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HomeMy Public PortalAbout6116 OAK AVE_Building__ I 76AG88A CE#80811-87 APPLICA`fION FOR BUILDING PERMIT ]. COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS 90.0AR ST. BUILDING AND SAFETY DIVISION LOCALITY TEMPLE CITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST GARI BALDI CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. FOR APPLICANT TO FILL IN DISTRICT NO. GROUP TYPE SEWER MAP K G BUILDING Z I CONST. I i ADDRESS 6116 NO o OAK ST- STATISTICAL CLASSIFICATION I LOT NO. BLOCK CLASS.NO..�'3 DWELL.UNITS MAP 21 ®D r� HWYE YES NO NUMBER fit J TRACT USE ZONE SPECIAL NO.OF BLDGS. /»� CONDITIONS SIZE OF LOT NOW ON LOT EX STING BLUSEOF DG. IntiIELLINC BUILDING EXIST. YARD HWY STREET NAME v� SETBACK WIDTH OWNER �'!AL''ER HAFFERKAMP FRONTMAIL ADDRESS 6116 NO.o OAK ST. SDE CITY TEMPLE CITY TEL. P.L. ARCHITECT OR TEL. INSPECTION RECORD ENGINEER NO. ADDRESS CONTRACTOR ° No. '�8 39 3 ADDRESS OVAVF, hL_HON1 DESCRIPTION -OF WORK NEW ADD ALTER REPA DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE A 111 ng FROOF t I,PH 2;0# LOCK COMPO SIGNATURE OF APPROVALS APPLICANT AVE.22 6 LOMA VE DATE INSPECTOR'S SIGNATURE ADDRESS FOUNDATION: LOCATION FORMS.MATERIALS $ 556 o OO P.C. S FRAME: FIRE STOPS. FEE BRACING,BOLTS VALUATION S /1 FURNACE: LOCATION, FEE 4 G 00 GAS VENT.DUCTS I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS R U P BUILDINW CONSTRUCTION. LATH.EXT. SIGNATURE OF HOUSE NUMBER COR_ PERM=EET RECT AND POSTED ADDRESS 2226 LOIvIA -AVE a ELIyIONTE FINAL 6-118 r CLYDE N.DIRLAM, PRINCIPAL STR U AL ENGINEER PLAN CHECK VALIDATION Cs, M.O. CASH PERMIT VALIDATION Cs, m.o. CASH MI. 6 6 7S JUN 9 1 A 4..0 0 M ®P '6A686A DBS-8 5-66 - APPLICATION ION FOR BUILDING PERMIT 1 DIVISION OF BUILDING AND SAFETY ADDRESS 'lam/ Department of County Engineer County of Los Angeles LOCALITY Tie ON WM.J.FOX.COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. DISTRICT NO. GROUP I SPE SEWEfiIR MAP PG FOR APPLICANT TO FILL IN �' �� CONST. + ��+.j��0�^ s F • JMAP � 1)3 STATE DDRES r� � YES NOBUILDING Ay LOT NO OViggs/®FJ11,C'Of W 10 U9E ZONE SPECIAL !. Cc, `+ Jp�� CONDITIONS TRACT SAIUM y�A I 4-44,9a `D c/ •Y s / NOFr SIZE OF LOT !/ /► l60 I NOW ON LOTHLDGS SETBAICK YARD HWY STREET NAME EXIST. WIDTH USE . o EXISTING BLDG. /;��+•C='� =-'-' -' FRONT F +p c 60 P. L. r SDE OWNER t;: l x "ems 1 3 F�� '� P.L. MAIL ADDRESS / d O• TRACT DWELL. I UNIT 5 INDUSTRIAL + p TEL P `*+l•ti;', 1 DWELL. I UNIT ClJt -f�.�P /, %A N tr,s 0 6 PUBLIC BLDG. ARCY;ITECT PfR 4 2 DUPLEX f UNIT TEL \ 7 ADDN.,ALT.. ETC. ENGINEER \ NO." ` u APT. UNITS MISCEL. ADDRESS \ 4 COMMERCIAL CONTRACTOR TEL. INSPECTION RECORD ©✓i/ f��:: � NO. ADDRESS DESCRIPTION OF WORK _ . t ,1e,ex, v Z y NEW ADD ALTER REPAIR DEMOLISH 9't 0 Co r'/+,-/fT/1//C i/I A/IT SQ.FT. q4_ NO. F / NO.OF SIZE UU STOI RES FAMILIES USE OF STRUCTURE j :'"4l -rt '%r.' '• SIGNATUREj�F .. 4 4.^ '`.- �`!r j`.= f G ; ,t�G�C r f�'1+ /• �f i", t, APPLIC,�•NT �•' ' ' d A APPROVALS Y ADDRESS mw -K✓� DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION �- $�� o P.C. S FORMS.MATERIALS FEE FRAME: FIRE STOPS. Z _ (� << 1 O - BRACING.BOLTS VALUATION r I1�R FEE FURNACE:LOCATION. 