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HomeMy Public PortalAbout5356 PERSIMMON AVE_Building__ APPLIGA 1 IUN FUR BUILDING PERMIT FOR.-APPLICANT TO FILL IN (Print or type only) Fi,bovEss :�) ING - �M�n COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER f E C zIP BUILDING AND SAFETY DIVISION N OF BLOGS. BUILDING r� /OF LOT / ,Z NOW ON LOT / ADDRESS J sip �L(`gLL , TRACT /og(011 �S BLOCK LOT NO �� LOCALITY pry TEL. NEAREST OWNER © NO. Z CROSS ST. ASSESSOR ADDRESS E MAP BOOK PAGE PARCEL DISTRICT GROUP TYPEFIRE I PROCESSED BY CITY ZIP Q CONST.I ZONE R TEL. t 08 NO. STATISTICAL CLASSIFICATION SEWE MAP ADDRESS CLASS NO._-Zej_DWELL•UNITS SK PG TEL. CONTRACTOR ,U, NO og USE ZONE MAP rye LIC. R' NO. Liv �� ADDRESS C n�Q SPECIAL CITY �,� ! IC. V" CONDITIONS �. gelh--4 ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ CONSTRUCTION LENDER y� NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) c ADDRESS CITY _ HIGHWAY }- YARD TOTAL SETBACK FROM TYP •OF EXISTING SQ. FT NO. OF NO. OF CHECK FRONT P OP. LINE HI;IWAY WIDTH SIZE ��U STORIES 1 FAMILIES ONE ` DESCRIPTION OF WORK NEW ❑ + C D �O ADD BLDG.SETBACK FROM (STREET) JS SIDE PROP.LINE OF i ALTER ❑ _ TOT L S TBACK F OM TYPE OF EXISTING jeAHIGHWAY + YARD HIGHWAY WIDTH USE O �+ + REPAIR 1:1 IDE PROP. L E EXISTING BLDG. ,o e!5:. DEMOL ❑ ` APPLICANTq. +� TE ` CORNER CUTOF YES Oma❑ (PRINT) U h N BY (SIGNA R IN OPEN SPACE YE^ NO D IN COASTAL ZONE 1 _YES NO ❑ , VALUATION CAT GORICAL EXEMPTION YES❑ -• NO ❑ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ENVIRONMENTAL ` 7 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IMPACT EX M PTION_DECLARATION'SIGNEa." (DATE) WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON= C. - STRUCTION.• I CERTIFY THAT -IN DOING THE WORK AUTHORIZED 1' PACT REPORT PROCESSED',' � (DATE) HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA ON OF THE _ LABOR CODE OF THE STATE OF CALIF !NIA IN ELATING 0 ///� WORKMEN'S COMPENSATI SU CE. E/ 6w . ' -j ' \ SIGNATURE OF r. �C f i7 � � � PERMITTEE ,. - _ ADDRESS •�' Jrc!�lQ Y j!�f i(! r�� .��i�G -�-1 J r ,/ FINAL BY LH:AtRVEY Y, / NO. DATE / AKE_ CHECKS PAYABLE TO: FEE FEE T. BRANDT. COUNTY ENGINEER foQ PLAN CHECK VALIDATION CK. M.O. CASH _ PERMIT VALID TION CK. M.O. CASH 76A638A CE#803 7/73 3-8 SLPMAY •27 1 D6 9-0-08 a-p APPLICATION F _ COUNTY OF LOS ANGELES _. BUI•L.DING� PERMIT °BUILDING ANDSAFETYDIVSIONR .. • BUILD FOR APPLICANT TO FILL IN -' ADDRIE55 J� _ BUILDING 6 ADDRESS LOCALITY NEAREST Ar CITY ZIP CROSS ST. NO.OF BLDGS. ASSESSOR SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL J DISTRICT GROUP TYPE FIRE PROC ED BY TRACT/3 3 U BLOCK LOTNO.e� �.� Q 8 ; CONSTa / �E OWNER NOet� . • •` STATISTICAL CLASSIFF.II�CA'TTION SEWER MAP ADDRESS = CLASS NO. DWELL.UNITS BK PG CITY ZIP �I NO.. ARCHITECT OR TEL. /lCr SPECIAL ENGINEER NO. CONDITIONS ADDRESS ROAD DEPARTMENT APPROVAL REQUIRED YES❑ NO❑ TEL. CONTRACTOR AWz.- BLDG.SETBACK FROM , LIC.. FRONT PROP.LINE OF (STREET) ADDRESS /:5_&/r A'ail, Z,NO. HIGHWAY .+ YARD = TOTAL SETBACK FROM TYPEOF EXISTING LIC. FRONT PROP.LINE HIGHWAY WIDTH CITY G�fN© CLASS CONSTRUCTION LENDER + O NAME AND BRANCH BLDG.SETBACK FROM U ADDRESS CITY SIDE PROP.LINE OF (STREET) 0 SQ.FT. - NO.OF NO.OF CHECK HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING V SIZE STORIES FAMILIES ONE SIDE PROP.LINE HIGHWAY WIDTH. N DESCRIPTION OF WORK NEW ❑ — ADD Li CORNER•CUTOFF YES ❑ NO ❑ boe— _ ALTER ❑ IN OPEN SPACE YES ❑ NO ❑ USE O REPAIR El IN COASTAL PERMIT ZONE YES ❑ NO ❑ EXISTING BLDG. DEMOL El APPLICANT TEL (PRINT) NO. f f l``;� •' I rt71 ' C Lam' ^ >'C11�� ✓ BY(SIGNATURE) IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF ' THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELArING TO WORKMEN'S COM-_ PENSATION INSURANCE. ' SIGNATURE OFg FINAL ' PERMITTEE DATE `- Q//.