HomeMy Public PortalAbout5428 MCCULLOCH AVE_Building__ �: _APPLICATION FOR BUILDING PERMIT
NT 'FILL IN (Print or type only)
FOR AMICk
FADDRE
W a �. PARTMENT
COUNTY OF LOS ANGELES
/ QC r OF COUNTY ENGINEER /�
!t zIP BUILDING AND SAFETY DIVISION GNO.OF BLDGS. BUILDINGLOT C/ NOW ON LOT ADDRESS CSG
TRACT �L BLOCK LOT NO. LOCALITY A4 AE Of r
E7 NEAREST
OWNER J' i f/Ce !t OL CROSS ST. CJ
ASSESSOR
ADDRESS `p MAP BOOK PAGE PARCEL
_ DISTRICT GROUPTYPET. . ZONE FIRE ESSED BY
ONS
CITY •� I✓r✓ ZIP
ARCHITEC TE /(J�
ENGINEE Lei _ NO.
f STATISTICAL CLASSIFICATION 1 SEWER MAP
ADDRESS % L CLASS NO. 0-2 DWELL.UNITS T� BK/D G
CONTRACTOR OL USE'ZONE MAP n' ®
LIC./ NO. G/
ADDRESS NO. �� CONDITIONS
CITY SPECIAL
� + • "17 LIC.
CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO
CONS RUCTION LEN cc
NAME AND BRANCH - @ moi,✓%G S BLDG.SETBACK FROM I
FRONT PROP.LINE OF (STREET)
ADDRESS (p C(TY L� _ TOTAL SETBACK FROM TYPE OF EXISTING C-
HIGHWAY + YARD - FRONT PROP. LINE
SQ. FT. •G NO OF NO OF CHECK HIGHWAY WIDTH p
SIZE / STORIES }� FAMILIES ONE C
DESCRIPTION OF WORK ! NEW + lJ Li
ADD ❑ BLDG.SETBACK FROM a
Gy f-s �� SIDE PROP.LINE OF (STREET)
ALTER ❑ HIGHWAY •l- YARD = TOTAL SETBACK FROM TYPE OF EXISTING
REPAIR❑ SIDE PROP. LINE HIGHWAY WIDTH
USE OF
EXISTING BLDG. 'J`II !� ' �1 DE MOL ❑ +
APPLICA �jA/ TEL CORNER CUTOFF YES ❑ NO ❑
(PRINT) I/�
IN OPEN SPACE YES ❑ NO ❑
BY (SIGNATOR
�J IN COASTAL ZONE YES ❑ NO ❑
VALUATION$-30 /� CATEGORICAL EXEMPTION YES❑ N0 ❑
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 AN PERSOII IN IOLAT
JOA_PF THE
LABOR CODE THE STAT NO TO •-�/` �Al ®A�' r y
WORKMEN'S : OF NSATI 7 �fsr
SIGNATURE O K
PERMITTEE
ADDRESS
TEL. FINAL BY ,
CITY NO. DATE i� 7 7)
MAKE CHECKS PAYABLE TO: P. E $ PMT.
HARVEY T. BRANDT, COUNTY ENGINEER FE Q Q FEE c=;2 /-3
r
PLAN CHECK VALIDATION CK. M.O. CASH PER V IDATION CK. M.O. CASH
8'7'7NFEB 2723 D, ' 2 7.80 W
76A688A CE 0809 12/72
9 9 NN+AY 9 1 0 2 1 3.0 0 •98
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have certificate of consent to self APPLICATION. -F O R� B U I L D I N G PERMIT
insurA, or a certificate of Workers' Compensation Insurance,
orcertified copy thereof(Sec. 3800,,Wb- /C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.D62721Z Company Snrl"uo 1� j / �
El copy is hereby furnished. FORbAPPLICANT TO FILL I n ADDRESS 5'1 AV./ • �• i/1.(�C}� A
Certified copy is filed with the county building inspec- BUILDING SG�Za ( G Lli 0 L .
tion department. ADDRESS p/,�/' I ADDRESS
Date L7 119- Applicant Aw^ omi � lu1 �1c. CIT �71f �r C!/ ZIP LOCAUTY - IF
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 BOOKPAGE PARCEL
hundred dollars ($100)or less.) TEL.ZI3
OWNE DLT/ 11-W Z61C-0WJf&J NO. Zkf^304 USE ZONE MAP
•1 certify that in the performance of the wprk for which this NO.
