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HomeMy Public PortalAbout6022 PRIMROSE AVE_Building__ FGA898A CE#803 11.117APPLICATION FOR 8URLbING PERMIT ,.' COUNTY OF IAS ANGELES BUILDING 1 -'DEPARTNIENT OF COUNTY. ENGINEER ADDRESS a: BUILDING AND SAFETY DIVISION' LOCALITY JOHN-A.LAMBIE•COUNTY ENGINEER NEAREST CASSATT D.GRIFFIN.SUPT OF BUILDING CROSS ST. 31 DISTRICT NO. GROUP R� SEWER MAP _ FOR APPLICANT TO FILL IN L ]TYPE L1=K 1 6� BUILDING ADDRESS STATISTICASIFICATION /• CLASS.NO: DWELL.UNITS LOT NO. A A BLOCK MAP - ry STATE YES O I r NUMBER t O / HWY. TRACT USE ONE SPECIAL y NO.OF BLOT /�_ CONDITIONS SIZE OF LOT�7 O �S— NOW ON LOT USE OF EXISTING BLDG. BUILDING EXIST. SETBACK YARD HWY STREET NAME WIDTH OWNER C9. FRONT - 6C20 / S MAIL P.L: ADDRESS Zoo S' SIDE TEL. • P.L. CITY,Tio—.a& epe Day NO. INSPECTION RECORD ARCHITECT OR TEL. ENGINEER NO. ADDRESS s TEL ' CONTRACTOR + O, ADDRESS 79 DESCRIPTION OF WORK' NEW D ALTER REPAIR DEMOLISH SQ.FT, NO.OF NO:OF .SIZE STORIES FAMILIES USE O R CTURE SIGNATURE OF' APPROVAL$ -APPLICANT DATE INSPECTOR'S SIGNATURE ADDRESS a FOUNDATION: LOCATION r FORMS,MATERIALSe'.I.'i•#2-l?z, r P.C• $ FRAME: FIRE STOPS, FEE BRACING;BOLTS rl��iYl VALUATION $ D FURNACE: LOCATION, FEE. 'GAS VENT.DUCTS ' I HEREBY ACKNOWLEDGE"THAT I HAVE READ THIS AP- LATH,INT. PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS RE NG BUILDING NSTRUCTION. . LATH,EXT. SIGNATURE OF I•IOUSE NUMBER COR- PERMITT92 •'RECT AND POSTED ' ADD RES w a FINAL �I7S't� '✓1 CLYDE N.DIRLAM, PRIliCtIgAL STBkWMFil_ENGINEER PLAN CHECS VALIDATION CK. M.O. CASH PEBMIT VALIDATION CK o. Crosti :ACI 4.2 0 ,tea 2 1 A - 11.00 ®. I WORKERS'COMPENSATION DECLARATION ` hereby affirm that I have a certificate of consent to self APPLICATION 1`® U I L®INC PERMIT insure, or a certificate of Workers'Compenstion Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS AN ELE BUILDING AND SAFETY Policy No. Company UILDING Certified copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS z ✓moo• Certified copy is filed with the county building inspec- BUILDING // / tion department. ADDRESS (C/0 /2/'� S 74tt7iOCALITY � - //j� C� NEAREST ' Date Applicant CITY 7,— 1m LF C.// ZIP / l 7 S-V CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' s/J �( �S NOW ON LOT rNO.OF BLDGS. / MAP BOOK ASSESSOR PAGE PARCEL COMPENSATION INSURANCE SIZE OF LOT (This section need not be completed if the permit is for one U �ONPhundred dollars ($100)or less.) TRACT BLOCK LOT NO. . �O >- 2 ty4/�I t f�� TEL. 1/ CIAL 0. I certify that in the performance of the work for which thisOWNER NO�o M�7 7NDITIONS 0 permit is issued, I shall not employ an person in an manner / / /► DI RICT GROUP TYPE FIRE O SSED BY U so as to become subject to the Workers'Compensation Laws. ADDRESS (p c9 Z /Y 2/ ✓)2[)S {—/J� CONST. / Z NE O Date Applicant CITY / e— , ZIP STATISTICAL CLAS ICATION ` AP . CONDO. U NOTICE TO APPLICANT: If, after making this Certificate of a ARCHITECT OR TEL. UA Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SE M with comply with such provisions or this permit shall be deemed revoked. TEL. PG ,7 VALIDATION CONTRACTOR NO. / LICENSED CONTRACTORS DECLARATION LIC I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESS NO. VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC. G Professions Code, and my license is in full force and effect. CITY CLASS $ lJ SQ. FT./��// NO.OF NO.OF CHECK MOWN License Number Lic.Class SIZE !T� STORIES FAMILIES ONE Contractor Date y DESCRIPTION OF WORK /O 0.7 O F NEW $ I am exempt from the licensing requirements as I am a 117aLL �f},_/� (/-� ADD licensed architect or a registered professional engineer ALTER FINAL acting in my professional capacity (Section 7051, Q S 6— / REPAIR DATE 0 Business and Professions Code). USE OFFINAL c EXISTING BLDG. 7J F !