HomeMy Public PortalAbout5004 PAL MAL AVE_Miscellaneous__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 MISCELLANEOUS PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS MP 0508 0004270001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGA ID: NO. OF CONST NEW B I DI G ADDRESS:
TR: 12205 LT: 18 SQ. FT STORIES TYPE OCCUP GROUP 5004 PAL MAL AV
STRUCTURE: 1 VN R3 TEMP CA 917803431
ASSESSOR I FORMATION NUMBER: NEAREST CROSS STREET: KEY WEST
8585-030-022 EXIST BLDG USE: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY
EXIST OCC GRP: R3 USE ZONE: R-1
TENANT: ISSUED 0 PROCESSED BY: EXPIRES-ON:
BLDGS. NOW ON LOT: VALUATION: 04/27/00 UT 10/24/00
0
OWNER: TEL. NO: FINAL DAT FFINAL BY: CO
HUANG TING H;SUSIE TRS (626) 492-2018- LIST ITEMS: `
5004 PAL MAL AV
TEMP 917803431 DESCRIPTION OF WOR
TO FINALIZE BUILDING PERMITS-#5482 (ADDITION OF 112 SQ. FT.
OCCUP LOAD EXIST: AND ENCLOSURE OF 56 SQ. FT.) #5148A, #5150A, #6928A--
APPLICANT: TEL. NO: OCCUP LOAD NEW: ADDITION OF KITCHEN -160 SQ. FT.
SAME AS OWNER -
PARKING SPACES REQU ED• SPECIAL CONDITIONS:
PARKING SPAC P f-DED.
CONTRACTOR: TEL. N0: EXIT H ARE N C LIMITED TIME USE
SAME AS OWNER - NB }. FROM TO
LIC. NO
/f /j Q FEES P - D
FJ/ 4� r1 APPROVALS DATE INSPECTOR SIGNATURE
/SFE DESC 0 QUA TITY: UOM AMOUNT:
ARCHITECT OR ENGINEER: EL. 0: - TRAILER USE
0 PERMI I S OE 27.75
LIC. N0. 1 SE I S 145.95 SAFETY PERMIT
0 AL FEE 1111111 73.70
TEMP. SRC . APPROVED
MAP N0: SEWER MAP 800K: PAGE: FIRE ZONE: �Mp�:�n n D L
�C
���O R
n/� � TEMP. STRUCT. REMOVED
147H273 lug U lu'`]
0. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLAS
NO C O ❑
SCHOOL WITHIN HAZARDOUS �, �Ii"
AIR QUALITY: 1000 FEET MATERIALS e Q ❑ :�t�:! '"
NO NO NO A Ll ® �5
REQUIRED TOTAL SETBACK FROM EXIST—
SET
XIS
SETBACK YARD: HWY: PROP LINE: WIDTH: �arV
'le S, 1FRON
ic
SIDE PL-
REPORT ID: DPR267 ROUTE TO: BS0508
WORKERS'COb4PEVSATION DECLARATION CE 875(11-84) MISCELLANEOUS APPLICATION
.by affirm that I have a certificate of consent to self
, or a certificate of Workers)Compensation Insurance,or COUNTY OF LOS ANGELES BUILDING AND SAFETY DIVISION u
ified•copy thereof(Sec.3800,Lab.Q.
No. Company FOR APPLICANT TO FILL IN BUILDING ADDRESS
:ertified copy is hereby furnished. BUILD'NG O�� LOCALITY
ADDRESS 10Z AE:
:ertified copy is filed with the county building inspection LOCALITY • / J7� NEAREST
I.epartment. ri (/!� CROSS ST.
Applicant NEAREST ! -4,1� DISTRICT C07 NO O TYPE CONST ROCE99ED BY
CROSS ST. (i day
ERTIFIC,ATE OF EXEMPTION FROM WORKERS LEGAL
COMPENSATION INSURANCE DE9CRIPTI ON LOT NO. DLOCK MwF HIGHWAY
STATE MAJOR SECOND LOCAL
,/� No. OF BLDGS. NO. (CIRCLE')
SCCtIOn need not be completed if the WOIk 1nVO1Ved TRACT ,�(/� NOW ON LOT u9ri ZONE SP¢CIAL CONDITIONS
e permit is for one hundred dollars ($100) or less.) "XI
SIZE OF LOT / CASE of OF G OLD G.
fy that in the performance of the work for which this o
is issued, I shall not employ any person in any manner OWNER 0
® y
to become subject to the Workers' Compensation Laws. MAIL OCCUPANCY GROUP 3
ADDRESS S � U
Applicant
TEL."/ E"
:E TO APPLICANT: If,after making this Certificate of CITY � OCCUPANT LOAD z
)tion, you should become subject to the Workers'
)nsation provisions of the Labor Code,you must forth- APPLICATION FOR EXIT HARDWARE:
omply with such provisions or this permit shall be TRAILER USE ❑ GEOLOGY INSPECTION❑ No Spec. Knowl.
d revoked.
LICENSED CONTRACTORS DECLARATION OCCUPANCY INSPECTION Panic Devices
)y affirm that I am licensed under provisions of Chapter SAFETY PERMIT ❑ (LIST ITEMS BELOW)
tmencing with Section 7000) of Division 3 of the Busi- NO. OF EXITS
1d Professions Code,and my license is in full force and
PARKING REO'D D PROVIDED
SPACES
e Number Lic. Class
LIMITED TIME USE
ctor Date DATE DATE
. FROM: TO:
am exempt from the licensing requirements as I am a
sensed architect or a registered professional engineer S IZAAOFNO. OF INSPECTOR'S
;ting in my professional capacity (Section 7051, Bus- EXISTING BLDG. 7 STORIES SIGNATURE
ess and Professions Code). _ / c
PRESENT U E OF BUILDING FINAL APPROVAL
Reg.No. Date
HOME OWNER-BUILDER DECLARATION NO. OF EXISTING BUILDINGS ='
ON LOT AND USE
'•••- JL
by affirm that I am exempt from the Contractor's
Law for the following reason (Section 7031.5, Busi- 3303 1°i;_
Ld PIofessions Code): NO. PARKING
as owner of the property, will do the work and the SPACES PROVIDED '
l1i•
.{. EIME
ructure is not intended or offered for sale (Section TOTAL 22 7ro 70)44,Business and Professions Code).
PROPOSE° E OF BUILDING CHECKi.I�� °i IJ
CONSTRUCTION LENDING AGENCY
)y affirm that there is a construction lending agency «.� CHANGE ° 1.
e performance of the work for which this permit is
(Sec.3097,Civ.Q.
-'s Name
PROPOSED MAX. OCC.
's Address PERMIT FEE otip. QS flat, 1 AN !'
Fy that I have read this application and state that the
information is correct.I agree to comply with all County ISSUANCE FEE
aces and State laws relating to building construction, n
:reby authorize representatives of this County to enter TOTAL.FEE o� 7
Pie above-menti ne property for inspectionyurposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permitte Date