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HomeMy Public PortalAbout10212 RANDWICK DR_Building__ .' a 73A333A CE 0803 1/7 APPLICATION FOR BUILDI G PERMI� COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING ADDRESS 0 COLEMAN W. JENKINS, SUPT OF BUILDING • LOCALITY FOR APPLICANT TO FILL IN NEAREST e Print or tvDe onl CROSS ST. BUILDING DISTWT NOQ. GROUP TYPE O E ADDRESS Jop ° 5 t 0 V �ONST. STATISTICAL CLASSIFICA T N SEWER MAP LOT NO. BLOCK R CLASS NO. DWELL, NITS BK PG TRACT (.' USE ZONE MAP /© NO.OF SLOGS. NO. SIZE OF LOT NOW ON LOT SPECIAL USE OFC CONDITIONS EXISTING BLDG, TEL. OWNER NO. BLDG.SETBACK FROM ADDRESS C N FRONT PROP.LI NE OF (STREET) TYPE OF EXISTING SETBACK HIGHWAY f YARD = TOTAL CITYHIGHWAY WIDTH FROM C.L. E/77 C ARCHITECT OR TEL. + = ENGINEER NO. BLDG.SETBACK ADDRESS SIDE PROP.LINE OF (STREET) r TEL. TYPE OF EXISTING SETBACK WAY } YARD = TOTAL CONTRACTOR NO, HIGHWAY WIDTH FROM G.L. C C: ADDRESS 1 y NOLIC' 4V t = C LIC. CITY CLASS V-� CORNER CUTOFF YES ❑ ❑ yi' CONSTRUCTION LENDEM NAME AND BRANCHOr SEE REVERSE SIDE FOR SPECIAL APPROVALS ADDRESS . r SQ. FT. �j� NO. OF NO, OF NEW ❑ / �I f"" SIZE a :� STORIES FAMILIESUSE STRUCTURE �A ADD i ■ J .t_. �le .� !F•,f .�t; ALTER ❑ SIGNATURE OF REPAIR❑ APPLICANT DEMOL ❑ VALUATION S APPROVALS DATE INSPECTOR'S SIGNATURE P.C. IN in PMT• FOUNDATION: LOCATION li FEE 3-5 / FEES a FORMS, MATERIALS FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF 'CALIFORNIA IN RELATING TO WORKMEN'S COMPEN ATION INSURANCE. LATH, EXT, SIGNATURE OF Z9 / HOUSE NUMBER COR- PERMITTEE RECT AND POSTED ADDRESS V41FINAL JOHN F. LEWIS. PRINCIPAL STR TURAL ENGINEER PLAN CHECK VALIDATION M.O. CASH _ PERMIT VALIDATION CK. M.O. CASH Af',. 1 1 0 8` JUN 29 2 3 D 5.00- 114 1 ��„ 11 0 -9 JM29 1 D 6.00cli Z6? t hyCE#803 12/89 '���L • r APPLICATION FOR BUILDING PEFMIT COUNTY OF LOS ANGELES ASSESSOR DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL BUILDING AND SAFETY DIVISION BUILDING r�' i�l/P JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS G� ` ` ((((((�� COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY �Q� \ FOR APPLICANT TO FILL IN NEAREST Ar Print or tvDe onl CROSS ST. BUILDING DISTRICT NO. GR?U,P TYPE P SSED BY ADDRESS �Q wr�� 6- 0 lu",'ICONST. /7 STATISTICAL CLASSIFICATION SEWER MAP LOT NO. BLOCK CLASS NO. / DWELL.UNITS B%-----PQ TRACT USE ZONE MAP NO.OF BLDGS. NO. SIZE OF LOT NOW ON LOT _ SPECIAL USE OF CONDITIONS EXISTING BLDG, OWNEry ' TEL. nV o NO. BLDG.;;T8XCNkROM ADDRESS FRONT PROP.LIN (STREET) 7- TYPE OF EXISTING SETBAC IGHWAY + YARD = TOTAL CITY HIGHWAY WIDTH FROM C.L. ARCHITECT OR g^ TEL + ENGINEER ./ NO. BLDG.SETBACK FROM ADDRESS S � SIDE PROP.LINE OF (STREET) • TEL TYPE OF EXISTING SETBACK HIGHWAY •F D = TOTAL CCrNTRACTOR Np, -� HIGHWAY WIDTH FROM C.L. ADDRESS /4/16023 pLI . LIC. c CITY S' CLASS CORNER CUTOFF YES ❑ NO ❑ CONSTRUCTION LEN R O NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APP ALS ADDRESS O co SQ, FT. , NO. OF NO. OF SIZE //Y STORIES FAMILIES NEW47 USE OF � ADD - 0 _ !1. STRUCTURE �ld �(/ .3 ALTER ❑ REPAIR[:] SIG E APPLICANT Cl a4 EMOL ❑ VALUATION Swolo, APPROVALS DATE INSPECTOR'S SIGNATURE P.C. PMT. FOUNDATION: LOCATION FEE$ - O. FEE 5 FORMS, MATERIALS _ I FRAME: FIRE STOPS, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING BOLTS AND STATE THAT THE ABOVE I5 CORRECT AND AGREE TO COMPLY FURNACE: LOCATION, WITH ALL ORDINANCES AND LAWS REGULATING BUILDING CON- GAS VENT, DUCTS STRUCTION. I CERTIFY THAT IN DOING THE WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF THE LATH, INT. LABOR CODE OF THE STATE OF -CAL ORNIA IN LATINS TO / WORKMEN'S COMPENSATION INSURANCE. C,�o�I a_ TI-1. EXT. /— :� •- PIGNATU IE / V'ILB�JWj'(�]ya SE NUMBER COR- / CT AND POSTED ADDRESS 484OX 3,61/ FINAL JOHN F. LEWIS. PRINCIPALS R RAL ENGINEER. PLAN CHECK VALIDATION cK. .O. CASH _ PERMIT VALIDATION CK. M.O. CASH .05 4 5 69 JULY1? 