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Home My Public Portal About10206 RANDWICK DR_Building__ TEMPLE CITY rus3o11 CE ho*I-BI APPLICATION FOR BUILDING PERMIT - COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS oG IO BUILDING AND SAFETY DIVISION LOCALITY � JOHN A. LAMBIE, COUNTY ENGINEER NEARESTi WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DI � NO GROUP TYPE P CES I�B FOR APPLICANT TO FILL IN / - (y/1 (O[ coNsr. BUILDING STATISTICALCLASSIFICATION SEWER MAP ADDRESS (/ -7 BK PG CLASS.No. Z WELL.UNITS LOT NO. BLOCK —J WATER CERTIFICATE: NOT REQUIRED_01 RECEIVED TRACT Z- 3O MAP /� lj �y HIGHWAY STATE MAJOR SECOND• LOCAL NO.OF BLDGS. n/ NO. LV V SIZE OF LOT. �C X O' I NOW ON LOT f� USE ZONE SPECIAL USE OF • CONDITIONS EXISTING BLDG. pf TEL. dF OWNER V NO. BUILDING EXIST. ' ° SETBACK YARD HWY STREET NAME WIDTH ADDRESS FRONT ARCHITECT OR TEL. P.L. ENGINEER NO. SIDE ADDRESS P.L. > TEL. INSPECTION RECORD p CONTRACTOR NO. - V ADDRESS a' Q DESCRIPTION OF WORK ' W NEW ADD ALTER REPAIR DEMOLISH rn SQ.FT. NO.OF NO.OF ? IZE STORIES � FAMILIES STRUCTURE S LO L(-C WA- SIGNATURE OF APPLICANT VALUATION APPROVALS DATE INSPECTORS SIGNATURE FOUNDATION:LOCATION F E �-' FEE $ '� FORMS.MATERIALS. \ FRAME:FIRE STOPS, / J 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS / I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS. ,A✓ ` BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK y AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURANCE. LATH,EXT. SIGNATURE OF HOUSE NUMBER COR- PERMITTE RECT AND POSTED ADDRESS FINAL CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL E 7-c.- CHECK VALIDATIION OK, M.O. CASH PERMIT VALIDATION cm. M.O. CASH 7,C. ( " ) I ` 14 TEMPLE CITY FBA88BA CB B1B08•I—BI APPLICATION F LI OR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGMM ADDRESS ! R BUILDING AND SAFETY DIVISION LOCALITY JOHN A. LAMBIE, COUNTY ENC;INEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTRICT NO. G OUP TYPE P SSED BY FOR APPLICANT TO FILL IN CONST. BUILDING STATISTICAL CLASSIFICATION K R MAP PG ADDRESS �� C CLASS.NO. WELL.UNIT LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED CERTIFICATE: TRACT G MAP / HIGHWAY STATE MAJOR SECOND, O AL Y NO.OF BLDGS. NO. / (CIRCLE) SIZE OF LOT. O I NOW ON LOT USE ZONE SPECIAL USE OF / CONDITIONS EXISTING BLDG. OWNER NJ e. � �� CO,NO.AT A,ROlf BUILDING EXIST. SETBACK. YARD HWY STREET,NAME WIDTH' ADDRESS�LL �� Cf?-P- ieyoo FRONT ARCHITECT OR TEL. P.L. C. ENGINEER NO, SIDE P.L. } ADDRESS ��rr TEL, b / IN.S�ECTION RECORD A A O CONTRACTOR E� /!y. NO. . P7 U ADDRESS fro `/Z �L/0 ,I�CYri, �,,:i.i'w Y/i 1A" � r .�,lecoll OG / :4 f -,r a r r �' s! O DESCRIPTION OF WORE `,�,1�1! EW ADD ALTER REPAIR DEMOLISH ' �f^ rr �•t 'd~ V y Z NO.OF NO.OF SIZE �. STORIES FAMILIES I USE OF STRUCTURE 1[J r SIGNATURE OF APPLICANT y� VALUATION$ w t-11'0-0 B B CJ APPROVALS DATE J .INSPECTOR'S•SIGNARU.RE PMT. FOUNON:LOCATION �* / ``�'' �r•• P-C. �q FORMS,DATIMATERIALS z A /S�� FEE $ FEE $ _ !/ FRAME:FIRE STOPS, f_r1! ,If I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS !! ,{tP AND STATE'THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE'LOCATION, 'l y e u''• >,rrr�/ WITH ALL COUNTY ORDINANCES AND BTATE,LAWB REGULATING GAS VENT DUCTS s?�,•fi� 'n I BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- , tt / TION OF THE LABOR CODE OF THE STATE OF CALIFORNIA RELAT- ING LATH,INT. .1 P'� �is (.n"-f'�:• .� TO WORKMEN'S MPENSA IN ANCE. LATH,EXT.. '.. �.'•�� s SIGNATURE OF HOUSE NUMBER COR- ��j PERMITTE --ECT AND POSTED D`/t x w�� ✓�o�!