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HomeMy Public PortalAbout9202 LEMON AVE_Building__ 76A838A CE11803 3-88A•PPLICATION FOR BUILDIN PERMI - COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDREss E BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENGINEER NEAREST _ COLEMAN W. JENKINS, SUP T OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN "DISTRICT NO GROUP_ TYPE PROCESSED BY _ (Print ort a only)- l d -' CONST. � BUILDING STATISTICAL CLASSIFICATION SEWER M'AAPP/� ADDRESS 9202 -Lemon,. Temple City- CLASS NO.=o;_7 DWELL-,UNITS © - BKS PG LOT NO �� BLOCK USE ZONE MAP NO TRACT _ 3 SPECIA ' NO.OF BLDGS. CONDITIONS' SIZE OF LOT NOW ON LOT USE OF chicken shed EXISTING BLDG. BLDG.SETBACK FROM , OWNER Ray G. Fortner NOL 286-3125 FRONT PROP.LINE OF -(STREET) TYPE OF EXISTING SETBACK• HIGHWAY' + YARD TOTAL ADDRESS 9519 , Las Tunas HIGHWAY WIDTH FROM C.L. CITY Temple City, Calif . - I.., - - - I + - - ABLDG.SETBACK FROM ARCHITECT OR TEL. SIDE PROP:LINE OF (STREET) ENGINEER NO. - TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL HIGHWAY WIDTH FROM C.L. ADDRESS a' TE CONTRACTORMead H. reckNOL 796-4051 +LIC > d ADDRESS 1.35 N. Daisy NO13370C- r",- CORNER CUTOFF YES ❑ NO ❑ U CITY Pasadena, qa.LirCL SS SEE REVERSE SIDE FOR SPECIAL APPROVALS DESCRIPTION OF WORK_ W a z NEW ADD ALTER REPAIR DEMOLIS _ SQ FT NO. OF NO.-OF -SIZE STORIES FAMILIES _ USE,OF STRUCTURE , DEMOLITION SIGNATURE OF APPLICANT - VALUATION a VALUATION $ APPROVALS DATE INSPECTOR'S SIGNATURE P.0 PMT, FOUNDATION: LOCATION FEE SFEE $ .0 FORMS, MATERIALS FRAME: FIRE STOPS, _ 1 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 CODE OF THE STATE OF CALIFORNIA RELAT. LATH, INT - ING TO WORKMEN S MPENSATION INSU NCE ' f LATH, EXT. SIGNATURE O HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS 35 N. Daisy Avenue FINAL , •JOHN'F .LEWIS. PRINCIPAL STRUCTURAL ENGINEER PLAN CHECK VALIDATION CK M 0 CASH _ PERMIT VALIDATION CK MO CASH I �('n'9 7 5 dw MAY 5 �� ... -'-APPLICATION-FOR BUILDING 'PERMIT .FOR PRLANT TO FILL IN (Print o�tvae only) ` BUILDING COUNTY OF LOS ANGELES ADDRESS 2,69 '40'S DEPARTMENT' OF COUNTY ENGINEER CITY Jam' ZIP Q BUILDING AND SAFETY DIVISION NO OF BLDGS BUILDING C/.2�Q L oa'� SIZ4_ NOW ON LOT ?/ ADDRESS yy� _ T BLOCK LOT N.2; LOCALITY ,"` c / Ty TEL17 7 91716 AoNEAREST _yr IV / 7-A OWNER / - CROSS ST - ASSESSOR ADDRESS_ _ _ MAP BOOK _ PAGE JPARCEL - DISTRICT GROUP TYPE FIRE PROCESSED BY .SOV _ '_ CONST '[�� ZONE CITY ZIP ..i---- ARCHITECT OR TEL ENGINEER- NO _ STATISTICAL-CLASSIFICATION SEWER MAP ADDRESS _ -y, _ 4.�_ CLASS NO. DWELL UNITS BK PG TEL.L. _`y ti ;\ . „� NO e- USE ZONE MAP CONTRACTOR �O 2 i N O ADDRESS' - -'�x3�N0 `R re - '� CONDITIONSSPECIAL LIC CITY', r- _.�,. •V o1. .�`wsz; ..'CLASS ROAD DEPARTMENT APPROVAL REQUIRED YESE], ` NO ❑ CONSTRUCTION LENDER t � �� NAME,AND,BRANCH - --„_t �(/�__�- BLDG SETBACK FROM ``� - I << - FRONTPROP LINEOF Gr✓`��- (STREET) 0 -ADDRESS`•CITY TOTAL SETBACK FROM TYPE OF{ EXISTING 'V HIGHWAY + YARD SQ`-FNO OF - NO. OF * CHECK _ _ FRONT PROP LINE HIGHWAYI WIDTH SIZE 5'LZ STORIES FAMILIES ONE - _ _ _ _ _ O + j !o = lO L� 6p DESCRIPTION OF WORK NEW ❑ a BLDG SETBACK FROM, G/v c `y/I �(STREET) Z - _ o6?4wJ*vl -AL. ADD SIDE PROP. LINE OF _ ALTER ❑ HIGHWAY + YARD = TOTAL SETBACK FROM -TYPE OF EXISTING REPAIR❑ SIDE PROP LINE HIGHWAY WIDTH USE OF + LO = O EXISTING BLDG, DEMOL ❑ APPLICANT TEL CORNER CUTOFF YES ❑ NO ❑ (PRINT) . - NO. BY (SIGNATURE) IN OPEN SPACE_ • _ - YES ❑ - NO ❑ IN COASTAL ZONE _ YES ❑ NO ❑ VALUATION s' �" - _ CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNO LEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL- _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND _LAWS REGULATING BUILDING CON- , STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DAT ) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO , WORKMEN;S,COMPENSATION