HomeMy Public PortalAbout10122 NADINE ST_Building__ meaeADeea
21ea APPLICATION FOR BUILDING PERMIT 1
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BUILD
DIVISION OF BUWngC; AND SAFETY ADDRESSING
DDREISS a 2 Z E I
Deportment of County Eagineer
County of Los Angeles LOCALITY G I rtr
JOHN A LAMBIE, COUNTY ENGINEER NEAREST h ',,yYr 'I
CASSATT D GRIFFIN SUP T OF BUILDING CROSS ST /S'.L.0 ,/v
FOR APPLICANT TO FTT.L IN DISTRICT NO GROUP TYPE SEWER
MA PG
BUILDING �f ' / CONST
ADDRESS �J Z �/ MAP
NUMBER ��V v SjTjypyTyE YES NO
LOT NO ( , BLOCK USE ZONE SPECIAL
p� CONDITIONS a
TRACT A 2 3 O �-
NO OF BLDG
SIZE OF LOT NOW ON LOT gETBA1CK YARD HWY STREET NAME ILDNG WIDTH
USE OF
EXISTING BLDG FRONT
P L bilip-
I p, Qi.1 p- 5 T.
y
OWNER l SIDE
MAIL P L
ADDRESS S TRACT DWELL 1 UNITPrIS INDUSTRIAL
CI NO -3 i DWELL ' 1 UNIT 6 PUBLIC BLDG
ARCHITEC O TEL 2 DUPLEX2 UNITS 7 ADDN,ALT, ETC
ENGINEER NO - '�� 8 APT UNITS
ADDRE 4 COMMERCIAL 8 MISCEL
CONTRACTO .NO �3 J INSPECTION RECORD
ADDRESS V ,
DESCRIPTION OF ORS
NEW ADD ALTER REPAIR DEMOLISH
SO FT NO OF NO OF
SIZE STORIES FAMILIE
USE OF STRUCTURE
IGN OF
APPL CANT APPROVALS
ADDRE8 DATE INSPECTOR S SIGNATURE
{ FOUNDATION LOCATION
151-060P
`/�/q�, X X P C S FORMS MATERIALS
l ,/t 0/(J(J FEE FRAME FIRE STOPS ci `
VALUATION 8 �a BRACING BOLTS �p
FEE FURNACE LOCATION / !
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS GAS VENT DUCTS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LATH INT
AND STATE LAWS REGULATING BUILDING CONSTRUC-
TION LATH EXT /�
SIGNATURE OF HOUSE NUMBER COR- /
PERMITT RECT AND POSTED J
ADDRE8 FINAL
;499 ,
JOHN A LAMBIE.COUNTY EN -NEER YAMATION CLYDE N DIRLAM.CHIEF BLDG INSPECTOR
CK MO CASH
IjI57 5 9-0 VR SEP 19 1 6 1 7�50 s 2
fA p,2sas° NOV29 i 3 5.0 0 �In
l
WORKERS COMPENSATION DECLARATION
hereby affirm that 1 have a certificate of consent to self APPLICATION FOR BUILDING PERMIT
insure or a certificate of Workers Compensation Insurance
or a certified copy thereof(Sec 3800 Lab ) _ COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Y-5 Company 12, s -
r
Certified copy is hereby furnished FOR APPLICANT TO FILL IN BUILDING
Certified copy is filed with th county buil g inspec BUILDING
h , �-
on department ADDRESS q� �r
ss
DateApplican CITY ZIP LOCALITY
CERTIFICATE OF EXEMPT FRO WORKERS - NO OF BLDGS NEAREST
COMPENSATIO INSURANCE SIZE OF LOT NOW ON LOT CROSS ST
(This section need not be completed if the permit is for one ASSESSOR
hundred dollars($100)or less) TRACT BLOCK LOT NO MAP BOOK PAGE PARCEL
TEL USE ZONE MAP
I certify that in the performance of the work for which this OWNER NO i NO
permit is issued I shall not employ any person in any manner ADDRESS �' 1 SIA O
so as to become subject to the Workers Compensation Laws CONDITIONS 8
Date Applicant CITY ZIP ARCHITECT OR TEL DISTRICT GROUP TYPE FIRE D BY O
CO
NOTICE TO APPLICANT If after making this Certificate of ENGINEER NO �27 � G
Exemption you should become subject to the Workers r
Compensation provisions of the Labor Code you must forth ADDRESS �i 0& �'� 414� h
with comply with such provisions or this permit shall be -
deemed revokedTEL STATISTICAL CLASSIFICATION APT CONDO Z
CONTRACTOR NO 86�
LICENSED CONTRACTORS DECLARATION LIC CLASS NO DWELL UNITS
—
I hereby affirm that 1 am licensed under provisions of Chapter 9 ADDRESS 6 NO 1
(commencing with Section 7000)of Division 3 of the Business and F LIC SEWER MAP
Professions Code and my license is in full force and effect CITY CLASS C.-S d BK VALIDATION
� , SCS FT ST OF FA OF CHECK