2 1 0 2.70- a 5454578 JUS17 1 D 9.0 0;' ' TEMPLE CITY FGA666A S:6#809-1-61 APPLICATION FOR BUILDING PERMIT . COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGM= ADDRESS BUILDING AND SAFETY DMSION LOCALITY L1/ JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DISTR NO. GROUP, TYPE P C ED BY FOR APPLICANT TO FILL IN W X1, CONST. hi A ADDRD NI ESS STATISTICAL CLASSIFICATION EWER MAP BK PG CLASS.N0.3DWELL.UNITS LOT NO. BLOCK WATER CERTIFICATE: NOT RECUIREDrI�C1 RECEIVEDLi TRACT 2--73 MAP HIGHWAY STATE MAJOR SECOND OCA NO.OF BLDGS. NO. Q (J (CIRCLE) SIZE OF LOT. I NOW ON LOT USE ZONE SPECIAL USE OF + d. CONDITIONS EXISTING BLDG. TEL. OWNER NO. BUILDING YARD HWY STREET NAME EXIST. ADDRESS j. SETBACK WIDTH FRONT 2 O ARCHITECT R TEL P.L. ENGINEER NO. SIDE ' P.L. } ADDRESS TEL. INSPECTION RECORD O CONTRACTORF-awze BelQ ADDRESS L/4 32 joL �( IY'j�, O DESCRIPTION OF WORK NEW ADD ALTER REPAIR DEMOLISH ^- h Z SG!.FT. NO.OF NO.OF SIZE STORIES -FAMILIES USE OF STRUCTURE SIGNATURE OF APPLICANT VALUATION$ 9 I 'APPROVALS DATE INSPECTOR'S SIGNATURE FOUNDATION:LOCATION FEE $I FEE $ FORMS,MATERIALS FRAME:FIRE STOPS, 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING,BOLTS AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE:LOCATION, ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK - AUTHORIZED HEREBY 1 WILL NOT EMPLO.Y,ANY PERSON IN VIOLA- LATH.INT. TION OF THE LABOR CODE OF THE STATE.OF CALIFORNIA RELAT- ING TO WORKMEN'S COMPENSATION INSURAW. n LATH,EXT. SIGNATURE OF UV_K_Ri HOUSE NUMBER COR- PERMITTEE- RECT AND POSTED i ` � �AI ADDRES WRIFINAL. x Y�n CLYDE N. DIRLAM, PRINCIPAL STRUCTURAL ENjQLN6l&R /PPLAN CHECK VALMAATION CIL -m.o. CASH _. PERM VALIDATION CK. " M.O. '-CASH /��2� � ( ,C C ) 6 2 1 SUN J r`� C' TEMPLE CITY ►QAasa,l0ehue.l-8, APPLICATIQN FOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY JOHN A. LAMBIE, COUNTY ENGFINEER NEAREST WILLIAM A.JENSEN SUPT OF BUILDING CROSS ST. DIST? IST ICT NO. r_GlWUf2 TYPE P SSED BY FOR APPLICANT TO FILL IN D CONST. ` BUILDING STATISTICAL CLASSIFICATION S ER MAP ADDRESS I+dUAW/G� �/�1 K PG CLASS.NO.�DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED TRACT 11RECEIVED TRACT d NO.OF BLDGS. -� NOP l I(C�RCVLE) STATE MAJOR SECOND, CAL SIZE OF LOT. K IOb I NOW ON LOT USE ZONE SPECIAL USE CONDITIONS EXISTING BLDG. TEL. OWNER -9 NO. BUIL ING YARD H STREET NAME EXIST. ADDRESSMZ4 7&WJ4C1� Y Or AW- SETBACK WIDTH FRONT jogj& ARCHITECT OR TEL. P.L. If ENGINEER NO. SIDE P ADDRESS TEL J , INSPECTION RECORD ,. 0 CONTRACTOR 16-lI"OZ DE�rD=Co .NO. �Y / r• a ADDRESS 7i�s L![7� t� ,(„�r1 1 7 l/ YFL C✓ ! r �i if Jt yt"y-s' s O DESCRIPTION OF WORK _ G s r _..�_ �� I.. ;1%,1 A /n '89 C' h c�r.� ?fr•1 r: � C h N ADD ALTER REPAIR � DEMOLISH ] la r•t � r " e A' 1 1, Ala J,d".NO.OF IZE narl Z v. STORIES FAMILIES �]j USE OF Nor STRUCTURE _ 1 L F/31 lyw ��a Q l -<De APPROVALS DAfE:/ INSPECTOIPSSIGNATURE P.C. PMT. (f' FOUNDATION:LOCATION FEE $ FEE $ `� FORMS,MATERIALS �� �� ►LrA . .� FRAME:FIRE STOPS, c?=�¢ 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING,BOLTS . f//` '? AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO.COMPLY FURNACE;LOCATION, i` I ���� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS { '•'� /n BUILDING CONSTRUCTION. I CERTIFY THAT IN DOING THE WORK • rt _ �/ i•,,`j7 AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- [-ATH,INT. TION OF THE LABOR CODE OF THE STA O ALIFORNIA RELAT- e� ING TO WORKMEN'S C ENSATI N 1 U CE. LATH.EXT. SIGNATURE OF HOUSE NUMBER COR- L1 PERMITTE RECT AND POSTED ADDRESS FINAL �l i! A CLYDE N. DIRLAM, PRINCIPAL STR RAL ENGINEER PLAN CHECK VALIDATION M.o.