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Home My Public Portal About10507 LYNROSE ST_Building__ (2) TEMPLE C�TV 7aaeasACIE#eos +-sI APPLICATION FOR BVAL®tll\1G PERW7 COUNTY OF LOS ANGELES BUILDING �/ n DEPARTMENT OF COUNTY ENGINEER ADDRESS i !/ BUILDING- AND SAFETY DMSION LOCALITY U JOHN A. LAMBIE, COUNTY ENGINEER NEARESTyyyy�� `r WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST I// h ` DISTRICT NO., GROUP TYPE PROCESSED BY FOR APPLICANT TO FILL IN 5 ,,0-3 �'u EONST. G n L-0VKv BUILDING n - STATISTICAL CLASSIFICATION SEWER MAP ADDRESS �I y Z3 BK PG CLASS NO_'l_ —DWELL UNITS LOT NO BLOCK WATER y,/ CERTIFICATE NOT REQUIRED ❑ RECEIVED TRACT 'f NO OF BLDGS NO 200 4� 113H LA> STATE MAJOR SECOND, OC SIZE OF LOT / I NOW ON LOT USF ZONE _ SPECIAL - USE OF i CONDITIONS EXISTING BLDG —/ , TEL � OWNE NO ' ''Y BUILDING EXIST YARD HWY STREET NAME _ .'9 SETBACK WIDTH ADDRESS/ FRONT 4o , ENGINEER ARCHITECTOR NO��' TEL P L NO SIDE PL ADDRESS TEL. INSPECTION RECORD 0 CONTRACTOR NO CC t_ ADDRESS O DESCRIPTION.OF WORK a N NEW ADD ALTER REPAIR DEMOLISH Z SQ FT. NO OF NO OF IZE STORIES FAMILIES USE OF e/ STRUCTURE M/►S � WALL- , / -- '75- 6 ekT4 - -&AO J SIGNATURE OF _ APPLICANT VALUATION$ '3 00 mo _ ' _ APPROVALS DATE INSPECTOR'S SIGNATURE P C. PMT o 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, r A WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION 1 CERTIFY THAT IN DOING THE WORK / e AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA. LATH, INT. ff Ap TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- u r ING TO WORKMEN'S COMPENSATION 1 SURANCE +] ' •l • LATH",EXT. SIGNATUREOF �-�/Z/ HRECT AND POED PERMITTEE S D ADDRESS FINAL A + lGbt' CLYDE N. DIRLAM, [PRINCIPAL STRUCTURAL EN R PLAN CHECK VALIDATION Cr_ M.O. CASH PERMIT VALIDATION aK. M.O. CASH LO-IO 5 0 8 6 -' f SnY � 1 p 6.C-) 0 _s 76A838A CE#803-9 60. /,PPL.ICATION FOR BUIL 'IN ".. ERiVdlT , COUNTY OF LOS ANGELES AooREss 1, S- ' DEPARTMENT OF COUNTY ENGINEER Temple C City,: BUILDING AND SAFETY"DIVISIONLOCALITYY•: . JOHN A:LAMBIE, COUNTY ENGINEER" NEAREST WILLIAM A:JENSEN SUP'T OF BUILDING- CROSS ST " ' Pal•'Mal TYPE - _ s DISTRICT NO • ROU - ESSED BY FOR APPLICANT-TO mt IN. , CONST. • -BUILDING nr� _ '-� STATISTICAL CLASSIFICATION - �,5 WER MAP ADDRESS lO5C-/ J��-7�rose St Tpmpl e - - BK , PG ' _ �d 11 j Y'--�-' CLASS NO�DV1/ELL UNITS 4 ' y LOT NO,', 1.O L• t LOCK - MAP STATE;-yE5 NO - r (-,C� _ - NUMBER HWY TRACT 26571 „1 •• it• ,' �� USE'ZONE SPECIA NO OF BL-DGS �h l CONDITIONS, SIZE OF LOT 7 x, 90 V � I NOW ON LOT lion, l/ - USE OF ' EXISTING BLDG - BUILDING ' - EXIST lleVelO?'�rtleYltTEL. �,�• SETBACK YAR HWY ~. REET NAME -WIDTH OWNER {j l' NO FRONT .ADDRESS;132 E. Live0akAve. ,Arcadia, SIDE ARCHITECT OR TEL. P L 47 , - ENGINEER, '• Win. `•�:�• Wilke NO - -INSPECTION RECORD ADDRESS J. lY Vt7 ., ` tY Li+'' 'A �` '( f '": •' P„r O e er- eve l o nlem. CONTRACTORnmpan 7 NO " - r ;� / - r d U ADDRESS' Same as a ove , „ 4 ,1 A �,_ /d�Lix p ! _ I, Z f "�� 'Q DESCRIPTION OF WORK ' 2�� i /b*L�.K > Lica` V1/ v NEWIX ADD ALTER ,REPAIR DEMOLISH- ,,c - 'I• N SQ FTQ NO OF. NO OF - SIZE 12S BTORLES FAMILIES - USE OF �D, > �•t, v - STRUCTURE- flan _ D Re'siddnc detac Ara SIGNAT,URE-O ev APPLICANT - '• _ �'1 M VALUATION$ APPROVALS T ' INSPECTOR S SIClNNT•URE - P PMT, L) -� FOUNDATION LOCATION / _ 1" • "� FEE '$ �" •FORMS,-MATERIALS G2 _Fi�a!2 FEE $ '7• .. - FRAME FIRE STOPS, �j '"• . -I'_HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING,BOLTS I/ �1 .V ''•r�".� - 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 -1 CERTIFY THAT-IN THE,PERFORMANCE _ OF THE, WORK FOR,WHICH THIS PERMIT IS ISSUED •I SHALL NOT EMPLOY ANY PERSON I MANNER SO AS T ME SUBUECT _ //ry TO•THE WORKM i S MPE SATI.ON.LAWS CAL QRNyq .LATH, EXT �1'(/e�.