permit is issued, I shall not employ any-person in any manner ADDRESS So. X//JA/E 4tm, 41,92, 3/0 SPECIAL �
so as to become subject to the Workers'ComCONDITIONSpensation Laws. CITY 6�.�IE �/ ZIP �/ZQ� O
Date Applicant ARCHITECT ORix
TEL• DISTRICT GROUP. TYPE FIRE ROCESSED BY O
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST.•
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- ADDRESS -5!oy I-3 a
with comply with such provisions or this permit shall be f TEL. 213 STATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. CONTRACTOR G/F1L9MV,. O/f. NO. 2X/-3/]7 Z
LICENSED CONTRACTORS DECLARATION ADDRESS�f��IG ltI�//�/�tic J3l✓� LIC. CLASS No. _DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter NO�g�7a�'
,J ( LIC. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business CITY,�0,3 AN 6L7 �ZQ• %�Z3 CLASS �-39
and Professions Code,and my license is in full force and effect. BK. PG. VALIDATION
.�yamj C--�7 SIZE FT STORIOES �� FAMILOIES ONE
License NumberB`070Z Lic. Class
n/ p �p r�C� r ., _+0 NEW ❑ VALUATION
Contractor_G% 0lt�?01I ,fGurJ pate 7��7ra / DESCRIPTION OF WORKt2"WCoJSFaKc $ JY06
❑I am exempt under Sec. plyW.dj,ods 3ytl#fr4,q -a Amyk, ,111(irdt ADD ❑
ALTER pop.
for this reason - t/� of-y0! I bb?fr wrl tilt e�/f ❑
REPAIR ❑ $
Date: USE OF• //JJ
EXISTING BLDG.KEffy4Y� DEMOL El
Signature APPLICANT /J �] r TEL. Z/3.. FINAL
OWNER-BUILDER DECLARATION (PRINT) d K ruT101r f .dJll NO. Ul-3177 "
I Herebyaffirm that I am-exem t from the Contractor's License II II 'I''JJ� ,f DATE
Law for the following reason (Section 7031.5, Business and ADDRESS 47-4 NNI fIT/[Z O✓ �'~' 0023 FINAL 3307 59■25
Professions Code): PRESENT
R SSE NG By. 1 ITEMS
❑ I, as owner of the.property,'or my employees with ADDRESS TOTAL
wages as their sole compensation,will do the work and e, '-
the structure is not intended or offered for sale(Section LOCALITY C
25
70,44, Business and'Professions Code.) MOVING TEL. , t CHECK 59■25
❑ I, as owner of the-property,am exclusively contracting rADDRE
TOR NO.
With licensed contractors to construct the project (Sec- CHANGE(V ■
00
tion 7044, Business and Professions Code.) .
D TOTAL SETBACK FROM EXIST. 1'
CONSTRUCTION LENDING AGENCY K YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for 00Q --0001 9/19/8?
the performance of the work for which this permit is issued ■
(Sec. 3097, Civ. C.), r 57c86 1 ���■�1
Lender's Name.
Permit Fee $! LD"Ref. #
Lender's Address
I certify that I have read this application and state that the Issuance Fee !� LD"P/C#
above information is correct. I agree to comply with all County ion Fee
ordinances and State laws relating to buildingconstruction, Total Fee • LDMA Perm. #
and h r by authorize re pre tativ of this County to enter
upo th above-mention ope for inspection purposes.
�/�. �lzl - -�yr` SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Applicant or Agent Date
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 1210040058
PHONE: (626) 285-0488 EXT:
LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
ITR: 31886 UN: 15 I SQ. FT STORIES TYPE I 5428 MCCULLOCH AV A I
I ISTRUCTURE: 600 VN I TEMP CA 917803562 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LIVE OAK I
18573-014-040 I I THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl
ITENANT: ]EXIST BLDG USE: RESID USE ZONE: R-2 JISSUED ON: PROCESSED BY: 1
] (EXIST OCC GRP: 110/04/12 SR 1
10WNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FIN BY: CODE: 1
IGARDEN VIEW HOA — 1 3,900 II
15428 MCCULLOCH AV 1 1 I
ITEMP 917803562 1 FEES PAID I� •y
DESCRIPTION OF WORK I
ITEAR OFF EXISTING ROOF, INSTALL 28 # BASE SMOOTH TORCH I
[ ]FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IWAVE GRANULATED TORCH OVER FLAT AREA INSTALL 30TH BASE AND 1
[APPLICANT: TEL. N0: 130 YR GAR ASPHALT CLASS "A" SHINGLE OVER EXISTING SHINGLES I
IJIM RODGERS (626) 355-4585— IAA BLDG PERMIT ISSUANCE 27.80 1 I
5750 SAPPHIRE ST. JAB STATE GREEN BLDG FEE 3900.00 VAL 1.00 ISPECIAL CONDITIONS:
]ALTA LOMA CA 91701 IAC STRONG MOTION RESID 3900.00 VAL 0.50
ID2 PERMIT W/O EN—HC 3900.00 VAL 115.80
I 1 TOTAL FEES 145.10 I
ICONTRACTOR: TEL. NO: 1 APPROVALS DATE INSPECTOR SIGNATURE 1
RODGERS ROOFING (909) 732-3293-
5750 SAPPHIRE STREET LIC. NO 1 LOCATION AND SETBACKS I
IALTA LOMA, CA 91701 620156 C39 I [
� I
I I [SOILS ENGINEER APPROVAL I I I
]ARCHITECT OR ENGINEER: TEL. NO: — 1 ]FOUNDATION/TRENCH FORMS I I I
LIC. NO: I IS /UNDER FLOOR I I
I 1 ]RAISED FLOOR FRAMING I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:,( (UNDERFLOOR INSULATION I I I
1147H277 3 01.1 1 1-1 I
I I IFLOOR SHEATHING I I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS:] I I I� ot
I 1 YES 21 1 IROOF SHEATHING I
SCHOOL WITHIN HAZARDOUS 1 ISHEAR PANELS I/ I .
