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Home My Public Portal About5434 MCCULLOCH AVE_Building__ a�IdXNT 3APPLICATION FOR -BUILDING PERMIT FOR Ttl FILL IN (Print or type only) 2 BUILDING _ u / 3 G COUNTY OF LOS ANGELES - ADDREss "TMENT OF COUNTY ENGINES CITY zIP BUILDING AND SAFETY DIVISION. NO.OF BLDGS. BUILDING r _ SIZE OF LOT ) r 10 NOW ON LOT ADDRESS YL JJ ♦r. (� TRACT ` BLOCK LOT NO. LOCALITY �r % y TEL NEAREST OWNS O. CROSS ST. ASSESSOR ADDRESIZA16 fun ke. MAP BOOK PAGE PARCEL DISTRICT I GROUP ITYPE FIRE (MESSED BY CITY'affiadencL ZIP 'O CONST ZD,p�E ARCHITECTgl t TE ✓C ENGINEER NO STATISTICAL CLASSIFICATION SEWER MAP ADDRESS .J, CLASS NO.0DWELL.UNITS / B",0 PG CONTRACTO . TEL USE ZONE MAP O NO. U ADDRESftk NO. �(�j SPECIAL LIC, CONDITIONS C 1 T CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LE NAME AND BRANCH SLOG.SETBACK FROM FRONT PROP.LINE OF C (STREET) C ADDRESSn. HIGHWAY +CITY TOTAL SETBACK FROM TYPE OF EXISTING YARD SQ. FT. p- NO OF N0. OF CHECK FRONT PROP. LINEHIGHWAY WIDTH p SIZE p STORIES FAMILIES ONE C DESCRIPTION OF WORK ` NEW ® ( + /� 6 G • `�� ADD C] BLDG.SETBACK FROMco / SIDE PROP.LINE OF (STREET) ? LTER ❑ HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING SIDE PROP. LINE HIGHWAY WIDTH REPAIR❑ EXISTING BLDG DEMOL ❑ -USE OF + APPLIC T CORNER CUTOFF YES ❑ NO ❑ (PRINTyp 0. _ I BY (SIGNATURE) � IN OPEN SPACE YES El - NO El IN COASTAL ZONE YES ❑ NO ❑ VALUATION s CATEGORICAL EXEMPTION YES❑ NO ❑ I HEREBY ACKNO EDGE THAT I HAVE READ THIS APPLICATION ENVIRONMENTAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 IMPACT EXEMPTION DECLARATION SIGNED (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- STRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED IMPACT REPORT PROCESSED (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LABOR CODE OF THE STATE OF TING TO � WORKMEN'S COMPENSATIO SIGNATURE OF PERMITTEE ADDRESS FINAL BY CITY NO. DATE �rr-7 � � ,SAKE CHECKS PAYABLE 'TO: F E $ PMT FEE HARVEY T. BRANDT, COUNTY ENGINEER 7O 13 'PLAN CHECK VALIDATION UK. ' M.O. CASH / PERMIT VA ATIONGK. M.O. CASH 8 79 FEB -27 2 3 8 1.9-0 ksw 78A898A CE4803 12/72 A—,r�1` 8 9 71tZMAY 9 .1 0 1 3 6.5 0 Aad WORKERS' COMPENSATION DECLARATION hereby affirm that I have certificate of consent to self APPLICATION FOR BUILDING. P E RM I T insures, or a certificate of Workers' Compensation Insurance, or a certified copy thereof(Sec. 3800p,, ab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 4 7 V2 � Company.J � wry BUILDING Certified copy is hereby-furnished. . •/FO�R/i4P.P,LICANT TO FILL IN ADDRESS � G Certified copy is filed with the county building inspec- BUILDING J�7IJ "A AL 41 OG �✓E tion department. [►��/��^ Pn�J Date y Applicant"ALJ 0J. ,04 tf SouS. 1e, CITY4 /Er�/T ZIP 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•�l3 OWNER 61*a r I/A / 6"OtJ/✓E�2S NO. -gyp USE ZONE MAP I certify that in'the performance of the work for which this yy^� // / �L" (' NO. permit is issued, I shall,not employ any person in any manner ADDRESS <71J� JOS G��/O�7�E AYE �/ '3�a SPECIAL CL CONDITIONS so as to become subject to the-Workers'Compensation Laws. O CITY 61j'21.001,6- ed. ZIP 7 Q/zas, U Date Applicant ARCHITECT OR TEL. - DISTRICT GROUP TYPE FIRE ROCESSED BY NOTICE TO APPLICANT: If,. after making this Certificate of ENGINEER NO. �' ZONE O Exemption, you should become subject to •the. Workers' /�� CONST. / 0 Compensation provisions of the Labor Code, you must forth- ADDRESS / (J LLJ V o_ with comply with such ,provisions or this permit shall be (� � TEL. y/3 STATISTICAL CLASS FICATION APT. CONDO. N NO. Z(e/-,3/77 deemed revoked. CONTRACTOR 011%!V IJ tJtw Z LICENSED.CONTRACTORS DECLARATION ��//// / f! LIC. CLASS NO.�DWELL. UNITS ADDRESS q4 If✓1r17172 Nvd NO. C.