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS : GAS VENT.DUCTS APPLICATION AND STATE THAT H£ ABOVE 16 CORRECT AND AGREE TO COMPLY WIT L COUNTY ORDINANCES ATH,INT. AND STATE LAWS_; REGU ING BUILDING CONSTRUC- TION. ^ _LATH.EXT. SIGNATURE HOUSE NUMBER COR- PE RM7TTEE 0r " I RECT AND POSTED i a. ADDRESS f r � •j FINAL 15 WM.J.FOX.COUNTY ENGINEER VALIDATION C.N. DIRLAM.CHIEF BLDG. INSPECTOR 42 :5—U3 JAN 3 1 2.0 0 � i e . r APPLICATION FOR 8,U"ILDING PERMIT ~'v COUNTY OF LOS ANGELES �J BUILDING.AND SAFETY WORKER'S COMPENSATION DECLARATION BUILDING ADDRESS FOR APPLICANT TO FILL IN $UI ANG KESS I hereby affirm that I have a certificate of consent to self insure, or a certificate of Workers'Compensation Insurance,or a c d copy thereof(Sec.3800,Lab.C.) CITY( 1 ZIP n/ ,�1� 6� LSJ� LOCALITY Policy No. Company SRE•OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. l NEAREST CROSS ST. 2 ❑ Certified copy,is filed with the county building inspection TRACT BLOCK LOT NO. !� de en USE ZONE MAP NO. Date ,.Applicant L fL �� (9�iClJ O�• ASSESSOR MAP K PAGE. PARCEL _.�3 � VQ 0�tj SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER rL E N,Oj COMPENSATION INSURANCE Y 14- O� /�J WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one'hundred ADDRESS DISTRICT GROUP TYPE CONST. FIRE ZONE PROCE dollars($100)or less.) CITE ZIP /! 2• /wT I certify that in the performance of the work for which this permit - � — is issued, I-shall not employ any person in any manner so as to become subject-to the Workers'Compensation Laws. ARCHITECT OR ENGINEER Tp . 9 r (J oG 'STATISTICAL CLASSIFICATION APT dONDO Date Applicant ADDRESS CLASS NO. DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate' of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith -Vol FRONT comply with such provisions or this permit shall be deemed revoked. ADDAMS LIC.NO. P L } LICENSED CONTRACTORS DECLARATIONCITY LIC.C LASS PIDE C I hereby affirm that I am licensed underprovisions of Chapter 9 '- (commencing with Section 7000)of Division 3 of the Business and St g. NO.OF STORIES NO.OF FAMILIES SEWER MAP Professions Code,and dmyy license is in f II or a nd effect. T(�U NEW ❑ BK PG• C License Number / C v DESCRIPTION OF WORK n $ ADD ❑ 'VALUATION , C (.{� �QOOi /' _ ALTER Q $ 0-501a Contractor / z:,-e n z ❑ 1 am exempt under Sec.. REPAIR ❑ $ Z BAP.C.for this reason EMOL ❑ LDMA P/C Date: USE O XISTI G BLDG. URM ❑ Signat4(re APPLICANT(PRINT) D TEL O. [FINAL DMA Perm# €1CCT'r• X1, as owner of the property, or my employees with wages as C� /`� Z 3303 142.20 their sole compensation, will do the work and the structure•is ADDRESS /� O _ not intended or offered for sale (Section 7044, Business and l /G ' DATE a 1 1 I�f`� Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL { "O �' OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE = TOTAL -�42 _20 ❑ I, as owner Of the property, am exclusively contracting 44, AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL ; r licensed contractors to construct the project.(Section 7044, �j �:HE4{'. �,4`�,20 Business and Professions Code.) YES❑ NO`P WILL THE INTENDED USE OF THE BUIOUNG BY THE APPLICANT OR FUTURE BUILDING CHANGE• s[J OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR • GUIDELINES. I hereby affirm that there is a construction lending agency for YES❑ Nofif ` )000-0001 'l ✓1 the performance Of the work for which this permit IS ISSUed(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING /� 3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, (/I '7t 1 i}II "� 6 a,+�(j.. U3 TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS V f t Lender's NameMATER%S/q �GFOR OBTT OGCEFA �QSHE SCAOMD. , G � ' Lender's Address IX OMER OR-Ae6NP I certify that I have read this application and state under