HomeMy Public PortalAbout5018 MCCLINTOCK AVE_Building__ DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES BUILDING
WM. J. FOX. CHIEF ENGINEER
FOR OFFICE USE ONLY
�FsO�R� APPLICANT TO FILL IN•-� / DISTRICT NO. PLAN CK.�NjO. PERMIT NO.
BUILDING �l ,d /l r /I/rG° w. �� '! /1! vl C7 /F! / ��f,
ADDRESS ..y
LOCALITY / �- RECEIVED BY �DATE OF APPL. DATE ISSUED/
NEAREST +� / `` Efr�r-•o V ^/ �R���I�v.. l
CROSS ST. BUILDING �••- A !n; l /r"����!/�1 I/C7 G
ADDRESS /• `' J
OWN[RVe;h
MAILLOCALITY
ADDRESS r �a„ SIP v ,Gf,F_2 Cl NEAREST
j - b TEL. CROSS ST. �� f , . =,
CITY r' a [ '+�,J`j �$°[� r NO. FIRE NO. OF y/� TYPE GROU!�-
ARC7HITECT OR TEL ZONE PLApN�S-` f� Iq�
ENGINEER NO. SETBACK LINE (sem ,— r/ , of,M/ORD. NO.
ADDRESS APPROVED �!
�a �JT,EL. /��O BY , DATE
CONTRACTOR��N , �G=`rsp Wig'O , ,/C`+1 USE °'i I APPROVED
�� n r / ZONE��7 rpj'li'BY DATE
ADDRESS /, HCOUSE NUMBERING
LEGALDESCRIPTION I LOT NO.2 � � BLpOCK ® MAP NUMBER p X71 FIELD CHECK BY
TRACT C 8—IZ " NO. ASSIGNEDNO. OF BY• ��'d HATE
SIZE OF LQT/,> �G t�NOW ON LOT S� egO�RRECT�I,OvNS' r/
USE OF NO. OF 4 .:r7ll eV 10 ..l / /f�xa. !a G_~K< -t f<
EXISTING BLDG, — �s I FAMILIES / gg d�••- rry„1
DESCRIPTION OF WORK f
I Al
NEW I 41<ALTERATION I I ADDITION
REPAIR I I DEMOLITION
SIZE Zl ROOMS STORIES ` ®/� �/1Jp/(r .`5aA•✓ bf� Z YUC
EXT.WALL Q ROOF /' / I'
COVERING Jfi1�C-® I COVERII� y.. f'/`��,+ftp'
USE'OF- TRUCTURE / L 37 13,_f)e- JI/r� YTS .lTA4—OA.7 �.jo
e,� `/✓'. �' /_ '/ .-y e" Gam. �4.GoGt�'S /MIra web. co.c/
r ,•'' 1,'�. '� �' c� LTJ�1'G! T4'! ' .elm.s!1— S/i,4PO,L.T..wc,
APPRO �c 00
e�JC 9GG c/d'vrN9PE RLI43fATU1�F0Y-e
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FOUNDATION: LOCATION
PLICATION AND STATE THAT ,THE INFORMATION GIVEN IS FORMS, MATERIALS
CORRECT.
1 AGREE TO COMPLY WITH THE COJRRECTIONS LISTED FRAME: FIRE STOPS �\!
HEREON AND WITH ALL COUNTY ORDINANCES AND STA E BRACING,.BOLTS
LAWS REGULATING BUILDING CONSTRUCTION.
s• o FURNACE: LOCATION,
SIGNATURE OF GAS VENT, DUCTS n
PERMITTER 1% 112—11-k
LATH, INT.
0
ADDRESS LATH, EX7.
.
AUTHORIZED AGT. v '
• a� /}� PLASTER, INT.
70AaaaA• Dass 10-80 3�(dt .PyC?$ �All
OFEE 1 PLASTER, EXT.
VALUATION a FEE $c� R="�r FINAL
Y ?" APPLICATION FOR BUI.L.DING PERMIT
FOR APPLIIJ�4NTJO FILL IN (Print or type only)
NG= � COUNTY OF LOS ANGELES
BUILD
ADD01� � O.QA xr L DEPARTMENT OF COUNTY ENGINEER
CITY + ZIP BUILDING AND SAFETY DIVISION
"No.OF BLDGS..' BUILDING
SIZE OF LOT ; NOW ON LOT ADDRESS f
0-
TRACT/ti4. �j`�► BLOCK - LOT NO. QL LOCALITY -
TEL. NEAREST
OWNER NO. 3^'(e-��p�j CROSS ST.ASSESSOR
ADDRESS B(j fl C �°,�� MA BOOK \)PAGE PARCEL
CITY �Q ZIP (t(� 1 DISTRICT GROUP TYPE` `� FIRE P ED BY
O Z CONST.'/� ZON
ARCHNEER•ITECr OR i .. (..,,(NO.�4ENGIB V
STATISTICAL CLASSIFICATION SEWER-MAP
ADDRESS Au Cts, Wmio CLASS NO. `?'/ DWELL.UNITS BK
TEL. _
CONTRACTOR NO. USE ZONE-r..NO . U S
LIC. IV CIAL
ADDRESS NO. 7aNDITIONS
LIC.
