HomeMy Public PortalAbout5456 LOMA AVE_Building__ 76A6�;" CE #80'3_1/71
APPLICATION; FOR, BUILDING PERMI
COUNTY OF,LOS ,ANGELES, ASSESSOR i
DEPARTMENT OF•.COUNTY ENGINEER MAP BOOK PAGE PARCEL
V BUILDING AND, SAFETY DIVISION BUILDING
ADDRESS
COLEMAN W: JENKINS, SUPT OF BUILDING L'OCALITY•- +
FOR-APPLICANT TO FILL IN NEAREST'
` CROSS ST
(Print or'tyge onl•
_ - DIST�R�LCT NO GR TYPE P O D BY•
BUILDING y� /� D ,,• CONST. ^
ADDRESS, r(j !�/• / 1_• I- '
STATISTICAL' CLASSIFICATION^ - 5 WE MAP z
LOT NO - BLOCK '
CLASS NO, DWELL UNITS y BK PCi�
,,TRACT USE ZONE MAP a
NO.OF BLDGS NO. _
SIZE OF LOT r NOW;ON LOT - SPECIAL ,
USE OF 'i - CONDITIONS
'EXISTING, LDG ' ?q
TEL
OWNER •-''NO' BLDG SETBACK FROM �' 's' .. ••
ADORE FRONTPROP LINEOF (STREET)
TYPE OF EXISTING -SETBACK HIGHWAY + YARD ' = TOTAL
CITY' , HIGHWAY WIDTHS FROM-Cil_ -
ARCHITECT OR'. TEL_,
ENGINEER NO. BLOG,SETBACK'FR '
ADDRESS '
' SIDE"PROP.LINE'OF ! (STREET) '
. - TEL .TYPE-OF EXISTING SETBACK HIGH } YARD-'. _ TOTAL' �O
'CONTRACTOR r NO. HIGHWAY WIDTH FROM C.L - U
S LIC, t ; 4>
ADDRESS NO .F — O
LIC - F—
CITY- CLASS CORNER CUTOFF •'YES ❑ NO•❑ ` W
CONSTRUCTION LENDER
NAME AND BRANCH' ' SEE REVERSEeOE FOR SPEC L•AP ROVAL.S z
ADDRESS - "`
d�
SQ FT, NO OF, NO. OF NEW ❑ -
SIZE TORIES FAMILIES
USE OF r. '' "ADD ❑ � L.
STRUCTURE
ALTER-
SIGNATURE OF REPAIR
r
APPLICANT DEMOL
VALUATION ,p`APPROVALS ' DATE -'iNSPE OR's sl URE
P C' 1' " PMT FOUNDATION: LOCATION
r FEE $,'„ ;'+' + ' FEE S' FOR
MS;'MATERIAL'S
FRAME: FIRE STOPS, A
,I HERE SY,A'CKNOW,L'EDGE THAT;i HA,VE'READ',THIS"APPLIL
CATION BRACING BOTS
AND STATE THAT THE ABOVE,IS CORRECT'AND„'AGREE TO COMPLY
FURNACE- LOCATION,
WITH' ALL ORDINANCES AND LAWS REGULATING' BUILDING CON- ',-,'GAS VENT.,-DUCTS '
•STRUCT16N I CERTIFY THAT- IN DOING THE` WORK AUTHORIZED
HEREBY I WILL NOT EMPLOY ANY PERSgN-IN VIOLATION OF THE, LA T,H`INT.
LABOR CODE OF T TATE,OF 'CAL•IFORNIA IN RELATING T0:
WORKMEN'S COMPE SATI N•INSURA E ,LATH, EXT.-
' •• ` r
SIGNATURE OF ' �- HOUSE NUMBER COR-
PERMITTEE RECT^AND-POSTED
ADDRESS -rr ,
FINAL•
JOHN F,LEWIS PRIN PAL S C RAL ENGINEER
PLAN CHECK VALIDATION ''CK M o c sH' _ PERMIT VALID I _CK M 0 CASH
19,
V b' ,�
76A63BA CE 'IB03 6-62=A'PPLIC_�►T1.ON-FOR BUItDiNG .P'ERii/IIT.
>,
COUNTY OF LOS',-ANGELES= ui
BLo
�NG'
DEPARTMENT OF�'COUNTY •ENGINELI ADDRESS '}
BUILDING'A'ND-SAFET•Y'•'DIVISION a LOCALITr
JOHN,A: E:COUNTYAENGINEER �t) NEAREST''
t W,ILLIAM,A• JEN_SEN, SUPKT,'OF BUILDING,,- CROSS ST'
si _ - � DISTRICT O GROUP. TYPE PR - SED BY" -
FOR',APPLICANT, TO�'FII.L IN` ' "� ,� coNsr -
BUILDING i,J 'STATISTICAL CLASSIFiCATI ONSEVYER.MAP
ADDRESS e' - • CLASS NO DWELL'<,UNITS-
LOT NO BLOCK } •WATER a� ' - r':'
_ ,CERTIFICATE NOTREQUIRED�. RECEIVED- .
