HomeMy Public PortalAbout5634 MCCULLOCH AVE_Building__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 1 z= BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS AL-T-ERAT-ION/REPA-I.R---__,
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 9810060047
PHONE: (818) 285-0488 EXT:
LEGAL ID: NO. OF CONST 1-BUILDING-7AD RESS:--
TR: 12049 LT: 6 SQ. FT STORIES TYPE 5654 MCCULLOCH AY '
STRUCTURE: 0 VN TEMP-CA 9]Z802961-J�
ASSESSOR INFORMATION NUMB NEAREST CROSS STREET: DAINES
8573-013-040 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY
TENANT: EXIST BLDG SE: RESID USE ZONE: R-2 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 10/06/98 UT 0/06/99
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAT FINAL BY CODE:
STRAUB ANTHONY P;IONE L (626) 445-5792- 1 3,240 1 fo-A`
5654 MCCULLOCH AV
TEMP 917802961 FEES PAID DESCRIPTION OF WOR
RECOVER WITH GAF FIRESCREEN SHING E CLASS A 20 YR.
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
APPLICANT: TEL. NO:
RANDOL ROOFING (626) 288-4040- AA BLDG PERMIT ISSUANCE 27.75
529 E. VALLEY BLVD. AC STRONG MOTION RESID 3240.00 VAL 0.50 SPECIAL CONDITIONS:
SAN GABRIEL, CA D2 PERMIT W/O EN-HC 3240.00 VAL 115.80
TOTAL FEES 144.05
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
RANDOL ROOFING (626) 288-4040-
529 E VALLEY BLVD LIC. NO LOCATION AND SETBACKS
SAN GABRIEL, CA 91776 B
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
140H277 3 01
FLOOR SHEATHING
N0. OF AMILIES: DWELLING UNITS. APT COND: STAT CLASS:
NO 21 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/DRYWALL
EXTERIOR LATH
RATED F 00 CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPENINGS
T-BAR CEILINGS
* ADDITIONAL DATA ON FILE
OT DRAINAG
REPORT ID: DPR261 ROUTE TO: BS0508
WORKERS'COMPENSATION•DECLARAtION
enre ,have �
t'inssu insure, o affirm that I or a certificbte'of Workers'
certificate of consent to self kers'Compensation Insurance, APPLICATION FOR L®I N G PERMIT
or a certified copy thereof(Sec. 3800, tv. C.) a COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company r711..''1-< Lf�-
QFOR APPLIC NT TO FILL IN BUILDING IS� —L
Certified copy is hereby furnished. ADDRESS
Cert' 'ed copy„is filed with the county building inspec- BUILDING
ti epartr7r/►ent. ADDRESS J� n I c_ L� OG�
Date 5F 1 Applicant CITY �Lb�rC��J ZIP LOCALITY
/CERTIFIC' TE OF EXEMPTION FROM WORKERS' SIZE OF LOT �x'LG (• T NOW ON LOT `�— CROSNO.OF BUJ0S. SSST. 1
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one ASSESSOR
.hundred dollars ($100)or less.) TRACT Q-L BLOCK LOT NeDl MAP BOOK PAGE PARCEL
TEL. USE ONE MAP
I certify that in the performance of the work for which this OWN V NO. NO.
permit is issued, I shall not employ any person in any manner �� SPECIAL IL
so as to become subject to the Workers'Compensation Laws. ADDRESS !ll���--- CONDITIONS 0
Date Applicant CITY ZI (-7 ad
NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT - T DISTRICT G UP TYPE FIRE PROCESSED BY 0
ENGINEER O• 70-0 "r CONST. ZONE
Exemption, you should become subject to the Workers' �/) �� � �
Compensation provisions of the Labor Code, you must forth- ADDRESS r%/(J. i �r `� T AL
with comply with such provisions or this permit shall be 2 #A
CONTRACTOR �CC31.c NO. 7 �� �STATISTICAL
NOCLASSI�TIgN�� Uy�s1 APT. NDO. g
deemed revoked. _ vAT IO UNITS
LICENSED CONTRACTORS DECLARATION e" 3 LIC. �/
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS ✓� 7) NO. '/ SEWER MAP
(commencing with Section 7000)of Division 3 of the Business and LIC. /
Professions Code, and y Ii rise is' full force and effect. CITY CLASS BK VALIDATION
.�rJtf'7 jv[4 SQ.FT. NO.OF NO.OF CHECK
License Number t / 7 Lic.Class r SIZE STORIES � FAMILIES ONE l 6 5 4.6 A
{x'^� �j VALUATION Contractor _ ate `' / DESCRIPTION OF WORK NEW L� $ LM
CI® 0 0 0 0 2 3
I am exempt under Sec. / �-GtJ ADD ❑•' ® ( o (�L 7.()
ALTER ❑-
B.&P.C. for this reas REPAIR ❑' $ a a 4 2 7 0 7 z
USE OF
Date: ❑
EXISTING BLDG. DEMOL
Signature t APPLICANT TEL FINAL (i G 2 V-
OWNER-BU DECLARATION PRINT al Sds✓ NO. DATE/Z,
I herebyaffirm that I am exempt from the Contractor's License q� �� A-IO�
Law fothe following reason(Section 7031.5, Business and ADDRESS O�3S �y • ' FIN
Professions Code): PRESENT By
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS -27 01 8 A
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section c LOCALITY
7044, Business and Professions Code). r MOVING TEL. ® # 0 0 0 0 0,1
❑ I,as owner of the property,am exclusively contracting CONTRACTOR NO. - 72a25
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). t
REQUIRED TOTAL SETBACK FROM 1 0 - 7213255
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
I hereby affirm that there is a construction lending agency for FRONT U512-87
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ. C.). SIDE
P.L.
Q Lender's Name ?
ll + LDMA Ref. #
Lender's Address P.C. Fee$ s��r U Permit Fee 1 I
I certify that I ha read this application and state that the Issuance Fee C� .� LDMA P/C# 100,
above informatio corr . I agree to comply with all County Investigation Fee i
ordinances and to aws elating to building construction, I Total Fee LDMA Perm.#
u and hereby au ri repr sentatives of this County to en
3 upon the a o m ntio d property for inspection pur, s.
o ( � � SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig re of WIcant or Agent D e