- eve pm l� SIGNATURE O �� H COR PERMITTE ECT-AND POSTEDADDREss;132'',E.j iv ,al, e. ArCaCZ1 FIN;4L ER PLAN CHECK VALIDATION G)'m O. CASH CLYDE NPERIMIT VALIDATION LAM, PRINCIPAL TR cK u-MLO.ENCASH, Ln.M:3&4,7 8 Fal 5 1 Q 4 8.; v i WORKERS' COMPENSATION DECLARATION M msurebor afclertrftcatejof WorkerseColmpenscate ahon Insuranconsent to ces olr V �[rU� O lJ V O a certified copy thereof (Sec 3800, Lab C ) cY�-400-106�0?�aan Argonaut Ins. " COUNTY OF LOS ANGELES BUILDING AND SAFETY CP9 y BUILDING Certified copy is hereby furnished FOR APPLICANT TO FILL IN ADDRESS 105107, 'E_. L nr'ose Certified copy is filed with the county building inspec- ) BUILDING tion department ADDRESS 10507 E. L erose LOCALITY NEAREST T'-Mpl 1=1 City Date 11-1-82 Applicant Howard L. Randoms CITY - -Tem le� Cit --- zip - 91780 CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' NO OF BLDGS ASSESSOR - I , r COMPENSATION INSURANCE- f SIZE OF LOT NOW.ON LOT MAP BOOK PAGE PARCEL USE ZONE MAP (This section need not be completed if the permit is for one I - ,, ti ' hundred dollars ($100)or less ) TRACT " BLOCK LOT NO' NO , 1. C/ , >- TEL -4 SPECIAL OWNERWalter Johnson - NOA45-6011 , CONDITIONS O + I certify that in the performance of the work for which this - - 'DISTRICT GROUP TYPE FIRE PROCESSED BY 0 permit is issued, I shall not employ any person,in any manner CONST ZONE ADDRESS so as to become subject to the Workers'Compensation Laws O - Date'- 7-29-82 Appliconk��w�T d T,_' RandOl CITY m ZIP 17 STATISTICAL CLAS IFICATION APT CONDO V NOTICE TO APPLICANT If,-after making this Certificate of ARCHITECT OR TEL Exemption, you should become subject to the, Workers' ENGINEER NO CLASS NO DWELL UNITS N Gompensation'provisions of the Labor Code, you must forth- ADDRESS SEWER MAP - with comply, with such proyisions or this permit shall be deemed revoked CONTR rd I, lRandol, CL BK PGJ VALIDATION LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS -NO VALUATION (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 — $1.204 . 00 1 SQ FT NO OF NO OF CHECK License Number 1 P 6 n R 6 Lic Class 1 SIZE STORIES FAMILIES QONE ' J _ NEW 1-1 $ , Controcj�j��r�T_ r evllate 7-2Q—R 7, DESCRIPTION OF WORK OADD ❑ I am exempt from the licensing requirements as'l am a licensed architect or a registered professional engineer, ALTER ❑ FINAL acting in my professional capacity (Section 7051, _ _�7 DATE • � REPAIR ?i.29 Business and Professions Code) USE OF - REPAIR FINAL - EXISTING BLDG ❑ By ;. rp Lic or Reg No Date APPLICANT - TEL 5 3'4 1 A OWNER-BUILDER DECLARATION (PRINT7-;4 NO228-4040 I hereby affirm that I am exempt from the Contractor's License ADDRESS 529 E Valle B1. San Crab. '#,o o e o 0 1 Law for the following reason (Section 7031`5, Busi6ess and' Professions Code) PRESENT - 2 0'o'(� O 0 BUILDING • j, as owner of the property, or my employees with ADDRESS wages as their sole compensation, will do the work and 0,0 o 43,0 0 L' . the structure-is not intended or offered for sale(Section LOCALITY - 7044,Business and Professions Code) MOVING - TEL 0 8,0 2'_8 2 ' - / - I, as owner of the property, am exclusively contracting CONTRACTORNO • with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code) 6 REQUIRED TOTAL SETBACK FROM EXIST 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. _ -- Lender's Name _• PCC Fee$ Permit Fee Lender's Address 114 W I certify that I have read this opplicahon and state that the _ Issuance Fee 8 ` 50 : aabove information is correct I agree to comply with all County Investigation.Fee $ ordinances and State jaws relating to building construction, Total Fee 43 . 00 . and hereby authorize representatives of this County to enter ^ up o 'the bove-mentio d pr erty for inspection purposes SEE REVERSE FOR-EXPLANATORY LANGUAGE, o ignoture of Applicant or Agent Doe ' ®5