�• ��,o(�/�� Iff&S,.�•" • ADDRESSS !ll��� goo— CITY./+�/� � 4 NO P.C.PCFee$ Permit Fee Issuance Fee 7 VALUATION p 3 Total Fee PLAN CHECK VALIDATION ' CK. M.O.' -CASH ' PERMIT VALIDATION CLC. M.O. CASH Q7(o 4L'Y vC-e� 5 9 4 0 HAY 23 1- D 4.3.0 .(D ®S 76A638A CE/803A 8/77 , - WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to selfo insure,ror a certificate of Workers' Compensation Insurance, A P P L I C6'®T I N' F OBUILDING P E RSA I T or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND-SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING. ADDRESS ❑ Certified copy is filed with the county building inspec- * y ADDRESS 5_3 S (O P�`$ �lve-(c7 K IJ�Q tion department. Date Applicant CITY yr�l (..e �, ZIP 90 LOCALITY / LG NO. OF BLDGS. NEAREST ' CERTIFICATE'OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST. COMPENSATION INSURANCE ' PARCEL ASSESSOR (This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP OOK PAGE hundred dollars-($100)or less;,) :, I l !r1 EL OWNER�f�OA, 1N V4 de E• NO.iI�� USE ZONETA /g(7 17�7/ I certify that in the performance'bf the work for which this IAL permit is issued,.l shall not employ any-person in any manner ' ADDRESS S^3�� �r��$lo�i�ca•� A?_ / DITIONS a- so as to become subject to the Workers'Compensation Laws. ,,-? G CITY /® c— ZIP I, 70 e2 U Date Applicant :ARCHITECT OR NOTICE TO APPLICANT: If, after making this Certificate of- ENGINEER NO' DISTRICT GROUP NST. ZONE PROCESSED BY or 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 TEL. STATISTICAL CLASSIFICATION APT. CONDO. to deemed revoked, CONTRACTOR �. NO. ' Z LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. KZ1 DWELL. UNITS ' 1 hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS i ' _ NO. (commencing with Section 7000)of Division 3 of the Business LIC- SEWER MAP and Professions Code;and my license is-in full force and effect. CITY CLASSBK VALIDATION SQ. FT. NO. OF NO. OF CHECK License Numbed Lic.'Class SIZE STORIES FAMILIES ONE LLL���I VALUATION Contractor Date. DESCRIPTION OF WORK NEW $ 00 El am exempt under Sec. �(�(�. ADD v ALTER ❑ B.BP.C. for this reason USE OF REPAIR $ ❑ Date: EXISTING BLDG. DEMOL ❑ Signature APPLICANT TEL. FINAL q OWNER-BUILDER DECLARATION (PRINT).• NO. '7� I hereby affirm that I am exempt from the Contractor's License -;l RATE ' :Law for the fdll'owing reason (Section 7031.5, Business and ADDRESS FINAL Professions Code): PRESENT' r By I, as owner of the property, or BUILDINGv my employees with ADDRESS , wages as their sole compensation,will do the work and _ the structure is not intended-or offered for sale(Section ' LOCALITY , +=;'J1 7044, Business and Professions Code.) MOVING' TEL. ® El1, as owner of the property,am exclusively contracting CONTRACTOR NO. i i Ell�L with licensed the to construct the project (Sec- 'r's 5 5 tion 7044, Business and Professions Code.) ADDRESS ! fel. . .s m . -_3 REQUIRED• TOTAL SETBACK FROM EXIST.• j%"6 HEI:1S 105. