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HomeMy Public PortalAbout6466 LOMA AVE_Building__ APPLICATION FOR BUIL�G PERMIT FOR APPLICANT TO•FILL IN (Print or type only) COUNTY OF LOS ANGELES BUILDING ADDRESS Z-- DEPARTMENT OF COUNTY ENGINEER '"' BUILDING AND SAFETY DIVISION CITYZIPNO.OF BLDGS. SIZE OF LOT NOW ON LOT. ADIDRESS TRACT BLOCK LOT NO. LOCALITY r TEL. NEAREST OWNER N _5O$'d CROSS ST. AC/z S ASSESSOR ADDRESS �/y`� MAP BOOK PAGE P44CEL DISTRICT GROUP I TYPE -FIRE P OCEAD BY -CITY ZIP �O CONST ZONE ARCHITECT OR TEL _1Ar1vvz'.6w- ENGINEER - % C[— NO.GSZc�/ STATISTICALCLASSIF AT NSEWER MAP ADDRESS St1 (� /JL�S�[1g1 ✓ CLASS NO. WELL.UNITS 8K G�PG CT CONTRAOR D - x)&& NO. TG+LE:—� USE N MAP e-� [ LIC., NO. z v ADDRESS = NO.z SPECIAL . LIC.' CONDITIONS CITY CLASS C- '3 ROA DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑ CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF' EXISTING SQ.FT. NO.OF NO.OF CHECK HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH SIZE STORIES FAMILIES ONE } _ n_ DESCRIPTION OF WORK NEW + O ADD ❑ BLDG.SETBACK FROM 0� �y® SIDE PROP.LINE OF (STREET) O ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w ❑ HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH - N USE OF REPAIR Z EXISTING BLDG. IDEMOL ❑ + APPLICANT / TEL /i�J3 CORNER-CUTOFF YES ❑ NO ❑ (PRINT) ` IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ IHEREBY ACKNOWL DGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE - WORK AUTH fB'FTERE OT EMPLOY ANY PERSON IN VIOLATION OF THE LABO ODE OF THE STATE Of CAL IA IN RELATING TO WORKMEN'S COM PENSATIO NSURANCE. - - - SIGNATURE OF PERMITTEE ADDRESS FINA CITY&/��J�e -L.�1 TEL.NO. 5��6� DATEL BY MAKE CHECKS PAYABLE TO: FEE T $ FEE HARVEY T.BRANCIT,COUNTY ENGINEER > � J PLAN CHECK VALIDATION cK. CASH PERMIT VALIDATION K. M.O. CASH— ' 1 4$.2 SEP 13:2.1 ._ 1.:6 6 A96 1 �! J 5:55- ®s 76A638A CE 8803 375 APPLICATION FOR BUILDING PERMIT FOR APPLICANT TO FILL IN (Print or type only) BUILDING COUNTY OF LOS ANGELES ADDRESS' 7 DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION CITY �• �1 e p ZIP BLDGS. BUILDING SIZE'OF LOT YXIIIS, NOW ON LOTADDRESS (�T �/� "-PV'-� TRACT BLOCK LOT NO. 1 LOCALITY ( TEL. NEAREST OWNERL o8 NO. CROSS ST. ff ASSESSOR ADDRESS 6 •,'A MAP BOOK - PAGE PARCEL DISTRICTGROUP TYPE FIR [ZPEtSED Y CITY ZIP CONST ZON ARCHITECT OR TEL. L ENGINEER NO. ,_ STATISTICAL CLASSIFICATION SEWER MAP ADDRESS CLASS NO.�,DWELL•UNITS �B DPG EL. ZONE MAP CONTRACTOR T c? NO I-LIC NO. U ADDRESS,. NO. 66 �wd� SPECIAL LIC. CONDI TIONS CITY _J CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO ❑ CONSTRUCTION ENDER NAME AND BRANCH BLD%.SETBACK FROM FROT PROP.LINE OF (STREET) a HIGWAY } YARD ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING O SQ. FT. NO. OF NO.-OF- CHECK FRONT PROP, LINE HIGHWAY WIDTH U SIZE STORIES FAMILIES ONE CD .F = H- DESCRIPTION OF WORK NEW ❑ W ADD BLDG.S CL SIDE PROP. LINE OF (STREET)aml 13, Z ALTER ❑ _ TOTAL SETBACK FROM TYP F EXISTING HIGHWAY } YARD - SIDE PROP. LINE HIGHW Y WIDTH _ REPALR❑ , USE TI DEMOL ❑ } .EXISTING BLDG. "yi 1 APPLICANT TEL CORNER CUTOFF YES ❑ NO (PRINT) c> �^ NO. BY (SIGNATURE) IN OPEN SPACE YES 1:1E]NO Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION Y CATEGORICAL EXEMPTION YES❑ NO ❑ . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) W-ITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- I STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY IWILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE - LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM PE NS TION INSURA NCE. a SIGNATURE OF PERMITTEE ADDRESS-,Jf//— FINAL TEL. CITY NO. DATE 2— 7 BY f�.'. a •P� • f P.C. PMT. tillh: CNl CKS I :A)I-A LL lO: FEE FEE HARVEY T. BRANDT, COUNTY ENGINEER (/ PLAN. CHECK VALIDATION CK. M.O. CASH' - PERMIT VALIDATION cK. M.O. CASH 6 4 ,4 FEB g 1`- 8 215 p ® 3 76A638A CE#803 12/72 - APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES.. BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING DR n I hereby affirm that I have a certificate of consent�to self 'nsure, BUILD G ell! S$/ _ _ a or a " ate of Workers' ompensat n surance,or a rtified C/.//l copy z S-1pa t r ) CLLY�r ZIP LOCALITY Poli Co. - SIZE OF LOT I o.OF BLDGS.NOW ON LOT ❑.Certified copy'is hereby fur shed. NEAREST CROSS ST. El Certified copy's filed w' e ou uilding insp c TRACT BLOCK LOT NO. department: USE ZONE MAP NO. - Date - t' ASSESSOR MAP BOOK - PAGE PARCEL - SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER rye- U COMPENSATION INSURANCE ,� WITHIN 1000 FT.OF SCHOOL? YES No (This section need not be completed if the permit is for one hundred ADDRESS DISTRICT GROUP TYPE CO T. