HomeMy Public PortalAbout5417 MCCULLOCH AVE_Building__ : TEMPLE CITY
76A636A CE#803 2-63 APPLICATION. FOR BUILDING PERMIT - ,
COUNTY OF LOS ANGELES- BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS 7
BUILDING'AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN, SUPT OF BUILDING CROSS ST.
DISTRI T NO. GROUP TY16E •`,I BR-CESSED BY
FOR-APPLICANT TO FML IN CONST. 1! •
BUILDING STATISTICAL CLASSIFICATION S WER MAP
ADDRESS ✓ rr`c C.1 c. -CLASS. NO.1�_DWELL.UNITS -.BK/Ll ZG
LOT NO. M BLOCK WATER NOT REQUIRED y RECEIVED
TRACT Iw CERTIFICATE: IIlLLL111
MAPNO.OF HIGHWAY STATE MAJOR SECOND, GAL
SIZE OF LOT ('00Y ��� NOW ON LOTS NO., (CIRCLE)
e��, USE ZONE SPECIAL
USE OFEXISTING BLDG. VWF�I� CONDITIONS
��
OWNER Irl , � 'DO�Ay.I NO. DING EXIST.
�j //'� SETBACK YARD HWY STREET NAM WIDTH
ADDRESS S`4I �CW C FRONT i
ARCHITECT OR TEL. P• L•
ENGINEER NO. 'SIDE ',-
ADDRESS TEL.
��J P L O
�WQw4z n w•f 4\. `��,:� fid. �n V
CONTRACTOR NO. ,
�` 4
ADDRESS. S t%*1 rL �` .�1 ?..^\/�• "",}� .. �� ,.�?4' +f .!IP.1°!� l�;4" t ! 0
DESCRIPTION OF WORK
NEW ADD ALTER REPAIR DEMOLISH R �
Z
SQ.FT. 5C) TORIES , FAMILIES
I G Aj, l`�•�� , 'r`k-'.�' r -•._
SIZE .a77 USEOFrr �y�,9e y/
STRUCTURE 1�i T. TA��� N��WN _a
r :Lei =o4 41
-Cl. l..�f,•rS n.41
a.
SIGNATURE
APPLICAN 4/" .�+
47
VALUATION $ eid - �,1 � f r
APPROVALS DATE INSPECTOR'S SIG ATURE
PMT. ,. /�Q FOUNDATION: LOCATION -7_?FEE $ FEE $ FORMS, MATERIALS (S
FRAME: FIRE STOPS. ) r !
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING. BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION. _ ��
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT• DUCTS G •J
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK -
A(JTHORIZED HEREBY I WILL NQT EMPLOY ANY PERSON v1oLq- LATH. INT.
TION OF THE LABOR CO F^TRE E C IFO A RELAT- I
INC TO WORKMEN' MPENSATION INSU E /' .� �/ f• f
LATH.EXT.
SIGNATUR OF HOUSE NUMBER COR-
PERMITTEE1 RECT AND-POSTED
H /
ADDRESS e , FINAL _�-' •�� �/ f�;�jf{a�
JOHN F. LEWIS. f RINCIPAL ST R URAL ENGINEER
PLAN CHECK-VALIDATION CK. M.O. CASH _ PET VALIDATION CK. M.O. CASH
'or 3':i 4 �wN 1'9 15:S•4'~ q
TEMPLE CITE'
II.A6311A CE#BOB-,6, APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING
ADDRESS S /
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIWSION LOCALITY [ '
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. Cir
TIDISTRICT NO. ROUP TYPE P SED BY
FOR APPLICANT TO FILL.IN Sf � CONSBUILDING L /i TICAL CLASSIFICATION SE ER MAADDRESS .L G C Gf mac, S.NO. DWELL.UNITS K BLOT NO. BLNOT REQUIRED RECEIVED
/ CATE:
TRACT r E!f + MAP fA HIGHWAY
NO.OF BLDGS.
NO. (CIRCLE) STATE MAJOR SECOND, OC L
SIZE OF LOT. Q X co NOW ON LOT i USE ZONE SPECIAL
USE j CONDITIONS
EXISTING BLDG. /
�/J �(- TEL.
OWNER /1,�/V + Do ft ON NO. f BUILDING
ADDRESS T/7 /& CIV o u� V jL YARD HWY STREET NA E IDT
JJ SETBACK WIDTH
{ FRONT
ARCHITECT OR TEL. P.L.
ENGINEER NO. SIDE
P.L. .�
ADDRESS a
TEL, INSPECTION RECORD p
CONTRACTOR NO. U
ADDRESS ix
ESCRIPTION OF WORK 0
U
W
n.
