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Home My Public Portal About4925 PERSIMMON AVE_Building__ 76A636A CE#.03 10-6S APPLICATION FOR BUILDING P MI 1 COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION LOCALITY JOHN A.LAMBIE,COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN,SUPT OF BUILDING CROSS ST. DISTRICT ITO. 7 7GRr IT I P SSED BY FOR APPLICANT TO FILL IN CONST. BUILDING ADDRESS STATISTICAL CLASSIFICATION SE ER MAP CLASS.NODWELL. NITS id, //zPG . LOT NO7 Q� BLOCK MAP p ,p STATEO /�— NUMBER HWY. yES TRACT /�Q® USE ZONE SPECIAL NO.OF BLDGS. j CONDITIONS SIZE OF LOT f I NOW ON LOT / USE OF EXISTING B G. BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH OWNER FRONT MAIL P. L. ADDRESS .� SIDE clrY N INSPECTION RECORD ARCHITECT TEL. ENGINEER NO. ADDRESS TEL. _ CONTRACTOR NO. AD R S DESCRIPTION OF WORK NEW ADD AI LTEU-) REPAIR DEMOLISH SQ.FT. NO.OF NO.OF SIZE STORIES FAMILIES USE OF STRUCTURE SIGNATURE APPROVALS APPLICANT i DATE INSPECTOR'S SIGNATURE ADDRES FOUNDATION: LOCATION $ FORMS.MATERIALS P,C. $ - FRAME: FIRE STOPS. FEE BRACING, BOLTS VALUATION S �, FURNACE: LOCATION, �- FEE GAS VENT,DUCTS I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STAT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 H ALL COUNTY ORD" NCE, AND STATE LAWS RE L TING BUILDIN O TRUCTION. LATH, EXT. SIGNATURE OF HOUSE NUMBER COR. PERMITTEE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL EN PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH .'U07 1 2 8 1 A 5.0 Ci r APPLICATION FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETYI WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS I hereby affirm that I have a certificate of consent to self insure, BUI D A RE �/'� or a certificate of Workers'Compensation Insurance,or a certified A MS/07/7dW Copy thereof(SBC.3800,Lab.C.) CIT (GE �/ ZIP ®/ �� LOCALITY Policy No. Company SIZE OF LOT NO.OF BLDG&NOW ON LOT® ❑ Certified copy is hereby furnished. NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS /� -JY D/ CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER /� o TEL _ f COMPENSATION INSURANCE p WITHIN 1000 FT.OF SCHOOL? Yes No (This section need not be completed if the permit is for one hundred ADDRES ��Ch` C� 16 C V� DISTRICT GROUP TYPEj,tONST FIRE ZONE PROCESSED BY dollars($100)or less.) 1yVice'� Q I Certify that in the performance of the work for which this permit CITY c/ ZIP is issued, I Shall not employ any person i any manner So as to ARCHITECT OR ENGINEER TEL NO..O become subject to the Workers Compensation ion Laws. STATISTICAL CLASSIFICATION APT CONDO 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 t0 the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION SIDE CITY LIC.CLASS PL I hereby affirm that I am licensed underprovisions of Chapter 9 SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.F . E NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. NEW BK PG ® a License Number Lic.Class DESCRIPTION —WORK O ADD ❑ VALUATION Contractor Date E ALTER ❑ $ �' 7 O L/ cc ❑ 1 am exempt under Sec. REPAIR ❑ Q B.BP.C.for this reason DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ qq CD SignatureAPPLICANT(PRINT) TEL NO. LDMA Perm# d z 99.11, as owner of the property, or my employees with wages as Z ACCT. their sole compensation, will do the work and the structure is ADDRESS O not intended or offered for sale (Section 7044, Business and FINAL DATE a 3303 a�( Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL 1 as owner of the property, am exclusively contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE 1 ITEMS