HomeMy Public PortalAbout10240 RANDWICK DR_Building__ 7fiA538A.CE 9803 4/72 I
APPLICATION FOR BUILD NG PERMI
COUNTY OF LOS ANGELES ASSESSOR
DEPARTMENT OF COUNTY ENGINEER MAP BOOK PAGE PARCEL
BUILDING AND SAFETY DIVISION BUILDING
61AKE CHECKS PAYABLE TO: ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN NEAREST
Print or tvoe onIvl CROSS ST.
BUILDING DIS�CT NO G TYPE / PR
ADDRESS ' li Z4 d �Z C I� . D � CONST. )//
zmr,
LOT NO. BLOCK
STATISTICALSIFICATION J' SEWER MAP
CLASS NO. DWELL.UNITS 6i-"PG
TRACT Z� 2
2, rJ USE ZONE MAP jl /�
1 NO OF BLDGS. NO. C/ L/
SIZE OF LOT ' C 1 NOW ON LOT r SPECIAL
USE OF I CONDITIONS
EXISTING BLDG. IJP 'ELL I WC-_
TEL.
OWNER A , a P lZ�,E a O. BLDG.SETBACK FROM
ADDRESS O'er 4 b IZ AN kl, i.AJ 1 C K I FRONT PROP.LINE OF (STREET)
TYPE OF EXISTING SETBACK HIGHWAY + YARD = TOTAL
CITY p LE Cy HIGHWAY WI TH FROM C.L.
ARCHITECT OR TEL. f _ D
ENGINEER NO. BLDG.SETBACK FROM a
ADDRESS SIDE PROP.LINE OF (STREET) L
TEL, TYPE OF EXISTING SETBACK HIGHWAY YARD = TOTAL C
CONTRACTOR IFj C�� SeJ NO. `S-OQj HIGHWAY WIDTH FROM G.L. F
LIC
ADDRESS�j t r 1r_14 LAN NO.* I I + 4
LIC. C/
CITY Sh IF-17-12A PA44Z)2 E CLASS CORNER CUTOFF YES ❑ NO ❑
CONSTRUCTION LENDER
NAME AND BRANCH SEE REVERSE SIDE FOR SPECIAL APPROVALS
ADDRESS i
S ZE T STORIES ' NO. IIIF. NEWUSE OF ❑ //`� /�� f�S'
STRUCTURE '� Fl AMIL-Y--
L ADD //i v
ALTERbdA
❑
SIGNATURE O REPAIR❑
APPLICANT L DEMOL ❑
VALUATIONS O APPROVALS DATE IN CTOR'9 SIGNATURE
P.C. S FEE$ �D rOUNDATON:FORMS!MATLOCATI
ERIIALSON U 7
FRAME: FIRE 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 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 HE STA E OF •CALIF NIA IN RELATING TOa.
WORKMEN'S COM SATI SURANC E. LATH, EXT.
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESSS AL �'
PLAN CFIECK VALIDATION CK. M.O. CASH _ PERMI jVALIDATION CK. M.O. CASH
Cc
,�,� 4 0 5 2 1 u 5 5.5 DN
TEMPLE CHTY
78ASSBA CE INOS•I-BI APPLICATION FOR BUILDING P IT
COUNTY OF LOS ANGELES BUILDINGrr�
DEPARTMENT OF COUNTY ENGIN]M ADDRESS -2
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE. COUNTY EN41NEER NEAREST
WILLIAM A.JENSEN 6UP•T OF BUILDING CROSS ST.
DISTRICT NO. GROUP TYPE P SED BY
FOR APPLICANT TO FILL IN CONST.
BUILDING STATISTICAL CLASSIFICATION SE ER MAP
ADDRESS N-4 ,95VA, Ore- PG
CLASS.NO. DWELL.UNITS--Ll
LOT NO. BLOCK WATER NOT REQUIRED ❑ RECEIVED
CERTIFICATE:
TRACT O MAP / HIGHWAY STATE MAJOR SECOND, L
/ NO.OF BLDGS.`r N f (CIRCLE)
SIZE OF LOT. �S lJ1t /�Q I NOW ON LOT USE ZONE SPECIAL
USE OF CONDITIONS
EXISTING BLDG. //�� `',gyp p
OWNER �. C�. NO. .(041 O BUILDING YARD HWY STREET NAME EXIST.
�74 T7 *0kr/�_ _ Ido, SETBACK WIDTH
_ADDRESS X77 1 C_!LY FRONT
ARCHITECT OR TEL. P.L. cr
ENGINEER NO. SIDE
P.L.
ADDRESS
CONTRACTOR TEL INSPECTION RECORD 0
� . NO.
ADDRESSS'1 "94 -Mdpw Or " B✓D.
DESCRIPTION OF WORE
0
W
a
ADD ALTER REPAIR _DEMOLISH Z
Q.FT. d NO.OF NO.OF
IZE D STORIES FAMILIES
USE OF
STRUCTURE
ws1L/aJC � � A
SIGNATURE OF
APPLICANT
VALUATIONS 4 7.00. I
APPROVALS DATE-) INSPECTOR'S SIGNATURE
P.C. 51,10 PMT p—G FOUNDATION:LOCATION
FEE $ FEE $ `• FORMS,MATERIALS
FRAME:FIRE STOPS.
