HomeMy Public PortalAbout9416 OLEMA ST_Building__ es 76AS38A CITY OF T E M P L Et-I•T Y
CE#803(REV.
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN ADDRESS
BUILDING
ADDRESS 141.0-91]RINE 941.6 .01 em a LOCALITY e, . r
CITYT em 1 e City ZIP , -91780 CNROOss T C L.
NO.OF BLDGS: ASSESSOR
SIZE OF LOT :NOW ON LOT MAP BOOK PAGE PARCEL
DISTRICT I GROUP TYPE FIRE PROCESSED BY
TRACT BLOCK LOT NO. CONST. ZOO
OWNER John Faught NO-, 28.2-987 -a6 R 3 � LLL �o�twe
STATISTICAL CLAS FICATION SEWER MAP
ADDRESS 9 6. 0 e CLASS NO.J DWELL.UNITS BK —32Je
CITY Temple' .. City Z;P .91780
ARCHITECT OR TEL. VALUATION $ � Ick
��
ENGINEER NO.. ')
ADDRESS- BLDG.SETBACK FROM
FRONT PROP.LINE OF (STREET)
CONTRACTOR.H• 1 . R a.n d o l C 0 NO.2 8 8-4 0 4 0 TOTAL SETBACK FROM TYPE OF�E�XISTING
LIC. HIGHWAY + YARD = FRONT PROP.LINE HIGHWAYWIDTH
ADDRESS. NO.
CITY San, :G a b.r i,e l , C:a. cess -C-39 rp + Zl� = 2f3 G 0G `�`
(.►
CONSTRUCTION LENDER BLDG.SETBACK FROM /jp/l9if
NAME AND BRANCH SIDE PROP.LINE OF (STREET)
HIGHWAY + YARD = TOTAL SETBACK FROM I TYPE OF EXISTING
ADDRESS CITY SIDE PROP.LINE HIGHWAY WIDTH
SQ.FT. NO.OF NO.OF CHECK + ' _
SIZE STORIESS 1 FAMILIES 1 ONE 09
DESCRIPTION OF WORK Re-roof house NEW E] P.C..Fee.$ Permit Fee 2.7'0.0
Cv id
�1❑1 ALTER Issuance Fee -7 .00QA
12X18 EPA R Jllb! Total Fee
$ - 3-4-.00
ai
USE DEMOL ❑
EXISTITI NG BLDG. Z
APPLICANT TEL C
(PRINT) -L. RandolNo.288-4040 c
BY(SIGNATURE)
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE LY
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES
AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE s 1 5.616 A
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF {J
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN'S COM- Qo o e e o 1
PENSATION INSURANCE.
d
SIGNATURE OF
_ 2 ° ° 340.0
PERMITTEE
ADDRESS 529 -El ValleyBlvd. 3 IL 0 0
Z
c 11,30=78
CITY San Gabriel NT.88-4940 a
o '
USEZONE MAP
f� NO.
;Wa SPECIAL t
CONDITIONS X
FINAL (y / r'B !
DATE
*DIVISION OF BUILDING AND SAFETY
Department of County Engineer nrT 2 g Iq B ' L D I G
%N County of Los Angeles APPLICATION
1
-WM. J. FOX, COUNTY ENGINEER
FO�t-APPLICANT TO FILL IN FOR OFFICE USE ONLY
BUILDING _ DISTRICT NO. PLANGCK.OR REO. ^ PERMIT NO.
ADDRESS
LOCALITY R_ ES7EIVEp BJH, DAT OF APPL DATE IBBe�UED
NEAREST v (vjV/ C E,
CROBB - BUILDIIN �.�. �e
OWN
MA1 //�� LQOALITY ( ca nA P LC C, i T V
ADDR 9 - ,Ci NEAREST .L T
_�P``
CITY NOL FIRE NO.OF TYPE GROUP
ZONE PLANS
ARC TE TELG�
ENGINEE ND. BLDG. / ORD. NO.
ADDRE O
p/ SETBACK LINE 2 0 R Q�
UBEf APPROVED
CONTRACTO NES 6- ZONE ` \ BY DATE
T HOUSE NUMBERING
ADDRESS o `" 14AP NUMBER O 0 *-A) NO. ASSIGNED BY
DE
DESCRIPTION LOT NO. BLOCK CORRECTIONS
TRACT ItIS-(3(3
p Na. DF 9LDBB.,2e.,Ak
SIZE OF LOT X I NOW ON LOT
USEOF NO.OF
e%f
EXISTING BLDG. I FAMILIES Loe
DESCRIPTION OF WORK
0
NEW ALTERATION ADDITIONf� Z
/L lri� `� X19 30
REPAIR DEMOLITION I f
h a
I) �ACf/ df. Ata
SNO or
CIZE 3 ROOMS STORIES � ��L IfV'�f' ,4V KI 7?�
EXT.WALL ROOF
COVERING ✓ COVERIN
USE OF STRUCTURE
INBPEOTION F
J o 0 o PPROVALS
OCCUPANCY kA p INSPECTOR'S SIGNATURE DATE
FOUNDATIDN: LOCATION /
I HEREBY ACKNOWLEDGE THAT 1 FJAVE READ TN19 AP- FORMS, MATERIALS -
PLICATION AND 13TATE THAT THE INFORMATION GIVEN IS FRAME: FIREBTOPB. ,) 7
CORRECT. C+ BRACING.BOLTSI AGREE TO COMPLY WITH ALL "�
ORDINANC
AND STATE LAWS REGULATING BUIL GING OONSTRUCTION. FURNACE: LOCATION, �,
OAS VENT,DUCTS L/U 1 1 I
SIGNATURE OF LATH. INT. r "Jr� �7, ZA1
PERMITTEE
ADDRESS
LATH, EXT. 'y(�1?A
AUTHORIZEDrT f PLASTER, INT.
