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HomeMy Public PortalAbout5233 MCCLINTOCK AVE_Building__ COUNTY OF LOS ANGELES APPLICATION FOR DEPARTMENT OF COUNTY ENGINEER; f.,.y E V I 'I D I.NGI PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN ADIDRENG BUILDING ADDRESS LOCALITY I NEAREST CITYM.QX eP CROSS ST. NO. BLDGS. ASSESSOR SIZE OF LOT NO ON LOT MAP BOOK PAGE PARCEL (, DISTRICT GROUP TYPE FIRE SED BY TRACT BLOCK LOT NO.' �d' CONS �OSIE_ OWNE NO. ,�,��?1� STATISTICAL CLASS[ CAT N SEWER MAP ADDRESS YQ Ve> CLASS N0. Xp DWELL.UNITS BK%/-7PG CITY ZIP USE ZONE NO. ARCHITECT OR JEL.,c•-5 �� / ENGINEER OO���� o(� i SPECIAL /�� CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ N T ' CONTRACTOR BLDG.BLDG.SETBACK FROM`___._` IC FRONT.PROP.LINE OF (STREET) ADDRESS����C1' Z�� HI HVVAY +'. YARD' = TOTAL SETBACK FROM TYPE OF EXISTING LIC, _ FRONT PROP.LINE HIGHWAY WIDTH CITY '.CS LA----i CLASS CONSTRUCTION LENDER + a NAME AND BRANCH BLDG.SETBACK FROM 0U ADDRESS CITY SIDE PROP.LINE OF (STREET) I O SQ.FT. NO.OF NO.OF .'CHECK HIGHWAY + YARD OTAL SETBACK FROM TYPE OF EXISTING �L j SIZE C7 STORIES FAMILIES ONE ROP.LINE HIGHWAY WIDTH N DESCRIPTION OF WORK NEW f 'r ADD ❑ CORNERCUTOFF YES ❑ NO ALTER ❑ IN OPEN SPACE YES ❑ N0,4a USE OF REPAIR 1-1 IN COASTAL PERMIT ZONE YES ❑ NO EXISTING BLDG. Ii DEMOL ❑ APPLICANT TEL (PRINT) NO LSJ! C BY(SIGNATURE) 'OS Q62 Y —Ala Fr, �.iNG-s I HEREBY ACKNOWLEDGE THAT I HAVE RTHIS APPLICATION AND STATE /VD L I G"H•T THAT THE ABOVE IS CORRECT AND AGREE TOED MPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION:I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF /I / nG /I P I•��v� .� ��--�; THE LABOR CODE OF THE UAZOF CALIFORNIA IN RELATING TO WORKMEN'S COM• PENSATION INSURANCE SIGNATURE OF ` FINAL �Vl� BY PERMITTEE DATE ADDRESS CITY d`�--�� TEL P.C.Fee$ Permit Fee 51i—o 0 NO. ®� Issuance Fee VALUATION �D Od' Total Fee,,, S15-.g>v PLAN CHECK VALIDATION K. ' M CASH PERMIT VALIDATION CK. M.O. CASH 6 0~9tiSEP 2' 2 1 ©• '. 6.6 m9ts 6 10 rL--SEP 2 1 D 5 5.0 0 ®ys DS 76A63iBA CE ja08A 6/76 TEMPLE CITY 76A638A CE#803 2-63APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF' COUNTY ENGINEER ADDRESS S-2-33 /Wc c,o� BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE. COUNTY ENGINEER NEAREST WILLIAM A.JENSEN. SUP'T OF BUILDING CROSS ST. -DISTRICT NO. GROUP TYPE �� PR ESSYD BY FOR APPLICANT TO FILL IN �r d� -T CONST. BUILDING /� l STATISTICAL C`LLA�`ASSIFICATION SEWER MAP ADDRESS 3 �.. / CLASS. NO._(?DWELL.UNITS 6 BK11 7 PG LOT NO. f BLOCK WATER CERTIFICATE: NOT REQUIRED RECEIVED ❑ TRACT / :33 8 NOP oS I.IRCVLE) STATE MAJOR SECOND,LOCAL y NO.OF BLDGS. SIZE OF LOT n NOW ON LOT USE ZONE SPECIAL USE OF ' �. CONDITIONS EXISTING BLDG. '� p �/ TELOWNER 'O I'1 Bl^� NO. S'/G�b . BUILDING YARD HWY STREET NAME EXIST. p� SETBACK WIDTH ADDRESS,5A.;3 C -kOe, L FRONT C �l� j C r ARCHITECT OR TEL. P. L. /�'� �s ENGINEER NO. SIDE d P. L. ADDRESS I I O TEL. CONTRACTOR (per+ &'r' NO. a I ADDRESS 1h DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH �t J I Z SQ.FT. NO. OFNO. OF SIZE STORIES FAMILIES USE OF STRUCIIR G' ' SIGNATURE OF APPLICANT VALUATIO IK".19-0--0 (� APPROVALS DATE INSPECTOR'S SI NATURE P.C. Q PMT. j��...