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION BRACING BOLTS
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY FURNACE:LOCATION..
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VE T DUCTS I � /
BUILDING CONSTRUCTION. 1 CERTIFY THAT IN DOING THE WORK ••�� ..- s��``�+
AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLA-
TION
LATHINT.
TION OF THE LABOR CODE OF THE STATE OF gCAALI NIA RELAT ,-,
ING TO WORKMEN'S C S ON IN URA C LATH,EXT,
SIGNATURE OF HOUSE NUMBER COR-
PERMITTEE RECT AND POSTED
ADDRESS
FINAL
,CLYDE N. DIRLAM, PFUNCIISAL ST CT rRAL ENGINEER
PLAN CHECK VALIDATION cK. .M.O. CASH J PERM VALIDATION V M.D. CASH
LH�a 6 6 1 5 NOV 72 3 D 2 8.5 Q A
L 7 557 5 5 IQNOV2 8 1 D 5 7,00N
WORKERS'COMPENSATION DECLARATION i
to
insurebor afcertif certificate of Workers'Compensation irm that I have a certificate of coent Insuran elf j APPLICATION FOR BUILDING P E RM I T
or a certified copy thereof(Sec. 38000,,aLalb. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
PolicyNd MOZ Company^51_; 77� �i�')Q
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN BUILDING
❑ 6 d
ADDRESS / tq
Certified copy is filed with the county building inspec- ' [ADDRE
UILDING �r77
tion department.
s� SS JS o OAhay.,J LOCALITY
Date — 'v[7Applicant A, 241 _�a_d ITY [ - L!or— ZIP NEAREST
CROSS ST.
CERTIFICATE OF EXEMPTION FROM RK S' NO.OF BLDGS. ASSESSOR
COMPENSATION INSURANCE IZE OF LOTNOW ON LOT MAPBOOK PAGE PARCEL
.(This section need not be completed if the permit is for one USE Zggq{{{JJJE MAP
hundred dollars($100)or less.) RACT BLOCK I LOT NO. NO.
J TEL. SPECIAL }
I certify that in the performance of the work for which this OWNER 12- /Z e17&NO. CONDITIONS 0.
permit is issued, I shall not employ any person in any manner DISTRICT UP TYPE FIRE I PR r-ESSED BY O
so as to become subject to the Workers'Compensation Laws. ADDRESS %AsYX CONST. , ZONE U
Date Applicant CITY ZIP STATISTICAL CLASSIFI TION APT.4rNDO. U
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 d
Compensation provisions of the Labor Code,.you must forth- ADDRESS SEWER MAP
with comply with such provisions or this permit shall be TEL VALIDATION
• deemed revoked. CONTRACTOR j/(�f�z/'9�_ ��7N� . NO. %3/°I Al BK. PG,
LICENSED CONTRACTORS DECLARATION -7 �y /
I hereby affirm that I am licensed under provisions of Chapter 9 ADDRE 16 & vN(b �/t VALUATION
(commencing with Section 7000)of Division 3 of the Business and U
Professions Code, and my license is in full force and effect. CI f>S'rr'/rJ/�r/9� CLASS ep-33 $ ,
�y SQ.FT. p NO.OF ' NO.OF CHECK
License Number ' "J Lic.Class SIZE STORIES FAMILIES ` ONE
G� DESCRIPTION OF WORK /tc�� NEW $
Contractor���,i'�J�J /�/•/ �. Dote •/
I am exempt under Sec. �f( L H� ADD
ALTER FINAL
B.&P.C. for this reason REPAIR
DATE
USE OF FIN
Date: EXISTING BLDG. i• DEMOL B
SignaturE{ APPLICANT TEL. /
OWNER4: ILDE DECLARATION PRINT 1 NO.
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and ADDRESS 110. c 7 IL 8'A
Professions Code): PRESENT
❑ BUILDING
I, as owner of the property, or my employees with ADDRESS
t o 0 0 0 0,�
wages as their sole compensation,will do the work and
the structure is not intended or offered for sale(Section LOCALITY o 1 2 4,8 8
7044, Business and Professions Code). MOVING TEL.
1, as owner of the property,am exclusively contracting CONTRACTOR NO. o 0 12 4.8 8 5
with licensed contractors to construct the project (Sec- ADDRESS
tion 7044, Business and Professions Code). 9,23-88
REQUIRED TOTAL SETBACK FROM EXIST.
CONSTRUCTION LENDING AGENCY SET BACK YARD HWY PROP. LINE WIDTH
1 hereby affirm that there is a construction lending agency for FRONT
the performance of the work for which this permit is issued P.L.
tSec. 3097, Civ. C.). SIDE +
P.L.
