HomeMy Public PortalAbout9005 PENTLAND ST_Building__ -�
Ile, >a Aea 1 � t � �'yr/ 7`/- f�✓��✓��'s�^��,���� ��j����
1-'
APPLICATION FOR BUILDING PE IT
COUNTY OF LOS ANGELES A BUILDING AND SAFETY,
FOR APPLICANT TO FILL IN Bu - '-
ADDRES$ 0%o3-u S` �(J1-..-Lt.c.-�'
BUILDINGa �+ +
ADDRESS 00/- 03 -'O , LOCALITY Pentland & Rosemead CO
CITY Temple Cit 7P CROSSST S G ASSESSOR
SIZE OF LOT U X 16 OW ores o5MAP BOOK 340 PAGE_ 50PARCEL 43.'DISTRICT GROUP TYPE FIRE �RpCESSED BYTRACT 14983 BLOCK • '+� LOT A CONST ZON )OWNER onn 1la $ N022 �� (�`.` 71/STATISTI CAL C1A551 FICATION 11 EWER MAP
ADDRESS 26 N.Temple reit GLA55 NO 03 DWELL UNIT' 8K PGE ;MarY Temple Cit ' • zIPh ENGARCMEER TECT OR 47'C• 'sley NOL 3 VALUATION $ l�o 0 dADDRES5842 Alessaddro, Teitl B�TSPETTBBAAR pCKN OF, � 57REEI
CONTRACTOR John Marshall NoL22 TOTAL SETBACK FROM_ TYPE OF E%ISTING
HIGHWAY + YARD = FRONTPROP LINE HIGHWAY WIDTHADDRESS T C Bl d No5
CITY Temple- City CLA Bl GSO + ao
CONSTRUCTION LENDER BLDG SETBACK FROM /
NAME AND BRANCH Self SIDE PROP LINEl -STREET)
HIGHWAY } YARD TOTAL SETBACK FROM TYPEOF EXISTING
ADDRESS CITY SIDE PROP LINE IHIGHWAYI WIDTH O
50 Fi NO OF 1 NO OF CHECK + � >• JAV fU
SIZE mQ STORIES FAMILIES 3 ONE I °O
cc, `A
DESCRIPTION OF WORK ` NEW P C Fee$ ��l �D Permit Fee IrLj
Frame & StUeco ADD ❑ Issuance Fee V�d
Comp Roof ALTER +, Z
REPAIR ❑ Totol Fee _
USE OF
EXISTING BLDGSingle Family DEMOL ❑ 3931 z
APPLICANT TEL
(PRINT) Jolin jjarshal1 No 28648A2-: a3 +
��yy c •.7-I
BY(SIGNATURE)6L& l.i- �— 6.2-6 �t
HEREBY OWLEWE THAT HAVE REAO THIS APRLIUTKIN AND RATE .'z - R>R, '
THAT THEA IS CORRECT AND AGREE i0 COMPLY WITH ALL ORDINANCES ` 1I\
AND LAWS R LATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THES
WORK AUTHORIZED HEREBY'I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF _-t_3-7-
THELACODE OF THE STAT FULIFORNIA IN RELATING IO WORKMEN SCOM y ' Z
PENSATIOTIO N INSURAN
f
1,
SIGNATURE OF /Y••/'�,/E• /. _
PERMITTEE �>L � [)//r•''/ 'I"
ADORES em 2 IV Te Cit Blvd. �tii'n ✓
Z
O
CITY Temple City No 286- 82 �'
USE ZONE MAP -�> 217
(///1/•
R_3 SPECIAL �r
FINAL 'BY Y
DATE, "
' r
'JR 7eAe3e
CE/803(REV 6/9E) � lfsl
1 �
APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS ANGELES . BUILDING AND SAFETYBUIL ~
FOR APPLICANT TO FILL IN ADDUR G U3-06
ADORES$ Ov�- �"
BUILDIN ,p Pentland '& Rosemead
ADDRESS OOI-UJ -0.r /_ LOCALITY
CITY Temple Cit ZIP t 1 80 cR�ousr ` '
SIZE OF LOT 8 'x 163 NOW ON LOTNO S Vacant PBOOK + 340 PAGE 50,' PARCEL 43 '
TRACT 14 8 DISTRICT GROUP TYPE FIRE PROCESSED BY
BLOCK IOi '0 CONST ZONE
a)o n !Wars a TEL �/�Q
OWNER ��. N0286- 822
STATISTIC AL CLASSIFICATION I �SEW �
ADDRESS 592 rT, em 1e Crit Blvd • CLANS NO DWELL UNITS BK PG
CITY Temple Ctt zip 91 80
ARCHITECT o I.C.PUrs le No 286- 8 1 vn unnoN $
ENGINEER T
ADDRE555842 Alessa.ndro,Temp Te City BLDG SETBACK FROM '
FRONT PROP LINE OF `- (STREET)
CONTRACTOR John Marshall- 'N0286- 8 TOTALSETBACKFROM iVPEOF EXISTING
LIC
HIGHWAY + YARD FRONT PROP LINE HIGHWAY WIDTH