CITY CLASS ROAD 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.LINEHIGHWAY WIDTH
SIZE ] STORIES FAMILIES ONE r
a
DESCRIPTION OF WORK NEW ❑ + O
ADD' BLDG.SETBACK FROM oe
SIDE PROP.LINE OF (STREET) O
1 ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w
I�d HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH.. N
USEOF REPAIR ElZ
EXISTING BLDG. DEMOL ❑ +
APPLICANT ' TEL COR R CUTOFF YES ❑ NO ❑
(PRINT) NO.9A jo
IN OPEN SPACE YES ❑ NO ❑
BY(SIGNATURE) IN COASTAL PERMIT ZONE • - YES ❑ NO ❑
VALUATION ,. j��lJ' �
I THE ABOVE IS HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE A ,,r) �+•
ANDTHALAWS REGULATING BUILDING CONSTRUCTIRRECT AND AGREE TON COMPLY1 CERTIFY THAT IN ORDINANCES
DO NG THE
If��` /� r f �I! d jJ l�,Aj`� ItiJD�f C /LS
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INSURANCE,
SIGNATURE OF A �. �y�. ;'i r
PERMITTEE �—
ADDRESS S
O 9L6a9rdQ")
TEL ,I FINALBY `
CI Nb
DATE' l'.
ct
MAKE CHECKS PAYABLE TO: FEE FEET'
HARVEY T.BRANDY,COUNTY ENGINEER ;.• C�^ S
f^ 4
PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALIDATIONL55-,/ M.0'. CASH
�Y 2t3 :1 U 8 9:� �.•
3 .2 9�P�OV
®s 76A638A CE#803.3.75'
WORKERS'COMPENSATION DECLARATION
APPLICATION FOR BUILDING PERMIT
P herebl affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance,
oca rtified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Po i
r �No.9/ V wr 3s1Company-
.Srofr�AC-1-0
BUILDING C.o
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS _110 A?
Certified copy is filed with the county building inspec- FADDRESS
O�� /Yf i_,,1vTOCx-
tionrtdepartment. q6-G6- ( c E t�iT'/ ZIP //��( LOCALITY INE$
le
Date Applicant NO. OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCE �i ASSESSOR
(This section need not be completed if the permit is for one TRACT 0.3 BLOCK OO I LOT NO.IfS7 MAP BOOK I PAGE 00 PARCEL 00 S
hundred dollars ($100)or less.) TEL. ,J
�V/!Yf �-/ X
I certify that in the performance of the work for which this OWNER ,t NO. USE ZONE MAP 77
NO.
permit is issued, I shall not employ any person in any manner ADDRESS �O/� /J� C'L//y TD L°.G / SPECCONDITIONS a
so as to become subject to the Workers'Compensation Laws. T ��, O
CITY /6/y A E �iTv zip U
Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY ix
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE O
Exemption, you should become subject to the Workers' y� , / U
Compensation provisions of the Labor Code, you must forth- ADDRESS �U� -� V
with comply with such provisions or this permit shall be TEL. N
f�F..�ivA�trJEZ / i . NO. � 0 STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR _
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
ADDRESS �ItfZ��H ,L �� NO,G 72 W_
Ihereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC.
