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Home My Public Portal About6052 KAUFFMAN AVE_Building__ . w APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN sU1LDl DRESS BUILDING ADDRESS 1 hereby affirm that I have a certificate of consent to self insure, 60S-2- 2 or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) LOCALITY CITY -7 Policy No. Company SIZE OF OT NO.OF BLD .NOW ON LOOT El Certified copy is hereby furnished. (0 0 X top I NEAREST tRO7WT TRAC BLOCK LOT NO. . ❑ Certified copy is filed with the county building inspection f S / !I J USE ZONE MAP O. department. l0 / ASSESSOR MAP BOOK PAGE PARCEL. Date Applicant r-3 C�� / o 2!- SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER d TEL.NO. 54// COMPENSATION INSURANCE Rac-he ro jp� ;igr-' WITHIN 10DO Fr.OF SCHOOL? VES NO ADDRESS (This section need not be completed if the permit is for One hundred5"Awe a4 �� ✓e DISTRI j7P TYPE ST' FIRE ZONE P OCESSED B dollars($100)or less.) CITY .ZIP certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL.NO. bBCOme t to the Worke�pensation Laws. STATISTICAL CLASSIFICATION x PT CONDO ete L/ Applican��n ADDRESS CLASS NO.�1--DWELL UNITS—lam ///// NOTICE TO APPLICANT: If, after making thi 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 A 1 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS • LIC.NO. PL SIDE. >' LICENSED CONTRACTORS DECLARATION CITY V LIC.CLASS PL 1 hereby affirm that I am licensed under provisions of Chapter 9 .OF STORES NO. SEWER (commencingwith Section 7000 Of Division 3 of the Business and SQ.FT.SIZE FAMILIES ,yr O NO � Professions Code,and my license is in full force and effect. NEW ❑ PG �O j DESCRIPTION OF WORK ADD VALUA�'ION , s 1 W License Number Lic.Class. ) _ _ ti r 3:07 j; a .`i Z Contractor Date / ALTER ❑ v�Of _ •1�� . I ❑ I am exempt under Sec. A rf REPAIR ❑ $ i l LI I B.&P.C.for this reason DEMOL ❑ LDMA P/C# TI 3`AL 51Bs oa 75 USE OF EXISTING BLDG. _ Date: URM 11 :i�EC � w �� yi�'ae Signature APPLICANT(PRINT) TEL.NO. LDMA Perm# 111, as owner of the property, or my employees with wages as p CH HINGE 1. their sole compensation, will do the work and the structure is ADDRESS . not intended or offered for sale (Section 7044, Business and FINA Professions Code.) 1/ ( Iii;{i-;t'u 1 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL - -�it, j .J�._L I :) JF Lt OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN ❑ 1, as owner of the property, am exclusively contracting With THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINf7 f - Y'' > ?7 4 i AN 2-:51 licensed contractors to construct the project.(Section 7044, Business and Professions Code.) WILL El No El THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 1 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST , _ the performance of the work for which this permit is issued(Sec. ) FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES 1-1No 1:1 :�i 3097,CIV.C.. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES ao. COUNTY CODE,TITLE 2,CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. a Lender's Address OWNER OR AGENT o 1 certify that I have read this application and state that the above P.C. EE PERMIT FEE information is correct. I agree to comply with all county . S -75- ordinances and State laws relating to building construction,and hereby authorize representatives of this County to enter upon ISSUANCE FEE f d the ve-mentioned property for inspection purpos Gr QT1f O INVESTIGATION FEE TOTAL FEE naAcpr IorAgM � SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RETAINING WALL BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0203280027 PHONE: (626) 285-0488 EXT: LEGAL ID: TOTAL HEIGHT: 7 FT BUILDING ADDRESS: TR: 6561 LT: 111 RETAINING HEIGHT: 6 FT 6052 KAUFFMAN AV WALL LENGTH: 280 FT TEMP CA 917801741 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5385-019-024 