� DEMOL ❑. 8y .�. Lic.or Reg.No. _Date APPLICANT TEL.NO. S T) J /\ t G/`��E zgL, y 7l OWNER-BUILDER DECLARATION ` I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and ADDRESS Pr ssions Code): PRESENT BUILDING I, as owner of the property, or my employees with ADDRESS Jr C G P wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section LADDRE TY 7044, Business and Professions Code). G TEL. tj o 0 0 0 0 1 I, as owner of the property, am exclusively contracting ACTOR NO. 0 ° G 1, ✓C with licensed contractors to construct the project (Sec- S tion 7044, Business and Professions Code). 1 r. IRED TOTAL SETBACK FROM EXIST. ° 'CONSTRUCTION LENDING AGENCY ACK YARD HWY PROP. LINE WIDTHI hereby affirm that there is a construction lending agency for T (' r' (' 1 —the performance of the work for which this permit is issued(Sec. 3097, Civ. C.).Lender's Name Lender's Addresse$ Permit Fee ��I certify that I have read this application and state that theIssuance Feeabove information is correct. I agree to comply with all County ation Fee ordinances and State 1 s relating to building construction, Total Fee and hereby a riz resentatives of this County to enter = upon e b ve- t' ned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 0 gnature of pplicant or Agent Dote es APPLICATION FSR BUILDING PERMIT COUNTY OF L''OS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING ADDRESS h Z 2 ` � . , I hereby affirm that I have a certificate of consent to self insure, BUILD] G ADDRESS 0,t) L. or a certificate of Workers'Compensation Insurance,or a certified ;z. d3r— Iq'yir, copy thereof(Sec.3800,Lab.C.) CIT�rn LA f ZIP ( LOCALITY y– Policy No. Company SIZE OF LOT If NO.OF BLDGb.NOW ON LOT / [ICertified copy is hereby furnished. % / NEAREST CROSS ST. ❑ Certified copy is filed with the county building inspection TRACTBLOCK LOT NOUSE ZONE MAP NO. .,.., department. Date Applicant ASSESSOR MAP OOK PAGl PARCEL ©© SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' owN� �/� TEL NO. COMPENSATION INSURANCE J dC r G/2 d�! ✓ S �fo JC- WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS dollars($100)or less.) 6o,a z % A/dyJ d2(9 34 DISTRICT GROUP TYPE CONST, FIRE ZONE PROCES I certify that in the performance of the work for which this permit CITE `r, �� ZIP 7 ;2s—o is issued, I shall not employ any person in any manner so as t0 ARCHITECT O ENGINEER TEL NO. become subject to tl Workers'Cg�lpDensation/Laws. /� STATISTICAL–CLLASSSSliIIFICATION APT CONIO Date �{�� Applicant / G� �r`�� "—� 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 bo/v fl fz– FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATIONSIDE CITY UC.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 SO.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. � r NEW ❑ BK PG d DESCRIPTION OF WORK License Number Lic.Class -• nry, ADD VACUA ON Contractor Date / �7 J � t, ��rpl O �y1 ALTER ❑ ❑ I am exempt under Sec. ' ��� ��1�A�rG' REPAIR ❑ $ BAP.C.for this reason DEMOL ❑ CDMA Pic# W Date: USE OF EXISTING BLDG.5 ,c�. URM ❑ IL Signature APPLICAN (PRINT / TEL NO. CDMA Perm# � Z ❑ I, as owner of the property, or my employees with wages as �?