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Home My Public Portal About5102 PERSIMMON AVE_Building__ i DIVISION OF BUILDING AND SAFETY Dep arianent of County Engineer ABRUILDING County of Los Angeles WM. J. FOX, COUNTY ENGINEER APPLICATIORN FOR APPLICANT TO FILL IN ADDRESS 166A BUILDING .� ADDRESS LOCALITY NEAREST LOCALITY � CRO83 ST. NEAREST y- DISTRICT NO. PIAN CK.oR REC.No. PERMIT NO. CROSS ST. �y / Icy OWNER p f, RECEIVED BY DATE OF APPL. DAT ISSUFA MAIL ,'` j• � ADDRESS 0a2 t S J ho H USE ZONE 1 140. OF TYPE GROUPFIRE ZONE CITY erH� I TEL / PLANS I I r�� I NO. f7 / ARCHITECT OR ZONING DATED ENGINEER EL1 S" rm APPROVED BY- ADDRESS 9 f BUILDING / 1��/ so• I , (,� SETBACK LINE: �" j� (�G� of CONTRACTOR j 4 ' NOL. BBPPROVED DATE HOUSE NUMBERING / �i ADDRESS MAP NUMBED p 74 � L; .Cs�i� LEGAL J NO.�AS8IGNED HY DESCRIPTION LOT NO. BLOCK • �� / /yJ DATE I �,OnEC'1'IONS I INSPECTOR _TRACT (/� �/ NO. OF BLDGS. / p SIZE OF LOT 3-0 X eSG I NOW ON LOT /l/OT'/I�/�Q !•./C�?`� GJ USE OF r� NO. OF ! EXISTING BLDG. 110--n I FAMILIES O DFasCRipTION OF WORK .'.' z • NEW ALTERATION ADDITION REPAIR 0 oeDEMOLITION i I SIZE �Q NO. OF ROOMS STORIES I EXT. WALL ROOF I COVERING ,g�).,eC'./I,ti++�l COVERING rt USE OF STRUCTU El �- AMOVXLS INSPECTO 8 SIGNATURE DATE FOUNDATION: LOCATION ��-.__.S5 FORMS, MATERIALS 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP- FRAME: FIRE STOPS, �J PLICATION AND STATE THAT THE INFORMATION GIVEN 18 CORRECT. BRACING, BOLTS I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES FURNACE: LOCATION, AND STATE LAWS REGULATING BUILDINGCONSTRUCTION. �UCCTION. GAS VENT, DUCTS SIGNATURE OR I _ //_L_ L ��/�� 7h LATH, INT. PERMITTEE �� a r LATH, EXT. ADDRESS :�Z O-2 AUTHORIZED AGT. PLASTER, INT. PLASTER, EXT. HOUSE NUMBER COR- 7A9 FEE RECT AND POSTED FEE VALUATION ! E � FINAL JJ c {•��y,�� ,�- ��///t�� 76ASSBA DBS 3 8-89. • - mJIS'tl®1= OF aovw! MMMW ` BMW RAMYBUILDINGcao� Or ros aera�.»e IWILLIAM J. FOAL. COUNTY Ia1dINEE11 aNr rr�agp� CATSATT D. MIFFIN. SUPT OF■ulLwme M APPLEM TO - - Fm OFFICE = MY SUILDHId DISTRICT NO. `S'CK.=RKo.No. PERMIT NO. ADDRESS D 2-RAXId LOCALITY f2zDATEOPAPrL 13ATE INUM NKARKaazzSr 90 _ (� EN d MUILDIM 01111DIER ADDR // LITT ADDI REN �' 5a- PL �!®� NEARER CITY '�- ARCHITIM OR TEL, FIRKO.OF TYPE dRa Nd KIN ZONE a� PLAN■ �( .• AnnISINg ■LAI. J-a le ORD.NO. ■LTMACK LINK CONTRACTOM �' TNOD.. -�' �6 unm,A-/ MYPPRovED OATZ AD /Z JZ`- HouN NUM■KRIM LEGAL MAP Nummuml 00 xz --No. ANIsN DESCRIPTION TRACrZZMArf ■=OF LOTOD �� No' oN LAT - e USE OF� NO.OF DElcwwm D _ N O Z RQAIR OKMOLITION sm ROROONS aTORIsoKIM �Me co slim s �CD CALL OY N of F. u■K of■muamm Jugs" S INSPECTOR'■SI TURK DATE FOUNDATIONS LOCATION FORMS. MATERIALS 1 IIKRKMY AcKNOWL�■K THAT 1 NAYS READ THIS AP- FRAMMu FIRE■TOP■. r PLICATION Alm STATE THAT THE INFORMATION GIVEN IS MRACINd MOLT■ 3 MS'.I TO OOYPLY weM ALL COUNTY ORDINANCES FURNACZr LOCATION.dA■MIT. Dutra �3.- AND MATE L.ArYS RK■ULATIM■UILDIM OOINTRUCTION. ■ 77lRK OF - 1 LATH. INT. -S3 F r, ,0 AUTilOR®AOT J PLASTRIL INT. s O� P.a. PLATTER. 017. Hou■E mum■ cola =oe �O RECTAN VALUATION 0 8 �" RN ■L to .