ADDRESS5926, N.T.C.Blvd. NO 165015 _
CITY Temple City- CABS Bl +
CONSTRUCTION LENDER Self BLDG SETBACK FROM + r
NAME AND BRANCH _ SIDE PROP LINE OF (STREET]
HIGHWAY + YARD TOTAL SETBACK FROM TYPEOF EXISTING
ADDRESS CITYDlpdt- SIDE PROP LINE 5.-HIGHWAY WIDTH
NTO OF
SOOl WS HKK +
SIZE < GRIES ~ In
V
ONE 0
DESCRIPTION OF WORK NEW ® F C Fee E Zr U U Permlt Fee _ -
Frame & Stlicc6 ADD ❑
issuance Fee
ALTER Z
COP1D Roof C REPAIR ❑ Total Fee
USE OF
EXISTING BLDGS-s.'�1-� a"E."`-r3.1� DE'V'OL v O
APPLICANT TEL ,_
IPRINTI Jo _ P9 shall NO 286-g8
• I
BY(SIGNATURE) 7Z pO
HEREBY A OWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE �- �� Y " 1 . ` •T'
THAT
THE A IS CORRECT AND AGREE i0 COMPLY WITH ALL ORDINANCES
AND LAWS EATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE �A/_Z 3 .•' S _ T • rv•I
WORK AUTH RIZED HEREBY LL NOT EMPLOY ANY PERSON IN VIOLATIOMOF / 5 '
THELABORCODEOFT STA CALIFORNIA IN RELATING TO WORKMEN S COM = r `y.
PENSATION INSURA t ./
r >
SIGNATURE OF _ _ •„
PERMITTEE r� 1 �• - �K' , L '
ADDRE 2 tf %_A fr _ 2
/ {{yuyu'' O I
TEL
rFINAL
Temple City No 286- 822 1
ONE OP -�`17 J��� _ •4
3
t
BV
WORKERS COMPENSATION DECLARATION � '
APPLICATION FOR - BUILDING - PERMIT u
e affirm that I have o cerbf¢ate of consent to self
insure lir a cerohcote of Workers Compensation Insurance
or a Eerirfied cepy thereof (Sec 3800'Lob C ) )) COUNTY OF-LOS-ANGELES t BUILDING AND SAFETY '
V y `-2�Ji. ...? A � ,7 .+,1 �-?tr W. _M.nZ1 �
Policy No Company ' g
Certified copy is hereby furnished ,� �ti1 -_ x P BUILD
I ING
T FIL I A-A gppRE55
❑ Certified,<opy is filed with the county building nspec BUILDING 1ta
�a� rt�
tion department ADDRESS IV
A
Dote' + '� Applicant CITY l —I T C/�ZIP LOCALITY
NO OF BLDGS»
- CERTIFICATE OF EXEMPTION FROM WORKERS 1 �. NEAREST '
` COMPENSATION INSURANCE SIZE OF LOT r •DHOW ON LOT CROSS ST .t
(This section need not be completed If the permit is for one + TRACT ' BLOCK LOT NO - ' ASSESSOR '
hundred dollars ($100)or less ) ' MAP BOOK�'r PAGE PARCEL
OWNER {''yn �CO Ns n2 a cfNOS7q-73� USE ONE v, `
I certify that m the performance of the work'for which this' �""�� NO � -
permit is issued I all not em y any Person in any manner D A s A dN ,�� - SffCIAt ,
,so as to be ome bleu to the rke Co -nsation Laws ADDRESS^ l ss.. ,e d A '1Q CONDInONS _
CITY L 'CA ZIP / / DID ,
Date A� pj. tf ^ OC
'NOTIC O A LICANT If ,afte m ing this Certi6<ote o ENG NEER ARCHO C.{LFT1S TNO DISTR�.. TYPE FIRE s SSED BY `) Q
Exemption u should become subject to the Workers CONST / ZONE r U
Compensation provimonaaf the labor Cade you must forth- ADDRESS LyJ
with comply with such provisions or'this permit shall be TEL STATISTICAL N APT CONDO �
deemed revoked u • 6 CONTRACTOR N'�E NO.1t' '� C� �'Z
LICENSED CONTRACTORS DECLARATION LIC•� CLA55 NO DWELL UNITS_ —
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS E NO J /
(commencing with Section 7OD0)of Division 3 of the Business and _ LIC _ SEWER MAP " a
