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HomeMy Public PortalAbout5024 MCCLINTOCK AVE_Building__ #�EPARTIVi •BUILDING ANDr SAFETY APPLICATION FOR PERMIT OF LOS ANGtLES�; -WM: J. FOX, CHIEF ENGINEkR BUILDING .FOR APPLICANT TO FILL IN FOR OFFICE USE ONLY BUILDING J'1' /dam �(/ {I+!� DISTRICT NO-.- ?PLAN CK. NO. PERMIT NO�y. L/p ADDRESS• tis C V 1 I'!'P�,.ka• /a 1 U C7 G f{ t— �� ' LOCALITY. JRECEIV.ED BY. DATE OF APPL. DATEISSUED NEAREST �tle, BUILDINGOWNER s ADDRESS 6 /r?7 MAIL LOCALITY ADDRESS r 3 5(B C✓� �G�C NEAREST ,s��� TEL. CROSS ST. e j vz,-v, CITY !��12401F/�jf,�rc� NO. ZFIRE NO. OF ONE I PLANS I TY I GROG ARCHITECT OR' .. TEL. ENGINEER NO. BLDG. r, f C`//ORD. NO. SETBACK LINE [✓iJ �T , 6� j`y ADDRESS' APPROVED I BY CONTRACTOR a �.�-ru>- eWO- ' 1 USE PA PROVED DATE n / ZONEr.'`I BY DATE '� � ®1 - -G�--�r� ,�,- 'd HOUSE NUMBERING ADDRESS LEGAL DESCRIPTION LOT NO. 4 Al" LOgx- MAP NUMBER �'' FIELD CHECK BY TRACT i�i r NO. ASSIGNED BY /. AT . 3�C/G_ S^� I NO. of SLOGS. T NOW ON LOTCORRECTIONS SIZE OF LOT USE OF I NO. OF y EXISTING ELDd, - 'r FAMLLI68 / 63 %s - DESCRIPTION OF WORK NEW ;.I,t-'O ALTERATION I I ADDITION REPAIR :I DEMOLITION SQFT. NO. OF ✓ j /Al Q. � ,?+ ROOMS `� STORIES / S' Z EXT. WALL r° ROOF _�' f '- ' jl' iN. �`� > COVERING S� t= .I COVERING USE OF STRUCTURE > �-�/' ��H ��i�r�y n 5 r•�a) �L�/f/�/G.. .y /�r.�3_.�t;:.C_ ri'�PJ` C s'r'�-.rr£:s +'.'��•i t�� .G .r.. i!J _' �u'T A7'-• .► APPR�OV S INSPECTOR'S SIGNATURE DATE 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- FOUNDATION: LOCATION PLICATION AND STATE THAT THE INFORMATION GIVEN IS FORMS, MATERIALS r1 CORRECT. I AGREE TO COMPLY WITH THE 'CORRECTIONS LISTED FRAME: FIRE STOPS, HERRON AND WITH ALL COUNTY ORDINANCES AND STATE BRACING, BOLTS LAWS REGULATING HU DING CO1VSTjRUCTIONL FURNACE: LOCATION, t� SIGNATURE OF .1,/•T// '-GAS VENT, DUCTS PERMITTEE LATH, INT. ADDRESS AUTHORIZED AGT. LATH, EXT._ _ - PLASTER, INT.. 76AG88A- 1)888 10�.� ? P. C. $ ''�.• PLASTER, EXT. VALUATION ` FEE {,��Gf0 FINAL U h, l e WORKERS' COMPENSATION DECLARATION 4 c'I hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING P E RM I T ' insure, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800, Lab. C.) . I COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT'TO FILL INS^ ADDRESS �j Or� /U C, //�1 G C �' ❑ Certified copy is filed with the county building inspec- BUILDING ��a'` \�G tion department. /�7�j I ' `g Date Applicant CITY ` l ZIP q1-7 9 � LOCALITY . CERTIFICATE OF EXEMPTION FROM WORKERS'. SIZE OF LOT NO.OF BLDGSNEAREST NOW ON LOT 3 CROSS ST. tHJ p' ,COMPENSATION-INSURANCE p (�t �t (This section need not be completed if the permit,is for one TRACT I-f3 p BLOCK , LOT NO. MAP BOOK d7 61 `�"i PAGE � � PARCEL e,r hundred dollars ($100)or less.) ; TEL, OWNER 'M b �• / N USE ZONE MAP I certify-that in the.performance.of-the work for which this Vl r R permit is issued, I shall not employ ciny person in any manner ADDRES G -/ IAL a DITIONS so as io become subject to the Workers'Compensatiori Laws. �A OO CITY �/71f Date Applicant ' ARCH[" OR TEL. NOTICE TO APPLICANT: If, after making,this•Certificate of I ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY CONST. ZONE � Exemption, you should become subject -to the Workers' �i U Compensation provisions of the Labor Code, you must forth- ADDRESS O at'�' {r CE��2'�K-c- a with comply with such provisions or this..permit shall beTEL. STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR ����f''���✓� NO. Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. �a��� DWELL. UNITS I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS . NO. LIC. SEWER MAP (commencing with Section 7000)of Division 3 of the Business , and Professions Code,and my license is in full force and effect. CITY CLASS BK PG VALIDATION ' SQ. FT.' NO. OF NO. OF CHECK License Number Lic. Class ' SIZE L�1 O STORIES " FAM IL{ES ONE VALUATION', ContractorDate DESCRIPTION OF WORK ho NEW ❑ $ ❑1 am exempt under Sec. r �`h, $4; + ��-�'�(� ADD 10pool.iP V'�l� ©�5/ —� ALTER kd D : . B.BP.C. for this reason LJ ❑ Date: USE OF EXISTING BLDG. RA70 DEMOL Signature I APPLICANT �-//,, TEL FINAL / OWNER-BUILDER DECLARATION (PRINT) �� NI/1'e NO. �/a.y�Z I hereby affirm that I am exempt from the Contractor's License �, . ?.� G (YI G V.moi DATE Law for the following reason (Section 7031.5, Business and ADDRESS FINAL rjessions Code): I PRESENT By JLI� I,•as owner of theproperty, 'or m to with i BUILDING r e a Y employees Yees ADDRESS wages as their sole compensation,will.do the work and the structure is not intended or offered for sale(Section LOCALITY 7044, Business and.Professions Code.) MOVING TEL. , ❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. _ with licensed contractors to construct the project (Sec- t'�"II- � "'+ F - 00 ADDRESS tion 7044, Business and.Professions Code.) IL��tti•Ii REQUIRED TOTAL SETBACK FROM EXIST. 88.a T.l • CONSTRUCTION LENDING AGENCY � SET BACK YARD HWY PROP. LINE WIDT I hereby affirm that there is a construction lending agency for FRONT CHANGE the performance of the work for which this permit is issued P.L. I (Sec. 3097, Civ. C.). SIDE /V / P.L. _I ISI-(If�lu[X is Lender's Name 3 - �� LDMA Ref. # P.C. Fee$ Permit Fee 6569 Ar, Lender's Address 2 I certify that I have read this application and state that the Issuance Fee O ' tDA&A-0/c# 3 'above information is correct.-I agree to comply with all Countyi Investigation Fee ordinances and State laws relating to building construction, Total Fee O LDMA Perm. # and hereby auhesentativ of this Count to enter g u'erl'the0 - J gc1v:e-=rn�p propert for.' spect' pr ses. /YJ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date • • APPLICATION FOR BUILDING PERMIT • COUNTY OF LOS ANGELES '� ' ' h BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDIN AD RES o rL"v�� I hereby affirm that 1 have a certificate of consent to self insure, BUILDING ADDRESS 4,--P— or --P— or a certificate of Workers'Compensation Insurance,or a certified IT ZIP 7Z6*r!+`�ikj copy thereof(Sec.3800,Lab.C.) (,o TV LOCALITY Policy No. Company SIZETX Iv:y NO.OF BprE NOW ON LOT ❑ Certified copy is hereby furnished. � NEAR CROSS d� ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. ciY'fi�'/_ USE ZONE MAP NO. p department. d Date Applicant ASSESSOR MAP BOOK PAG /yew PARCEL OC y SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' Q °ERPKlL nVQ LA,, , , �J�r��, (�S TEL N°. � YES NO COMPENSATION INSURANCE alt WITHIN 1000 FT OF SCHOOL? (This section need not be completed if the permit is for one hundred A 0``1'�Sd -L ,14— �{� p DISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) P 47 \ +- q I certifythat in the performance of the work for which this ermit P P CITV��nw `� ZIP�Ap d�'tV is issued, I shall not employ any person in any manner s0 as to ARCHITECT RIENGINEER (L TEL�N(O become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant 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' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATIONSIDE LIC.CLAS PL I hereby affirm that I am licensed