HomeMy Public PortalAbout4916 MCCLINTOCK AVE_Building__ J
APPLICATION' FOR BUILDING PERMIT
i. __ COUNTY OF LOS ANGELES. BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS
BUIL ANG ADDRESS
I hereby affirm that I have a certificate of consent to self insure, I f f�
or a certificate of Workers'Compensation Insurance,or a certified CITY zIP4916
copy the 3800 Lab.c.) -� 9,7Ff Q)
LOCALITY
Policy NO.' Company �/(/�lf� SIZE OF LOT NO.OF BLDGs NOW ON LOT
❑ Certified copy is hereby furnished. I NEAREST C OSS ST
�rtified copy is filed with th county building Inspection ffOWNER��'
0 BLOCK LOT NO. -y USE ZONE MAP NO.
department.' J
Date �'6�ApplicantP�O � O�� �1 SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS.' TEL.NO. YES NO
COMPENSATION INSURANCE 'Z WITFIINlow Fr..OFSCHOOL?
ADDRESS I
(This section need not be completed if the permit is for one hundred I 11WT10 DISTRICT GROUP TYPE CONST' FIRE ZONE 5CESS BY
dollars($100)or less.) CITY ZIP � '
I certify that in the performance of the work for which this permit 5 V� k,-3 1 3
is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. VVVV AAA��,
become subject to the Workers'Compensation Laws. STATISTICAL IFICATION O 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' CON OR TEL O. SETBACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code,you must forthwith I f-AloGT�M FRONT
comply with such provisions or this permit shall be deemed'revoked. ADDRESS LIC.NO. PL
1 23Z)1 1 SIDE
LICENSED CONTRACTORS DECLARATION CITY LIC.CLASS PL
I hereaffirm that I am licensed under provisions of Cha O
1 by P Chapter 9 I O."* ' SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and so.FT IZE NO.OF STORES NO. FAMILIES C
Professions Code,and my license is in full force and effect. rZA
W ❑ BK PG I,,
23�>/ g DESCRIPTION OF WORK D VALUATION , W
License Numbeeq LIC.Class /�`�✓�2 Wy
Contractor A194510 4w1'Oate-7"�—� TER ❑
111 am exempt under Sec. 1�WI 3 l q9r REPAIR ❑
B.&RC.for this reason DEMOL ❑ LDMA PIC#
Date: USE OF IXISTINCI BLDG. URM• ❑ {
Signature APPLI (PRIM TEL. O. LDMA Perm# Z 1
❑ I,as owner of the property, or my employees with wages as �� '7 �' �v a
their sole compensation,will do the work and the structure is ADDRESS s�� .0T
not Intended or offered for sale (Section 7044, Business and / —CONT� vrc. L,-W-A., FINAL DAV)_�V illo- 3-307 70 a My
Professions Code.) WILLTHEAPPLICANT OR FUTURE BUILDING OCCUPANT HANDLEA HAZARDOUS MATERIAL
❑ I, es owner of,the property, am exclusively contracting OR A MDTTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN
g with MS
THE AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY
�
licensed contractors to construct the project.(Section 7044, yES❑ NO❑
Business ons Code.)
a mcs
WILL THE INTENDED USE OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING CHECK 70.380
CONSTRUCTION LENDING AGENCY OCCUPANT QUALITY
MANAGEMENT
T FOR DISTRICT
(S CONSTRUCTION PE ION TINGFROMHECKUTH
COAST AIR QUALITY MANAGEMENT D18TRICT(SCAQMD)SEE PERMITTING CHECKLIST �{
FOR GUIDELINES. CHANGE .011
I hereby affirm that there is a construction lending agency for yre❑ NO❑
the performance of the work for which this permit Is Issued(See. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD
3097,CIV.C.). _PERMITTING CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES �y�y ('� �}�'y { 7/17/90
}
' CERNING
Lender's'Name HAZARDOUS MUNTY ATERIALS REPORTING ANDDFFOR OBTAINING A PERMIT FROM THE SCAOMD. A,j000-0 01 (/17,.90
Lender's Address OWNER ORAGMT 1U43 1 � e 3
o' 1 certify that I have read this application and state that the above
Information IS correct. I agree to comply With all county RC.FEE PERMIT FEE �!
ordinances and State laws relating to building construction,and J
hereby authorize representatives of this County to enter upon ISSUANCE FEE
the above-me lone party for inspection purposes. ,:3,0 ,
INVESTIGATION FEE TOTAL FEE , /1
Y `J
A aAPPkmQAqm DO.
SEE REVERSE FOR EXPLANATORY-LANGUAGE. ;
` COUNTY OF LOS ANGELES TEMPLE CITY # 5703• BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508-9812210036
PHONE: (818) 285-0488 EXT:
LEGA I 0. OF CONST BUILDING AD ESS:
TR: 4902 LT: 7 BL: D SQ. FT STORIES TYPE 4916 MCCLINTOCK AV
STRUCTURE: 0 VN TEMP-.CA-917804103-
ASSESSOR I ORMAT-IO NUMBER: NEAREST CROSS STREET:
8574-023-010 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
—ON-
TENANT: E STB G 5 RESID SE ZO E: R- ISS E ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 12/21/98 UT 12/21/99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FI L D TE I ,BY: CODE:
NAKAMOTO HATSUYE (626) 448-2808- 1 5,000q
4916 MCCLINTOCK AV
TEMP 917804103 FEES PAID D S RI.PT,,O 0 0
HOUSING-REHAB REPLACE EXISlqmv WINDOWS AND NEW HEADER IN
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: GARAGE_ 401X121IX171-
APP CA : TEL. - -
AMPB GENERAL CONSTRUCTION (626) 284-3260- AA BLDG PERMIT ISSUANCE 27.75
1699 ORANGE ST. AC STRONG MOTION RESIDs5OOO.O0 VAL 0.50 SPECIAL CONDITIONS:
ALHAMBRA, CA 91803 D2 PERMIT W/0 EN-16�--5000:00 VAL 132.60
CONTRACTOR: TEL. NO: � '•� 60
���ETOTAF�E `l 160.85 APPROVALS DATE INSPECTOR SIGNATURE
AMPB GENERAL CONSTRUCTION (818) 284-3260-
1600 ORANGE STREET LIC. NOLOCATION AND SETBACKS
ALHAMBRA, CA 5490616 \
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. N0: � --_--� — ` FO DATIO / RENC FORMS
LIC. N0: 4 I t ;ii \ I� SLAB/UNDER FLOOR
ISED FLOOR FRAMING
NAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP.p -j1LIP,i%) I rir ��4 ,11��' rl�l�j.;.� r� II UNDERFLOOR INSULATIO
147H277 3 01 , I ` _J�'J �� l I� L���C`-�� M1'
_________ _ ____ ,� FLOOR SHEATHING
0. OF FAMILIES: DWELLING UNITS: APNO 0 : S 215- , � ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS ��' i , ! - Y'• /�l�yd S PA LS
AIR QUALITY: 1000 FEET MATERIALS '
NO NO NO FRAME INSPECTION
230Ala
REQUIRED TOTAL SETBACK S ✓ SP LE HANGERS
SET BACK YARD: HWY:, PROP LINE: WIDTN: '
FRONT PL- Qe P NJ►a%-J 4" INSULATION/WEATHER STRIP
��VSC /
SIDE PL- �
TERIOR LATH/DRYWAL
EXTERIOR LATH
RATED F OOR CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED S S OPEN GS
T-BAR CEILINGS
LOT D AI AG
REPORT ID: DPR261 ROUTE TO: BS05O8