� FOUNDATION: LOCATIONUl- FEES 7 �` FEE .s` FORMS, MATERIALSFRAME: FIRE STOPS, IHEREBYACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.WITH BALL COUNTY ORDINANCES AND STATE LAWS REGULATING I GAS VENT, DUCTS BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE -- AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENS TION INSURANCE. LATH.EXT. SIGNATURE OF �C. HOUSE NUMBER COR. PERMITTEE lJ RECT AND POSTED ADDRESS ImsFINAL JOHN F. LEWIS. PRINCIPAL STIR URAL ENGINEER PLAN CHECK VALIDATION cK. M.o. CASH _ PERMIT VALIDATION CK. M.O. CASH ►_f`il,o,1 4 7 JUL1023 0 9.2 5`, ,v I�i�o 4 o AL 17 1 0 1 8.50- Its 3 A Gunn ®S 78A663 A I CE,}803(REV.6/78) � APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY BUILING FOR APPLICANT TO FILL IN ADDRESS ``� BUILDING ADDRESS 4946 McClintock LOCALITY CITY Temple City ZIP 91.780 CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT p f`NOW ON LOT MAP BOOK PAGE PARCEL TRACT— / 0 -b BLOCK U LOT O.. DISTRICT GROUP CONS TYPE ZIjEIE OC S DBY OWNER Tom Torres NO. }I — �J1 4946 1&Clintock STATISTICAL CLASSIFICATION ER MAPP� ADDRESS CLASS NO. DWELL.UNITS__j G BK// VG CITY Temple C ity ZIP 93,780 ARCHITECT OR TEL. VALUATION $ ENGINEER NO. ADDRESS BLDG.SETBACK FROM TEL. p FRONT PROP.LINE OF (STREET) CONTRACTOR MY d •• CO• NO. 26 - V TOTAL SETBACK FROM TYPE OF EXISTING LI 159496 HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH ADDRESS P.OoBOx 6782 LIC. + CITYLoo Angelesp CLASS C- CONSTRUCTION LENDER BLDG.SETBACK FROM NAME AND BRANCH SIDE PROP.LINE OF (STREET( HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH SQ.FT. NO.OF NO.OF CHECK + = V SIZE STORIES FAMILIES ONE0 y/: DESCRIPTION OF WORK Re-roof With NEW ElP.C.Fee$ Permit Fee c� 0a 1 j g Rigid prepared Chaos C" ADD C3Issuance Fee /• O0 In material ALTER ❑ REPAIR ❑ Total Fee USE OF residence DEMOL ❑ EXISTING BLDG.residence APPLICANT TEL _O (PRINTI NO. 4 '9 BY(SIGNATURE) I HEREBY ACK DGE THAT I HAVE READ THIS APPLICATION AND STATE Y THAT THE ABOV�IS RRECT AND AGREE TO COMPLY WITH ALL ORDINANCES tui AND LAWS REP LATI BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE V WORK AUT RIZED EREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABO ODE OF HE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM. g 1 4.7,3 A PENSATI N INSUR CE. O. dd c ' .. # 0 0 0 0 0 1 SIGN PERM GN R 2 034,00 AD Y s Angeles, Ca 90022 TE 63-5181 ,° 0034,005 /� o 1 1.22-78 FUSENE NOP a DS PECIAL r ONDITIONS FINAL '/� DATE�(1 !�(- BY` !/�!/� or APPLICATION FOR ,B..UtL_DING PERMIT `9 COUNTY.OF LOS ANGELES ' a.. ., . BUILDING AND SAFETY Y I FOR APPLICANT TO FILL IN BUILDING ADDRESS WORKER'S COMPENSATION DECLARATION � / ' .�1 I hereby affirm that I have a.certificate of consent to self insure, BUILDING ADDRESS AA �`I ��/L � W or a certificate of Workers'Compensation Insurance,or a certified CITY 7 /"� ZIP AvF- ct,,or copy thereof(Sea 3800,Lab.C.) _T1 copy LOCALITY Policy No. Company SIZE OF OT NO.OF BLDGS.NOW ON LOT I ❑ Certified copy is hereby furnished. 