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Home My Public Portal About6213 KAUFFMAN AVE_Building__ V 76A638A1. #803 3`69 APPLICATION FOR BUILDING F5ERMIT op COUNTY OF LOS ANGELES ADDREIN DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W'. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. ' DISTRICT N0. GROUP•", ,.TYtE�k7 PROCESSED BY FOR APPLICANT TO FILL IN (PRINT OR TYPE ONLY) z._ p L.J STAi-I BUILDING _ N CLASSSNIOCAL CLA IFDWELLONUNITS �-- SEWER L. PG � ADDRESS LOT NO. BLOCK USE•ZONEMAP Do, - - - ^• - - . N 0. - TRACTSPECIAL- IND i .'OF BLDGS. ,1 CONDTIONS SIZE OF LOT U X I7d NOW ON LOT USE OF � / EXISTING BLf__. ..$ A�' G. Q� BLDG. SETBACK FROM • TEL. V FRONT PROP. LINE OF, � �r (STREET) , OWNER 'm fit.1-C I 4. -NO. Cl 'r, TYPE OF EXISTING SETBACK HIGHWAY' '+, -YARD' TOTAL �"�C- HIGHWAY WIDTH FROM C.L. ADDRESS q„ _ - - �• 21-a CITY )-e BLDG.SETBACK FROM z ARCHITECT OR TEL. SIDE PROP. LINE OF w (STREET) ENGINEER NO. TYPE-OF -EXISTING -SETBACK •HIGHWAY +- YARD" = TOTAL kRE SS HIGHWAY WIDTH FROM C.L. ' TEL ACTOR NO. (j�p LIC. CORNER CUTOFF 'YES ❑ NO SS r F Q, NO. _ _ _ c IC. L (� CLASS S EVERSE SIDE FOR SPECIAL APPROVALS RUCTI N LENDER Z1171 c AND BRANCH (J Q. 44 LL SST. N0. OF N0. OF STORIES FAMILIES NEWF ADDTURE OHO ALTERREPAIR ❑TURE OF DEMOL ❑CANT VALUATION $ .6f ° APPROVALS D TE INSPECTOR'S S' NATURE P.C. PMT. i FOUNDATION: LOCATION FEE $ FEE $ FORMS MATERIALS _ /(• l I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION FRAME: FIRE BSTOLTS BRACING OPS, - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUC- GAS VENT DUCTS TION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE LATH, INT. OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF '� _ A,.__ LATH, EXT. `i L HOUSE NUMBER CORRECT PERMITTEE ,A/I !n� AND POSTED ADDRESS /V - aI'4-Fl;7MC-(V FINAL - E JOHN F. LEWIS, PRINCIPAL STDURAL ENGINEER PLAN CHECK VALIDATION CK, M.0. CASH - PERMIT VALIDATION- M.O. CASH ' E;� .0" 'AW26 . , 1 -U 17.25 WORKERS' COMPENSATION DECLARATION affirm tconsent APPLICATION- ,I CAT I O N: .F O R: BUILDING L D I N G P E RM I T insure-ora certifcate'of Workers, Compensation suan , or a certified (�copy JtheereofJSI;�_3800,'L ib.C.) t r COUNTY OF LOS ANGELES• BUILDING AND SAFETY Policy No3LJSLY'timpany BUILDING^• ❑ Certified copy is hereby furnished. ��y� FOR APPLICANT TO FILL IN - ADDRESS Certified copy is filed with the-county b ilding inspec- BUILDING - tion,department. ; ADDRESS Date A licant CITY IP LOCALITY •PP O. OF BLDGS NEAREST _ CERTIFICATE.OF EXEMPe WA TIO F OM.WO ERS' SIZE OF LOT ' NOW ON LOT CROSS ST" COMPENSATION INSURANCE ASSESSOR (This section need not be completed,if the permit is for one TRACT BLOCK' LOT NO MAP BOOK-',-' PAGE PARCEL hundred dollars ($100) or.less:), cp O s s OWNER-. oC I USE ZONE MAP I cerci- that m the performance of,`the•work.fo� which this NO' fY P �y SPECIAL,,- 'a. permit Is •issued, I,shall not employ"•any,person•m any manner ADDRESS pct �" CONDITIONS' so as•to become subject to the Workers'Compensation Laws. O i CITY - w A ZIP U 'Date A licant- ARCHITECT OR TEL 0 PP DISTRICT' _GROUP TYPE FIRE _ PROCESSED BY TO'APPLICANT: If,.after making this,Certificate of ENGINEER. NO. CONST ZO E Exemption, you`should become subject to the- �- i / Compensation provisions of the Labor Code, you must forth-' ADDRESS v a" with comply,vvith such provisions or this permit shall,be TEL STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked.,. CONTRALTO NO. z LICENSEDCONTRACTORSDECLARATION LIC. CLASS.NO �� DWELL. UNITS I hereby affirm that I am licensed under-provisions,of Chapter 9,' ADDRESS LIC SEWER MAP - (commencing with Section 7000)'of.Division 3 of_the Business LIC CITY; 1- ,OLJ CLASS VALIDATION . and Professions.Code,and'my license is in full force and effect. _ � � BK. - "-PG„ ' C=2— VALUATION� 50. FT NO. OF , NO. OF CHECK .'