HomeMy Public PortalAbout10555 OLIVE ST_Building__ 78A8384E#8038'+84 APPLICATION FOR BUILDING ERMIT lJ
'` COUNTY OF LOS ANGELES BUILDINGd, _ �
DEPARTMENT OF COUNTY ENGINEER ADDRESS
F BUILDING AND SAFETY DIVISION LOCALITY 1
JOHN A. LAMBIE'. COUNTY ENGINEER NEAREST
COLEMAN W. JENKINS,SUP•T OF BUILDING CROSS ST.
DISTRICT NO. GROUP' TYPE. R ESSED BY
FOR APPLICANT TO FILL IN coNsrC�
BUILDING I. STATISTICAL CLASSIFICATION S WER MAP
ADDRESS CLASS NO._�DWELL UNITS BK PG�J z
LOT NO. 45' '� BLOCK USE ZONE MAP G
NO. g7ltl 40
TRACT. SPECIAL
SIZE OF LO • NO. OF BLDGS
CONDITIONS
NOW ON LOT
USE OF
EXISTING BLDG. SETBACK FROM
TEL. FRONT PROP. LINE OF (STREET)
OWNE / O. TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESS �� � HIGHWAY WIDTH 'FROM C.L.
r o Zo + _
CITY LOG. SETBACK FROM
ARCHITECT TEL SIDE PROP. LINE OF (STREET)
ENGINEER NO.
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
ADDRESSHIGHWAY WIDTH FROM C.L.Mk flpa
TEL. + = 0
CONTRACTOR NO u
LIC CORNER CUTOFF YES ❑ No El DG
ADDRESS NO 0
CITY c� SEE REVERSE SIDE FOR SPECIAL APPROVALS U
11,
DESCRIPTION OF WORK CL
z_
NEW ADD ALTER REPAIR DEMOLISH _ �r •�
.FT. NO. OF NO. OF I'_/'.•ci�1+�/J'r!
SIZE STORIES F M LIES
USE OF i �� iii is�T N iAY >>��'T i S L�J�liL�
STRUC URE'
SIGNATUR U ! A� •�S 'a a�'v/ ,t'—z-
APPLICAN
VALUATION 000 t- /6 GAPPROVALS DATE I NSP ECTOR!SSIG NATURE
P.C. PMT. FOUNDATION, LOCATION 2- r �"`•+ ,.�
FEE$� FEE$ � FORMS, MATERIALS _ (, '1= �--y •'a �
FRAME, FIRE STOPS,
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLT I/ / .•'
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION / -eM G'•+ "
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT. DUCTS t1
9UILDI NG CONSTRUCTION. 1 CERTIFY THAT. IN DOING THE WORK 1 1
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH. INT. 's
/ � � �,ey
TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT. r, 'r'
ING TO WORKMEN'S COMPENSATION
INSURANCE. LATH. EXT.
SIGNATURE OF /�/ HOUSE NUMBER COR- (/
PERMITTEE w RECT AND POSTED A 1. /J!