penalty CL of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE �n with all county ordinances and State laws relating to building (1 10 construction, and hereby authorize resentatives of this County ISSUANCE FEE. to ent upon t b - d ro rty for nspectio pur oses. Z1131 W INVESTIGATION FEE TOTAL F Y2aQ 2u GV--rd roar Atd D.i SEE REVERSE FOR EXPLANATORY LANGUAGE Air . #NORKERS'COMPE1`4SATIO14 DECLARATION �t + I hereby affirm that I have a certificate of consent to self APPLICATION FOR BUILDING PERMIT ' insure ,or a certificdte of Workers'Compenstion Insurance,or ' a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company i ❑ YNEARE Certified copy is hereby furnished. FOR APPLICANT TO FILL IN Certified copy is filed with the county building inspec- BUILDING %� - / t tion department. ADDRESS V�//(G lJ Date Applicant CITY \ i ZIP C G NEARET. 'L s "CERTIFICATE OF EXEMPTION FROM WORKERS' ' / NO.OF BLDGS. R COMPENSATION INSURANCE SIZE OF LOT / �' NOW ON LOT OK PAGE PARCEL (This section need not be completed if the permit is-for one E �SP P TRACT BLOCK LOT NO. . Q�� hundred dollars ($100)or less.) �. TEL.:77 CIALcertify that 'in the performance of the work for which this OWNER +/ NOi� 7' ' I NDITIONS permit is issued, I shall not employ any erso in n manner /� f�>'' C CT, GROUP TYPE FIRE PRO SSE BY U so as'to become subject to the Wor\ Compe i n �w{ J ADD'R�ES`(S�jtnG� 9 ! (f V CONST. y ZONEagr ( I CITYC/ r . _41ZIP 000 O Date Applicant �( STATISTICAL CLASSIFICATION NOTICE TO APPLICANT: If,'afte g tht rtt tca o ARCHITECT OR TEL. LU Exemption; you should become bject. to the Workers' ENGINEER NO. CLASS NO. DWELL.UNITS Compensation provisions of the Labor Code, you must forth- I ADDRESS' ! SEWER MAP � with comply with such provisions or this permit shall be TEL — deemed revoked. r,, CONTRACTOR NO. BK. C PG,�-G� VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. Professions Code, and my license is in full force and effect. CITYCLASS $ U p Q ' SQ. FT_ NO.OF NO.OF CHECK License Number Lic.Class SIZE STORIES FAMILIES ONE Contractor ' Date DESCRIPTION OF WORK NEW " 10 lI am exempt from the licensing requirements as I am a t �) ���� �,��'�� / ADD \ licensed architect or a registered professional engineer, ALTER ❑ FINAL acting in my professional capacity (Section 7051; REPAIR ❑ Business and Professions Code). USE OF \ EXISTING BLDG. DEMOL ❑ PINAL ' Lic.or Reg.No. Date APPLICANT TEL. ' OWNER-BUILDER DECLARATION (PRINT) NO. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5,Business and ADDRESS Professions Code): PRESENT E-1BUILDING I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sole(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. ❑ 1, as owner of the property, am exclusively contracting CONTRACTOR NO. �0 6 7.8 A with licensed contractors to construct the project (Sec- ADDRESS + o o o R tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. ` CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH •2 0 o J 2.0 Q' 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. 0 0 � �' �� �.� 'A. (Sec. 3097,.Civ. C.). SIDE �' ` P.L. Lender's Name 0 8•I~7— 9 1 t P.C. Fee$ Permit Fee Lender's Address ' I certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee ordinances and State. laws relating to building construction, Z andt; authoriz r rP7&do- sent five WINS County to enter Total Fee. u N. t ve, ti erty r fnspe tion purposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE i atur i' p'fant or Agent %,J Dot ®s