underprovislons of Chapter SEWER MAP >- (commencing with Section 7000)of Division 3 of the Busine SIZE NE-6F STORIES NO.OF.FAMILIES O 0. Professions Code,and my license is in full force and effect. NEW ❑ BK PG pop- V License Number LIC.Class DESCRIPTION OF RK ADD 11VALUA N Contractor Date � • $ 0 66 IM rr ALTER ❑ 0 ❑ I am exempt under Sec. C �� A V i REPAIR ❑ U BAP.C.for this reason N O 5 I DEMOL ❑ $ KI IC's! w LDMA P/C# a Date: USE OF EXISTING BLDG. URM 11 _ N Signature APPLICA �(PAINT / TEL NO. 2 3 I as owner of the property, or my employees with wages as ' ���© tJ C '.� LDMA Perm# Z ;II�-U.T their sole compensation, will do the work and the structure is ADDRESS w/ O 00.���I-, 50.r not intended or offered for sale (Section 7044, Business and SDI- `� FINAL ATE Q '='•�01`u Professions Code.) �_'Z � WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r r OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, a3 owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? Q ++ E > t licensed contractors to construct the project (Section 7044, FINAL BY Business and Professions Code.) YES❑ No❑ �� WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING i303 OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCACMD)SEE PERMITTING CHECKUST FOR {� ` GUIDELINES. _ .2.. I hereby affirm that there is a construction lending agency for YES El NO 11TOTAL 349-75 a the performance of the work for which this permit is issued(Sec. 0 1 HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING a 3097,CIV.C.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, CHECK 75 i� ,(/L .S TALE I CHAPTER TING SECTIONS 2 OBTAINING THROUGH 2.ROM T CONCERNING HAZARDOUS Lender's Name, MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. � tC C OWNER OR AGENT 0135 Lender's Address ta�C '� Nb ° C b I certify that I have read this application and state under penalty c of er•ur that the above information is correct.I agree to comply P.C.FEE PERMIT FEE P J Y 9 PY J!"Q N with all county ordinances and State laws relating to building J co rection, and hereby au' ize reps ntatives of this ounty ISSUANCE FEE 7� ( ';: 3 CO to ter upon a above enti ne rep' for inspec'Io u s. 4,�Q a 1,t1 l ,D INVESTIGATION FEE TOTAL FEE n 6' d App4Wn1 a aoe,n DRIB 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 0511140015 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CONST BUILDING ADDRESS: TR: 13384 IT: 3 SQ, FT STORIES TYPE 5024 MCCLINTOCK AV STRUCTURE: 21 VN TEMP CA 917803554 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GRAND 8574-005-004 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY, C TENANT: EXIST BLDG USE: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 11/14/05 JK 11/09/06 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAM nBY: CODE: ORNELAS SANDRA (626) 448-8145- 5,300 M 5024 MCCLINTOCK AV �__[/)A TEMP 917803554 FEES PAID DESCRIPTION-09-WORK REROOF TEAR OFF TWO LAYERS COMPOSITION SHINGLES 30 YR FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: COMPOSITION SHINGLES HOUSE AND GARAGE APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION REBID 5300.00 VAL 0.53 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 5300.00 VAL 149.40 TOTAL FEES 177.68 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO LOCATION AND SETBACKS SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION 147H277 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS: NO 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATE RATED FLOOR CEIL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508