HomeMy Public PortalAbout5421 PERSIMMON AVE_Building__ APPLICATION FOR BUILDING PERMIT
COUNTY OF LOS AN%ELES BUILDING AND SAFETY
WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDR / Zo7v
BUILDING ADDRESS
I hereby affirm that I have a certificate of consent to self insure, —• ,
or a certificate of Workers'Compensation Insurance,or a certified
copy thereof(Sec.3800,Lab.C.) CITY -'/-
ZI # LOCALITY
a
Policy No. Company SIZE OF LOT NO,OF BLDGS.NOW ON LOT
❑ Certified copy is hereby furnished. NEAREST CROSS ST
OF
❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO.
department. USE ZONE MAP NO./,/�— i 7 0
Date Applicant ASSESSOR MAP BOOK PAGE PARCEL 7 p /.3
SPECIAL CONDITIONS
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE OWNER `I i% WITHIN 1000 FT.OF SCHOOL? YES NO
(This section need not be completed if the permit is for one hundred ADDRE S Y Y 0
� s� DISTRICT GROUP TYP NST. FIRE ZONE PROCESSED BY
dollars($100)or less.)
I certify that in the performance of the work for which this permit C _ _ ; ZIP
is issued, I shall not employ any person in any manner so as to ARCHITE OR ENGINEER TEL NO. oe
become subject to the Workers'Compensation Laws. STATISTICALCL SIFICATION dV 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 to the Workers' CONTRACTOR _ TEL NO. SET BACK YARD HWY PROP LINE WIDTH
Compensation provisions of the Labor Code, you must forthwith Il/ 16 FRONT
comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL
LICENSED CONTRACTORS DECLARATION SIDE
CRY 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.FT.SIZE NO.OF STORIES NO.OF FAMILIES13
Professions Code,and my license is in full force and effect. NEW BK PG 13® C
License Number Lic.Class /aDESCRPJw
OF WORK ADD E] VALUATION O
00 C
Contractor Date ALTER ❑ $ ~ c
r S� REPAIR ❑ Lico
❑ 1 am exempt under Sec. 14�- 6
B.BP.C.for this reason V& I Im <lLiq�• S DEMOL ❑ LDMA P/C#
Date: USE OF EXISTINGIBLDG. URM ❑
—/�Ignature APPLICANT(PRINT) TEL NO. LDMA Perm#
Lam"I;as owner of the property, or my employees with wages as Z
their sole compensation, will do the work and the structure is ADDRESS O .A--'°r
not intended or offered for sale (Section 7044, Business and I FINAL DATE G Jj!s (r, °
Professions Code.) WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL
❑ 1, as owner of the property, am exclusive) contracting With OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE O'V Q }
Y y 9 AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? FINAL BY a.
licensed contractors to construct the project (Section 7044, YES❑ No❑
Business and Professions Code.) ACCT.
WILL THE INTENDED USE'OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING
OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 3 3I13
CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR Ni s �^
GUIDELINES, r T TES
I hereby affirm that there is a construction lending agency for YES 11 NO❑ / . L
Cil the performance of the work for which this permit is issued(Sec. I HAVE READ THE HAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAOMD PERMITTING D"� TOT E AG.' 216 s.30
3097,CIV.C.) CHECKLIST.I UNDERSTAND MY REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE,
TITLE 2.CHAPTER 2.20 SECTIONS 2.20.100 THROUGH 2.20.140 CONCERNING HAZARDOUS !}.! '".•1.'s ;'a
Lender's Name MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAOMD. '-•H1= i 1
r�•-•I;
Lender's Address GINNER OR AGENT �I+(-'-
0
c I certify that I have read this application and state under penalty f
0 of perjury tha a above information is correct.I agree to comply P.C.FEE PERMIT FEE
N with all r� my rdi and State laws relating to buildings) j�j?-jfj Ll y, /,'
co
construlion,a y au orize representatives of this County IPSUANCE FEE �j
to ender -me toned property for ins pe i n pur se . p� d j 12213 } j; ---T;:.
