HomeMy Public PortalAbout5435 MCCULLOCH AVE_Building_7/14/1978_ APPLICATION FOR COUNTY OF LOS ANGELES ��]]//
• DEPARTMENT OF COUNTY ENGINEER 11-164
BUILDING PERMIT BUILDING AND SAFETY DIVISION ��''�-
FOR APPLICANT TO FILL IN BUILDING ADDRESS 541g 0. MC CULLOCH
BUILDING 5435 N0. MC CULLOCH LOCALITY TE CITY
NEAREST
ADDRESS
CITY TEMPLE CITY ZIP CROSS ST.
NO.OF BLDGS. ASSESSOR
SIZE OF LOT 60 J L7 D NOW ON LOT MAP BOOK PAGE PARCEL
G DISTRICT GR PE FIRE R SSED Y
TRACT 3 3 BLOCK LOT NO. NS �zrpe(E,
TEL. ��YA
OWNER O. 44-
ADDRESS 535 No• MC CULLOCH STATISTICAL CLASSIF A ON P
SEWER
CLASS NO. DWELL.UNITS BK `� G
CITY TEMPEL CITY ZIP 1 U ZONE MAP
`(. NO. d`�
ARCHITECT OR TEL. SPECIAL
ENGINEER Q NO. - 8/yU8 CONDITIONS
ADDRESS 13824 Ventura.Sherman Oaks ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑
CONTRACTOR AQUATIC POOLS No. 446-46 BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
ADDRES3101 E.Huntington NO. 315620 . TOTAL SETBACK FROM TYPEOF EXISTING
LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAY WIDTH
CITY ARCADIA CLASS _ __
CONSTRUCTION LENDER + O
NAME AND BRANCH BLDG.SETBACK FROM U
ADDRESS CITY SIDE PROP.LINE OF (STREET) ODe
SQ.FT. O.OF NO.OF CHECK HIGHWAY + YARD = TOTAL SETBACK FROM TYPE OF EXISTING bJ
SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH ti
= Z
DESCRIPTION OF WORK' NEW +
Swimming- Pool & Spa ADD ❑ CORNERCUTOFF YES ❑ NO ❑
435 Sq•Ft• ALTER ❑ IN OPEN SPACE YES ❑ NO ❑
USE OF REPAIR ❑ IN COASTAL PERMIT ZONE YES ❑ NO ❑
EXISTING BLDG. Residene DEMOL ❑
APPLICANT TEL af& _ lJ *-5-
(PRINT) NO. l
BY(SIGNATURE) G �7
r
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE _ r
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM-
PENSATION INnF
.I
AQUATIC . OOL
SIGNATURE
PERMITTEE DATEL r 2 7/7 9 BY
ADDRES Ston Drive
A DIA TE446-4661 P.C.Fee$ 3,75N, 2E Permit Fee I
CITY NO.
Issuance Fee
VALUATION Total Fee
20 1
PLAN CHECKMALIDATION <:G CASH PERMIT VALIDATION CK. M.O. CASH
6 7 4 Lee JUL 14 E'3 i) 3 5.2 8 Ab; 6 7 5"'JUL 14 1 n 70.Q 0 °SIL•
I% 76A638A CE/803A 6/77 ^ '
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have r certificate of consent to self APPLICATION M R BUILDING PERMIT
insure, or a certificate of Workers' Compensation Insurance, � •
a cgrtified copy thereof (Sec. 3800,:Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
"yNO-z.33 MS a-Company A-4 - VWR 1GRJ
❑ NG
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRIESS ,
IK-Certified copy is filed with the county building inspec- BUILDING
•���,�/�C'CULLOL� ,'¢vC�
�f tion department. /�
Dat e � ApplicaiCITY/-�PLF Cf—/ y zip LOCALITY
NO.OF BLDGS. NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCEASSESSOR
(This section need not be-completed if the permit is for one TRACT/)36Q BLOCK LOT NO. MAP BOOK• �� PAGEQ 7 PARCEL 99-2 d
hundred dollars ($100)or less,) TEL.
OWNERS & % C&Wp�d J NO.�y d USE ZONE MAP NO. y7 pP 77
I certify that in the-performance of the work for which this AA
SPECL
permit is issued, I shall not employ any person in any manner ADDRESS .3,Sr �G C�L L rT � v/ CON DTIONS L
so as to become subject to the Workers'Compensation Laws. , e g •� O
CITY TGF e2�T ZIP C/l
Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER- NO. CONST. ZONE
Exemption, you should become subject to' the Workers' w
Compensation provisions of the Labor Code, you must forth- ADDRESS dU 3 a
N
with comply with such provisions or This permit shall beEL. STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR O.?3.-7
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. A:P7/ DWELL. UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS •e=er SEWER MAP
(commencing with Section 7000)of Division 3.of.the-BusinessLIC.
and Professions Code,and my-license is in full force and effect. CITYAr 44, 4 CLASS BK. PG. VALIDATION
SQ. FT. NO. OF NO.OF CHECK
License Number!V2,30 r� Lic. Class SIZE. STORIES FAMILIES ONE
NEW ❑ VALUATION
Contract Date ���^� DESCRIPTION OF WORK / //9L L $ •/1 ���" ��
❑I am exempt under Sec. �L ADD ❑ ► .
ALTER
B.BP.C. for this reason �-ir � 3 REPAIR 11 $
• ��,,XX// Ools - -
Date: USE OF
EXISTING BLDG. DEMOL ❑
Signature APPLICANT TEL. FINAL
OWNER-BUILDER DECLARATION . T^�n
1 hereby affirm that I am exempt from the Contractor's License DATE 7 _17
s a -,�
Law for the following reason (Section 7031.5, Business ADDRE .Zoe'X/ � �L -Al� AXV& FINAL •
I °
Professions Code):- PRESENT 'By 4 -":;-i�•'
❑ I, as owner of We property, or m employees with BUILDING .s"•�' �G
P P Y. YADDRESS ./ .���_{ _�,j"
wages as their sole compensation,will do the work and ���i
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions Code.) MOVING TEL. + `
❑ I, as owner of the property,am exclusively contracting CONTRACTOR NO. iY.{_ ,_
with licensed contractors to construct the project.(Sec- CC ADDRESS 33111.
,
tion 7044, Business and Professions Code.) :3 1!. ,"i•.
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH 1
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.
i7ti•.I "
(Sec. 3097, Civ. C.). SIDE _31) _T" a'•'
Lender's Name ,._
8 � y� LDMA L# J
a i`)`�_,
P.C. Fee$ Permit Fee
Lender's Address i'I 298 m ��3
I certify that I•have read this application and state that the Issuance Fee ol�7s LDMA , _
3 above information is correct. I agree to comply with all Count Investigation Fee � / +''= '
9 PY. Y g !� t'HEC-T4 _?Q
ordinances and State laws relating.to building construction, Total Fee LDMA P _
and hereby authorize representatives.of this County to enter ,,:H ;(t„t ,01
g
up�o�n the a ned property for inspection purposes.
oi�%�7� ;k; SEE REVERSE FOR EXPLANATORY LANGUAGE
t ECIF;rs_�Ir1i j
Signature of Applicant or Agent Date i A