Loading...
HomeMy Public PortalAbout9532 KENNERLY ST_Building__ TEMPLE CITY r^' 76A638A CE#803 3-68 �I I r APPLICATION FOR BUILDING PERMIT U COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMB]E, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING NEAREST CROSS ST. DISTRICT NO. GROU TYPE PROC 6 BY FOR APPLICANT TO FILL IN D CONST. (Print or type only) � t BUILDING STATISTICAL C S IFICATION SEWER MAP ADDRESS 9532 Kenner 1 St . T C . CLASS NO. DWELL.UNITS BK PG LOT NO. BLOCK USE ZONE NOP ©/ TRACT D V 1 CONDIT ONS NO.OF BLDGS. SIZE OF LOT NOW ON LOT USE OF EXISTING BLDG. BLDG.SETBACK FROM TELFRONT PROP.LINE OF (STREET). OWNER H . P Wan ama ke leo. -.5268 TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL ADDRESS 9532 Ke n n e rl St . IGHWAY WIDTH FROM C.L. - CITYCity ARCHITECT.OR TEL. BLDG.SET KFROM (STREET) SIDE PROP.LI ENGINEER NO. TYPE OF EXISTING SETB HIGHWAY + YARD = TOTAL ADDRESS HIGHWAY WIDTH FROM C.L. CONTRACTOR H . L Randol Co4oL'2888-4040 ADDRESS 5 2 9 E . Valle NO 186086 CORNER CUTOFF YES ❑ ❑ cCD.;I LIC. CD CITY cLAss SEE REVERSE SIDE F R SPECIAL APPROVAL o� DESCRIPTION OF WORK U L-I O_ � C/7 Z NEW ADD ALTER REPAIR XX DEMOLISH SQ. FT. NO. OF NO. OF A�fn 5 SIZE STORIES FAMILIES USE OF STRUCTURE re-roof Dwlq with F/G Compo SIGNATURE OF APPLICANT VALUATION $ lJ G 00 . 00 APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT, FOUNDATION: LOCATION FEE $ FEE $ FORMS, MATERIALS 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 CODES OF THE STATE,OF CALIFORNIA,RELAT- LATH, INT. ING TO WORKMEN'S COMPS ATION-INSURANCE. /� /r � LATH, EXT. SIGNATURE�OF �`- HOUSE NUMBER COR- /J PERMITTEE' RECT AND POSTED ADDRESS QEr Val- loy Blvd .—�Sa" �INAL ������0 �.� t��,�✓_. _ JOHN F. LEWIS. PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION CK. M.O. CASH = PERMIT VALIDATION CK. M.O. CASH APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FORSLPPLICANT TO FILL IN BUILDING ADD_-9ESS - I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRESS 5J or a certificate of Workers' Compensation Insurance,or a Certified C//- copy thereof(Sec.3800,La ) LOCALITY 1 r'T� CIT 7 Policy IN �� •Company SIZE O1-1 NO.OF BLDGS.NOW ONY� Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. USE ZONE MAP NO. department. Datel - Jot 1 Applican ��_ ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' * �a COMPENSATION INSURANCE a vcGt(p WITHIN 1000 FT.OF SCHOOL? YES NO This section need not be completed if the permit is for one hundred ADD ss ( P P 2� DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) J I certify that in the performance of the work for which this permit CIl: 7 J' is issued, I shall not employ any person in any manner so as to ARCHITECT ENGINEER � �� p-31 � � � T q- ZIP �. become subject to the Workers'Compensation Laws. TEL 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' CO RA 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. yppRESS uG ?00� P L LICENSED CONTRACTORS DECLARATION J3L� SIDE CI YOlLe LIC.CLASSC-3 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 OF STORIES NO.OF FAMILIES ons Code,and /l'icen is in full force and eff t. - NEW ❑ BK PG d Professi License Number V0 Lic. CIS DESCRIPTION OF RK ADD ❑ VALUATION-1'1' 55o , OV d� Contracto 11UP Date i ALTER ❑ REPAIR O El am exempt under Sec. $111 V BAP.C.for this reason �3rJ J- DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ IL Signature APPLICANT(PRINT) TEL/&,3` LDMA Perm# Z El 1, as owner of the property, or my employees with wages as L LZ their sole compensation, will do the work and the structure is ADDRESS (� J �y /y//j 0 01 �J[A ,32/ cV v//�'�1 J��3 FINAL DATE ~ not intended or offered for sale (Section 7044, Business and �] Q a Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ACCT°a OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 / I J (� ��6Q ❑ 1, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY V 1 licensed contractors to construct the project (Section 7044, Yes❑ No❑ 1 ITEMS Business and Professions Code.) 1 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH TOTAL 158 . 