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Home My Public Portal About6230 KAUFFMAN AVE_Building__ APPLICATION FOR BUILDING .P-ERM•I•T:.,,. FOR APPLICANT TO FILL IN,(Print or type only) - BUILD!NG• 6"23 0 Kauffman' COUNTY OF LOS ANGELES, . ADDRESS ,, DEPARTMENT OF COUNTY ENGINEER CITY Temple City Z;1. 91780 BUILDING AND SAFETY DIVISION -- NO.OF BLDGS., BUILDING , SIZE OF LOT 43X152 NOW ON LOTS 2 • • ADDRESS ,�ci, I 'IlCG�I�• T A '6-713. ' BLOCK )VI T O LOCALITY �C�C NEAREST OWNER. Mr. John M. rPeot •No 3943 CROSS ST.ASS SSOR 'ADDRESS: 623Q Kauffman _ MAR BOOK _ - PAGE P RCEL /+s DISTRICT Tz- NO. GROUP TYPE FIRE RO SSED BY CITY Temple City ZIP 91780 CONST - ' •-� ARCHITECT OR _ TEL. '�"09 ' r' ENGINEER STATISTICAL CLASSIFICATION - EWER MAP ADDRESS - • + • - CL'ASS NDWELL;UNITS •'. _BK C ' Z a Yonstruc NO USE ZONE MAP - •• , ADDRESS' 1,317 .;. Las Tuna 'D NO, c>20,U,-�•- . O• —Zi SPECIAL San Galiriel LIC.-- CONDITIONS CITY CLASS B-1 - - ROAD DEPARTMENT APP'R'OVAL REQUIRE D- YES NO, CONSTRUCTION LENDER NAME AND-BRANCH - • BL G.SETBACK FROM - _ FR NT PROP.LI NE OF T• (STREET) , ADDRESS - - CITY NIG AY } YARD _ ITOTAL-SETBACK FROM TYPE OF EXISTING SQ, �*�T NO. OF 0, OF- CHECK FRONT PROP, LINE HIGHWAY WIDTH S'ZEG97 STORIES FAMILIES 1 'ONE: _ + _ a DES+C RIPT NpOF-WORK - _ NEW ❑ - ' O •� A`DD BLDG,SE•TBACK FROM ''i�•• V Add Famil Room Downs talrs' SIDE PROP.LINE OF •(STREET) . . c= Bedroom & _Barth ,Upstairs• LTER ❑ _•TOTA.L'SETBACK OM TYPE OF EXISTING O� HIGHWAY }1 YARD C� _ EPAIR❑ ' SIDE PROP. L-INE HIGHWAY WIDTH- Iy USE ISOF. T } NG BLDG: Dwell'in EXDEMOL ❑ z APPLICAN an a 1 - TEL'L87LC�7[� CORNER CUTOFF YES,E] NO, (PRINT),�j0ns truc t3 nnuoln�0. . BY, (SIGNATURE) 'IN-OPEN SPACEA :;, YES•❑,:. NO, S IN COASTA -PERMIT ZONE, •.Y LES NO 'I HEREBY ACKNOWLEDGE THAT I-HAVEREAD THIS'APPLICAT ION "-`��•' Com- �'� •`� Nom, c 7 - AND STATE THAT THE ABOVE IS CORRECT AND AGREE"TO COMPLY; ��a WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- �'�(�• .�� •_• fih' �,p�� v - , STRUC TION. I CERTIFY THAT IN DOING .THE WORK AUTHORIZED" HEREBY IWILL NOT EMPLOY ANY'' N F PERSOIN VIOLATION OTHE' f� - LA'BOR CODE OF THE•'S,Tf1TE 'OF CALIFORNIA IN RELATING TO ;,��j•, . tl'/ �•4r!f' -• -`ter.•', - WORKMEWS COMP N A '�a-N ditINS R C S da•. Constr.' oI" SIGNATURE O PERMITTEE° V - - • ' ADDRESS 131 •E. Las• Tunas -Dr: - �.;5- ''� ' - � y`"`Gi_ `�.rio T'-.DoN6. _, y S , - 1'p FIN�AL� BY , '-I - San Gabriel. TEL287-97.4 DATE I ^ �� C I T Y -N O. ddd VVV "P. t t`, '( �+ �•' PMTf MA KE,CHECKS PAYABLE`7'O: - FEE'+',y` j l ! -�' Fee �I :%,ID• HARVEY T•.' BFZANDT,:COUNTY ENGINEER u 6• �� 7c PLAN"-CHECK-VALID :cic M'O, CASH,'• '- PERMIT VALIDA O Mo' CASH ' 'z '6 5.7' 1:696'- 7 76A638 0803 5 _ _ 9 . O t-,O t DIVISION OF BUIMING AND SAFETY • ' = + Department of County Engineer County of Los Angeles wm. J. FOX, COUNTY ENGINEER APPLICATION A=0111111111110 ---- FOR APPLIC TO FILL IN ADDRESSBUILDING /yJQ BUILDING �� LOCALITY 77 �- ADDRESS ` NEAREST LOCALITY C� W A6j-74r CROSS ST. DISTRI&THIO. - PLAN'Cit OR Rec. No. PERMIT NO. CROSS ST. OWNER sc � e A' RECE BY ATE OF APP ATE ISSUED ADDRESS (9/AIL7 O `/ S-7 S /' USE ZONE O. OF E RO FIRE.