(AIR QUALITY: 1000 FEET MATERIALS 1 I [ I I
] NO NO NO I IFRAME INSPECTION
I I I
IFIRE SPRINKLER HANGERS [ I I
I I
1 �I ]INSULATION/WEATHER STRIPI—
I INTERIOR
IINTERIOR LATH/DRYWALL I I I
I ] 1EXTERIOR LATH I I I
I [ ]RATED FLOOR/CEIL ASSEM. 1 I I
I I RATED WALL ASSEMBLIES ] 1
1 ] RATED SHAFTS/OPENINGS
] I ]T—BAR CEILINGS ] 1 ]
] I ]LOT'DRAINAGE ] I I
[ ]REPORT ID: DPR261 ROUTE TO: BS0508
• 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 0405040033
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST B IL G. DDR SS:
TR: 31886 UN: 15 SQ. FT STORIES TYPE 5428 MCCULLOCH AV A
STRUCTURE: 600 VN TEMP CA 917803562
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK
8573-014-040 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID 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: FI AL DATE FINAL BY: CODE:
CORSE, HELEN - 1,400 i
5428 MCCULLOCH AV
TEMP 917803562 FEES PAID DE CR PTO OF WORK
T/O EXIST FLAT ROOF AREA ONLY AND INSTALL TORCH DOWN 600 S.F
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:
I 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 SETBACKS
UPLAND, CA 91784 652996 C39
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
XX 3 01
FLOOR SHEATHING
NO. OF AMILIES: DWELLING UNITS: APT/CO D: STAT CLASS:
YES 21 i 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/ WY-WALL
EXTERIOR LATH
RATED FLOOR/C IL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: OPR261 ROUTE TO: SS0508
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BIIILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1012010025
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST I BIIILDING ADDRESS: I
ITR: 31886 UN: 14 I SQ. FT STORIES TYPE I 5428 MCCULLOCH AV B 1
I ISTRUCTURE: V-B I TEMP CA 917803562 1
(ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
18573-014-039 1 1 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl
ITENANT: (EXIST BLDG USE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY: 1
1 1EXIST OCC GRP: 112/01/10 SR 1
(OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: I FIjqAL DATE FINAL BY: CODE: 1
ILEE, NANCY - 1 3,500 1I
15428 MCCULLOCH AV 10
ITEMP 917803562 1 FEES PAID ID SCRIPTION OF WORK I
I I 1REPLACE 8 WINDOWS SAME SIZ RETRO FIT ]
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1
(APPLICANT: TEL. NO: I I I
IOCHOA, NORBERTO (323) 888-6112- JAA BLDG PERMIT ISSUANCE 27.80 1 I
15925 E. OLYMPIC BLVD JAB STATE GREEN BLDG FEE 3500.00 VAL 1.00 ISPECIAL CONDITIONS: J
].LOS ANGELES 90022 JAC STRONG MOTION RESID 3500.00 VAL 0.50 1 ]
I JD2 PERMIT W/O EN-HC 3500.00 VAL 116.00 I
I 1 TOTAL FEES 145.30 1 I
ICONTRACTOR: TEL. NO: 1 JAPPROVALS DATE INSPECTOR SIGNATURE
ITHE GLASS CONNECTION ENTERPRISES (323) 888-6112- 1 1 I
15925 E. OLYMPIC BLVD. LIC. NO 1 1LOCATION AND SETBACKS 1 1 1
ILOS ANGELES, CA 90022 930820 C17
I ISOILS ENGINEER APPROVAL I 1 I
JARCHITECT OR ENGINEER: TEL. NO: I JFOUNDATION/TRENCH FORMS I I I
I - I
1 LIC. NO: ; JSLAB/UNDER FLOOR I I ]
1 1RAISED FLOOR FRAMING
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:J JUNDERFLOOR INSULATION ] I I
1147H277 3 001 1 J I I
I I IFLOOR SHEATHING
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I
I
1 NO 21 1 1ROOF SHEATHING I I
SCHOOL WITHIN HAZARDOUS I ]SHEAR PANELS I I
JAIR QUALITY: 1000 FEET MATERIALS
1 NO NO NO 1 1FRAME INSPECTION I I I
I ] 1FIRE SPRINKLER HANGERS ] I 1
] ] JINSULATION/WEATHER STRIP I I
1 I I I
I I I NTERZOR LATH/DRYWALL I I I
I I [EXTERIOR LATH
I I I
I I IRATED FLOOR/CEIL ASSEM. J I I
IRATED WALL ASSEMBLIES [ I I
I 1 IRATED SHAFTS/OPENINGS ] 1 1
I
] I IT-BAR CEILINGS I I I
I ] I
I (LOT DRAINAGE I 1 1
] I
I IREPORT ID: DPR261 ROUTE TO: BS0508 I I I I