.TRACT , '4.` ,� rr MAP' �� _ HIGHWAY
t _ - •NO bF BLDGS' - `NO• p-(CIRCLE>, STATE MAJOR SECOND,
SIZE OF LOT 1 _ d NO_W„ON LOT USE ZO, E' SPECIAL
USE OFCONDITIONS '
EXISTING BLDG
OWNER_• - 'NO ' ° -BUIL' • '
,)SET ACK'INGz YARD .'HWN� REET•NAME`.-' •',aWj0 H
ADDRESS cdcQNT _
TEL' - ,� .-P, L'
`NO - TSIDEI - _ - -
'CONTRALTO- D�4 , . 0
ADDRESS
DESCRIPTION OF',WORg ,� �
r4 _ W
(, ADD ' .•AL'TER = REPAIR- - DEMOLISH' • ,Qr r -- - _ i�. '' NE
'SO FT ,A NO OF.” NO OF ' x •. ` Z
:SIZE', W •tSTORIES_ t' FAMILIES
USE OF
STRUCTURE
3SIGNATURE 0 '• ' '. t4, "�#� - 'i^ "
APPLICANT -- '•� ' r "h•;. •' ,.r w ' - ,
VALUF,TION�$" - �I°� �,� j' k
yps 'APPROVALS• ATE' +INSPE;.- R'S•SIGNATURE r
p`C s t P[PMT ; °FOUNDATION -,LOCATION. .✓ /Z,
.FEE -FEE.$ -FORMS„MATERIALS
_ �GRAME FIRE"STOPS,
` I-HEREBYACKNOWLEDGE THAT,.I HAVE,READ THIS� N
APPLICATIO ' 4' BRACING ,BOLTS ( ~^' -_
"'AND STATE'THAT:-THE,ABOVE IS.CORRECT'AND AGREE TO'COMPLY- !FURNACE :LOCATION
t -
n'� WITH ALL!, COUNTY,`O DI NANCES AND STATE�LAWS REGULATING ,I GASVENT, DUCTS' ,-
BUILDING CONSTRUCT ON I CERTIFY THAT,IN DOING THE WORK—
• AUTHORIZED HERE WILL NOT EMPLOY NY PERSON IN VIOLA- , "{i'., 7L
TION OF THE'LAB CODE'OF,THE STAT Fy,CALIFORNIA RELAT- LATH„INT -
ING•TO W RKMF` OMPENSATION INS CE` °' -
- - y'LATH;,EXT .-•ti
_SIGNATORHOUSE,NUMBER COR=+
PERMITTEE r - ' _ 'I'RECT AND`POSTED"' _
ADDRE !lw id 164
FINAL, �,
' ' 1• JOHN4,F,- LEWIS, PRINCIPAL STRAL ENGINEER
-PLAN 'CHECB`'VALIDATIO CK` MO, ;'CASH _ y PERMIT VALIDATION' cK M O: CASH'
n '•e -.'r=�, any �, r, •I T r s - M+;+ ���
Akb
A "'[PUCAMON' FOR BUL
uv
COUN1 'OF,LOS.ANGELES'
•� _+- " - BUILDING AD RE
-WORKERS COMPENSATION DECLARATION = FOR APPLICANT TO FILL IN
f `� '`` ' ' �• •t'' +.• BUILDING ADDRESS
I',hereby:affirm that,I ha�ve" ' certfioate of,rconsent to self Insure„ ��VyJlA9AVE
ora:certrficate of Workers'•Compensation Insurance„or a certified, V
• copyAhereof (Sec 3800,•Lab C)' _,
� a ,QI �� l� s;. ZIP 9. 9,� LOCALITY .�
Policy No `-Company,-, 4 SIZE.OF LOT - -NO OF'B JS NOW ON LOT
"OtCert'tied,copy Is hereby furnished' ' -•�{ dl. - NEAREST CROSS ST -
• `D�Certified copy Is filedwth the county"bwlding inspection _ �- `TRACT, "BLOCK" LOT NO,
department _ - ,P• • _ - USE ZONE MAP NO
_ ° 'ASSES,-,O
R MAP BOOK, - - PAGE ii- PARC - -• -�''1' _f _ r ,1�
>.
Date Applicant0,� 1.