. License Num er 3 ,Lic. Class S. 2 SIZE STORIES NO. ONE VALUATION DESCRIPTION OF WORK NEW ❑; �9i Q Contract0 ate ; / ADD -❑ ❑I am exempt,under•Sect' ►" a P LTER ❑ B.&P.C. for this reason ❑ $ Date: SE OF EXISTIN D MOL ❑ Signature APPLICANT a -_ FINAL ~ OWNER-BUILDER DECLARATION (PRINT) N DATE I hereby affirm that.l.am exempt from the Contractor's-bi ense Law for the following reason (Section 7031.5, Business and ADDRESS FINA ,. Professions Code): .' PRESENT . BY.a • =t, ❑ I, as owner 'of the ro ert or-m employees with BUILDING fTE°_(_i ,g P P Y YADDRESS 77 wages as their sole compensation,will do the work and - 7.�yI7 the structure is not intended or offered for sale(Section LOCALITY - 7044 Business and Professrons'C*de. MOVING TEL , _ / j r + ❑ I, as owner of The ro ert am exclusively coniractin CONTRACTOR NO. - l 'I�'`€'' •`` P P .Y• Y 9., �� TI f. with licensed contractors to construct the project (Sec ADDRESS TOTAL �2 � 00 tion 7044,,Business and Professions Code.) i REQUIRED NOTAL SETBACK FROM•' EXISTRL}•i: CONSTRUCTION LENDING'AGENCY SET BACK YARD HWY PROP LINE WIDTH y I hereby affirm that there is a construction lending agency for FRONT CHANGE a I_ILI , the performance of the work;for which this'perrrirt is issued PL' (Sec. 3097, Civ. C.) SIDE Lender's Name P L I tji!—SII , t'! ,`' '? LDMA Ref. N- '• -, v -•o•,: P C Fee$' Permit Fee - �O i`"� �i"_` 4 AI 1 Lender's Address µ 2 w I certify that I have read,this applii:ation and state*that the r Issuance Fee �/ LDMA P/C# 8 above information is correct. I agree-to comply with all County Investigation Fee - "ordinances and Sta `laws relating to�building construction, - Total Fee LDMA Perm N R hereby auth ii 'repr ti s f this County to enter inspection purposes. z a . SEE REVERSE'FOR EXPLANATORY LANGUAGE t. Si ature of Apphcont or Agent Date - APPLICATION FOR BUILDING PERMIT 3� COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TQFILL IN BUILDING ADDRESS � ._JV` hereby affirm that I have a certificate of consent to self Insure, BUILDING ADDRESS 41 or a certificate of Workers' Compensation I *nc r certifie �a M copy th wYe7 Oil 'C.) ZIP �O Policy N� I '� LOCALITY Compan SIZE OF LOT NO OF BLDGS NOW ON LOT �❑ Certified copy is hereby furnish NEAREST CROSS S _ _ - _ _ ,�/� TRACT BLOCK bit LOT NO �r I�'Gertlfied copy isqplicant d with the'c y uilding,inspection de rt t n USE ZONE MAP NO Date ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS Cd"�P.r CERTIFICATE OF EXEMPTIO FROM WORKERS' okER COMPENSATION INSURANCE ��G ' WITHIN 1000 FT OF SCHOOLS YES NO (this section need not be completed if the permit Is for one hundred Af .� DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY dollars ($100)or'less.)I certify that in the performance of the work for which this permit ZIP is issued,-I shall not employ any person In any manner-so as to 5()16 �f— beCOme•subject to the Workers'Compensation Laws.'. ARCHITECT OR ENGINEER TEL NO STATISTICAL CLASSIFICATION APT 6NDO _ 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 t0 the Workers' A R D NO /�D SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith `n C� �� - r FRONT comply with such provisions or this permit shall be deemed revoked. AbDR / UC yD� PL LICENSED CONTRACTORS DECLARATION j 5 SIDE ,^- G - LIC CLASS/ PL ' I hereby affirm that I am licensed underprovisions of Chapter 9 "N v SEWER MAP CL CL (commencing with Section 7000)of Division 3 Of the Business and Sd F7j SIZEO NO OF ST0 S NO OF FAMILIES, NEW ❑ BK PG V �(J O Professions Cod a 'my I nse7is in full force�nd¢ffit License cc Numb I SIC CIaSS v� ( DE IPTION/OF _ RK / 'M ADD ❑ VALUATION d R Contractor to �' ` !j�/ l1-9 ALTER ❑ $ REPAIR ❑ y ❑ I.am exemp nil r Sec $ B.