INSURANCE. _ - SIGNATURE OF t PERMITTEE t ADDRESS FINAL BY TEL. DATE J3� CITY NO, 11,1 h6 C.1IL-L P,1}ABLL- 10. FEE FEE HARVEY T. BRANDT, COUNTY ENGINEER j-O 'PLAN CHECK VALIDA'T'ION CK M O CASH � PERMI ALIDATION H CK M O CAS - - r 2 8 5 673 tUG 22 1 D 2 8 .50A T, #�rr. 76 g638A-CE#803 12/72 WORKERS'COMPENSATION DECLARATION y \1 re rr>rthat I havecertificate of consent to self A P P L I CATION � F O R BUILDING PERMIT insure, or a certificate of Workers' Compensgtion Insurance, or a certified copy thereof (Sec 3800, ttLa--bLLC )' 'COUNTY OF LOS ANGELES BUILDING•AND SAFETY Policy No- 'Company gil`q �(� ❑ Certified copy is hereby furnished-- FOR APPLICANT TO FILL IN BUILDING ADDRESS r, ❑ Certified copy is filed with the county building-inspec- BUILDING �� D hon department ADDRESS 7 /� /� Date Applicant CITY G ZIP Ji 7O O LOCALITY CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS - NEAREST ; COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT CROSS ST (This section need'not be completed of the permit is for one - ASSESSORa hundred dollars ($100)or less ) - TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL 'TEL USE ON MAP I certify that in the performance of the work for which this OWNER ANO��y (1/'he NO NO permit is issued,I shall not employ any person in any manner Q/ ,, SPECIAL • so as to become subject to the Workers'Compensation Laws ADDRESS E L_cin O h• (I'� CONDITIONS- 0 CITY V4,01ealt ZIP q,(7JV V Date Applicant NOTICE TO APPLICANT If, after makirig this Certificate of ARCHITECT OR TEL DISTRICT UP TYPE FIRE PRO SSED BY ENGINEER NO '\ CO Z (— Exemption, you should become subject to the Woikers' - U � j� - V • Compensation provisions of the Labor Code, you must forth- ADDRESS V a with comply with such ,provisions or this'permit shall be /� ^ TEL / STATISTICAL CIASSIEICAT ON APT rE5NDO fn deemed revoked CONTRACTOR 10 H I � h NO t �(p 7�3 !9/_ Z LICENSED CONTRACTORS DECLARATION , n A u LIC CLASS NO. DWELL. UNITS • I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO EWER MAP -(commencing with Section 7000)of Division 3 of the Business and pLIC Professions:Code, and my`license is in full force and-effect:- ' : _-`n CITY- Leh ,- , �4" -71Tc�0 CLASS = _-- _____> s ____ _ __ _ VALIDATION G G SQ FT NO.OF NO OF CHECK BK p(' - License Number �a 3{7a 3 Lic Class e '3 Sr SIZE STORIES FAMILIES ONE �j n ,�+ �i VALUATION Confractor!ll' / '4 ero'9 Date �a DESCRIPTION OF WORK QNh i+a� Ca NEW ❑ �' ADD ❑ : /ova ❑ I am exempt under Sec. / - Ad t �� O E]ALTER B 8P C for this reasonyx 4 � #OJsREPAIR E] : ; D to USE OF DEMOL ❑ 9.1 6.4 A EXISTING BLDG Signature APPLICANT TEL FINAL # • • o 0 o s1 OWNER-BUILDER DE ATION PRINT NO DATE I hereby affirm that I am exempt from the Contractor's License J o}0 4.0 5 0 Law for the following reason (Section 7031 5, Business and ADDRESS FINAL "Professions Code) " , - By: o,o a 4 0 5 0' • ❑ BUILDING I, as-owner of the property, or my employees with ADDRESS 1•(L_$8 wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code) MOVING TEL - ❑ I,*as owner of the property, am exclusively contracting' CONTRACTOR NO with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) REQUIRED ITOTAL SETBACK FROM CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT the performance'of the work for which this permit is issued P L (Sec 3097, Civ C ) „ SIDE PL Lender's Name ` m - - LDMA Ref'# Lender's Address PC Fee$ Perms fee I certify that I have read this application,and state that the Issuance Fee LDMA P/C# oil, a above information is correct I agree to comply with all County Investigation Fee 0 ordinances and State jaws relating to building construction, g4�9 a and hereby authorize representatives of this County to enter Total Fee LDMA Perm # - upon the abo e-mentioned pr erty for inspection qurpo es SEE REVERSE FOR EXPLANATORY LANGUAGE` Signature of Apphca t r ent e