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY Z1P I certify that in the performance of the work for which this permit If 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 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' C R - /7/} SET BACK YARD HWY. PROP LINE WIDTH Compensation provisions of.the Labor Code, you must forthwith vSiVs FRONT comply with such provisions or this permit shall be deemed revoked. AD LIC N gpP L. SIDE LICENSED CONTRACTORS DECLARATION .CLA _ P L CI LIC I hereby affirm th - I am licensed underprovisions of Chapter 9 SEWER MAP (commencing It io 7 0 f ivision 3 of B e nd SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions a i in full force nd e f t. NEW ❑ BK PG a License Numb Lic.ClassDEf-TIPTIC O .ADD ❑ VALUATIOP Q Contractor ! ALTER ❑ REPAIR ❑ 0 I am exempt under Sec. $ V B.&P.C.for this reason DEMOL ❑ LDMA P/C# . W Date: USE OF EXISTING BL URM ❑ 1 - Ca .Signature APPLICANT(PRINT) _ ! TEL NO. •, LDMA Perm# ACCT AL - 'z ❑ 1, as owner of the property, Or my,employees with wages as Z their sole compensation, will do the work and the structure is ADDRESS O ,3303 M 175°65' not intended or offered for sale (Section 7044, Business and FINAL DATE p 1 ITEMS Professions Code.) WILL THE.APPUCANT OR TURA BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL I I-1 "q _ ❑ 1, as owner of the property, am exclusive) contractin with OR A MIXTURE CONTAI A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J Y g AMOUNTS SPECIFIED THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY TOTAL :178-5 m 6-_e licensed contractors to construct the project (Section 7044, ves❑ N v Business and Professions Code.) CHECK 175.65 WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING °OO OCCUPANT REQUIRE A PER FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH E CONSTRUCTION,LENDING AGENCY COAST AIR QUALITY MAN _ENT DISTRICT(SCAQMD)SEE P ITTING CHECKLIST FOR �/'rrLlAtij(:��''11�NG . GUIDELINES. I hereby affirm that is a construction lending agency for YES❑ N - N the performance of the work for which this permit is issued(Sec. (y(►(�(� [� rn (HAVE REA EHAZARDOU TERIALS INFORM NGUIDE AND TH CAQMD PERMITTING - 0000-0001 10/3 1/95 3097,CIV.C.) CHECKLIS UND RSTAN REQUIRE NTS E LOS AN LES COUNTY CODE, _ (� N' TITLE TER IO S 0. 0T UG 2.20,140C CERNINGHAZARDOUS'- - 3VV0. 1 AM11°Ow 3 Lender's Name MATE REPORTING D FO G E IT ROM SCAQMD. - o Lender's A ress O OR AGENT o I certify at I have read this a ca I and state under penalty 0 of pe ry that th bove inform tion is rrect.I agree to comply P.C.FEE PERMIT FEE N wi 11 ounty inances an State I ws'relating to building n ruc n, hereby th pre ntatfftiOA4� f'this ISSUANCE FEE 0 � nter upo he - ti ed rope y for i + INVESTIGATION FEE TOTAL FEE 10 (�! Sgnal of Applicant o,Aged 0- SEE REVERSE FOR EXPLANATORY LANGUAGE 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 BL 0508 0105240055 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 5904 LT: 274 SQ. FT STORIES TYPE 6266 LOMA AV STRUCTURE: 0 VN TEMP CA 917801634 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5384-011-010 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: SFR USE ZONE: XX ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/24/01 UT 11/20/01 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE / FINAL BY: CODE: BESSER PHYLLIS M TRUSTEE (818) 285-8872- 3,000 / 6266 LOMA AV 40*0V TEMP 917801634 FEES PAID DESCRIPTION OF WORK SHOWER PAN- PATIO DOORS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: WILDE (626) 448-2175- AA BLDG PERMIT ISSUANCE 27.75 4905 BALDWIN AVE AC STRONG MOTION RESID 3000.00 VAL 0.50 SPECIAL CONDITIONS: TEMPLE CITY CA 91780 D2 PERMIT W/0 EN=HC —=`3000.00 VAL 99.00 NOTAL FEES 127.25 CONTRACTOR: TEL. NO: ©�� /1\ APPROVALS DATE INSPECTOR SIGNATURE WILDE'S CONSTRUCTION (818) 448-2175- 4905 BALDWIN AVE LIC. NO LOCATION LOCATION AND SETBACKS TEMPLE CITY CA 91780 401407 B � � SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: ��� —� 11 I� FOUNDATION/TRENCH FORMS LIC. NO:, SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: , �� /r =�� i =�� UNDERFLOOR INSULATION XX 3 01_� FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:- --- - — -- - -- -- --- - --- -- NO 21 ��� ROOF SHEATHING \\ �� U �� nG°� �'�� SHEAR PANELS SCHOOL WITHIN HAZARDOUS � � 'r q. / AIR QUALITY: 1000 FEET MATERIALSO NO NO NO \„�G� . FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST 1 .. y FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: \ ����' r� ,, FRONT PL- ��ePFfd�� %� 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