PLASTER, EXT.
FEEE G$ :2 `(� r"• HOUSE NUMBER OCR-
VALUATION
d $
RECT AND POSTED
REE FINAL
�r �- .� rl �}'Lt•�E��f `�
7"WBA D138 3 I-52
r. 1 /,
.,WORKERS' COMPENSATION DECLARATION
insure, affirm certif certificate of Workers'tificate of Compensation insurancelf e, APPLICATION FOR BUILDING PER M IT
or a cert ifiied c there'of�!ec. 3800,__Lab.gb. C.) � COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy o G�ZG mpony f
Certified co is hereby furnished. FOR APPLICANT TO FILL IN BUILDING'
PY Y ADDRESS �J
Certified copy is filed with the co; tbuilding inspec- BUILDING ' ) /1 �m
do clartment. ADDRESS -"1 & V
ig-
Date Applicant - CITM L' LOCALITY
NO.OF-BLDGS.
C RTIFICATE OF EXEMPTION FRO RKERS' SIZE OF LOT NOW ON LOT NEAREST
CROSS ST.
COMPENSATION INS URA I ASSESSOR
(This section need not be•complel if the ermit is for one TRACT BLO(;K LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) ^ TIO [;
OWNER J ' NO(�cT USE ZONE MAP
I certify that in the performance of the work for which this NO.
SPECIAL >
permit is issued, I shall not employ any person in any manner ADDRES f) CONDITIONS a-
s
so as to become subject to the Worke 'Compensation Laws. O
CITY ZIP'
Date Applicant ARCHITECT OR TEL.
NOTICE TO APPLICANT: If, after makingthis'Certificate of ENGINEER NO. DISTRICT GROUP TYPE FIRE PROCESSED BY Q
CONST. ZONE
Exemption, you should become,.subject to the Workers' D O •vim
Compensation provisions of the Labor'Code, -you must forth- ADDRESS / / a CL
with comply with such provisions or this permit shall be TEL- q ,�`� STATISTICAL CLASSIFICATION APT. CONDO. J Z
deemed revoked. CONTRACTOR .L. NO / / `y _
LICENSED'CONTRACTORS DECLARATION LIC. CLASS NO. a DWELL. UNITS
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS 'CC NU `b J SEWER MAP
(commencing with Section 7000)of Division 3 of the,Business LIC. p
and Professions Code,and my license is in full force an eff I. CITI!2 Yt62 -e-t"u CLASS Ci3. ( BK PG VALIDATION
�' SQ. F NO. OF NO.OF CHECK
License Number �-7 �� Lic. Class I SIZE Zd d ' STORIES AMI F ONE
aVALUATION
-
Contract l " ` Date L' f DESCRIPTION OF WWORRKy NEW ❑L{I
ADD ;LJ �i ►
❑I am exempt under Sec.
��Q _ ALTER ❑
BAP.C. for this reason 149-19 D'IREPAIR $
Date: USE OF-
EXISTING BLDG. sip DEMOL ❑
Signature APPLICANT TEL. FINAL I
OWNER-BUILDER DECLARATION (PRINT) NO.
I hereby affirm that I am exempt from-the Contractor's License DATE �—L — 1
Law for the following reason (Section 7031:5, Business and ADDRESS FINAL'
Professions Code):. PRESENT By }3's t.; :T
❑ I, as owner of the property,.Yor my employees with BUILDING
ADDRESS
wages as their sole compensation,will do the work-and
the structure is not intended or offered for sale(Section LOCALITY
TEL.
7044, Business and Professions Code.) - MOVING
CONTRACTOR NO. - +;t
❑ I,as owner of the property,am exclusively contracting ±i„w( :+'
with licensed contractors to construct the project (Sec- I ADDRESS
tion 7044, Business and Ptofessions Code.) ;�I=': _-•' C
F
TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY IYARD HWY PROP. LINE WIDTH•
I hereby affirm that there is a construction lending agency for ithe performance of.the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name �Qti DLDMA Ref. # I.7 ti ';y Permit Fee 1Lender's AddressI 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 allCounty ee-. ,Q
ordinances and State I ws relating to-building construction, Total Fee �” LDMA Perm. #
and hereby authorize presentatives of this County to enter
upon the above- nti ed property for inspection purposes.
q Q SEE REVERSE FOR EXPLANATORY LANGUAGE
10
Signat&e of lice for Agent Date