r z` INVESTIGATION FEE TOTAL FEE
�` A. A°MI Dere 7 •
SEE REVERSE FOR EXPLANATORY LANGUAGE
WORKERS'COMPENSATION DECLARATION r� 41�/ r ' ' / "
G jnher , ra c"r that I have r certificate of consent to self APPLICATION F®R WADING P E RM I T
iq�ure, or a certificate of Workers' Compensation Insurance,
o�a certified copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
BUILDING �
El Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDREss ,.I .65g
Certified copy is filed with the county building inspec- BUILDING �7
tion department. ADDRESS �i� ( VK
Date a�+ Applicant � �+" CITY ZIP "LOCALITY
NO. OF BLDGS. NEAREST Nr
CERTIFICATE OF EXEMPTION FROM WORKERS' SIZE OF LOT NOW ON LOT CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the permit is for one TRACT BLOCK LOT NO. MAP BOOK PAGE PARCEL
hundred dollars ($100)or less.) OWNER NO. USE ZONE MAP �7
I certify that in the performance of the work for which this NO.
permit is issued, I shall not employ any person in any manner ADDRESS �7a� - �� SPECIAL a-
so as to become subject to the Workers'Compensation Laws. CONDITIONS O
CITY ZIP / PD U
Ix
Date Applicant ARCHITECT OR TEL. DISTRICT GROUP TYPE FIRE PROCESSED BY
NOTICE TO APPLICANT: If, after making this Certificate of ENGINEER NO. CONST. ZONE R
Exemption, you should become subject to the Workers' I: �d1� 3 U
Compensation provisions of the Labor Code, you must forth- ADDRESS d _g a
with comply with such provisions or this permit shall bei. TEL• STATISTICAL CLASSIFICATION APT. CONDO. Z
deemed revoked. CONTRACTOR _ (.48,NO. 5 _
LICENSED CONTRACTORS DECLARATION LIC. CLASS NO. DWELL. UNITS
—
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS Zf qq NO.
` LIC. SEWER MAP
(commencing with Section 7000)of Division 3 of the Business W [.�{i
and Professions Code,anndmy icense is in full force and effect. CITY CLASS BK PG VALIDATION
License Number- 1 15771 Lic. Class SIE STORIES FAMILLIIES ONE VALUATION VALUATION
j ffl / �2—cJf DESCRIPTION OF WORK NEW ElBD
Contractor IN riif`�u+C4'►�+' Date QQQ.
ADD $
❑I am exempt under Sec. 1 %"— ALTER. ❑ ► �t't' '�
B.&P.C. for this reason $ '�"t-
USE OF REPAIR ❑ 3
r
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS RESIDENTIAL ADD
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1202220059
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I NO. OF CONST NEW I BUILDING ADDRESS: I
ITR: 13613 LT: 45 I SQ. FT STORIES TYPE OCCUP GROUPI 5421 PERSIMMON AV I
STRUCTURE: 550 1 V-B U TEMP CA 917802804 I
(ASSESSOR INFORMATION NUMBER: I GARAGE: I NEAREST CROSS STREET:
18573-003-020 I OTHER: I THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl
I I I I
(TENANT: EXIST BLDG USE: USE ZONE: ISSUED ON: PROCESSED BY:
1 EXIST OCC GRP: 102/23/12 SR
(OWNER: TEL. NO: 1BLDGS. NOW ON LOT_: VALUATION: FINAL T
1
ISUM PAUL;PAULINE C (626) 215-2456- 1 7,700 ( c.,E NAL CODE:
15421 PERSIMMON AV I I v
ITEMP 917802804 1 FEES PAID IDES PTI OF WORK 1
I I 1550 SQ.FT. ICC 1953 ALUM PATIO COVER I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 I
(APPLICANT: TEL. NO: I I
IMORTON, EVONNE (714) 288-1314- ID1 PLANCHECK W/O EN-HC 7700.00 VAL 155.90 1 1
131621 PEPPERTREE JAA BLDG PERMIT ISSUANCE 27.80 ISPECIAL CONDITIONS: I
(SAN JUAN CAPISTRANO JAB STATE GREEN BLDG FEE 7700.00 VAL 1.00 I 1
ID2 PERMIT W/O EN-HC 7700.00 VAL 183.00 1
TOTAL FEES 367.70 I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
TALL PRO REMODELING (714) 288-1314- 1 1 r A1
1706 N TUSTIN AVENUE LIC. NO I 1LOCATION AND SETBACKS 1
IORANGE, CA 92867 574698-B * 1 I_ I