+Vr�s ZAGCT a their sole compensation, will do the work and the structure is ADDRESSO not intended or offered for sale (Section 7044, Business and SPA WV G� FINAL DATE a 3303 c;y 5011 Professions Code.) t] WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL ❑ OR A MIXTURE CONTAINING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE i, as owner of the property, am exclusively contracting with AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDES Q licensed contractors to construct the project (Section 7044, VES 11 No 11 FINAL BY,` > ACCT.� Business and Professions Code.) 1 WILL THE INTENDED USE OF THE BUIDUNG BY THE APPLICANT OR FUTURE BUILDING i�J "' 852.92 C852� OCCUPANT REQUIRE A PERMIT FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH 3303 n Y r_ CONSTRUCTION LENDING AGENCY COAST AIR QUALITY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES 2 I TENS I hereby affirm that there is a construction lending agency for VES❑ NO❑ a the performance of the work for which this permit is issued(Sec. TOTAL � ' �t z (HAVE READ I HE UNDERSTAND MY REQUIRE INFORMATION GUIDE AND THE SCSCOUN PERMITTING . 3097,CIV.C.) CHECKLIST I UNDERSTAND MV REQUIREMENTS UNDER THE LOS ANGELES COUNTY CODE, cm TITLE 2,CHAPTER 2 20 SECTIONS 2 20.100 THROUGH 2 20 140 CONCERNING 2 HAZARDOUS �Fl;� 0701"' i Lender's Name `� MATERIALS REPORTING AND FOR OBTAINING A PERMIT FROM THE SCAQVD. ti J R'f 0 Lender's Address CHANGE O OVAER OR KENT o I certify that I have read this application and state under penalty 0 of perjury that the above information is correct.I agree to comply P.C.FEE O n PERMIT FEE a with all county or ' State lawsrelating to building [000-0001 7/I2/1y-construct' nd er A�Ces e representatives of this County ISSUANCE FEE to ent upo vd grope y for ins t—' �oses� 1281 1 }( 9:41 W '/ INVESTIGATION FEE TOTAL FEE � S gnJum d J or ng. Q 01 SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT r DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR 11 / BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 0412170035 PHONE: (626) 285-0488 EXT: GAL NO. OF CONST B ILDI G ADDRESS: TR: 6561 LT: 259 UN: .002 SQ. FT STORIES TYPE 6022 PRIMROSE AV STRUCTURE: 1200 VN TEMP CA 917802033 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: WOODRUFF 5385-013-016 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, C TENANT: EXIST B DG USE: R SID USE ZONE: R- SSUED-0-9 T. PROCESSED BY: EXPIRES ON: EXIST OCC GRP: 12/17/04 JK 12/12/05 OWNER: TEL. NO: SLDGS. NOW ON LOT: VALUATION: FINAL DAT FINAL BY: CODE: 022ZALUNPRIMROSEOAV (770) 554-5817- 2,000 TEMP 917802033 FEES PAID DESCRPTION OF WORK RE-ROOFING OVER THE EXISTING ASPHALT HOUSE ONLY APPLICANT: TEL. 0: FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SAME AS OWNER - AA BLDG PERMIT ISSUANCE 27.75 AC STRONG NOTION RESID 2000.00 VAL 0.50 SPECIAL CONDITIONS: D2 PERMIT W/O EN-HC 2000.00 VAL 82.20 TOTAL FEES 110.45 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 150H265 3 01 0. OF AMIL LI S: DWELG I S: APT COND: STAT CLASS: FLOORSHEATHING NO 21 ROOF SHEATHING SCHOOL ITHIN A RDOUS SHEAR PANELS AIR QUALITY: 1000 FEET MATERIALS NO NO NO FRAME INSPECTION EQUIRED TOTAL SETBAC FROM EXIST FIRE SPRINKLER HANGERS SET BACK YARD: HWY: PROP LINE: WIDTH: FRONT PL- INSULATION/WEATHER STRIP SIDE PL- INTERIO LATH/DRYWALL EXTERIOR LATH RATED FLOOR/C IL ASSEM. RATED WALL ASSEMBLIES RATED SHAFTS/OPENINGS T-BAR CEILINGS LOT DR I AGE REPORT ID: DPR261 ROUTE TO: BS0508