HomeMy Public PortalAbout9424 LEMON AVE_Building__ , TEMPLE CfTY
76,11,e3811,celXe03• +-e+ APPLICATION FOR BUILDING PE IT
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY i �C
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST.
DIST ICT NO. I GROUPTYPE SSED"BYE
FOR APPLICANT TO FILL INjt coNST -c�1
BUILDING �f STATISTICAL CLASSIFICATION SF WEj.lA'P
ADDRESS �G 6K`� Pati
CLASS. NO. DWELL.UNITS
LOT NO. F 116- A al U19Do a btg-Lo-,K19 WATER NOT REQUIRED ❑ RECEIVED
_1 CERTIFICATE.
TRACT .Z �( MAP- `� HIGHWAY STATE MAJOR SECOND, OCA
NO OF BLDGS. NO J (CIRCLE)
SIZE OF LOT --Zrl•11j_X301D I NOW ON LOT USE ZONE SPECIAL -
USE OF CONDITIONS
EXISTING BLDG.
TEL-M,
OWNER I�f/Z BUILDING EXIST.
NO.
ADDRESS arL_ YARD HWY ST EET NAME
SETBACK � WIDTH
T'.
• FRONT
ARCHITECT OR TEL. P. L. <a(�(J C.l✓t/
ENGINEER NO. SIDE
ADDRESS TEL. INSPECTION RECORD _ , „ O.
CONTRACTOR NO.
Im
ADDRESS �/'2�Y ..A�+.'�:< JthY .t� C3•� - ;?,moi '`l"F
SCRIPTION OF WORK G
a
N
NEW ADD ALTER REPAIR DEMOLISH Z
SQ ZE 5 /,� NO.OF NO.OF '
(v STORI FAMI IES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT
VALUATION$
APPROVALS DATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION: LOCATION � C�
FEE $ 3 FEE $ -' FORMS, MATERIALS �7 fi
FRAME:FIRE STOPS, qq /
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS I i �/Y'� S Z. 'D•
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, ./ "- �° v% J'
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK A
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH, INT. -Z nw�IIY
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT-
ING TO WORKMEN'S COMPENSATION INSURANCE.
SIGNATURE OF HOUSE CT AND POSTED R ,CICD - wA'fir•
PERMITTEE
ADDRESS FINAL
CLYDE N. DIRLAM. PRINCIPAL STRU RAL ENGINEER
PLAN CHECK VALIDATION CK M.O. CASH PERM VALIDATION m m.o. CASH
ria 6
4. �u.) 4 2 D 3 3 .75L
i + o7 J�L24 67.50.
WORKERS'COMPENSATION DECLARATION
hereby affirm that I havecertificate of consent to self APPLICATION FOR BUILDING PERMIT
insure, or a certificate of Workers' Compensation Insurance,
oro certified cop thereof (Sec 3800, Lab ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No �� ` Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
ADDRESS _T
® Certified'copy is filed'with the cou building mspec- BUILDINGn
tion department ADDRESS 4`
of
Date 13 Applicant CITY J t ZIP LOCALITY
CERTIFICATE OF EXEMPTIG FROM WORKERS' NO OF BLDGS NEAREST
COMPENSATION INSURANCE . SIZE OF LOT NOW ON LOT CROSS ST
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars ($100)or less ) TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
TEL USE ZONE MAP
I certify that'in the performance of the work for which this OWNER NO NO
permit is issued, I shall not employ any person in any manner SPECIAL +
so as to become subject to the Workers'Compensation Laws ADDRES CONDITIONS 0
Date Applicant CITY• ZIP
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL DISTRICT GR UP TYPE FIRE P ED BY C)
P p Y ENGINEER NO CONST.V ZO�E W
Exemption, you should become subject to the Workers' UIJY _
Compensation provisions of the Labor Code, you must forth-
with comply with such provisions or this ADDRESS
p y p permit shall be d
deemed revoked. TEL STATISTICAL CLASSIFI TION APT NDO. N
CONTRACTOR NO 066 Z
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS
1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS-4,0/e; NO. SEVyER MAP
(commencing with Section 7000)of Division 3 of the Business and LIC
Professions Code, and my license is in full force and effect. CITY CLASS 9 BK PG VALIDATION
�C� h s, SQ. FT NO. OF NO OF CHECK
,
License Number /j 23 ! / Lic.Class 9 SIZE STORIES IFAMILIES ONE VALUATION
ConlractorLfi' a Dote
3 . ❑
�J� � DESCRIP ION OF WORK NEW $
I am exempt under Sec. ADD ❑
ALTER 101 Pilo.