&PC for this reason DEMOL ❑ LDMA P/C# Date USE OF Ef9 G URM ❑ Signature A CA NTT(PROW-) TEL NO LDMA Perm# ❑,I,as owner,of the property, or my employees with wages as G(' -J64 ',I'S v Z s 'their sole compensation,`will do the work and the structure Is ADD v H!_L o s not intended or offered for sale (Section 7044, Business and U K �• FINAL DATE Q 1 Professions Code) 7: !S'�Q� WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL J ❑ I, as owner of the property, am exclusively contracting with OR A MIXTURE WANING A HAZARDOUS MATERIAL EQUAL.TO OR GREATER THAN THE i{ 1 ��-1+� Y g AMOUNTS SPECIFI THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY / 1 ITEM, f licensed contractors to construct the'project (Section:7044, Business and Professions Code) YES❑• NO T�fr A •-� 2.1-= :35- WILL WILL THE IN NDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING I I`t['Ei .F ® F OCCUPANT RE IRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH SlyJ v/G=/.7C---1- O• �<• {�cr •j CONSTRUCTION LENDING AGENCY consr AIR QunuTv NAGEMENT DISTRICT(SCAQMD)SEE PERMRTING'CHECKL ST FOR �/ hfw� �q r 4•i Gt�. Li3v •_I GUIDELINES - I hereby affirm that there is'a construction lending agency for YES N `'.HANhl 'ILLI a the performance of the work for which this permit is issued(Sec t 'INANE READ RDO MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING 3097,CIV C.) CHECKLIST STA MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N TITLE 2,CHAP 2 ECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS - / Lender's Name MATERIALS O AND FOR OBTAINING A PERMIT FROM THE SCAOMD I}ill i—}�}�}} _r i fin Lender's Address77 ' ONTlER OA ADEN 59871 i 1. 411111 e yy�} O o I certify that I have read this application and state under penalty . C of perjury that the abo a information Is correct.I agree to comply PC FEE PERMIT FEE N with all county ordi ce�' ed nd State laws relating to building a construction, and her urize representatives of this County ISSUANCE FEE m � Q O to enter upon the n property for ec p INVESTIGATION FEE TOTAL FEE s,�,,,e a Appy® oae 1 SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES' TEMPLE CITY � � # Q506 BUILDING PBRMITG ' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS '" ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0508020003 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: ON FILE SQ. FT STORIES TYPE 6213 KAUFFMAN AV STRUCTURE: 12 VN TEMP CA 917801746 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN _ 5385-016-026 THOMAS PAGE. 597 GRID: A2- LOCALITY: .TEMPLE CITY, C TENANT: EXIST BLDG USE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 08/02/05 JK 07/28/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI AL DATE FINAL BY: CODE: ULLRICH NORMAN L;MARCIA TRS (626) 298-4127- 3,460 6213 KAUFFMAN AV �J TEMP 917801746 FEES PAID DESCRIPTION OF WORK RE-ROOF REAR HOUSE PORTION OF BACK HOUSE ROOF WITH 40 YR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CLASS A COMPOSITION SHINGLES FLAT SECTION ROOF WITH 4 PLY APPLICANT: TEL. NO• J N DAVIS ROOFING - (626) 815-1279- AA BLDG PERMIT ISSUANCE 27.75 235 E. COLORADO #B AC STRONG MOTION RESID 3460.00 VAL 0.50 SPECIAL CONDITIONS: PASADENA, CA 91101 D2 PERMIT W/O EN-HC 3460.00 VAL 115.80 TOTAL FEES 144.05 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE J N DAVIS ROOFING (626) 815-1279- - 235 E COLORADO BLVD #202 LIC. NO + LOCATION AND SETBACKS PASADENA, CA 91101 572125C39 * + - 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 153H269 3 01 - NO. OF FAMILIES: DWELLING UNITS: APT/GOND: STAT CLASS: FLOOR SHEATHING NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- ' INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS * ADDITIONAL DATA ON FILE LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508 r