License Number Lic Class SIZE STORIES FAMILIES ONE
Contracto Date i DESCRIPTION OF WORK ADHD ❑ $uuATION
� -� 6 ' ®U
I am exempt under Sec ,
B&P C for thi reason ALTER $ _ 1208-88
REPAIR
` ate USE OF
EXISTING BLDG DEMOL
Signature APPLICANT TEL FINAL
ht
B LDER DECLARATION PRINT NO DATE
I hereby,off that I am exempt from the Contractor s License
Law for th allowing reason (Section 7031 5 Business and ADDRESS FIN
Professions Code) FKW1 -
❑ BUILDING
I as owner of the property or my employees with ADDRESS
wages as their sole compensation will do the work and LOCALITY
the structure is not intended or offered for sale(Section h
7044 Business and Professions Code) MOVING TEL
I as owner of the property am exclusively contracting CONTRACTOR NO ` ,✓� (/,
with licensed contractors to construct the project (Sec 400,
tion 7044 Business and Professions Code) ADDRESS
REQUIRED TOTAL SE K
CONSTRUCTION LENDING AGENCY - �BACK YARD HWY pjlOp LINE WIDTH la'
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
(Sec 3097 Civ C) SIDE
P L
e Lender s Name
LDMA Ref #
Lender s Address PC Fee$ Permit Fee p0�
1 certify that I have read this application and state that the Issuance Fee ! v 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 /�J CJ LDMA Perm #
u and ereby auth representatives of this County to enter
u the above en oned property for inspection purposes
e �tL SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ture of Applicant or Agent Date - 0 i
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 1106270076
PHONE (626) 285-0488 EXT
ILEGAL ID I NO OF CONST
BUILDING ADDRESS
ITR 22438 LT 10 I SQ FT STORIES TYPE I 1
STRUCTURE 2700 V-B I 10122 NADINE ST 1
(ASSESSOR INFORMATION NUMBER I TEMP CA 917802725 I
- I NEAREST CROSS STREET
18586-025-011 ] i THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY Ci
(TENANT (EXIST BLDG-USE RESID USE ZONE R-1 +]ISSUED ON PROCESSED BY 1
EXIST OCC GRP 106/28/11 SR 1
(OWNER TEL NO ]BLDGS NOW ON IAT VALUATION (FINAL TE FIYJAL BY CODE
(WARREN, DON - I 8 000
110122 NADINE ST
(TEMP 917802725 I FEES PAID ID CR IO F WORK 1
(TEAR OFF EXISTING ROOF REPLACE W/NEW SHINGLES I
I IFEE DESCRIPTION QUANTITY UOM AMOUNT I I
(APPLICANT TEL NO
IWEBB, MARK (818) 563-5325- IAA BLDG PERMIT ISSUANCE 27 80 1 I
I IAB STATE GREEN BLDG FEE 8000 00 VAL 1 00 ISPFCIAL CONDITIONS I
I IAC STRONG MOTION RESID 8000 00 VAL 0 80 I I
ID2 PERMIT W/O EN-HC 8000 00 VAL 183 40 1 I
I I TOTAL FEES 213 00 1 I
{CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE
IDELTA CONSTRUCTION & REPAIRS INC (818) 563-5325 I I
12315 N SAN FERNANDO BLVD LIC NO ]
IBURBANK CA 91504 935983 1 ILocATION AND SETBACKS I I I
ISOILS ENGINEER APPROVAL I I I
ARCHITECT OR ENGINEER TEL NO - i IFOUNDATION/TRENCH FORMS I I I
LIC NO i (SLAB/UNDER FLOOR I I I
I I I
IRAISED FLOOR FRAMING I I I
IMAP NO SEWER MAP BOOK PAGE FIRE ZONE CMP I (UNDERFLOOR INSULATION I I I
1147H273 3 00)
I I ]FLOOR SHEATHING ] I I
INO OF FAMILIES DWELLING UNITS APT/GOND STAT CLASS I
0 NO 21 i IR00%" SHEATHING I I I
I I
I SCHOOL WITHIN HAZARDOUS I ISHLAR PANELS I I
(AIR QUALITY 1000 FEET MATERIALS I
I I
NO NO NO ] IFRAME INSPECTION I I I
(FIRE SPRINKLER HANGERS I I I
I I (INSULATION/WEATHER STRIP( I ]
I
I (INTERIOR LATH/DRYWALL I I I
] I I I
(EXTERIOR LATH I I I
I I I I
IRATED FLOOR/CEIL ASSEM I I I
] I I I I
IRATED WALL ASSEMBLIES I I I
I I I
IRATED SHAFTS/OPENINGS I I I
IT-BAR CEILINGS I I I
1 I ]
(LOT DRAINAGE I
]
IREPORT ID DPR261 ROUTE TO BS0508 I I I I
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