ADDRESS Fl NAL ,'
JOHN F. LEWIS. PRINCIPAL STRU RAL ENGINEER
PLAN CHECK VALIDATION K. M.O. CASHPERMIT VALIDATION CK. M.O. CASH
6 9 1 3 0 923OCT 2 3 26.75A
A07,
2 6 1.- NOV 10 1 D 5 7.0 0,_. 1
WORKERS' COMPENSATION DECLARATION
VI
APPLICATI N ' F®R B .ILDING PERMIT hereby affirm that I have a certificate of consent to self
insure, or a certificate of Workers' Compensation Insurance, '
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS-ANGELES BUILDING AND SAFETY
Policy No, Company
NG
ElCertified copy'is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS
❑ Certified copy is filed with the county buildinginspec- BUILDING 10555 Olive Street
tion department. ADDRESS
Date Applicant . CITY Temple City ZIP 91780 LOCALITY
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT 7 2 X 91 ' . NOW ON LONO.OF T NEAREST
• „ CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK I LOT NO. MAP BOOK 8586 PAGE 029 PARCEL 042
hundred dollars ($100)or less.)• TEL. USE ZONE MAP /�7 5
OWNER Robert Prock NO.442-3439 No. 7J
I certify that in the performance of the work for which this SPECIAL
permit is issued, I shall not employ any person in any manner ADDRESS 10555 Olive Street / CONDITIONS 0
so as to become-subject to the-Workers'Compensation Laws. CITY • Temple' City ZIP 91780 V
Date Applicant ARCHITECT OR TEL. DISTRICTGROUP TYPE
FIRE PROCESSED BY
NOTICE TO APPLICANT: -If, after. making this Certificate of ENGINEER NO. CONST. ZONE O
Exemption, you should become- subject to the Workers' _
Compensation provisions of the Labor Code, you must forth- ADDRESS a
with comply with such provisions or this 'permit shall be TELSTATISTICAL CLASSIFICATION APT. CONDO. N
deemed revoked. : CONTRACTOR Owner NO. 442-3439 ` n z
LICENSED CONTRACTORS DECLARATION .. LIC. CLASS NO. 4 DWELL.UNITS
I hereby affirm that I am licensed under provisions of Chapter.9 ADDRESS 10 5 5 5 O'l ive S tr`e�. SEWER MAP
(commencing with Section-7000)of Division 3 of the Business CIN Temple City LIC.
and Professions Code,and my license is in full force and effect. CLASS BK PG. VALIDATION
SQEFT. 528 STORIIFS'NO.OF 1 AMILLIIES 1 O ECHECK
License Number � Lic. Class
VALUATION
Contractor Date DESCRIPTION OF WORK Patio Roof, NEW ❑ $ 5 , 000 .00
[JI am exempt under Sec. .11 ' X 44 ' ADD ® {
. ALTER El ® 1
BAP.C. for this reason �OO�va
'USE OF REPAIR $❑ .
Date: EXISTING BLDG. DEMOL ❑
Signature 3307 143.63
OWNER-BUILDER DECLARATION APPLICANT
T). Robert P ro ck TEL 3307 4 4 2-3 4 3 9 FINAL S 1 TTE
DATE
I hereby affirm that I am exempt from the Contractor's License ADDRESS 10555 Olive St. , T.C. 4, . FINAL TOTAL ►m
Law for the following reasoh (Section 7031.5, Business and63
Professions Code): PRESENT By ['( 7 L
I, as owner of the property, or my employees with ADDRESS OHE1�'i ��IJaOJ
wages as their sole compensation,will do the work and CHANGE .00
the structure is not intended or offered for sale(Section LOCALITY
7044, Business and Professions-Code.) MOVING TEL.,
CONTRACTOR NO. 3
❑ I,as owner•of the property,am exclusively contracting 0—[{Q[ji 1/7�1j/�j'ti,
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code.) 7821 1 . AN 9:113
CONSTRUCTION LENDING AGENCY SETT BACK YARD HWY TOTA PROP L�NE ROM WIIDTH
I hereby affirm that there is a construction lendirig agency for FRONT
the performance of the work for which this permit is issued P.L.
(Sec. 3097, Civ.C.). SIDE.
P.L.
Lender's Name
3 a �/ LDMA Ref. #
P.C. Fee$ Permit Fee O
Lender's Address
I certify that.1 have read this application and state that the Issuance Fee 42C it LDMA P/C#
above information is correct. I agree to comply with all County Investigation•Fee
ordinances and'State lawq relating to building construction, I Total Fee LDMA Perm. #
and ereby lhorize'rept'eseittatives of this County to enter
yb7,41 - "entio rsd prop r)''for inspection purposes.
r' � ,, -1/22/93 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature ofppllcant or Agent. Date