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Home My Public Portal About10220 RANDWICK DR_Building__ TEMPLE--CITY awes.ae Deus.,—s, F ll APPLICATIONOR BUILDING PERMIT COUNTY OF LOS ANGELES BUILDING DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DMSION LOCALITY f JOHN A. LAMBIE, COUNTY ENGINEER NEAREST WILLIAM A. JENSEN SUPT OF BUILDING CROSS ST. i DISTRICT NO. GROUP TYPE PR SED BY FOR APPLICANT TO FILL IN CONST. BUILDING /�o� STATISTICAL CLASSIFICATION SE ER MAP ADDRESS ®*I ,vJJGr/�� K PC' CLASS.NO.�DWELL.UNITS LOT NO. BLOCK WATER NOT REQUIRED RECEIVED �y CERTIFICATE: TRACT /,7O MA -9 HIGHWAY NO.OF BLDGS. NO�® CIRCLE, IR LEl STATE MAJOR SECOND, OCAL . SIZE-OF LOT.�D X /OO I NOW ON LOT "�� USE ZONE SPECIAL USEOF CONDITIONS EXISTING BLDG. ..s OWNERv NO. �� BUILDING YARD HWY STREET NAME EXIST. SETBACK WIDTH ADDRESS a6 FRONT ARCHITECT OR TEL P.L. ENGINEER NO. SIDE ADDRESS TELINSPECTION RECORD 0_ CONTRACTOR'V Co NO. T ZP1 /A I _ �/I,�I A O ADDRESS ff2 ]'�i✓Ara— C,-r / 2!/�• /� /.G; %'�, � G>o?+s�iP,;2, Vf �&r��.' o: DESCRIPTION OF WORE fAa''l�Y:''� °�-� �'' `'` �`'' w ADD ALTER REPAIR DEMOLISH $IZE /L7� NO.OF NO.OF STORIES FAMILIES AL; �je--.//,-meq`. USE OF HAL; / •G STRUCTURE `mow � ,� .v7�.� L /�'.'so�� '�ver��.►•.� SIGNATURE APPLICAN 6' VALUATION$ /1" -��dG �� APPROVALS DATE INSPECTOR+S SIGNXTVAE P.C. CC�� D PMT. �/ FOUNDATION:LOCATION FEE $„1r FEE $J FORMS.MATERIALS FRAME:FI RE STOPS, {� I 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 / v BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK rye 2 AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA- LATH,INT. O TION OF THE LABOR COD F THE STATE O CA ORNIA RELAT- INC TO WORKMEN'S C NS ION 1 ANC LATH,EXT. i1/ �JiW!"!•' COR- PERMITTEED SIGNATUFE OF HRECT AND POSTEDOUSE NUMBER J!�' ltrf. /✓I-GG✓L.Z<''� ADDRESS �, U / FINAL CLYDE N. DIRLAM, PRINCIPAL ST URAL ENGINEER PLAN CHECK VALIDATION cK. M.O. CASH• PERM VALIDATION C M:o. . CASH Li to 6 6 1 1 NOV 7 2 3 D 2 5,00h- N 75470' NOV28 1 D 53,50w WORKERS'COMPENSATION DECLARATION I / hereby affirm.that I.have a certificate pe of consent to self APPLICATION F®RWILDING PERMIT insu„r,=or'a cOrtificafe of Workers'Compenstiori Insurance,or , a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGEL ( I BUILDING AND'SA PPolicyNo.00-93-29 Company E.,B. I . Certified copy is'hereby furnished. FOR APPLICANT TO FILL IN ADD Ess MX Certified copy is filed with the county building inspec- BUILDING tion department. ADDRESS 10220 Randwick Drive LOCALITY �' Y Date 7-21-81 Applicant CAL-PAC ROOFING, INC' clrY Temple Cif' , CA. zip 91780 NEARECROSS ST. T. CERTIFICATE OF EXEMPTION FROM WORKERS' NO.OF BLDGS. ASSES SOR COMPENSATION INSURANCE SIAOF'LOT NOW ON LOT MAP BOOK / PAGE PARCEL . USE ZONE MAP (This section need not be-completed if the permit is far one t TRACT BLOCK LOT NO. NO. G hundred dollars($100)or less.) �i y. TEL. �-/ SPECIAL I certify that in the performance of the work for which this OWNER MSM C. Heiser ' No.448-8483 CONDITIONS O .permit is issued, I shall not-employ any person in any manner1E DISTRICT GROUP TYPE FIRE PRO SSED BY ADDRESS 10220 Randwick Drive CONSTtJ . zc�D so as to become subject to the Workers'Compensation Laws: ''j�% �i� � CITY Temple -Cityzip 917801 Date Applicant STATISTICAL CLASSIFICATION APT. JCONDO,�/ cy NOTICE TO APPLICANT: If, after making this Certificate of ARCHITECT OR TEL. LU Exemption, you should become subject to the Workers' ENGINEER NO. CLASS NO. �� DWELL. UNITS Compensation provisions of the Labor Code, you must forth- ADDRESS SEWER MAP with comply with such provisions or this-permit shall be TEL. ' deemed revoked. CONTRACTOR CAL-PAC ROOFING NO.681—8560 I BK. PG, VALIDATION LICENSED CONTRACTORS DECLARATION LIC. I hereby affirm that I am licensed under provisionslof Chapter 9 ADDRESS .618 NO.