� FINAL APPLICATION FOR BUILDING PERMIT" COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL INBUILDING pp�ppDRE y ' S I hereby affirm that I have a certificate of consent to self insure, BUILDING ADDRES5102 PERSIMMON AVE. or a certificate of Workers'Compensation Insurance,or a certified CITY ZIP copy thereof(Sec.3800,Lab.C.) TEMPLE CITY 91780 / Policy No. 1046140 Company STATE FUND77 LOCALITY dr SIZE OF LOT NO.OF BLDGS.NOW ON LOT ❑ Certified copy is hereby furnished. I NEAREST CROSS ST XXCertified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date 11-1-94 Applicant RANDOL ROOFING ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. YES NO COMPENSATION INSURANCE ROBERT ELLIS 444-7069 WITHIN 1000 FT.OF SCHOOL? (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) 5102 PERSIMMON AVE. DISTRICT GROUP TY ONST. FIRE ZONE PROCESSED BY I certify that in the performance of the work for which this permit CIT TEMPLE CITY, ZIP 91780 y� _ is issued, I shall not employ any person in any manner so as to ARCHITECT OR ENGINEER TEL NO. become subject t0 the Workers'Compensation Laws. STATISTICALCL SIIFICATION APT CONDO Date Applicant ADDRESS CLASS N- >=y — DWELL UNITS NOTICE TO APPLICANT,• If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith RANDOL ROOFING 288-4040 FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION 529 E. VALLEY BLVD. 451937 SIDE CITY LIC.CLASS P L I hereby affirm that I am licensed underprovisions of Chapter 9 -3 SEWER MAP > (commencing with Section 7000)of Division 3 of the Business and SO.FT.SIZE NO.OF STORIES I NO.OF FAMILIES a Professions Code,and my license is in full force and effect. I NEW ❑ BK PGC License Number 451937 Lic.Class C-39 DESCRIPTION OF WORK ADD ❑ VALUATION ® C ContractorRANDOL ROOFINGDate 1-31-94 EFROOF 140119E. AND GARAGE ALTER ❑ $ 3,000.00 Im WITH 20—YEAR CLASS A FIBERGLAS REPAIR C ❑ 1 am exempt under Sec. $ B,BP.C.for this reason SHINGLES. TEAR OFF ONE LAYER DEMOL ❑ LL LDMA P/C CL Date: USE OF EXISTING BLDG. URM ❑ i U Signature A T APPLICANT(PRINT) TEL NO. LDMA Perm# rSs C.C.i o Rte' ❑ I, as owner of the property, or my employees with wages as RANDOL ROOFING 288-4040 zn + ;c their sole compensation, will do the work and the structure is ADDRESS O iti(1_ ii�o not intended or offered for sale (Section 7044, Business and FINAL DATE a 1 I T EKS Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL r- -�� ❑ 1, as Owner of the property, am exclusively contracting with OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE FINAL BY T0TiAL 121�35 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, ves 11 No 11 CHECK 1421.3c Business and Professions Code.) WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING .-I`: OCCUPANT REQU;RE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH I NAraGE •U= CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES I hereby affirm that there is a construction lending agency for YES❑ NO❑ N the performance Of the Work for which this permit IS ISSUed(Sec. °' IHAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMDPERMITTING �i[I:I�f—��;liil s.i.t2,?/f �- 3097,Civ.C. � ) CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, a TITLE 2.CHAPTER 2.20 SECTIONS 2 20 100 THROUGH 2 20 140 CONCERNING HAZARDOUS d��{} i '� e�,� Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQM1 D. - 1 o Lender's Address O OWVER 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 94.95 a with all coun in es and St a laws relating to building m constru n, n authorize re tatives of this County ISSUANCE FEE ato t po a -n?It,o led p r for nsp t' n pur 26.40 A L / INVESTIGATION FEE TOTAL FEE Ggm1,.. 1 ApC I Q Ap.n o.-1. 121.35 SEE REVERSE FOR EXPLANATORY LANGUAGE