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HomeMy Public PortalAbout5034 MCCLINTOCK AVE_Building__ h APPLICATION FOR BUILDING PERMIT � COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION 1 FOR APPLICANT TO FILL IN BUILDING ADDRESS G A3DDR I hereby affirm that I have a certificate of consent to self Insure, BUILDINp eCG/N�—o�� / /� or a certificate of Workers'Compensation Insurance,or a certified A./J, z copy thereof(Sec.3800,Lab.LC CITY em" ZIP 7?D LOCAL �� Policy No. ,��9fl GOA peny `SrA1EFyN� SIZE OF Tr/�L� NO.OF BLDG/7S.NOW ON LOT 'Certified copy is hereby furnished. NEARESTROSS W.T. ❑ Certified copy is flle&wlth the county building inspection QCT BLOCK LOT NO. department. USEZONE MAP NO, 1 Date 24 O A licant ��T>DrL IN�°4' d- MAP BOOK PAGE PARCEL Pp Ig,�� O O b SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION OM WORKERS' oWNEq�y�2 LAS SC�iRe�S TEL NO. J�7� WITHIN TODD FT OF SCHOOL? YES NO COMPENSATION INSURANCE L [ �! U T (This section need not be completed If the permit is for one hundred ADDREs,S_O 3 T /��` (�//V/�.0 a DISTRICT GROUP TYPE CONST.' FIRE ZON50CESNBY dollars($hat or less.) CITY ZIP i✓ X P.3 I certify that in the performance of the work for which this permit TE/J9�GE &.1 7-y 9/7g0 C"J) :T .3 is Issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject to the Workers'Compensation Laws. STATISTICAL CLASSIFICATION APT CONDO Date Applicant ADDRESS CLASS NO.Q—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 forthwithE,&V*V(zz �/i! d? d7'�350-�?s�s FRONT comply with such provisions or this permit shall be deemed revoked. AD LIC.NO.. PL S&/RVS SIDE LICENSED CONTRACTORS DECLARATION C9( /001Veiq L� P L I hereby affirm that I am licensed under provisions of Chapter 9 SEINE AP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORES NO.OF FAMILIES Professions Code,and my license is in full force and effect. I NEW ❑ BK PG CD Z70741/,r `, q DES PTION OF WORK License Number `����T`� Lic.Class- C-3/ ADD ❑ VALUATION ��+I A Lu4NdEt ENT. i A 0 OJ EZ �7c/STi ug� vcy Contractor- Date X—2-9 8 ALTER ❑ � 9.5-6)s mom ariTir?N 400 �iTN REPAIR ❑ I am exempt under Sec. B.ARC.for this mason C Z'-92 AAWWf_7 8IFS DEMOL ❑ LDMAP/C# Date: USE OF EXISTING BLDG. URM ❑ Signature APPLICANT(PRINT) JW—NO. El 1, as owner of the roe TDMA Penn p property,rty, or my employees with wages as � p ACCTA e 4 their sole compensation,will do the work and the structure is ADDRESS not intended or offered for sale (Section 7044, Business and i FINAL DA <0, 3307 58075 Professions Code.) C ITEMS OR MIXTURE OR FUTURE BUILDING OCCUPANT HANDLERHAZARDOUS MATERIAL ❑ 1, as owner of the ro B THE A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO TI GREATER THAN p p rty, am exclusively contracting with THEAMOUNTS P IED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINalovy licensed contractors to construct the project (Section 7044, YES❑ No TOTAL 58.75 Business and Professions Code.) CHECK -�Ir �J �� 7 WILL THE INTENDED E OF THE BUILDING BY THE APPLICANT OR FUTURE BUILDING GHE i•T1 ,JVs 5 OCCUPANT REQUIREA PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THESOUTH CONSTRUCTION LENDING AGENCY COAST AIR QKED.OUS EMENT DISTRICT WAQMD)SEE PERMITTING CHECKLIST CHANGE FOR GUIDEUN CHANGE u 00 I hereby affirm that there is a construction lending agency