-, CAS14 PERMIT VALIDATION cK, M.O. CASH u06609Qi NOV 7 23 .D . . 26.75A LAC0 7 5 4 5- (SOV 2 8 :1 D 57.00- WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self0 insure, or a certificate of Workers'Compensation Insurance, A� T 1N F O R BUILDING P E M I T or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. dl 6=3476{ytpany Staf-rn ninr9 Certified copy is hereby furnished. BUILDNG FOR~APPLICANT TO FILL IN ADDREESS /0 02 r C1 Certified copy is filed with the county building inspec- BUILDING 4 I tion department. ADDRESS 10212 Rand ick Dr. A LOCALITY NEAREST Date 9/3/85 Applicant _QBC RmfG ` CITY le Cifzz ZIP 91780 CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSESSOR COMPENSATION INSURANCE SIZE OF LOT NOW ON LOT 2 MAP BOOK PAGE PARCEL (This section need not be completed if the permit is for one US ONE MAP hundred dollars($100)or less.) TRACT BLOCK LOT NO. ;t / NO. TEL. l SPECIAL I certify that in the performance of the work for which this OWNER NO. 444-8050r CONDITIONS d permit is issued, I shall not employ any person in any manner DISTRICT I GROUP ITYPE FIRE PROCE D BY O ADDRESS b; 7X/ �j CONST. / ZO �. so as to become subject to the Workers'Compensation Laws. � •aj (1// � Date Applicant CITY ZIP `'STATISTICAL CLASSIFICATION APT. CO NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. DWELL. UNITS LU - Compensation provisions of the Labor Code, you must forth ADDRESS SEWER MAP - v9 with comply with such provisions or this permit shall be TEL. deemed revoked. CONTRACTOR NO. _ BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. /.S J'J I hereby affirm that I am licensed under provisions of Chapter 9 ADDRESSbgarepigg 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 -� 4960.00 157613 SQ.FT. NO.OF NO.OF CHECK License Number Lic.Class C-39 `.SIZE STORIES FAMILIES ONE Contractor Cedar IbOfS CO. Dote 9/3/$5 DESCRIPTION OF WORK ❑. $ I am exempt under Sec. re—roof with Pressure treated ADD ❑ ALTER ❑+ ,FINAL B.BP.C. for this reason beciar shakes at 10" exp.New oeFAIR DATE �i USE OF DEMOLFIN Date: EXISTING BLDG. ce ❑ By Signature APPLP(PRI CEDAR ROOFS CO. No.284-7167 OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License ADDRESS 0$ S. MarP_Il BOX 87 Alhambra Law for the following reason (Section 7031.5, Business and Professions Code): PRE E T El BUILDING I, as owner of the property, or 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 7044, Business and Professions Code). MOVING TEL. 2 2 8 3 9 A I,as owner of the property,am exclusively contracting CONTRACTOR NO. 0 0 0 o o , with licensed contractors to construct the project (Sec- ADDRESS tion 7044, Business and Professions Code). REQUIRED TOTAL SETBACK FROM EXIST. o o 7 8,0 0 CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP.LINE WIDTH I hereby affirm that there is a construction lending agency for FRONT o 0 0 7 a 0 0� the performance of the work for which this permit is issued P.L. tSec. 3097, Civ. C.). SIDE P.L. 0 9 0 4=8 5 g a Lender's Name i P.C. Fee$ Permit Fee (57-50 Lender's Address 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 ordinances and State laws relating to building construction, % Total Fee $, and hereby authorize representatives of this County to enter upon t ove-mentio d property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Applicant or Agent ate es