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Home My Public Portal About5426 MCCULLOCH AVE_Building__ SYZ�� APPLICATION FOR BUILDING PERMIT FOR APPi•ICANT TO FILL IN (Print or type only) [ADDRESSSS allILDING -26 ' ; " �� COUNTY OF LOS ANGELES ARTMENT OF COUNTY ENGINEER ITY / ZIP BUILDING AND SAFETY DIVISIO FNO.OF BLDGS. BUILDING A ` t4eIZE OF LOT NOW ON LOT ADDRESS /_ " TRACT vL BLOCK LOT NO. LOCALITY r C ��!•�J E NEAREST OWNER Q` / V ��r O. J�l CROSS ST. .S may: J�, ASSESSOR ADDRESS _ / (�(V MAP BOOK PAGE PARCEL ,/ DISTRICT GROUP TYPE FIRE ESSED BY CITY ZIP r �/ CONST, NE ARCHITECT j� �j? L • TEL ), ENGINEER C I NO. STATISTICAL CLASSIFICATION ., SEWER MAP ADDRESS .Y a (,�/e r Al, CLASS NO. /Q62-OW/E�LCL,UNITS 4 /. BK/6 PG CONTRACTOR D /0 � USE ZONE NO. (/✓� ADDRESS r NO. �_3 SPECIAL 0��3Y1Q, �i C ASS CONDITIONS CITY J ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LE jr NAME AND BRANCH C .i BLDG.SETBACK FROM ADDRESS T� � + /� CITY FRONT PROP.LINE OF C (STREET) c HIGHWAY + YARD -_ TOTAL SETBACK FROM TYPE OF EXISTING � SQ. FT. NO. OF NO. OF CHECK FRONT PROP. LINE HIGHWAY WIDTH SIZE �(1 STORIES � FAMILIES ✓ ONE C //�� DESCRIPTION OF WORK ` NEW + `� V �y :ter ADD ❑ BLDG.SETBACK M SIDE PROP.LINE OF (STREET) a '•vwL� V ALTER ❑ HIGHWAY •F Y _ TOTAL SETBACK FROM TYPE OF EXISTING ARD JJ rDEMOL EPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH USE OF EXISTNG BLDG.,51 /e fr -rn1 ( [:] + �q y��y/( �j� O 7,9 CORNER CUTOFF YES ❑ NO ❑ AP PRINT V/!N./ J� C. DI'/�/� t BY (SIGNATU IN OPEN SPACE YES El1:1NO Q IN COASTAL ZONE YES ❑ NO ❑ VALUATION A 3Q '? " CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION I CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY ERS IN VI LATIO THE LABOR CODE OF THEWORKMEN'S COMPENSATSTAT F G TO (�-B'� -o f_,v�.� r�F®NL SIGNATURE PERMITTEE ADDRESS TEL. FINAL BY f' CITY NO. DATE/-/7 _ OMT SAKE CHECKS PA)"AL3L_G 'L'U: F C E HARVEY T. BRANDT. COUNTY ENGINEER FE �� FEE PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O.�J CASH 8 7 6 RFEB 27 2 3' D 1 2 7.80 9 0 0 Lgmky 9 1 21 3.0 0 •�Js 76AG38A CE 0803 12/72 + WORKERS' COMPENSATION DECLARATION APPLICATION FOR BUILDING PERMIT I•hereby affirm that I have a certificate of consent-to,self oror a certificate of Workers' Compensation Insurance, or certified copy thereof(Sec. 3800, b. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.a6��9�� Company cr �"�G BUILDING / U Certified copy is hereby furnished. FOR APPLICANT TO FLU IN ADDRESS .��zld LL Certified copy is'filed with the county building inspec- BUILDING tion department. �/� ,� Date �' Applicant" I.Mzy d�`�dJ' ' i CITY-Wwt r -,ITZIP LOCALITY NO.OF BLDGS. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the permit is for one TRACT "BLOCK LOT NO. MAP BOOK PAGE PARCEL hundred dollars ($100)or less.) // TEL .111 OWNERyy�-3oe`� USE ZONE MAP C7W f,9h7/ E7� �, 0XVIV- NO. NO. I certify that in the performance of the work for which this r / permit is issued, I shall not employ any person in any manner ADDRESS 300 SO- Glu � �1i� SP/50t-,3f0 SPECIAL E CONDITIONS so as to become subject to the Workers'Compe.nsatiori Laws. c 0 CITY 47/w/ L ZIP /laos V Date Applicant ARCHITECT ORTEL. ix DISTRICT GROUP TYPE' FIRE OCESSED BY O NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST.� ZONE Exemption, you should become subject to the Workers- 5 D� /-3 jT- CL Compensation provisions of the Labor Code, you must forth- ADDRESS •. �.11 I�_ GGGJJJLLL--• with :comply with'such,provisions or this permit shall be i TEL. 7/3 STATISTICAL CLASSIFICATION APT. CONDO. N deemed revoked. CONTRACTOR En?Oa U NO. 261-3177Z LICENSED CONTRACTORS DECLARATION - / // LIC. CLASS NO.'ADWELL. UNITS ADDRESS yZ�lo W /'T/tY1 ��v1. NO .�9!70.E I hereby affirm that I am licensed under provisions of.Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business // E�Ef LIC. and Professions Code,and my license is in full force•and effect. CITY LX -/ / � CLASS IC-39. BK• . PG. VALIDATION �f b SQ. Fr. NO. OF 7_ NO.IFAOF HECK License Number-�96/O6 Lic.'ClassC�`3ra9 SIZE STORIESONE % �� 9 'd f O��ddr•fc�FX/J17.0 NEW •❑ VALUATION� Contractor tj' O L/PTTd�/l�fOd. Date DESCRIPTION WORK $ 907 r- ❑I am exempt under Seca9t/e/-/Spm�� L�y}eildaF-A/��/ ADD ❑ Yd 1-/S -6�,¢1S eA/0 Z+' v AJOI-/!r� .O/� ALTER ❑ $ ► B.&P.C. for this reason REPAIR ❑ Date: USE OF EXISTING BLDG. MCOCIVI-Jtr DEMOL ❑ Signature APPLICANT//�� nn r/ , TEL. Zl3 •OWNER-BUILDER DECLARATION —(PRINT) KO6ExTRu �f. NO.ZG/-3/77 FINAL ,r �1 1 DATE I hereby affirm that I am exempt from the Contractor's License ADDRESS`-2qt. t IT77EtL 9W L,A• goo -3 Law for. the following reason (Section 7031.5, Business and FINAL 1 Professions Code): -PRESENT By ❑ I,.as owner,of the property, or my employees with ADDRIESSS jO -wages as their sole compensation,will do the work.and LOCALITY `(P' yl]/� °�� the structure is not intended or offered for sale(Section ❑ 7044, Business and Professions Code:) COVING O[2 NO. , `�-� ! ITEMS I,as owner of the property,am exclusively contracting _ with licensed contractors to construct the project (Sec- ADDRESS Y TOTAL 40.3— tion 7044, Business and Professions Code.). CONSTRUCTION LENDING AGENCY SETBACK YARD HWY rorAPROPALIINEFROM : WIDTH CHECK 40°511 1 hereby affirm that there is a construction lending agency for :FRONT !'ANGE ° the performance of the work for which this permit is.-Issued P.L. 00 (Sec. 3097, Civ. C.). SIDE. P.L. Lender's Name 9/f9/U`� LDMA Ref. # Lender's Address- P.C. Fee$ Permit Fee 5 57$8 q AM1.0:2i I certify that I have read this application and state that the Issuance Fee / LDMA P/C# , �t 1 above information is correct.I agree to comply with all County Investigation Fee ordinances and State laws relating to building construction, Total Fee LDMA Perm. # and hereby authorize repr .ntativ s of this County to enter e e up 21, above-menti prop for inspection purposes. a (/� SEE REVERSE FOR EXPLANATORY LANGUAGE , Signature of Applicant or Agent. Date a COUNTY OF LOS ANGELES TEMPLE CITY 9 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR • BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0405040034 PHONE: (626) 285-0488 EXT: LEGAL ID: NO. OF CON9T BUILDING ADDRESS: TR: 31886 UN: 16 SQ. FT STORIES TYPE 5426 MCCULLOCH AV A STRUCTURE: 600 VN TEMP CA 917803562 ASSESSOR INFORMATION NUMB R: NEAREST CROSS STREET: LIVE OAK 8573-014-041 THOMAS PAGE: 597 GRID: D3 .LOCALITY: TEMPLE CITY, C TENANT- EXIST BLDG USE: CONDO USE ZONE: R-2 ISSUED ON: PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 05/04/04 VG 04/29/05 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: MEOLA, IRENE - 1,400 5426 MCCULLOCH AVE K,�;V- TEMPLE CITY 91780 FEES PAID DESCRIPTION OF WORK T/0 EXIST FLAT ROOF AREA ONLY AND INSTALL TORCH DOWN 600 SF FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: RIGHT-WAY ROOFING (909) 981-5499- AA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID 1400.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 1400.00 VAL 82.20 TOTAL FEES 110.45 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE RIGHT-WAY ROOFING (909) 981-5499- 1714 N. SAN ANTONIO LIC. NO LOCATION AND SETSACKS__ UPLAND, CA 91784 652996 C39 SOILS ENGINEER APPROVAL ARCHITECT OR ENGINEER: T L. NO: FOUNDATION/TRENCH FORMS LIC. NO: SLAB/UNDER FLOOR IS•D FLOOR FRAMING MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION XX 3 01 FLOOR SHEATHING NO. OF FAMILIES: DWELLING UNITS: APT/CONDI STAT CLASS: YES 21 ROOF SHEATHING SCHOOL WITHIN HAZARDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION REQUIRED TOTAL SETBAC FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIOR LATH/DRYWALL EXTERIOR LATH RATED FLOOR/CEIL ASSEM. RATED WALL ASSEMBLIES i RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0508