- Eckho.f f •St. No.379503 VALUATION (commencing with Section 7000)of Division 3 of the Business and LIC O Gd �d Professions Code, and my license is in full force and effect. CITY Ora a Ca I 'f 92668 CLASS C39 $1_6 SCT. FT. NO.OF NO.OF CHECK License Number 379503 Lic.Class C39 SIZE STORIES t FAMILIES ONE $ Contractor CAL-PAC' ROOF I NG DO1e 7-2 1- NEW 8 I DESCRIPTION OF WORK ❑J. P g q RE-ROOF WITH TYPHOON ADD ❑ I am exem t from the licensing requirements as I am a licensed architect or a registered professional engineer ALTER ❑:' FINAL acting in my professional capacity (Section 7051, DECRABOND•T•I LE ? ` - Business and Professions.Code). USE OF REPAIR FINAL EXISTING BLDG... I .Fam 1 1 y Dwe I I Ing DEMOL Lic.or Reg.Na. Date APPLICANT OWNER-BUILDER DECLARATION . (PRINT) CAL-PAC ROOFING R& 681-8560 I hereby affirm that I am exempt from the Contractor's License ADDRESS 18 NO. Eckliof f St: Ora n e CA. `— Q 5(� Law-for the following reason (Section 7031.5, Business and Professions Code): PRESENT ' EJ 1, 0 0 0 0 0.1 I, as owner of the property, or my employees with ADDRESS wages as their sole compensation,will do the Work and 2 „ 0 6 1. 0 the structure is not intended or offered for sale(Section LOCALITY 7044, Business and Professions Code). MOVING TEL. x ❑ CONTRACTOR NO. o o h 1,0 0 5 I,as owner of the property,am exclusively contracting with licensed confracfors'to construct the project (Sec- ADDRESS 0 -7.3.0-81 tion 7044, Business and Professions Code). 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. ` l the performance of the work for which this permit is issued P.L. (Sec. 3097, Civ. C.). SIDE P.L. Lender's Name r ' P.C. Fee$ Permit Fee 54.00 Lender's Address I certify that I have read this application and state that the Issuance Fee 7.00 �°"'-=•„,. ^• ' above information is correct. I agree to comply with all County Investigation Fee ordinances and State laws rel91, g to building construction, Total Fee $61 .00 and hereby authorize ues of thisCounty to enter upon th ab e- e e prty fo pection purposes. ( I 7-21-81 SEE REVERSE FOR EXPLANATORY LANGUAGE Os ture o Applic nt or Agent Date igna Al APPLICATION F3WLDING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY WORKER'S COMPENSATION DECLARATION FOR APPLICANT TO FILL IN BUILDING AD+�DR��EISS BUILDING ADDRESS �o�c1!/ iyIl I hereby affirm that I have a certificate of consent to self insure, C��G� or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) CITYTS Ci 1 ZIP 1 LOCALITY Policy No. Company SIZE OF OT t NO.OF BLDGS.NOW ON LOT 9� ❑ Certified copy is hereby furnished. I NEAREST CROSS BY.' ❑ Certified copy is filed with the county building inspection TRACT BLOCK LOT NO. department. USE ZONE MAP NO. Date Applicant ASSESSOR MAP BOOK PAGE PARCEL SPECIAL CONDITIONS CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER TEL NO. ES COMPENSATION INSURANCE WITHIN 1000 FT.OF SCHOOL? YES NO (This section need not be completed if the permit is for one hundred ADDRESS IDISTRICT GROUP TYPE CONST. FIRE ZONE PROCESSED BY dollars($100)or less.) CITY ZIP I certify that in the performance of the work for which this permit a.0 S J is issued, I shall not employ any person in any manner so as to Gc� // ff become subject to the Workers'Compensation LAWS. ARCHITECT OR ENGINEER TEL NO. .J0 STATISTICAL CLASS FICATION APT CONDO Date Applicant ADDRESS CLASS NO. ` DWELL UNITS NOTICE TO APPLICANT.