B.BP.C. for this reas — � REPAIR ❑ $
Dat USE OF DEMOL
EXISTING BLDG ❑
Signature APPLICANT TEL FINAL
WN -BUILDER DECLARATION PRINT NO. DATE
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS F
r Professions Code): PRESENT
BUILDING BIN 7 21.0 A
I, as owner of the property, or my employees with ADDRESS
wages as their sole compensation,will do the work-and ® # 0 0 0 0 0
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 -.1 15.50
with licensed contractors to construct the project (Sec- ADDRESS.
tion °;�' 5 .5 Qc=t
tion 7044, Business and Professions Code).
REQUIRED TOTAL SETBACK
CONSTRUCTION'LENDING AGENCY SET BACK YARD HWY PROP LINE WIDTH O 60 9a S 7
1 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 "
LDMA Ref. #
P.C..Fee$ Permit Fee V
m Lender's Address
I certify that I have read this application and state that the Issuance Fee (/ LDMA P/C# pool
o above information is correct. I agree to comply with all County Investigation Fee 1 c
0 ordinances and State laws relating to building construction, Total Fee .J LDMA Perm. #
and her by rize representatives of this County to enter
upon t o e- entioned pro erty for inspection urposes.
^ 6 9 SEE REVERSE FOR EXPLANATORY LANGUAGE
` Signature of Applicant or Agent Date
J
COUNTY OF LOS ANGELES TEMPLE C'''-TY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS Q0711A5 TUNAS _ ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA BL 0508 9610240021
PHONE: (818) 285-0488 EXT: _.
LEGAL ID: NO. Of CONST BUILDING ADDRESS:
ON FILE SQ. FT STORIES TYPE 9424 LEMON AV
STRUCTURE: 0 V TEMP CA 917801302
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5382-014-031 THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY
TENANT: G US : RESID USE ZONE: R ISSUED PROCESSED XPIR S
EXIST OCC GRP: 10/24/96 ' TC 0/24/97
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY' CODE:
WERBELOW JOHN A;PAMALA J TRS (818) 446-9970- 1 3,900 (�Jpl„�
9424 LEMON AV 1"
TEMP 917801302 FEES PAID DESCRIPTION
REPAIR EARTHQUAKE DAMAGED CHIMNEY
FEE DESCRIPTION: C`QUANT TI YUOM': 0 AMOUNT:
APPLICANT: TEL. 0: �Ua /
BOSTON BRICK & STONE (213) 257-4298- AA BLDG PERMIT ISSUANCE' — 27.75
4274 CALEDONIA AC STRONG MOTION RESIb`• 3900:00-VAL- U 4`50 SPECIAL CONDITIONS:
LOS ANGELES, CA D2 PERMIT W/0 EN HC' ji 3900.-,00 VAL116:10
) ����,TOTAL FEES 3'Yj
CONTRACTOR: TEL. N0: %%/ �%� -•t'. APPROVALS DATE INSPECTOR SIGNATURE
BOSTON BRICK & STONE (213) 257-4298- �'!%i r _55� :f'. L' �� ��
�' `r F �'' � � ��� LOCATION AND S -TIN—
LIC.
4274 CALEDONIA WAY NO ;; a
LOS ANGELES, CA 90065 718181B �� / --
,����� SOILS ENGINEER APPROVAL
ARCHITECTOR ENGINEER: l_ :�. ��� J �� �' FO NDATIO /T 0
LIC. N0: � ' � �� - SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: ��� �� ��_.� ��✓`,a. �� ��� UNDERFLOOR INSULATION
153H265 3 01
FLOOR SHEATHING
0. OF FAMILIES: DWELLING S: A T/CON : STAT CLU§---
NO 21 \\ - �/� ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS �\—