•ZONE CI PPLANS ARCHITECT OR TEL. - - ZONING ._ �f/lam' __ _,._ DATED ENGINEER NO. APPROVED By- BUILDING Y- P ADDRESS - SETBACK LINE: �O 'r� v / / T APPROVED DATE CONTRACTOR^ K� NC N Bre ' /'.�" HOUSE NUMBERING ADDRESS I Q L.♦ ze N S• '`/� LEGAL MAP NUMBER - -✓ NO. ASSIGNED BYE -DESCRIPT N LOT NO. BLOCK t I "�� DATE I CORRMTIONS I INSPECTOR TRAC NO. OF SIZE OF LOT d I NOW ON LOTS 0 �`�"/ ` 3 L USE OF _ NO. OF I •1 O EXISTING BLDG. FAMILIES DESCRIPTION OF WORK NEW ALTERATION ADDITION �,,{/� r ' REPAIR DEMOLITION I /,ate/1Vt/,J ,iy1�G/ICjl�i rJ,,/ll/d,� \ SIZE ROOMS ORIES I �j/,,�4I jV G �JQ/,rT /fes WALL ROOF CIXOVERING I COVERIN e�-l•-a m FV,5 .v AW0,09'r I D-T' USE OF ST CTURE +�u G✓l/Z1 A APPROVALS INSPECTOR' SIGNATURE DATE FOUNDATION: LOCATION LEDGE THAT 1 HAVE READ THIS W FORMS, MATERIALS 1 HEREBY ACKNO PLICATION AND STATE THAT THE-INFORMATION GIVEN IS IS FRAME: FIRE STOPS, BRACING, BOLTS f CORRECT. •: _ 1 AGREE TO'COM�LY WITH ALL COUNTY ORDINANC ; AND STATE LAWS REGULATING BUILDING CONSTRUCTIONES. FURNACE: LOCATION, I GAS VENT, DUCTS .SIGNATURE O LATH, INT. -7 PERMITT ADDRE88 Q •° LATH, EXT. AUTHORIZED AGT. PLASTER, INT. -PLASTER, EXT. P.FEE.$ s��• HOUSE NUMBER COR- RECT AND POSTED ev, 416/ VALUATION FEE FINALE 7GA638A DBS 9 8-88 t. WORKERS'COMPENSATION DECLARATION � ` I hereby affirm that I have a certificate of consent to self A p p L I CATION 'FOR BUILDING .P E RM I T insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof.(Sec. 3800, Lab. C ); STi�TE 1 �,�, . COUNTY OF LOS ANGELES � BUILDING AND SAF TY - Policy No. Company r 1:1 • Certified copy,is hereby furnished-'4"' 06Ax7 Rwx-la - FOR APPLICANT TO Flll IN BUILDING ADDRESS (/ aCertified copy is filed with the county building inspec- , " BUILDING " ti/!on department. / ADDRESS' (J Date_l�� Z2- 7plicant CITY — ZIP LOCALITY CERTIFICATE OF EXEMPTION.FROM WORKERS' N .'OF BLDGS NEAREST COMPENSATION INSURANCE SIZE O5PLOT NOW ON LOT CROSS ST (This section-need not be completed of the permit is for oneASSESSOR ; hundred,dollars ($100)or less.) TRACT _ BLOCK LOT'NO MAP BOOK PAGE PARCEL TEL USE`ZONE MAP OWNER C—tTl" ' NO I certify thcit'.in the performance'of the'work for which this l NO. permit,is issued, I shall,not employ any person in any manner �1 �I SPEC so as to become subject to the Workers'Compensationilaws. ADDRESS + OAcA3 C7 (JF AAJ _ CONDITIONS C] CITY �L/%O�LC� �l T -zip U Date Applicant ' ARCHITECT OR TEL NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROC ED BY O 'Exemption, you should become subject to the Workers' CONSj. 