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I herebyaffirm that there is a construction lending agency for FRONT "1" 9 9 Y �'L•�Is�E IJI the performance of the work for which this permit'is issued P..L. (Sec. 3097, Civ. C.). SIDE s P.L. Lender's Name &Raw=Ig;;"EL.' It l P.C. Fee$ Permit Fee. 'o� _ LDMA Ref. # +Il ( -,,i0 Lender's Address �1 _ Ail r'_ r I certify that I have read this application and state that the Issuance Fee ' �� LDMA P/C# above information is correct. I agree to comply with all County Investigation Fee � Poo ordinances and State laws relating'to building construction, Total Fee a 16 LDMA Perm. # and hereby authorize reVndives of this County to enter up th .above-menti ert�r for inspection purposes. 1 � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applic-ant7ot Agent 15ate • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD/ALT/REP BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0611140018 PHONE: (626) 285-0488 EXT: [LEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: 1 [TR: 13613 LT: 22 [ SQ. FT STORIES TYPE OCCUP GROUPI 5356 PERSIMMON AV [ I STRUCTURE: 196 1 VN R3 [ TEMP CA 917802801 [ [ASSESSOR INFORMATION NUMBER: 1 GARAGE: I NEAREST CROSS STREET: DAINES/FREER [ 18573-005-010 1 OTHER: 50 1 VN Ul 1 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl TENANT: (EXIST BLDG USE: USE ZONE: 11SSUED ON: PROCESSED BY: EXPIRES ON: ' 1 I 1EXIST OCC GRP: 05/21/07 SR 05/15/08 (OWNER: TEL. NO: 1BLDGS. NOW ON LOT: VALUATION: IFINAL DATEXPR[cu" FllNALBY: CODE: [ IONTIVEROS ANTHONY;JUDITH TRS (818) 443-6069- 1 72,050 I 15356 PERSIMMON AV I I ITEMP 917802801 [ FEES PAID IDESCRIPTION OF WORK [ I I [INCREASE KITCHEN AREA, MASTER BEDROOM 196 S.F. NEW PORCH 50 I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:IS.F. AND REMODEL EXISTING HOUSE 1000 S.F. I (APPLICANT: TEL. NO: I I [ IONTIVEROS (626) 443-6069- IBI PLANCHECK W/ENERGY 72050.00 VAL 961.69 1 [ 15356 PERSIMMON AVE IAA BLDG PERMIT ISSUANCE 27.75 ISPECIAL CONDITIONS: 1 TEMPLE CITY CA 91780 AC STRONG MOTION RESID 72050.00 VAL 7.21 1 1B2 PERMIT W/ENERGY 72050.00 VAL 1,131.41 1 1 I 1 TOTAL FEES 2,128.06 1 I ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE IJUDITH E. ONTIVEROS (626) 443-6069- [ 1 I 15356 N. PERSIMMON AVE LIC. NO 1 ILOCATION AND SETBACKS ITEMPLE CITY, CA 91780 NONE 1 I I I I I ISOILS ENGINEER APPROVAL I I (ARCHITECT OR ENGINEER: TEL. NO: [ IFOUNDATION/TRENCH FORMS _( �/p�1tv [ IONTIVEROS AND ASSOCIATES, INC. (707) 725-7410- I 1 \ [ I 1167 S. FORTUNA BLVD. LIC. NO: 1 ISLAB/UNDER FLOOR FORTUNA, CA 95540 C55968r (� [ ti I [ �� (��` RAISED FLOOR FRAMING ` p I , � �``1 I I G lay. IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP-1 UNDERFLOOR INSULATION '�� 3 03.1 I 1 [1ST LEVEL FLOOR SHEATH T/COND: STAT CLASS: [NO. OF FAMILIES: DWELLING UNITS: AP1 ( I I I I 1 NO 211 �O i V t ��u�.p Q�'� . 12ND LEVEL FLOOR SHEATH I 1 I SCHOOL WITHIN HAZARDOUS I r (" �/ ROOF SHEATHING1 I [AIR QUALITY: 1000 FEET MATERIALS 1 l 6 J z l 1 l�,QtO{.V !fj 1 1 1 NO NO NO 1 ( ✓ tet•• / �l 1FIRE DEPT. FRAME INSPEC 1REQIIIRED TOTAL SETBACK FROM EXIST 1 '� r fir( r7 ` ,\) [BLDG DEPT. FRAME INSPECT ISET BACK YARD: HWY: PROP LINE: WIDTH: [ / V l 1 1 rs Q IFRONT PL- 1 ISHEAR PANELS I I SIDE PL- 1 I TRIP I I .�PL- INSULATION/WEATHER S [ I 1C(Sl� Li 116 16�� e I - I [ INTERIOR LATH/DRYWALL I 000 1 I (EXTERIOR LATH I 1 1 1 1 �- 1 S i vl 1LOT DRAINAGE 1 [ ISMOXE DETECTION DEVICES [ 1 1 1 IFIRE DEPARTMENT APPROVAL[ [ I I I [ I I I 1REPORT ID: DPR261 ROUTE TO: BS0508 1 I I I I I I I