�_�1�5J% : ADDRESSG% � ' FINAL 7��lr-6✓� L' CLYDE N. DIRLAM, PRINCIPAL STR RAL EN INEER PLAN CHECKS VALIDATION ,cK. M.O. CASH PERMIT VALIDATION la M.O. CASH i ACO 6 6 0 8% NOV 7 2 3 D 2'3.2 5 a LJ,L� 7 5 4 4 NO{!2 8 1 0 5 0.0 0, APPLICATION FOR BUILDING PERMIT. FOR APPLICANT TQ FILL IN (Print or type only) BUILDINGCOUNTY OF LOS ANGELES ADDRESS 10206 E. Randwick Dr.. DEPARTMENT OF COUNTY ENGINEER CITY Temple City ZIP 917$0 BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING ' SIZE OF LOT NOW ON LOT ADDRESS TRACT 27309 BLOCK LOT NO. 5 LOCALITY TEL. NEARESTck�l OWNER LampaSOna NO. 444 CROSSST. ASSESSOR ADDRESS SaMp MAP BOOKPAGE PARCEL DISTRICT GROUP TYPE FIRE PR SSED BY -CITY ZIPCONST4 i Z02 C� ARCHITECT OR TEL. -0 . z: V ENGINEER NO. STATISTICAL CLASSIFICATION SEWER MAP ADDRESS TEL. CLASS NO. �- I DWELL.UNITS• S BK/O IPG ' ' CONTRACTOR NO. USE ZONE - NOP• .10/ 0 LIC. ADDRESS' NO. / SPECIAL LIC. CONDITIONS CITY CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO ❑• CONSTRUCTION LENDER NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FROM TYPE OF EXISTING SQ.FT. NO.OF NO.OF CHECK' HIGHWAY. + YARD = FRONT PROP.LINE IHIGHWAY WIDTH SIZE STORIES FAMILIES ONE DESCRIPTION OF WORK NEW ❑ + - O U ADD. BLDG.SETBACK FROM O: SIDE PROP.LINE OF ISTREET) O ALTER HIGHWAY + • YARD = L SETBACK FROM TYPE OF EXISTING USE OF REPAIR ❑ SIDE PROP.LINE HIGHWAY' WIDTH. La EXISTING BLDG. DEMOL ❑ + APPLICANT TEL CORNERCUTOFF YES ❑ NO ❑ (PRINTI NO. IN OPEN SPACE YES C] NO ❑ BY(SIGNATURE( - IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAdNG ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH CES AND LAWS REGULATING BUILDING CONSTRUCTION.I CERTIFY THTHE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON OF THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WCOM- PENSATION INSURAN , SIGNATURE OF PERMITTEE ADDRESS FINAL �J� BY .TEL. DATE i CITY NO.MAKE CHECKS PAYABLE TO: FEE $ FEETHARVEY T.BRANDT.COUNTY ENGI _ PLAN CHECK VALIDATION CV- M.O. CASH PERMIT VALIDATION cK. M.O. CASH Os 76A638A CE#803 3.75' ° � APPLICAT ON'FOR BUILDING PERMIT F._APPLICANT TO FAIN (Print or type only( BUILDING COUNTY OF LOS ANGELES ADDRESS � 'o R 1I p W i C k A'U DEPARTMENT OF COUNTY ENGINEER CITY F m IpLF_ C- Ir zIP q 19 o Q BUILDING AND SAFETY DIVISION NO.OF BLDGS. BUILDING SIZE OF LOT Q d NOW ON LOT ADDRESS j Q TRACT r2 7 3 O 71]B�LOCK 61 LOT NO. .�` LOCALITYTEL. NEAREST OWNERLkfb 4 84SOArA NO. /to CROSS ST. alvL ASSESSOR ADDRESS /O F IZA&D Wt C 1` MAPBOOK PAGE PARCEL T_ C DISTRICT GROUP TYPE FIRE OCES D BY -CITY (-IT-%y l ZIP ARCHITECT OR TEL. .5—.0 CONST. / ZONF V c ENGINEER NO. STATISTICAL CLASSIFICAT ON << SEWER MAP ADDRESS TEL. CLASS NO. DWELL.UNITS c3 BK/0 CONTRACTOR .. NO. USE ZONE NOP Q Q � LIC. f ADDRESS Y NO. ��f SPECIAL LIC. CONDITIONS CITY CONSTRUCTION LENDER CLASS ROAD DEPARTMENT APPROVAL REQUIRED YES ❑ NO C] NAME AND BRANCH BLDG.SETBACK FROM FRONT PROP.LINE OF (STREET) ADDRESS CITY TOTAL SETBACK FRO TYPE OF EXISTING SQ.FT. NO.OF f NO.OF ' CHECK HIGHWAY + YARD = FRONT PROO9A1 E 1HIGHWAY1 WIDTH SIZE 9 62 1 STORIES ` FAMILIES ONE >, a DESCRIPTION OF WORK NEW ❑ + - O ADD BLDG.SETBACK FROM SIDE PROP.LINE OF (STREET) O ALTER ❑ TOTAL SETBACK FROM TYPE OF EXISTING w HIGHWAY + YARD = SIDE PROP.LINE HIGHWAY WIDTH . h USE OF REPAIR ❑ Z EXISTING BLDG. DEMOL ❑ + / APPLICANT TEL PKER CUTOFF YES ❑ NO ❑ (PRINT) NO. IN OPEN SPACE YES ❑ NO ❑ BY(SIGNATURE) IN COASTAL PERMIT ZONE YES ❑ NO ❑ VALUATION$ S [�0 D rT 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 RELATING TO WORKMEN'S COM- PENSATION INSURANCE. SIGNATURE