for YES❑ N the performance of the work for which this permit is Issued(Sec. I HAVE READ MATERIALS INFORMATION GUIDE AND THE SCAOMD q 3097,CIV.C.). PERMITTING CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES 11301130-1](]01 ,,}+/ 2/90 0 COUNTY CODE,TITLEZ CHAPTER 220 SECTIONS 2.20.100THROUGH 220.140 CONCERNING Lender's Name HAZARDOUS MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. n Lenders Address � owRm 6)R Agar 63 A 07 0 1 certify that I have read this application and state that the above information is correct. I agree to comply with all county P.C.FEE PERMIT FEE ordinances and State laws relating to building construction,and ,_7,j5 hereby authorize representatives of this County to enter upon I ISSUANCE FEE O e ebo g ed roperty for inspection purposes. p 1 v(r P 2 9y INVESTIGATION FEE TOTAL FE s mem of >A. DO- SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0002070046 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. 0 CONST EW BUILD G ADDRESS: TR: 13384 LT: 5 SQ. FT STORIES TYPE OCCUP GROUP 5034 MCCLINTOCK AV STRUCTURE: 0 1 VN R3 TEMP CA 917803554 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8574-005-006 OTHER: 255 1 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 02/07/00 UT 08/05/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DA E FINAL B CODE: CHI;ROGER (626) 333-3992- 3,500 -7 5034 MCCLINTOCK AV /'' TEMP 917803554 FEES PAID ESCRIPTION OF WORK �R FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW PATIO WITH OPEN WALLSEt. APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 1 AC STRONG MOTION RESID 3500.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN=HC "'-3500.00 VAL 115.80 i� G L STOTAL=FEES 144.05 ; CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO �/a� T� `�°a, OCA ION; AND SETBACKS f ` ✓� - �' SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: TEL. N0: FOU DATION/TRENCH FORMS LIC. N01: _ - I I *'- SLAB/UNDER FLOOR RAISED F OOR FRAMING MAP N0: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP,: �' �i (ter, X11 r`� q �I ,;� + v UNDERFLOOR INSULATION 3 4 07 J ILS- -) L'` `;1�`1J if-�l `��� 1 ST LEVEL FLOOR SHEAT 0. OF FAMILIES: WE LI G UNITS: APT/GOND: STAT--C S:-- -- — -- ------- - NO 21 --" - -- I-i --� -- --- jp+ ND LEVEE FLOOR SHEATH SCHOOL WITHIN HAZARDOUS AIR QUALITY: 1000 FEET MATERIALS ROOF SH �►THI G�;•, ` !� ! [ I I ;`j� FIRE DEPT. FRAME INSPECT NO NO NO REQUIRED TOTAL SETBAC FROM XIST \;.E��� �+ 1 �';%� BLDG DEP . FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: : FRONT PL- !Ice SHEAR PANELS SIDE PL- ''�a� __—_-_—__ ;,�'• 1 INSULAT QN/WEATHER STRIP INTERIORILATH/DRYWALL I EXTERIORi L T I LOT DRAIrAGE SMOKE DEFECTION DEVICES FIRE DEPARTMENT APPROVAL I REPORT ID: DPR261 ROUTE TO: BS0508 I COUNTY OF LOS ANGELES TEM!LE CITY # 0508 _ BLITDING PERMT�j DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/.ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT 'TEMPLE CITY CA 91780 `l gCt0508 207290033 PHONE:-(626) 285-0488 EXT: GA I • 0. OF CONST NEW B I. G A . R SS:4 TR: 13384 LT: 5 SQ. FT STORIES TYPE OCCUP GROUP5034 MCCLINTOCK AV STRUCTURE: 204 1 VN R3 NTEMPCA 9-1-7803554 ASSESSOR INFORMATION N MBER: GARAGE: NEAAREST CROSS STREET: 8574-005-006 OTHER: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY AEXIST BLDG USE: USE ZONE: ISSUED 0 PROCESSED BY: EXPIRES 0 : EXIST OCC GRP: 07/29/99 UT 01/25/00 / OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: E: CHI-ROGER (626) 333-3992- 1 11,000 5034 MCCLINTOCK AV TEMP 917803554 ID RIPTION OF'WORK CONVERT EXISTING PATIO TO BEDROOM 3 BEDROOM) AND USE EX_ FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ISTING SQ. FT. OF BEDROOM TO CREATE BATHROOM SAME AS OWNER TE N0: - AA BLDG PERMIT ISSUANCE 27.75 I +�'� f A��`,oAm w4F,6 AC STRONG MOTION" 11000.00 VAL 1.10 SPECIAL CONDITIONS: AX BUILDING EV W1 P E 54.70 B2 PERMI /E €RG �E 1'1'1(1Q0 0 VAL 256.74 CONTRACTOR: TEL. N0: - �O�j D �A� 340.29 APPROVALS DATE INSPECTOR SIGNATURE SAMELIC. NO LOCATION, AND SETBACKS SOILS ENGINEER APPROVAL XON ff Eff-M-EfflIf7917TO: _ . FOUNDATION/TRENCH POR LIC. NO0111111 SLAB/UNDER FLOOR RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: 0 P:, UNDERFLOOR INSULATION 3 0 J o RLV��OK S ST LEVEL F10—ORF—SHMEA79— NO. OF AMIL ES: DWELLING-UNITS: P 0 : STAT CLAS NO 21 16F pD LEVEL FLOOR SHEATH I19 0 m. SCHOOL- T A R 0 S ROOF.SHEATHING AIR QUALITY: 1000 FEET MATERIALS ❑ J `tl -- NO NO NO El - g FIRE DEPT. FRAME INSPEC -REQUIRED A S T C FROM EXISBLDG DEPT. FRAM SPEC SETFROBACK YARD: HWY: PROS LINE:. WIDTH: �C S�pV�e,jhat�0 SHEAR PA SIDE PL- INSULATION WE L- I S T O A R S INTERIOR LATH/DRYWALL TE OR LOT. DRAINAGE SMOkE DETEMOW DIM FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508 i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0002070046 PHONE: (626) 285-0488 EXT: LEGA ID: NO. 0 CONST NEW B ILDING ADDRESS: TR: 13384 LT: 5 SQ. FT STORIES TYPE OCCUP GROUP 5034 MCCLINTOCK AV STRUCTURE: 0 1 VN R3 TEMP CA 917803554 ASSESSOR INFORMATION NUMBER: GARAGE: NEAREST CROSS STREET: 8574-005-006 OTHER: 255 1 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY TENANT: EXIST BLDG USE: USE—ZONE: ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 02/07/00 UT 08/05/00 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL B CODE: CHI'5034ROGER MCCLINTOCK AV (626) 333-3992- 3,500 �% d© TEMP 917803554 FEES PAID ESCRIPT110N OF WORK NEW PATIO WITH OPEN WALLS FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: LCL APPLICANT: TEL. NO: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 3500.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC x'13500.00 VAL 115.80 5E 1 jT&rAt:PEES 144.05 f'•' CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO ���' ' `,� LOCATION AND SETBACKS SOILS ENGINEER APPROVAL Z ARCHITECT OR ENGINEER: TEL. 0: ` FOUNDATION/TRE C FORMS LIC. NO':l I_ — _�:— SLAB/UNDER FLOOR �L �— —�-- — �' ''� RAISED FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: I �� r!!,: �� UNDERFLOOR INSULATION 3 U1 , \,i,7 , I �. Cc / �� ST LEVEL FLOOR SHEATH NO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:—--- --- ------ -- ' NO 27 ;" ------- ; ND LEVEL FLOOR SHEATH i �; SCHOOL WITHIN HAZARDOUS +��� .` / cl _ r• ° ROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS i NO NO NO e`,\ ,r� -i ,•';44 FIRE DEPT. FRAME INSPECT REQUIRED TOTAL SETBACK FROM EXIST a; f`T- J—!/ I I , ,/v,•i..;' BLDG DEPT. FRAME INSPECT SET BACK YARD: HWY: PROP LINE: WIDTH: �s .�+; SIDE ` FRONT PPL-L- T �C'`"vtt;@ 1 �~ SHEAR PANELS INSULATION/WEATHER STRIP INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DETECTION DEVICES FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508