-'-3 I hereby affirm that I am licensed under provisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business /`_ // LIC. and Professions Code,and my license is in full force and7effect. CITY ZO& �Lf E/E'1 `� y�Z 3 CLASS �4 70� BK. VALIDATION 39 SIZE STORIES FAMILLIIES ONE License Number � �� Lic. Class ' ///� r n VALUATION Contractorst+tlDate 9-�G Ap DESCRIPTION OF WORK/AE7�y/J—' MtkNEW I-EX/.tTly ❑ s W7 ' �Git L'7*+aUL•'tOBLiF'r6 — ADD ❑ , El I am exempt under Sec. J ALTER ❑ ' B.&P.C. for this reason r_L/0 -/Jr -P/SSS`d� �� / 0 � REPAIR ❑ S� Date: -USE OF !'T/J&uTS, EXISTING BLDG. DE 01 71 Signature APPLICANT TEL. Zt? OWNER-BUILDER DECLARATION (PRINT) v 1117104 S//pU NO. Z6/^3/77 FINAL DATE I hereby affirm that I am exempt from the Contractor's License [�z(��. 1j(477,me el IJ. L,4. 9/,007-3 Law for the following reason (Section 7031.5, Business and ADDRESS FINAL. 3307. .. 4001911 Professions Code): PRESENT' ByEl i ITEMS I, as owner of the property, or my t BUILDING employees with ADDRESS wages as their sole compensation,will do the work and �Q, TOTAL �� the structure is not intended or offered for sale(Section LOCALITY , C ❑ 7044, Business and Professions Code.) MOVING TEL. fed, CHECK � I, as owner of the property, am exclusively contracting 'CONTRACTOR NO. ` 1 � eti with Iicensed contractors to construct the.project (Sec ADDRESS , CHANGE .011. tion 7044, Business and Professions Code.) REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 0000-130131 9/i9/89 the performance of the work for which this permit is issued P.L.' (Sec. 3097, Civ. C.). SIDE .57887 1 AM�,[I.7 i P.L. Lender's'Name LDMA Ref. # P.C. Fee$ Permit Fee Lender's Address , 11 I certify that I have read this application and state that the Issuance Fee 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 f,5 LDMA Perm. # and hereby authorize resent Lives of this County to enter up the above- ed'pr erty'for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent Date I _ I COUNTY OF LOS ANGELES Ir TEMPLE CITY # 0.508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0405040030 PHONE: (626) 285-0488 EXT: DUPLICATE EGALID: 0. 0 CONSTBUILDING D RES • TR: 31886 UN: 12 SQ. FT -STORIES - TYPE 5434 MCCULLOCH AV A STRUCTURE: 600 VN I TEMP CA 917803562 ASSESSOR- INFORMATION BER: `` NEAREST'-CROSS STREET: LIVE•OAK•. _ ( 85T3-014014-037 f, THOMAS AGE:-597 GRID:-.D3 FOCALITY: TEMPLE:CITY, C TENANT: IST BLDG USE: CONDO SE ZON R- ISSUED 0 PROC SSED BY: EXPIRES ON: {EXIST OCC GRP: 05/0'44/04 VG 04/29/05; OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION.: FINAL DATE FINAL BY: CODE: MOSSER JOHN L;ALINE B - 1,400 5434 MCCULLOCH AV /-2 f TEMP 917803562 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:. 1 RIGHT-WAY ROOFING (909) 981-5499- lAA BLDG PERMIT ISSUANCE 27.75 AC STRONG MOTION RESID \1400.00 V4L 0.50 SPECIAL CONDITIONS: CD2 PERMIT W/O-EN-HC 1400.00 VAL82.20 i TOTAL FEES 110.45 I CONTRACTOR: TEL. N0: I APPROVALS DATE, INSPECTOR SIGNATURE RIGHT-WAY ROOFING (909) 981-5499- " 1714 N. SAN ANTONIO LIC. NO LOC/�TION AND SETBACKS UPLAND, CA 91784 652996 C39 ; SOILS ENGINEER APPROVAL I ARCHITECT OR ENGINEER: TEL. NO: - I FOU D TION RE CH FORMS LIC. NO: I SLAB/UNDER FLOOR r i RAIjgD FLOOR FRAMING- MAP RAM NGMAP NO: SEWER MAP BOOK: -PAGE: FIRE ZONE: CMP:j UNDERFLOOR INSULATION XX 3 01 I N0. OF F I IES: DWFLOT SHEAT INGELLING NITS: APT COND: STAT CL SS: , YES 21 RDO SHEATHING .J Z. SCH00 ITHIN H RDO S SH R PANE S AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAIE INSPECTION REQUIRED TOTAL SETBA T FIR SPRINKI ER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- T RIOR LAT DRYWALL 1 EXTERIOR LATH RAT FLOOR/CEIL ASSE . RATED WALL ASSEMBLIES f RATF SHAFTS/OPENINGS JT-BJR CEILINGS 1 LOT.,',DRAINAGE REPORT ID: DPR261 ROUTE TO: BS0568 f _ I I