OF, PERMITTEE ADDRESS C FINAL BY CITY NO. DATE i/J Q MAKE CHECKS PAYABLE TO: FEE $ u FET L/, --7•�g HARVEY T.BRANDT,COUNTY ENGINEER_j �- PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION QcK. ).o. CASH 2 6 4 '40V 22 1 0 4 8.7 5 e ®s 76A63BA CE#803 3-75' WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self ti 6 insure, or a certificate of Workers'Compensation Insurance, A � � L� PERMIT or a certifie Y ec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 5 � Company S-I-a-tp Mind TTI., ..: ... . ..:,.: : , ,.;. _ BUILDING Certif leg copy is hereby furnished. FOR APPLICANT TO FILL IN ADDRESS Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 1 2 LOCALITY }�� NEAREST r Date 9Z3185 Applicant C'-dAr 7 1hdS 4r Orn_ CITY ZIP91780 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORS' NO.OF BLDGS. ASSESSOR RKE COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one USE ZONE MAP hundred dollars($100)or less.) "TRACT BLOCK LOT NO. NO. TEL. SPECIAL �- I certify that in the performance of the work for which this OWNER NO. _ CONDITIONS permit is issued, I shall not employ any person in any manner DISTRICT GROU TYPE FIRE PROLE D BY 0 ADDRESS 1 `' CONST. ZONE so as to become subject to the Workers'Compensation Ldws. Ol f Date Applicant CITY ZIP STATISTICAL CLASSIFICATION APT. CO U NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. ENGINEER NO. CLASS NO. DWELL. UNITS all Exemption, you should become subject to the Workers' � _, ,... . .,,. .• . .. ®.. Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this permit shall be VALIDATION deemed revoked. CONTRACTOR NO. _ BK PG, LICENSED CONTRACTORS DECLARATION LIC. ,3 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. Professions Code, and my license is in full force and effect. CITY CLASS — $dd�� 9284. 1 A SQ.FT. NO.OF NO.OF CHECK License Number 157613 Lic,Class C-39 ' SIZE STORIES FAMILIES ONE # a o 0 0 0 ContractOl�t�n r Roofs CO. Date 9/3/85 •:DESCRIPTION OF WORK a $ I o 0 7 8 O O v ADD FiI am exempt under Sec. ALTER ❑ FINAL 0 9 0 4-8 5 B.BP.C. for this reason REPAIR DATE Dat _ USE OF DEMOL B N EXISTING BLDG. Y 028R OA Signature APPLICANT erf�/�T . l N 725/VNP..4EL. 6� g O NER-BUILDER DECLARATIO PRINT NO. _ I� # ° 1 I hereby affirm that I am exempt from the Contractor's License ADDRESS P 0 I l\8�Q 0 0 Law for the following reason (Section 7031.5, Business and _ � . - Professions Code): PRE ENT ❑ C BUILDING I, as owner of the property, or myemployees with :ADDRESS wages as their sole compensation,will do the work and the structure is not intended or offered for sale(Section a'LOCALITY 7044, Business and Professions Code). `' MOVING TEL. I,as owner of the property,am exclusively contracting CONTRACTOR NO. with licensed contractors to construct the project (Sec- y ADDRESS # 0 0 0 0 0 tion 7044, Business and Professions Code). r REQUIRED TOTAL SETBACK FROM EXIST. CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT 1/ the performance of the work for which this permit is issued P.L. 0 0 cz tSec. 3097, Civ. C.). SIDE P.L. 09.04=85 Q Lender's Name Lender's Address P.C.Fee$ Permit Fee 67-50 - rI certify that I have read this application and state that the Issuance Fee above information is correct. I agree to comply with all County Investigation Fee 3 ordinances and State laws relating to building construction, Total Fee 78.00 9 and hereby authorize representatives of this County to enter uponthe v -mentioned"arty for inspection purposes. o Y, SEE REVERSE FOR EXPLANATORY LANGUAGE ignoture of Appl cant or ®s Agent ate