Professions Code and my license is in full force and effect CITY CLASS - VAfb71i9d14 A r
SO f tJ0 OF NO OF _CHECK e
License Number' Uc Class "? PG
SIZ DRIES '� FAMILIES _ ONE # •'e • • 2 3
- S dcNf r- NEW VALUATION O
♦ j DESCRI O OF RK $ 6 , ;'I 1,39Q39
Contractor Date ADD
I am exempt under Sec LA a Q Ur ❑
"LAR 9,1 39Q396
B 8P C for this reason REPAIR $ , '
Date t EXISTING BLDG DEMOL ❑ - v 0 9 2 1,-8 7
SignoWre ' r APPLICANT �/Q tea_ 1 TEL 7'! FINAL
OWNER BUILDER DECLARATION (PRINT
I) c• � 'V �fNW JJ DATE
I hereby off irm that I am exempt from the Contractor s License ADDRESS-"Oil—
.�••.. J r'T �N fTT r y
Low for the following reason (Section7031 5 Business and FI }
Profession`s Code) ' I. i - '
_ BUILDING as owner of the property or my employees with ADDRESS
wages as then sole compensation will do the work and
the structure is not intended or offered for sale(Section LOCALITY " ^
7044 Business and Professions Code) ' MOVING '- - r TEL
0 1 as owner of the property am exclusively contracting CQNTIRACTOR NO
with licensed contractors to construct the project Sec : •• - - ,v
lion 7044 Business and Professions Code)p ( ADDRESS i~ ' - kr i I - 5 \ .4 ,v- 9 7 2 A'
REQCONSTRUCTION LENDING AGENCY '" SET BACK YARD 1HWY `v IOTA PROP ACK
LINE I' n 'WIDTH ti wl^' ' �� w'J_ ,+r-' S\" ''� �0 a e e'e 11
I hereby off um that there is a construction lending agency for FRONTr `
the performance of the work for which this permit is issued p L ^ ' t J (,e l yt _ ` >•`: t (�: 1`L -!I
(Sec 3097 Ctv C ) SIDE `.` - I L -` 1 y' si { t ,ye•� O 4 C J,�
Lender s Nome �, 4 0 &,021`8 8 '
g i , LDMA Ref N ,
Lenders Address PC Fee f mit PerFee if
♦ '
g
g I certify that I have read this application and state that the ° Issuance Fee 0 J77 LDMA P/C'N-
4 above information is correct I agree to comply with all County Invests orlon Fw f
ordinances and State laws relating to building construction _ Total Fee �j ' `
R and hereby authorize representatives of this County to enter 9 s `� LDMA Perm N` - -1
' upo %hove-mentioned pro/perty�for inspection purposes -
SEE REVERSE FOR EXPLANATORY LANGUAGE l
Signature of Applicant or Agent Dnro
N WQRKERS COMPENSATION D€CLARATION
e-y,affirm that 1 have a certificate of aeon In, to self -APPLICATION"FOR BUILDING PERMIT
msuro or o Fertificate of Workers Compensation Insurance
or u certlhed copy thereof (Sec'3800 Lob C ) "
e 1 COUNTY OF LOS ANGELES BUILDING'AND SAF Y '
Policy No - Company ,
Certified copy isihereby furnished FOR APPLICANT TO FILL IN BUILDING
ADDRESS Cl
❑ Certified copy ,s filed with the county budding inspecI BUILDINGQ
tion deportment • /` ADDRESS 1d�S' NTl.hND
Date Applicant t_ ' i CITY ZIP LOCALITY e e • +
CERTIFICATE OF EXEMPTION FROM WORKERS SIZE W LOT 3 l S X 16T,7.0
NOW F
BLS
�� NEAREST `
COMPENSATION INSURANCE +
,(This section need not be completed ,f the permit is for one .. _ . _ ASSESSOR " -T. '
hundred dollars ($100)or less ) + TRACT BLOCK LOT NO ,L.s�� MAP BOOKS Y PAGE PARCEI r
` OWNER S wn&JNOS T�••l$ USE ZONE MAP