3NE U -Compensation provisions of the Labor Code, you must-forth- (� with comply.with such provisions or this permit'shall be ADDRESS ,/ TEL STATISTICAL C SS FICATION APT. CON U)deemed revoked. CONTRACTO C i NO. Z LICENSED CONTRACTORS DECLARATION . r LIC' CLASS NO. �� DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE G NO (/ (commencing with Section 7000)of Division 3 of the Business and _ LIC SEWER MAP ' Professions Code, and my•license,is in full force and effect. CITY (]� CLASS iv BK _ PG VALIDATION SQ FT. NO.OF NO OF CHECK License Number /`7��1n% '/ Lic.Class C� - 'SIZE STORIES FAMILIES ONE NEW I VALUATION ContractoDate ^ d / S DESCRIPTION OF WORK ADD �w� ;2S 416 Ay�%�C�7L/(J /�T QI am exempt under Sec. C ALTER O , # 0 0 0,0 0; B:BP.C. for'this reason /U REPAIR 0 $ 59.25 7244 Date: USE OF DEMOL EXISTING BLDG. a•0 e 5 9',2.5iO Signature APPLICANT TEL- -_ t+FINAL I 2 3 8 7 OWNER-BUILDER DECLARATION PRINT NO."` DATE -� I - 1 hereby affirm that I am exempt from the Contractor's License _ Low-for the following reason.(Section 7031.5, Business and ADDRESS FINAL Professions Code): r By BUILDING I, as owner of the'property, or my employees with ADDRESS wages as their-sole compensation,will do the work and LOCALITY the structure is not intended,or offered for sale(Section_, 7044, Business and Professions Code).• MOVING TEL 4. �• I; as owner of the property, am exclusively contracting CONTRACTOR NO •• with.licensed contractors,to construct the project (Sec- ADDRESS' • tion 7044, Business and Professions Code). - ' REQUIRED TOTAL SETBACK FROM EMS -CONSTRUCTION LENDING AGENCY - SET BACK YARD HWY PROP.'LINE WIDTH - I hereby affirm that there is a construction lending agency for. FRONT the performance of the work.,fo_r which this permit is issued P L (Sec. 3097, Civ. C.). SIDE P.L. Lender',s Name P.C. Fee$ Permit Fee IS CDMA Ref. # Lender's Address ' I certify that I have read this.application and state that the Issuance Fee , (/ CDMA P/C# o above information is correct. I agree to comply with all County Investigation Fee q ordinances and State laws relating to building construction, Total Fee =t R and hereby authorize representatives of this County to enter r CDMA Perm. # upon the above-mentioned pr perty for inspection purposes. ' 2 3 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature ofAp ca t or Agent Dote WORKERS' COMPENSATION DECLARATION hereby affirm that I havecertificate of consent to self APPLICATION FOR R U I L D I N G PERMIT insure, or a certificate of Workers' Compensation Ihsurance, or a certified copy thereof (Sec 3800,'Lob' C ) - COUNTY OF LOSANGELES, BUILDING-AND"SAFETY Policy No.' Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN' BUILDING ; ADDRESS ❑ Certified copy is filed'wrth the count building'inspec- BUILDING tion department: oo ADDRESS Av ^� 27 Date/ .1 S' Apic t CITY L / ZIP LOCALIT lee CERTIFICATE OF EXE ROM WORKERS' NO OF,BLDGS.