AMOUNTS SPEC IED N THE HAZARDOUS MATERIALS INFORMATION GUIDES FINAL BY5i licensed contractors to construct the project (Section 7044, YES 11No TOTAL ILC37 Business and Professions Code.) WILL THE CHECK (�_ �/ �y OCCUPANT IREQUIRE A PERMIT OR CONSTRUCTION OR MODIFICATION FROM THE NTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE USOUTH '!LDING & e `',+EC= �07 o 10 CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES. CHANGE .00 I hereby affirm that there is a construction lending agency for YES 11 No L cm the performance Of the Work for WI11Ch this permit IS ISSUed(SBC. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING �} (�++ ��yy `-}} U-20/9-5 f�-y a 3097,CIV.(i.) CHECKLIST I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES TITLE 2.CHAPTER 2 0 SECTIONS 2 20.100 THROUGH 20.140 O CONCERNING COUNTY HAZARDOUS I..i�IJLr—LI�IJ vj.��I�/7 Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQMD Ch Lender's Address [1977 1 PM 5:01 G O'NNER OR AGENT c I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE p� n with all county ordinances and State laws relating to building C117 �fJ m construction, and hereby authorize representatives of this County ISSUANCE FEE /, fu ato nter al he above-m ,'Pion roperty for inspection purposes. p{w m � -- INVESTIGATION FEE TOTAL FEE Z / D SEE REVERSE FOR EXPLANATORY LANGUAGE ` + COUNTY OF LOS ANGELES PLE CITY # 0508 "'� BjjI!.9ING PERMT-T DEPARTMENT OF PUBLIC WORKS - 9701 LAS TUNAS `iii , _ ^r^:;,cjfl'AL ADD BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 a - BL 0508 9810070048 PHONE: (818) 285-0488 ;EXT: LEGA ID: NO. OF CONST NEW _ _ B►IILD G AD R SS: TR: 4902 LT: 31 BL: F SQ. FT STORIES TYPE OCCUP GROUP 4925 PERSIMMON AV _ STRUCTURE: 864 2 VN R3 TE14P CA 917804105 ASSESSOR INFORMATION NUMBS :- GARAGE: NEAREST CROSS STREET: GRAND 8574-025-026 OTHER: THOMAS PAGE: 597 GRID: D4 20CALITY: TEMPLE CITY EAT: EXIST BLDG USE: USE 0 SS DON: PROCESSED BY: E P IIB�ES ON: EXIST OCC GRP: 11/30/98 UT 11/3D/99 OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE FINAL BY: CODE: LUK;KENT (626) 233-8148- 1 56,000 4925 PERSIMMON AVE. TEMP 917803148 FEES PAID DESCRIP IHON I OR ADDITION OF FAMILY ROOM, 2 BDRMS, BATH (2ND STORY) _ FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: APPLICANT: TEL. NO: SAME AS OWNER - 91 PLANCHECK W/ENERGY 40000.00 VAL 621.72 AA BLDG PERMIT ISSUANCE--��_ 27.75 SPECIAL CONDITIONS: AC STRONG MOTION!RESI_D- =-56000.0"0 VAL 5.60 B1 PLANCHECKs=-W%ENERG�Y�E„-C56000:U0' 181.76 _ B2 PERM I:T�W/ENERGY s • -VAL- 29 CONTRACTOR: TEL. NO: +�'�y� TOTAL`Fik� F� 1,782. APP OVALS DATE INSPECTOR SIGNATURE SAME AS OWNER ° A' "+. LIC. NO •� i! -✓�� , OCA AND SETBACKk J `�! SOILS ENGINEER APPRO / ARCHITECT OR—ENGINEER: TEL. NO: - S r-� '; '� CI - q� Np�1dy FOUNDATIONARENCH FOR LIC. NO: I' �.F("Iu' 'iii-7� p LAB/UNDER FLOOR / AISFD FLOOR FRA G rl T. 1. -" : +�.0 , MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CM UNDERFLOOR INSULATION 3 05 TST LEVET F OOR SHEAT NO.-OF-FAMILIES: DWELLING UNITS: APT/CO D: STAT CLASS: NO 21 `1 1 f �1 /� �j 1 //;, ND LEVEL FLOOR SHEATH SCHOOL WITHIN HAZARDOUS X\ \ �` : �� L-1 1 4 ! ` fROOF SHEATHING AIR QUALITY: 1000 FEET MATERIALS NO NO NO �� ,`_,', 5 ;-�x f ;:,�•`� FIRE DEPT. FRAME INSPECT �z r REQUIRED TOTAL SETBACK FROM EXIS °��(' I ' �%`•'�.' BLDG DEPT. FRAME I SPECT SET BACK YARD: HWY: PROP LINE: WIDTH: - �'��/ f ' FRONT PL- " 'fie ' C+6_ �r � SHEAR PANELS 77 SIDE PL- _ -- I�SUI.ATIO HER STRIP t INTERIOR LATH/DRYWALL EXTERIOR LATH LOT DRAINAGE SMOKE DET TIO DEVICES —let FIRE DEPARTMENT APPROVAL REPORT ID: DPR261 ROUTE TO: BS0508