I 1 (SOILS ENGINEER APPROVAL I 1 1
(ARCHITECT OR ENGINEER: TEL. NO: I IFOUNDATION/TRENCH FORMS
LIC. NO: I (SLAB/UNDER FLOOR
1 RAISED FLOOR FRAMING I I I
(MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: (UNDERFLOOR INSULATION I I
I 11ST LEVEL FLOOR SHEATH 1 I 1
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
0 NO 21 1 12ND LEVEL FLOOR SHEATH I I I
SCHOOL WITHIN HAZARDOUS 1 IROOF SHEATHING I I I
(AIR QUALITY: 1000 FEET MATERIALS 1 I
NO NO NO I (FIRE DEPT. FRAME INSPECT( I I
1 (BLDG DEPT. FRAME INSPECT( I I
1 11 ISHEAR PANELS I I I
I I 1 1-1 1
1 I (INSULATION/WEATHER STRIPI I I
I I I I I I
I I (INTERIOR LATH/DRYWALL I I I
I 1 L 1EXTERIOR LATH I I 1
I 1 ILOT DRAINAGE I I I
ISMOKE DETECTION DEVICES 1 I
IFIRE DEPARTMENT APPROVAL(
I 1* ADDITIONAL DATA ON FILE
I I i 1 I I
1 (REPORT ID: DPR261 ROUTE TO: BS0508 1 I I 1
I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0608010040
PHONE: (626) 285-0488 ERT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 13613 LT: 45 7STRUCTURE:
FT STORIES TYPE 5421 PERSIMMON AV
VN TEMP CA 917802804
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
6573-003-020 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C
TENANT: REBID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
08/0,1/06 JK 07/27/07
1
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DATE, FINAL BY: CODE:
SUM PAUL;PAULINE C (626) 215-1510- 4,000
5421 PERSIMMON AV
TEMP 917802804 FEES PAID DESCRIPTION OF WORK
TEAR OFF & REROOF HOUSE & GARAGE INSTALL 30 YR COMPOSITION
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SHINGLES
APPLICANT: TEL. NO:
AMPER RODARTE (626) 581-7688- SAA BLDG PERMIT ISSUANCE 27.75
516 N. DIAMOND BLVD. AC STRONG MOTION REBID 4000.00 VAL 0.50 SPECIAL CONDITIONS:
DIAMOND BAR CA 91765 D2 PERMIT W/O EN-HC 4000.00 VAL 115.80
TOTAL FEES 144.05
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SUNSHINE ROOFING (562) 860-1896-
516 DIAMOND BAR BLVD. LIC. NO LOCATION AND SETBACKS
DIAMOND BAR CA 91765 755126 _
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION TRENCH FORMS
LIC. NO: SLAB UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:l UNDERFLOOR INSULATION
147H273 3 01
FLOOR 588AT8ING
NO. OF FAMILIES: DWELLING UNITS: APT COND: STAT CLASS:
NO 21 ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO I FRAME INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH: _
FRONT PL- INSULATION/WEATHER STRIP
SIDE PL-
INTERIOR LATH/DRYWALL
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED SHAFTS OPENINGS
T-BA.4 CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508
i
s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0609190049
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
TR: 13613 IT: 45 SQ. FT STORIES TYPE 5421 PERSIMMON AV
STRUCTURE: VN TEMP CA 917802804
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8573-003-020 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, C
TENANT: EXIST BLDG USE: RESID USE ZONE: R-1 ISSUED ON: PROCESSED BY: EXPIRES ON:
EXIST OCC GRP: 09/19/06 JK 09/14/07
OWNER: TEL. NO: BLDGS. NOW ON LOT: VALUATION: FINAL DAT 77
CODE:
SUM PPERSIMMO NE C (626) 448-3351- 5,000 /(�
5421 PERSIMMON AV `�
TEMP 917602804 FEES PAID IDEtCRIPTION'OF WORK
REMOVE WOOD PANELS ON LOW PORTION OF HOUSE 4 GARAGE AND
FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: STUCCO AND RECOLOR CODE WHOLE HOUSE
APPLICANT: TEL. NO:
SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75
AC STRONG MOTION REBID 5000.00 VAL 0.50 SPECIAL CONDITIONS.