_ 1 SPECIAL CONDITIONS
CERTIFICATE OF•EXEMPTION FROM,WORKERS' OWNER •TEL'NO ” YES N
COMPENSATION INSURANCE ' ; ., 'S'f E.v e K:E:y S 19 a_8 10 370 S'O, WITHIN 1000 FT,OF SCHOOLS, O
•� - _ ADDRESS
(This's`ectlon need not be completed,rf'the.permd,ls for one hundred S[1�/_- /- /�yy�•A' .�) / DISTRICT GROUP T CONST FIRE ZONE PROCESSED BY
it
dollars ($100)�or,1e'ss)' ` '� ° 1.�•,1�1 HV
- ,I..; ^('. 3 •,s - .. -CITY , ' - - ZIP -
I certify,„that,in the,performance of-the work,,for'which'this permib TEM E, C 1'�Y q �, 86
Is issued,�I,shall not employ any person;In,any manner so.as to„ Z
�J6 , ,SubjeCt't0 the Workers-Compensation Laws , ” ARCHITECT OR ENGINEER - '' TEL NO
.4, - - -;STATISTICAL CLASSIFICATION ,, APT CONDO ,
kill Date a .Applicant - -� :r =^"*' 'ADDRESS' , • ' (CLASS NO 'DWELL UNITS
NOTICE TO APPLICANT: If, after making'this Certrficate,of'' ? Y REQUIRED TOTALr SETBACK FROM EXIST
Exemption, you should .'become subject�
to"'the' ,'Workers' CONTRACTOR v TEL NO SET-BACK YARD HWY`, PROP LINE WIDTH
Compensation provisionsl•of the%L`abor_Code, you 1,must,forthwith-
FRONT
Comply wlth,sucWprovS ons,or,thls permit Shall be deemed,revokea, '- yADDRESs - LIC NO ' " P L- _
-LICENSED CONTRACTORS DECLARATION y _ r
SIDE
-LICENSED
_ f c {: CITY 'LIC CLASS ,P L - '� .�,
hereby affirm'-that k aml licensed underp(ovisions-of,Chapter'9' - 'SEWER MAP
(commencing w1th;Sectior,7000).of Dvision'3 of,the:Busmess.and,. SFT-SIZE NO.OF STORIES NO OF FAMILIES
r• Professions Cade,and myxhcense Is''m;full torce'and'effect'' i NEW, BK' PG r 1 V
rDESCRIPTIOWOF'WORK"""^-5-��_4�•P-r -��- P�14•. r ,.o �..� .D��.... _ -,d.�K ._.�'•,_`'mss .
LICense,NUmber -+ _ Lic Class A ADDS ❑, VALU to
Corrtracto�" r'" Date''z _ IC.CJ ALTER ❑ �$ V r r j
O
❑ I am-exempt•under'Sec REPAIR ❑ $ U
' .1_• W
BBPC for this reason DEMOL ❑ a
LDMA�P/C# < ,
a Date - USE OF EXISTNG B5 Le - URM ❑ r f rr Cl)
4 - - Signature ` "� ` - 1 •. `'''% APPLICANT PRINT .� ', T L NO LDMA Perm# ,- ` • 'e;1 _
.��p(lI, as,owner"of the,,property„or,'my,employees with wages as S `V ” �5-
• •their-sole compensation, will do the wvA,and the structure Is, ADDR [_ /t � - _ /►.!y I _fw S� O I ®"0+=6 -
not Intended or offered for sale�(SeChOn'7044, Business and Sb l�/�'Ar. tl`�v` - "T. �-: -i I-]-Y0 FINALDATE' /� +„ a [( jyf F� { w •^
Professions Code) ;,;'• WILL,THE,APPLICANT-OR FUTURE BUILDING OCCUPANT HANDLE A-HAZARDOUS MATERIAL '�N
❑ 1, as 'owner';of the r0 eft , am excluslvel"tcontractl OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE DL
p p y y fTg,with, AMOUNTS,SPECIFI ON THE HAZARDOUS MATERIALS INFORMATION GUIDES - FINAL BY "? .1 P.t I(
licensed contractors to,construct the project (Section',7044, s +-
YES El NO - - v-• • r-, • >
-Business and,Professions Code) ��� �
,' . ,�� .' .`•" - - WILL THEINTENDED USE OF.THE BUIDLING BY THE APPLICANT OR FUTURE-BUILDING
OCCUPANT REQUIRE A'PERMIT FOR CONSTRUCTION OR,MODIFICATION FROM THE.SOUTH __
J CON$TRUCTION;LENDING AGENCY' COAST AIR QUALITY MANAGEMENTDISTRICT(SCAQMD)SEE PERMITTING,CHECKUST FOR �JJ I�
=t GUIDELINES ,�" S >•.4e*J,fL1�I1-f_li,J�6 ♦� �,7I 1�.•
I hereby affirm that-there Is a construction lending agency,'for, ves❑- , No `• v / �e '- i I°'+
