Z
their sole compensation, will do the work and the structure is ADDRESS O
0.not intended or offered for sale (Section 7044, Business and 6 /` G _FINAL DATE a "(33
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 3
❑ 1, as owner of the property, am exclusively contracting with OR
A MIXTURE
SPECIFIED CONTAINING
HE HAZARDOUS ATERIAL ALS EQUAL TOONRGURE?ER THAN THE
v�" Q
FINAL BY
licensed contractors to construct the project (Section 7044, Ai—
WILL
; '"�""� ,>` �•"
Business and Professions Code.) YES❑ NO 1:1 I 1 Ai
WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHECK
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR
GUIDEUNES, I`-
I hereby affirm that there is a construction lending agency for YES El No El 4G
A f l
N the performance Of the work for which this permit Is issued(Sec. IHAVEREAD THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMDPERMITTING
3097, CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, '
TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS I}Ill 0—) 0 f
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. i`!ti D
� 1
o Lender's Address LI!?u Am
O OWNER OR AGENT '
o I certify that I have read this application and state under penalty
of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE
101
/ O
o with all county ordinances and State laws relating to building
construction, and hereby authorize representatives of this County ISSUANCE FEEoo
` ��
ID to ent on aboy� ntione I perty for inspection purposes. 46
A /Y/�'`��, '7INVESTIGATION FEE TOTAL FEE
Slgnam.o or Apprwm o,Agent Dale
SEE REVERSE FOR EXPLANATORY LANGUAGE
• COUNT, OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
IEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0411080045
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST NEW BUILDING ADDRESS:
TR: 6561 LT: 116 SQ. FT STORIES TYPE OCCUP GROUP 6013 KAUFFMAN AV
STRUCTURE: 432 1 VN R3 TEMP CA 917801742
ASSESSOR INFORMATION NUMBER: GARAGE: _ NEAREST CROSS STREET:
5385-018-011 ' OTHER: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 06/28/05 JK 06/23/06
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE:
HILLER PETER J;ANN E (626) 286-5109-. 35,770 (�
6013 KAUFFMAN AV •���` ��
TEMP 917801742 FEES PAID DESCRIPTION OF WORK
ADD NEW MASTER BEDROOM AND BATH 432 SF.
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
SAME AS OWNER - B1 PLANCHECK W/ENERGY 35770.00 VAL 575.01
AA BLDG PERMIT ISSUANCE 27.75 SPECIAL CONDITIONS:
AC STRONG MOTION RESID 35770.00 VAL 3.58
B2 PERMIT W/ENERGY 35770.00 VAL 676.50
TOTAL FEES 1,282.84
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
RICHARD DIRADOURIAN (818) 249-1888-
3786 LA CRESENTA AVE LIC. NO: SLAB/UNDER FLOOR
GLENDALE CA 91208 C10336 /1
RAISED FLOOR FRAMING -�7
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION -// /
3 01 V
1ST LEVEL FLOOR SHEATH
NO. OF FAMILIES! DWELLING UNITS: APT/GOND: STAT.CLASS:
NO 21 2ND LEVEL FLOOR SHEATH
SCHOOL WITHIN HAZARDOUS ROOF SHEATHING
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FIRE DEPT. FRAME INSPECT
REQUIRED TOTAL SETBACK FROM EXIST BLDG DEPT. FRAME INSPECT��
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- SHEAR PANELS
SIDE PL-
INSULATION/WEATHER STRIP
INTERIOR LATH/DRYWALL j
EXTERIOR LATH �`L
LOT DRAINAGE
SMOKE DETECTION DEVICES
FIRE DEPARTMENT APPROVAL
REPORT ID: DPR261 ROUTE TO: BS0508