• NEARESTCOMPENSATION.INSURANCE' SIZE OF LOT NOW ON LOT CROSS Si.T (This section need not be completed if.the permit is for one TRACT BLOCK LOT NO ASSESSOR hundred dollars ($100)or less.) MAP BOOK PAGE PARCEL TEL. USE.ZONE MAP OWNER ,Git NO• y I certify that in the•performance of the`work for which this "ti' NO S3, .", permit is issued, I shall not employ any person in any mannerZ SPECIAL ' so as to become sublect to the Workers'Compensation Laws. - ADDRESS v /-o" CONDITIONS 01 Date CITY C// ZIP Applicant NOTICE TO APPLICANT- If, after making this Certificate "oARCHITECT OR TELf DISTRICT -GROUP I TYPE FIRE CESSED BY Exemption, you should become, subject to the Workers' ENGINEER NO CONST•. ZO, NE Compensation provisions of the Labor Code,,you must forth- ADDRESS �•UG �_3 - W with comply with such provisions or this permit shall-'be. r • TEL a. deemed revoked. // STATISTICAL CLASSIFICATION - APT CONDO. N CONTRACTOR /Np NO. Z- LICENSED CONTRACTORS DECLARATION- LIC CLASS NO DWELL UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS �a .1[t,✓/�•leY.t)14�2. NO (cornmenang with Section 7000)of Division 3 of.the Business and . LIC SEWER MAP Professions Code, and my license is iri full force and effect. ITY �i J'r/�� -� CLASS VALIDATION ' SQ FT INC.OF NO OF CHECK BK PG License Number Lic.Class SIZE STORIES FAMILIES ONE O VALUATION Contractor_:_ Date DESCRIPTION OF WORK NEW "s ��/I,a3 - ADD ❑ /(/v ❑ I am exempt under Sec. ' �� ALTER ❑ i B.&P.C. for this reason �' '/C.��. REPAIR ❑ $ Date; USE OF EXISTING BLDG DEMOL Signature _ APPLICANT- TEL. ' FINAL OWNER-BUILDER DECLARATION- (PRINT). NO. DATE I hereby affirm that I am exemptJrom the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS FIN Professions Code): PRESENT B ❑ I, as owner of the property, or mBUILDING 'y employees with ADDRESS wages as their solecompensation,will do the work and ' the structure is not intended or•offered for sale(Section LOCALITY • 7044; Business and Professions Code). -•- MOVING TEL. ❑ I, as owner of the property, am exclusively contracting CONTRACTOR NO: " with licensed contractors to'construct-the project (Sec- ADDRESS tion 7044, Business and.Pro'fessions Code). REQUIRED -TOTAL SETBACK �' t v ' CONSTRUCTION LENDING AGENCY EInvestigotion HWY PROP'L'INE WIDTH s' 2,0•7—8'$, I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ..•C.).• } Lender's Name Lender's Address $ Permit Fee LDMA Ref. N I certify that I have read this application and state that theIssuance Fee Jam` LDMA P/C# o above information is correct. I agree to comply with all County o ordinances and State laws relating to building construction, - , �•.and hereb uthonze repr sentatives of this County to enterTotal Fee �✓ �. LDMA Perm.`q upon t v -mentio property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE S1noture of Applicant or 7gent Date