1 certify that in the performance of the work for which this NO �
permit is Issued I shall not ampl-y any person in any manner �qN AN R.�"# � SPECIAL i
so as to be ome ubject to the rle ation,Laws ADDRESS CONDITIONS
,
Dote 1r AppL<ant _ CCTV
NOTICE'Th AFPtICANT If cnrter'mck�ing this Certificate of , r ARCHITECT OR* TEl .��/, DISTRICT GRpUP TYPE FIRE SSED BY C)
Exemption -you should become subject to the Workers ENGINEER 1JEN NSB'7(C� = NOTTi 17 S r(H\I CONS'T/ ZO1 U
Compensation provisions of the Labor Code you must,forth- ADDRESS tV L4.AkT'� JlT ,-V_ LL.I
wrth=compty�w,th 1such•prov,sionstar�this perm,tis_ ,hall he STATISTICAL CLASSIFICATION APT CO uN•
deemed revoked4-"-" CONTRACTOR—) /��j•,-�,�•-4 -.x .��.._— Z
LICENSED CONTRACTORS DECLARATION + w �, _ LIC a CIA NO i' — DWELL=UNITS-_ --- _ ,
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS SsTM NO "i
(commencing with Section 7000)of Division 3 of the Business'ond /� � - LIC SEWE
CIR P �_
Professions Code and my license is in full force and affect rV SCLASS BK -VALIDATION _
SO FT NO OF =LIES CHECK
bcense Number L,c Class SIZE 7 STORIES FAMILIES
a C.4 Nom`' VALUATION 8 7 9'6 5 A
Contractor Date - ' DESCRIPTION OF WORK
• ADD $ 1111, �3. , # •,• • • 23
I am exempt under Sec 4 • a
_ , ALTER N e 1 769,1
B 8P G for this reason REPAIR • ,f ' - '
Date USE OF DEMOL • is, 7 619 A 6
E%ISTING BL w t _ r
Signature a APRIPRIrn I DLJ O rEL r7y'73�y FINAL t^�j 0 9,2 1 i 8,7 '
OWNER BUILDER DECLARATION NCN DATE
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) - - -
0 BUILDING ,
as owner of the property, or my employees with ADDRESS s
wages m their sole compensation,will do the work and '4 •„ l - \
the structure is not Intended or offered for sale(Section LOCALITY -
7044, Business and Professions Code) - MOVING❑ TEL - - Y c �• #,• • • • • 1 CONTRACTOR Y L NO - I • 211�&6 3 ,
I as owner of the properly am exclusively contracting r
with licensed contractors to construct 44 the project (Sec- y ADDRESS,
- - '•"' �+ - '� f•�' s�' •r21 Q b 3 v
tion 70Business and Professions Code) \
IRED TOTAL SE j' s= \C ` � � i•
CONSTRUCTION LENDING AGENCY + ` SET BACK YARD HWV PROP LINE WIDTH {i - y �.4 1 (� O 2.'S S
I hereby affirm that there is a construction lending agency for FRONT r L"' ,
-the Performance of the work for which this permit is Issued .. P L
(Sec 3097, Civ C ) SIDE -�•, ,�((`` '
Lender s Nome '
c t
8 - _ LDW
-74
Lender's Address
c
PC Fee f• f Permit fee f.
I certif ,thotJ hade,readrthis application and state that the _ ^ `
Y DP -. Issuance Poe. J LDMA P/C N- t •�
above information is correct I agree to comply with all County � Investigation Fee
$% ordinances and Stole jaws relating to budding construction + ' Total Fee -< LpMA Perm N s _
R and hereby authorize representatives of this County to enter - -
a' upon the above mentioned
property for inspection purposes y
� L / �� (p�-�6 • SEE REVERSE FOR ULPLANATORY LANGUAGE
Signature of Applicant or Agent Date '� • i _- -