NEW ADD ALTER REPAIR DEMOLISH rA
SQ.FT. NO.OF NO.OF / z
IEE STORIES FAMILIES
USE OF
STRUCTURE
SIGNATURE OF
APPLICANT +
VALUATION$
APPROVALS IIATE INSPECTOR'S SIGNATURE
P.C. PMT. FOUNDATION:LOCATION 1 �. -"' `-✓,;.t'
FEE $ FEE $ P-� FORMS,MATERIALS J /j�/� 7�• ;!�`:t+y.'�.':° +�
FRAME:FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING,BOLTS �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK
AUTHORIZED HEREBY 1 WILL NOT EMPLOY ANY PERSON IN VIOLA- 1
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- LATH,INT. 3 r'
ING TO WORKMEN'S COMPENSATION INSURANCE. LATH,EXT. rr i
SIGNATURE OF' HOUSE NUMBER COR- j \
PERMITTE RECT AND POSTED f
ADDRESS a FINAL
CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENGI
PLAN CHECK VALIDATION CK, M.O. CASH PERMIT VALIDATION cK. m.o. cABH
Lo 5 3 4 OCT, 1 D 6.G ON011
WORKERS'COMPENSATION DECLARATION
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.) r
COUNTY OF LOS ANGELES � BUILDING AND SAFETY, ..
Policy No. Company--
Elereurnised. • ADDRESS
Certified copy is hby fhFOR APPLICANT TO FILL IN BUILDING ,{ J
•
❑ Certified copy is filed with the county buing inspec- BUILDING
tion department. r ADDRESS
Date Applicant`- "� - CITY ` ZIP y� LOCALITY x
NO. OF BLD S. NEAREST
ERTIFICATE OF EXEMPTION F ORKERS' SIZE OF LOT
NOW ON LOT CROSS ST.
COMPENSATION IN CE ASSESSOR
(This section need not be complete the permit is'for one TRACT' BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)•or less.) TEL.
01NNER /2 Qj NO cgb t'3 SE ZONE MAP
`�° NO.
I certify that in the performance of the'work for which this M
permit is issued, I shall not employ any person in any manner ADDRESS / '/' / �� SPECIAL �i a}..
CONDITIONS i// "'�� Q
so as to become subject to the Workers'Compensation Laws. 0
CU
CITY ZIP
Date Applicant ARCHITECT OR TEL.
NOTICE TO APPLICANT: If, after.making this Certificate of ENGINEER .NO DISTRICT GROUP TYPE FIRE PROCESSED BY Q
CONSZO E U
Exemption, you should become subject to the Workers' �O� �f
Compensation provisions of the Labor Code, you must-forth- ADDRESS fly a
with comply with such provisions or this z
p y p permit shall be TEL. � STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR 2
NO.,Z,91 ��66 _
LIC. /7 CLASS NO. / DWELL. UNITS
LICENSED CONTRACTORS DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. 76M SEWER MAP
(commencing with Section 7000)of Division 3 of the Business LIC. C
and Professions Code,,and my license is in full force and'effect. CITY.(:�FP CLASS G BK VALIDATION
SQ. FT. NO OF NO.OF CHECK
License Nu Lic.•Class SIZE A�'� STORIES FAMILIES ONE
Z. 6 DESCRIPTION OF WORK NEW ❑ VALUATION
ContractI d Date 7 ua
ADD ❑ 7
❑I amun
a der Sec. ►
ALTER ❑
BAP. . for this reason• L
REPAIR $
ate:
USE OF
EXISTING BLDG. ' DEMO/L^
Signature APPTEL
(PRNT� ?, NO.qe�d�/�C� FINAL
OWNER-B DECLARATION DATE
I hereby affirm that I aexempt from the Contractor's License /7J 1
Law for the follow reason (Section 7031.5, Business and ADDRESS .� /SC FINAL t+
Professions Code): PRESENT By ' ACCT°a
❑ I, as owner of the property, or myemployees with q ILDING DRESS 3303 161.55
wages as their sole compensation,will do the work and .I ,
the structure is not intended or offered for sale(Section LOCALITY 1 ITEMS
7044, Business and Professions.Code.) MOVING TEL. rlt�� ��
❑ I, as owner of the property,am exclusively contractng Tte, s.
ng CONTRACTOR NO. _
with licensed contractors to construct the project (Sec- ADDRESS HEft 161°55
tion 7044, Business and Professions Code.)
REQUIRED TOTAL SETBACK FROM EXIST.
1�
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH CHANGE °
I hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. c.). P.L.
0000-0001 7/29/96
Lender's Name 746 f 9:22
LDMA Ref.#
Lender's Address P.C. Fee$ Permit Fee J• O � Pool
certify that I have read this application and state that the Issuance Fee o �� LDMA P/C#
above information is correct. I agree to comply with all County Investigation Fee
ordinances and State laws relating to building construction, Total Fee i LDMA Perm. #
( and her authorizer sentatives of this.County to enter
upon a ove-mentio a propert or inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature 7f Applicant or Agent Da) I