• If, after making this Certificate Of REQUIRED TOTAL SETBACK FROM EXIST Exemption, you should become subject to the Workers' CONTRACTOR TEL NO. SET BACK YARD HWY PROP LINE WIDTH Compensation provisions of the Labor Code, you must forthwith / _ �7 Q,� FRONT comply with such provisions or this permit shall be deemed revoked. ADDRESS LIC.NO. PL LICENSED CONTRACTORS DECLARATION 4C V W- SIDE CITY �� J LIC.CUSS PL I hereby affirm that I am licensed underprovisions Of Chapter 9 a SEWER MAP (commencing with Section 7000)of Division 3 of the Business and SQ.FT.SIZE NO.OF STORIES NO.OF FAMILIES Professions Code,and my license is in full force and effect. I / NEW ❑ BK PG D}., License Number Lia Class DESCRIPTION OF WORK ,� ADD ❑ VALUATION yYl Poo. Q Contractor Date 4re� ALTER yy V a't 0 ❑ cc I am exempt under Sec. REPAIR ❑ � BAP.C.for this reason # -IS-( DEMOL ❑ LDMA P/C# W Date: USE OF EXISTING BLDG. URM ❑ IL Signature APPLICANT(PRINT) TEL NO. LDMA Perm# 23 z ❑ 1, as owner of the property, or my employees with wages as A.4 6 Z n their sole compensation, will do the work and the structure is ADDRESS O ACCT.e$s not intended or offered for sale (Section 7044, Business and (`Q WIL 'e .4v.. FINAL DATE Q3303 Professions Code.) yn G 147.17 WILL THE APPLICANT OR FUTURE BUILDING OCCUPANT HANDLE A HAZARDOUS MATERIAL / C 3 OR A MIXTURE CONTNNING A HAZARDOUS MATERIAL EQUAL TO OR GREATER THAN THE ❑ I, as owner of the property, am exclusively contracting with FINAL BY > q AMOUNTS SPECIFIED ON THE HAZARDOUS MATERIALS INFORMATION GUIDE? licensed contractors to construct the project (Section 7044, YES❑ NQ ACCT.7 Business and Professions Code.) WILL THE INT NDED USE OF THE BUIDLING BY THE APPLICANT OR FUTURE BUILDING -, OCCUPANT REQUIRE A PERMIT -, FOR CONSTRUCTION OR MODIFICATION FROM THE SOUTH ,,`30'12) 276.45 CONSTRUCTION LENDING AGENCY COAST NR QUAUTY MANAGEMENT DISTRICT(SCAOMD)SEE PERMITTING CHECKLIST FOR GUIDELINES ITE EP� I herebyaffirm that there is a construction lendingagency for TOTAL 3 �, 2 a the performance of the work for which this permit is issued ec. YES❑ "�'-n-�_ +-�-�- p� 1HAVE READ EHAZARDOUS MATERIALS INFORMATION GUIDE AND THE SCAQMD PERMITTING CIA 3097,CIV.C.) CHECKLIST UNDERSTAND MY REQUIREMEN NDER THE LOS ANGELES COUNTY CODE, TITLE 2.Lender's Name MA ERIAI,S REPO NG AN FORS NM A PERMIT F1 4THE SSE MD.RNING HAZARDOUS 423.62 }CHECK f 23 o 6? 0 Lender's Address C GWNw ORAGENT t�- _ . s!ry!;t c I certify that I have read this application and state under penalty of perjury that the above information is correct.I agree to comply P.C.FEE PERMIT FEE $ with all county ordinances and State laws relating to building / 7 / / i 1 n m construction,and hereby authorize representatives of this County ISSUANCE FEE �� 0000-0001 71 5/05 m to enter upon the ab mentioned property for inspection purposes. p��. -, o E- n 1_8e 1 FIM 10-54 ro 1�� 1/'�" /S INVESTIGATION FEE TOTAL FEE So a p!uW w Awn Dao SEE REVERSE FOR EXPLANATORY LANGUAGE