D2 PERMIT W/O EN-HC 5000.00 VAL 132.60
TOTAL FEES 160.85
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO LOCATION AND SETBACKS
SOILS ENGINEER APPROVAL
ARCHITECT OR ENGINEER: TEL. NO: FOUNDATION/TRENCH FORMS
LIC. NO: SLAB/UNDER FLOOR
RAISED FLOOR FRAMING
MAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP: UNDERFLOOR INSULATION
147H273 3 01
FLOOR SHEATHING
NO. OF FAMILIES: DWELLING UNITS: APT COND, STAT CLASS:
NO 21 I ROOF SHEATHING
SCHOOL WITHIN HAZARDOUS SHEAR PANELS
AIR QUALITY: 1000 FEET MATERIALS
NO NO NO FRAM INSPECTION
REQUIRED TOTAL SETBACK FROM EXIST FIRE SPRINKLER HANGERS
SET BACK YARD: HWY: PROP LINE: WIDTH:
FRONT PL- INSULATION WEATHER STRIP
SIDE PL-
INTERIOR. LATH DRYWALL h";L 6
EXTERIOR LATH
RATED FLOOR/CEIL ASSEM.
RATED WALL ASSEMBLIES
RATED-SHAFTS/OPENINGS
T-BAR CEILINGS
LOT DRAINAGE
REPORT ID: DPR261 ROUTE TO: BS0508
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
.3 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1202080011
PHONE: (626) 285-0488 EXT:
LEGAL ID: NO. OF CONST BUILDING ADDRESS:
ITR: 13613 LT: 45 SQ. FT STORIES TYPE 5421 PERSIMMON AV
I [STRUCTURE: V-B TEMP CA 917802804
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: DAINES
18573-003-020 -1 1 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl
TENANT: IEXIST BLDG USE: RESID USE ZONE: R-1 JISSUED ON: PROCESSED BY:
I _1EXIST OCC GRP: 102/09/12 SR 1
OWNER: TEL. NO: IBLDGS. NOW ON LOT: VALUATION: IFINAL DATE FINAL BY: CODE:
[SUM PAUL;PAULINE C - I 4,500
15421 PERSIMMON AV T
TEMP 917802804 FEES PAID I SCDE RIPT20N OF WORK
[REPLACE BROKEN HIP RAFTER FROM WIND DAMAGE
(FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[
APPLICANT: TEL. NO: I
P.S. CONSTRUCTION (818) 370-2901- ID1 PLANCHECK W/O EN-HC 4500.00 VAL 112.90
5415 PERSIMMON AVE IAA BLDG PERMIT ISSUANCE 27.80 ]SPECIAL CONDITIONS:
]TEMPLE CITY CA 91780 AH STATE GREEN BLDG FEE 4500.00 VAL 1.00
IAC STRONG MOTION RESID 4500.00 VAL 0.50
ID2 PERMIT W/0 EN-HC 4500.00 VAL 132.80
CONTRACTOR: TEL. NO: I TOTAL FEES 275.00 JAPPROVALS DATE INSPECTOR SIGNATURE
IP. S. CONSTRUCTION (626) 442-2764- I
15415 PERSIMMON AVENUE LIC. NO 1 ILOCATION AND SETBACKS
TEMPLE CITY CA 91780 431044-B * I _
(SOILS ENGINEER APPROVAL 1 I I
1ARCHITECT OR ENGINEER: TEL. NO: - 1 1FOUNDATION/TRENCH FORMS I I I
1 LIC. NO: I ISLAB/UNDER FLOOR
I 1 I
I 1
IRA-4SED FLOOR FRAMING I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I (UNDERFLOOR INSULATION I I I
I147H273 3 001 1 I I I
I I IFi,00R SHEATHING I I
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I I I I I
1 0 NO 21 1 IRGO,F SHEATHING
SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS I I
(AIR QUALITY: 1000 FEET MATERIALS I Imo_ I I
1 NO NO NO -1 FRAME INSPECTION��^I��1
I
FIRE SPRINKLER HANGERS SPRINKLER HANGERS IS I
NSULATION/WEATHER STRIPI I I
I I IINTERIOR LATH/DRYWALL
I I I
I (EXTERIOR LATH I I I
I I I
I 1
IRA-TED FLOOR/CEIL ASSEM. 1 I I
(RATED WALL ASSEMBLIES I /I
(RATED SHAFTS/OPENINGS 1
IT-BAR CEILINGS I I I
1 1* ADDITIONAL DATA ON FILE 1LAT DRAINAGE I I I
I I I I I
1REPORT .ID: DPR261 ROUTE TO: BS0508 1 I I I