and Professions Code,and my license is in full force and effect. CITY C,• MOIJTE �� /7ai2 CLASS e--7,9 BK PGVALIDATION
License Number
S6 72 C/T Lic. Class C-3 9 SIZE�ZBO(j TORIES I FAMILLIIES ONE VALUATION
7�- VALUATION
41C:�L �� (p _ f DESCRIPTION OF WORK f.emooE ExI'ma V4 NEW ❑ $
D0
Contractor Date /I�1
011
❑1 am exempt under Sec. `co . 5+k".a LEs (Z E- 1100 F= ADD ❑ ,
BAP.C. for this reason �} ALTER
W 1T�4 .306"' Ct�Jbt Sk{tNC�LES• REPAIR ❑ $
Date: USE OF � `�
EXISTING BLDG. IGxat�F��1'(,E DEMOL ❑
Signature APPLICANT TEL, /
g (PRINT) ��I e 1 d 1'IEt2 vU�Pk�vi�kZ NO. � _ FINAL _/ ]
OWNER-BUILDER DECLARATION DATE 1 1
I hereby affirm that I am exempt from the Contractor's License ADDRESS I�$'Zg CAS-al�E Z - �?�
Law for the following reason (Section 7031.5, Business and FINA `
Professions Code): PRESENT B -'
BUILDING y
❑ I, as owner of the property, or my employees with ADDRESS --+-, '
wages as their sole compensation,will do the work and 3 �
the structure is not intended or offered for sale(Section LOCALITY , 7v
7044, Business and Professions Code.) ; MOVING TEL. + +i a ,J
I, as owner of the property,am exclusively contracting CONTRACTOR NO. ',: _
ADDRESS �:ii a'�
R o �ht.
with licensed contractors to construct the project (Sec- _
tion 7044, Business and Professions Code.) -HECK .t_°Lf-,
CONSTRUCTION LENDING AGENCY EPFF5,.RON'T ACYARD HWY TOTAL PROP LINE FROM WIDTH - '.
I hereby affirm that there is a construction lending agency for ti'tii��r �'-
the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name Ifl"("'_I'� 1 ;� LDMA Ref.# 729 r Ari 9:,--Permit Fee ���� O
Lender's Address
' I certify that I have read this application and state that the Issuance Fee /� ' LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee Q
ordinances and State laws relating to building construction, Total Fee 7,0 -1- LDMA Perm. #
and hereby authorize representatives of this County to enter
on th -mentioned property for inspection purposes.
l (0-%-91 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signat a of Applicant or Agent Date
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 1408280111
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I N0. OF CONST I BUILDING ADDRESS: I
ITR: 13384 IT: 2 UN: .002 I SQ. FT STORIES TYPE I 5018 MCCLINTOCK AV I
ISTRUCTURE: 2800 V-B I TEMP CA 917803554
ASSESSOR INFORMATION NUMBER: I
I NEAREST CROSS STREET: GRAND
I8574-005- 003 I I THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY CAI
(TENANT: (EXIST BLDG USE: RESID USE ZONE: R-1 (ISSUED ON: PROCESSED BY: I
(EXIST OCC GRP: 108/28/14 SR I
(OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: ]]FINAL DATE INAL BY: CODE: I
DUIM ARTHUR (626) 232-7660- I 3,090 1 1
5018 MCCLINTOCK AV
TEMP 917803554 FEES PAID ID CR T NOF WORK I
I IRER F OVER 1 ROOF. INSTA14IMBERLINE COMPOSITION SHINGLES I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IAND NEW DRIP EDGE I
(APPLICANT: TEL. NO: I
ISAME AS OWNER - IAA BLDG PERMIT ISSUANCE 27.80 1 I
t IAB STATE GREEN BLDG FEE 3090.00 VAL 1.00 ISPECIAL CONDITIONS: I
IAC STRONG MOTION RESID 3090.00 VAL 0.50
1 ID2 PERMIT W/O EN-HC 3090.00 VAL 115.80
I TOTAL FEES 145.10
(CONTRACTOR: I
TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE
(
SAME AS OWNER _
I LIC. NO I (LOCATION AND SETBACKS I I I
(SOILS ENGINEER APPROVAL I I
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS I I
LIC. NO: I (SLAB/UNDER FLOOR I I I
I I I
(RAISED FLOOR FRAMING I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J (UNDERFLOOR INSULATION 3 001 1-1 I
I IFLOOR SHEATHING I 1 I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I II I I
NO 21 1 IROOF SHEATHING
SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I I
(AIR QUALITY: 1000 FEET MATERIALS I I I I
NO NO NO I IFRAME INSPECTION II I I
(FIRE SPRINKLER HANGERS I I I
I I (INSULATION/WEATHER STRIP( I I
(INTERIOR LATH/DRYWALL I I I
1 I 1EXTERIOR LATH
I
I I
I (RATED FLOOR/CEIL ASSEM. I I I
I IRATED WALL ASSEMBLIES 1 I
I I
1 i (RATED SHAFTS/OPENINGS
I
1 I IT-BAR CEILINGS
I I
I I I
ILOT DRAINAGE I 1 I
I I I I I I
(REPORT ID: DPR261 ROUTE TO: BS0508 I I I I
/I