0 C9 NEAREST CROSS ST. Z rJ ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK�M� PAGE OO� PARCEL &q.3`• SPECIAL CONDITIONS •����v�/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. C� COMPENSATION INSURANCE � �A/ 4FAFS WITHIN 1000 II FT OF SCHOOL? YES No W'(This section need not be completed if the permit is for one hundred ADORE 2� n'��"�`� dollars($100)or less.) S I"` DISTRICT GROUP TYPE CONST FIRE ZONE PROCESSED BY CITY ZIP certify that in the performance of the work for which this permit , �s issued;I shall not employ a CIVS41-1 — v p y Try person in any manner so as t0 ARCHrrE EE TEL NO. become subject to the Workers'Compensation Laws..• V�L �,t_ --may J 7 TATISTICAL CL SIFlCATION APT CONDO Date Applicant ADDRES lgG7 l 7 CLASS NO. DWELL UNITS N077CE Til APPLICANT If, after making this Certificate of � P LN REQUIRED TOTAL SETBACK FROM EXIST J Exemption, you should become subject to the Workers' TRACTOR 7 SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwithG FRONT comply with such provisions or this permit shall be deemed revoked. DRESSIC.NO. P L 62 23 LICENSED CONTRACTORS DECLARATION SIDE C & LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9h. s �+ (commencing with Section 7000)of Division 3 of the Business and Q Sl OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and my license is in full force and effect. NEW ❑ BK PGa 87a.��a DE RAPT NOF WORK VALUATI ► 1 ITEMS O License Number Lic.Class I N OF WORK ADD ❑ �---c7l�v Contractor Date ALTER 11 $ 7 TOTAL 870_950 ' .'• L� 1 G REPAIR ❑ CHECK - 870.950 11 $1 am exempt under Sec. BAP.C.for this reason I mo'� {— DEMOL ❑ LDMA P/C# CHANGE Date: USE OF XISTING BLDG: +• URM ❑ a IL Signature APL NT(PRI ! 7 O. �¢ LDMA Perm# Z I. as owner of the property, or my employees with wages as l� V(� •2- 1 ` o Z' }' oa i i 1 rU,� — 'their sole compensation, will do the work and the structure is AD ESS ^ ' —� qq,w, Fe,i�c not intended or offered for sale (Section 7044, Business and �Z ( IA/ ✓,/- `' /. FINAL DATE Q i Mff}_.f Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL' 1 ITEMS 1 OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE J - ❑ I, a3 owner of the property, am exclusively contracting with AMOUNTS SPE IFlED N THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY licensed contractors to construct the project (Section 7044, Yes❑ N0 TOTAL 1061.70 Business and Professions Code.) CHECK 1ab1.7a WILL THE INTENDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CHANGE CONSTRUCTION LENDING AGENCYCOAST NEQUALITY M GEMENT DISTRICT(SCAOMD)SEE PERMnTING CHECKLIST FOR *o i CHA,`GE .00 I hereby affirm that there is a construction lending agency for VES❑ N •, I CM the performance Of the Work for Wf11Ch this permit IS Issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION E AND THE SCAOMD PERMITTING C W 3097,CIV.C.) CHECKLIST.I UNDER MY RE RE E LOS ANGELES COUNTY CODE, t-' aOQo-aaa 1 1/ �� Tm.E 2. SE 20.1 T 20.140 CONCERNING HAZARDOUS 1 Lender's Name MATERI AN FOR AINI IT FQOM THE SCAOMD. L oTG 1 p�1�a 34 o Lender's Address `i JJ f o c I certify that I have read this application and state under penalty - C of perjury t e above information is correct.I agree to comply P.C.FEE rl �'• PERMIT FEE J N with all,4c t�ordinances d State Is s relating to building cons ctio ,and hereb u rize representatives of this County ISSUANCE FEE O m to r on ab Toned property for inspection purposes. -47. 8 �'-2-M INVESTIGATION FEE TOTAL FE 404 / ', m Q. n pram«• em SEE REVERSE FOR EXPLANATORY LANGUAGE