t _ .the performance of the work for,wFiich this permit is Issued(Sec D! L r'!`I
3097,CIV'C) -I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMCODE ; - r - - ? .• 1
N , 8 CHECKLIST'I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES•COUNTY CODE„_ s: -
TITLE 2 CHAPTER 2 20 ECTIONS 2 20 100 T ROUGH 1211 140 CONCERNING HAZARDOUS -
f�
Lender's Name MATERIALS,REPO F R OBTAININ PERMIT FROM THE SCAOMD '
(21 Lender.'s Address
' , r OWNER OR AGENT •• ; n f f
o, (,certify that I have read'this'application and_state under penalty
o
Of periu`ry f6t-the above Information Is Correct I'agree t0 Comply. -PC'FEE' '4a 8 tg- •L'PERMIT FEE,' E• - - - -.�,r
•a with all county ordinances and State laws relating to"buildl,ng-
m construction, and'hereby authorize'representatives of`this County ISSUANCE FEE
to en on the abov - entioned property for Inspection purposes
a ,•����-C��' INVESTIGATION FEE, - TOTAL FEE_' •/� L f ' - y "
SEE REVERSE FOR-EXPLANATORY LANGUAGE, = -
Y
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 i BL 0508 0805120012
PHONE (626) 285-0488 EXT
ILEGAL ID I NO OF CONST 1 BUILDING ADDRESS: 1
ITR 7796 LT 9 BL- -001 I SQ FT STORIES TYPE 1 5456 LOMA AV I
I ISTRUCTURE V-B 1 ( TEMP CA 917803003 I
(ASSESSOR INFORMATION NUMBER- I 1 NEAREST CROSS STREET BROADWAY 1
15388-001-032 j THOMAS PAGE 596 GRID H4 LOCALITY TEMPLE CITY, Cl
I I I I
ITENANT (EXIST BLDG USE- RESID USE ZONE R-1 (ISSUED ON PROCESSED BY EXPIRES ON: 1
(EXIST OCC GRP 105/12/08 SR 11708/08 1-
I
(OWNER TEL NO IBLDGS NOW ON LOT VALUATION FIWIL D TE FIN CODE 1
ITAM, STELLA M (626) 298-3213- 1 5,000 II
15456 LOMA AV I I - '�-7 I
ITEMP 917803003 1 FEES PAID 1D RIPT ON OF WORK 1
I I IWINDOW RETROFIT/CHANGE OUT 20 WINDOWS 1
IFEE DESCRIPTION QUANTITY UOM AMOUNT I
(APPLICANT TEL NO ',I -
ISAME AS OWNER - '1AA BLDG PERMIT ISSUANCE 27 75 1 I
IAC STRONG MOTION RESID 5000 00 VAL 0 50 ISPE'CIAL CONDITIONS I
I ID2 PERMIT W/O EN-HC 5000 00 VAL 132 60 I ' I
1 1 TOTAL FEES 160 85 I
I I I I
ICONTRACTOR TEL NO I - IAPPF.OVALS DATE INSPECTOR SIGNATURE I
ISAME AS OWNER - I 1 •-'}• I
I LIC NO !1 ILOCATION AND SETBACKS I I I
I I I I I I
I
11 ISOILS ENGINEER APPROVAL I I
(ARCHITECT OR ENGINEER -TEL- NO ,1 IFOUNDATION/TRENCH FORMS I I I ,
1 LIC- NO 1 (SLFLn/UNDER FLOOR
I IRAISED FLOOR FRAMING I I
IMAP NO- SEWER MAP BOOK PAGE FIRE ZONE CMP I 1UNDERFLOOR INSULATION I I
1147H265 3 Oil II I I
I - .-IFLOQR SHEATHING I I I
INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS
NO 21 /� I ROO,-, SHEATHING I II
SCHOOL WITHIN HAZARDOUS ISHE!'R PANELS
(AIR QUALITY 1000 FEET MATERIALS I I
NO NO NO 1 1 FRA14E INSPECTION I
I I I I I
IREQUIRED TOTAL SETBACK FROM EXIST I IFIRE SPRINKLER HANGERS I
ISET BACK YARD- HWY PROP LINE- WIDTH: I I I L I
IFRONT PL- 1 11NSULATION/WEATHER STRIPI - I I
I SIDE PL- I I I I I
IINTERIOR LATH/DRYWALL I I I
I I I I I I
EXTERIOR LATH
IRATED FLOOR/CEIL ASSEM I I
I RATED WALL ASSEMBLIES I I I
I I I
Z
I I IRATED SHAFTS/OPENINGS I
I I I
1 1 IT-BAR CEILINGS 1 I
I I I
I `I ILOT DRAINAGE I I
I I I I I I
I ,'IREPORT ID DPR261 ROUTE TO BS0508 I I I
I I I_ I I I
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