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: R-2 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 03/28/02 JK 09/24/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FIN Y: CODE: GOODYEAR INVESTMENT INC (714) 557-7970- 9,000 17195 NEWHOPE ST#209 FOUNTAIN VALLEY92708 FEES PAID DESCRIPTION OF WORK BLOCK WALL FOR PM26154 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 D2 PERMIT W/O EN-H 9000.00 VAL 199.80 SPECIAL CONDITIONS: T.O.T.AL FEES 227.55 CONTRACTOR: TEL. NO: - ®� �� APPROVALS DATE INSPECTOR SIGNATURE SAME AO LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: \�� FOUND/TRENCH FORMS C L DESIGN (626) 447 5958- ------ 1008 S. BALDWIN STE A LIC. N0: �� l 1111111 FORMS/GROUT LIFT ARCADIA, CA 91007 NONE ND GROUT LIFT MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP 150H269 00 �[ ' �� Fir(� �� RD GROUT LIFT �� ' iJ U U U �'v�� WALL DRAIN NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 20 BACKFILL COMPACTION SCHOOL WITHIN HAZARDOUS J SURFACE DRAINAGE AIR QUALITY: 1000 FEET MATERIALS NO NO NO , Ll ,; ��a REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0203280026 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 6561 LT: 111 SQ. FT STORIES TYPE 6052 KAUFFMAN AV STRUCTURE: 1000 TEMP CA 917801741 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5385-019-024 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: RESID USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 03/28/02 JK 09/24/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: GOODYEAR INVESTMENT INC (714) 557-7970- 1,000 17195 NEWHOPE ST#209 FOUNTAIN VALLEY92708 EES PAID DESCRIPTION OF WORK DEMO HOUSE & GARAGE FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN- 163.50 SPECIAL CONDITIONS: TOTAL FEES 191.25 CONTRACTOR: TEL. N0: ®� �� APPROVALS DATE INSPECTOR SIGNATURE , SAME AS OWNER - w LIC. NO PEDESTRIAN PROTECTION s� SEWER DISCONNECTION /y ARCHITECT OR ENGINEER: TEL. N0: Fr ABANDON PRIVATE DISPOSAL C L DESIGN (626) 447-5958- - ------ �\ 1008 S. BALDWIN STE A LIC. NO: I/ � I 77111 1 1111 UNDERGRND STRUCT REMOVAL ARCADIA, CA 91007 NONE AND SOIL RECOMPACTION l MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:: I'JL r 150H269 011 U L01 �L111' J L/ v NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: NO 23 SCHOOL WITHIN HAZARDOUS O ` J , AIR QUALITY: 1000 FEET MATERIALS n -' �--_ NO NO NO ' �6 Fyu� 4 REPORT ID: DPR261 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS DEMOLITION BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0203280026 PHONE: (626) 285-0488 EXT: DUPLICATE LEGALS S: TR: 6561 LT: 111 SQ. FT STORIES TYPE ' 6052 KAUFFMAN AV STRUCTURE: 1000 TEMP CA 917801741 ASSESSOR 0 0 NUMBER: NEAREST CROSS STREET: GARIBALDI 5385-019-024 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY TENANT: S • G D USE ZONE: SUED 0 9 T. PROCESSEDB : EXPIRES ON: EXIST OCC GRP: 03/28/02 JK 09/24/02 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: GOODYEAR INVESTMENT-INC (714) 557-7970- 1,000 17195 NEWHOPE ST#209_ / 2 Z FOUNTAIN VALLEY92708 FES PAID DESCRIPTION OF WOR DEMO HOUSE & GARAGE APPLICANT, TEL. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 0: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 02 DEMOLITION INSPECTN— 163.50 SPECIAL CONDITIONS: TOTAL;FEES 191.25 CONTRACTOR: TEL. NO: ®� �d1��m APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO /^ P-9DESTRIAN PROTECTION �� _1 SEWER DISCONNECTION dg ARCHITECT OR ENGINEER- EL. 0: ABANDON PRIVATE DISPOSALbL C L DESIGN (626) 447-5958- _ 1008 S. BALDWIN STE A LIC. NO: X1111111 UNDERGRND STRUCT REMOVAL ARCADIA, CA 91007 NONE AND SOIL RECOMPACTION MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: li 150H269 01'-, 0. OF FAMILIES: DWELLING NITS: APT/CO D: STAT CLASS. _ NO 23 SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS NO NO NO � siz REPORT ID: DPR261 ROUTE TO: BS0508