835 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. CHECK 1'MI C(y p I hereby affirm that there is a construction lending agency for °�c VES❑ NO❑ CHANGE j'C a the performance of the work for which this permit Is Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING CHANGE '°00 ° 3097,Civ.C. N ) 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 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. oLender's Address OWNER OR AGENT 0000-0001 10/12/95 FCI 49 °a o I certify that I have read this application and state under penalty 2796 7 °. O of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE N with all county ordinances and State laws relating to building m construction, and hereby authorize representatives of this County ISSUANCE FEE to enterer o �mentioned property for inspection purpos s5 /�/1, INVESTIGATION FEE TOTAL FE d [�' ^ �use of Aowioam m AW,t —�'T DateILL ! Q J s SEE REVERSE FOR EXPLANATORY LANGUAGE APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDILIG ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUIL GAD KESS /���,/ Z GIS or a certificate of Workers' Compensation Insurance,or a certified copy thereof(Sec.3800,Lab. Lab.C.) t_ CI . z 1/7J-6LOCALI Policy No.73d 14Company J�� I �� SIZE OF LOT NO.OF BLDGS.NOW ON LOT M ❑ Certified copy is hereby furnished. Z_ NEAREST CROSS ST. Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. �i dep tmen. USE ZONE MAP NO. __T_ / `� ASSESSOR MAP BOOK PAGE PARCEL Date Applicant ���+1 ®�/_� SPECIAL CONDITIONS /f� n ®/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER YI �` TEL NO. (f f� COMPENSATION INSURANCE // ! WITHIN 1000 FT.OF SCHOOL? YES NO This section need not be completed if the permit is for one hundred ADDRESS ( P P '9� DISTRICT GROUP TYPE CONST. FIRE ZONE PRO SED dollars ($100)or less.) I certify that in the performance of the work for which this permit CITY C_ zIP 7 J 7f6 Qa 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 CLASSIFICATION APT NDO Date Applicant ADDRESS CLASS NO. CP2/ 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 jj � TEL NO. q SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith LG !ice/ '�!Z FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. P L LICENSED CONTRACTORS DECLARATION /'C•u�SL� �1E9 SIDE CIT � � LIC.CL S P L I hereby affirm that I am licensed underprovisions of Chapter 9 J SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZ5 NO.OF ST RIES NO.OF FAMILIES Professions Code,and m licenses in full force and effect. NEW El BK PG a License Number Lic.ClaJss/` � _ DESCRIPTION OF WORK _ ADD ❑ VALUATION ` , 0 Contractor Date N' 0 AVE�" �CJU Ld ALTER ❑ $ ROW o ` ® REPAIR0 El am exempt under Sec. $ V B.&P.C.for this reason [�f� j �7��Qn �j DEMOL ❑ LDMA P/C# ° Q Date: L44k1, —1 US OF EAt�X1 IISTING BLr LDG.IIlLy URM ❑ a` Signature APP ANT(PRINT TEL NO. LDMA Perm# Z 7komEl 1, as owner of the property, or my employees with wages as2 O their sole compensation, will do the work and the structure is AD KESS -ter 'FINAL DATE ~ AC-PT not intended or offered for sale (Section 7044, Business and � - �.� ;";;,;. Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL n e r ❑ 1, as owner of the property, am exclusive) contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE Q ^i;0 f� P P Y• Y g AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY 5 licensed contractors to construct the project (Section 7044, _ _ VES❑. NO❑ 1.M`lb Business and Professions Code.) _ WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING "�3 ': 907 T � 0 s OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ! i'S?.. _ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAQMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ NO❑ _ �+ N the performance of the work for which this permit is issued(Sec. CHANGE .00 T I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING • - 3097, Civ.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, N TITLE 2,CHAPTER 220 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS ' Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD. n r C1 Lender's Address if fl t 1 != -ti?1 �' r O OWNER OR AGENT _ o I certify that I have read this application and state under penalty O of perjury that the above information is correct.I agree t0 comply P.C.FEE PERMIT FEE A � '=-F'J_ - M o with all county ordinances and State laws relating to building construction, and hereby authorize representatives of this County ISSUANCE FEE to en e abo enti ed property for inspection purpose INVESTIGATION FEE TOTAL FEE a r Sgn PPlicant or Age o1il�`a� ` SEE REVERSE FOR EXPLANATORY LANGUAGE