Lender's Name
a P.C. Fee$ Permit Fee
Lender's Address
rI certify that I have read this application and state that the Issuance Fee J0
above information is correct. I agree to comply with all County Investigation Fee
3 ordinances and State laws relating to building construction, Total Fee
9 and hereby authorize representatives of this County to enter
upon t above-mentioned prg erfy for i spection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign e o LA¢ icon t or Agent Date ®s
" COUNTY OF LOS ANGELES TEMPLE CITY # 0508 BUILDING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ALTERATION/REPAIR I
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 BL 0508 1209270110 " ,�r
PHONE: (626) 285-0488 EXT:
[LEGAL ID: I NO. OF CONST I BUILDING ADDRESS: I
]TR: 27309 LT: 12 [ SQ. FT STORIES TYPE [ 10240 RANDWICK DR I
[ ISTRUCTURE: 2500 V-B I TEMP CA 917803351 I
[ASSESSOR INFORMATION NUMBER: I [ NEAREST CROSS STREET: [
18585-004-039 1 1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
ITENANT: EXIST BLDG USE: REISD USE ZONE: R-1 ISSUED ON: PROCESSED BY:
1 1EXIST OCC GRP: 109/27/12 SR
[OWNER: TEL. NO: 1BLDGS. NOW ON IAT: VALUATION: [FINAL DATE FINAL BY: CODE: [
110 SHANA (626) 242-8542- I 1 5,000 I � Z 1
[10240 RANDWICK DR [ [ [
ITEMP 917803351 [ FEES PAID [ ESCRIP ION OF WORK [
1 [KITCHEN AND 2 BATHROOMS REMODEL
[FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[
[APPLICANT: TEL. N0:
ISAME AS OWNER - [AA BLDG PERMIT ISSUANCE 27.80 I I
1 JAB STATE GREEN BLDG FEE 5000.00 VAL 1.00 [SPECIAL CONDITIONS: [
[ ]AC STRONG MOTION RESID 5000.00 VAL 0.50 I [
[ JB2 PERMIT W/ENERGY 5000.00 VAL 145.90
1 JFR INV WORK W/O PERMIT 342.50 DOL 342.50 [ I
[CONTRACTOR: TEL. NO: I TOTAL FEES 517.70 [APPROVALS DATE INSPECTOR SIGNATURE I
ISAME AS OWNER - I I 1
LIC. NO [ [LOCATION AND SETBACKS [ [ I
1 (SOILS ENGINEER APPROVAL [ I
[ARCHITECT OR ENGINEER: TEL. NO: [ IFOUNDATION/TRENCH FORMS I I [
LIC. NO: 1 (SLAB/UNDER FLOOR [ [ I
I I IRAISED FLOOR FRAMING [ [ [
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:[ 1UNDERFLOOR INSULATION [ [ [
1147H273 3 001 1 I 1 1
I IFLOOR SHEATHING 1
INO. OF FAMILIES: DWE LO
ING UNITS: APT/COND: STAT CLASS: I I I [ I
21 1 IROOF SHEATHING 1 [ 1
SCHOOL WITHIN HAZARDOUS ISHEAR PANELS I I [
]AIR QUALITY: 1000 FEET MATERIALS 1 I II
NO NO NO I IFRAME INSPECTION 1 1
1 1 IFIRE SPRINKLER HANGERS [ 1 1
1 ] IINSULATION/WEATHER STRIPI I 1
I ] IINTERIOR LATH/DRYWALL [ I I
1 1 [EXTERIOR LATH 1 1 1
[ IRATED FLOOR/CEIL ASSEM. [ [ [
[ IRATED WALL ASSEMBLIES
1 IRATED SHAFTS/OPENINGS
1
1 IT-BAR CEILINGS 1 1
I 1LOT DRAINAGE [ [ I
I I I
1 IREPORT ID: DPR261 ROUTE TO: ES0508 1 1 1 1
I I I I I 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 1207200028
PHONE: (626) 285-0488 EXT:
ILEGAL ID: DING ADDRESS:
I NO. OF CONST
ITR: 27309 LT: 12 I SQ. FT STORIES TYPE I B10240 UILI
WICK DR
I ISTRUCTURE: 2500 V-B I TEMP CA 99/7803351
(ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: 1
18585-004-039 1 1 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI
I
TENANT: EXIST BLDG USE: REISD USE ZONE: R-1 (ISSUED ON: PROCESSED BY: I
(EXIST OCC GRP: 107/20/12 SR 1
(OWNER: TEL. NO: JBLDGS. NOW ON LOT: VALUATION: FINAL DATE FI�AL BY: CODE: J
ICHAO, SHANA (626) 242-8542- 1 1 7,000
110240 RANDWICK DR I I aqs-f�- 1
ITEMP 917803351 I FEES PAID JISCRIPTION OF WORK 1
I 1 ITEAR OFF EXISTING ROOF, COVER IIP 1/2" PLYWOOD AND 30 YEAR 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:ICOMPOSITION SHINGLE. HOUSE AND ATTACHED GARAGE. J
(APPLICANT: TEL. NO: J
IFUNGS CONSTRUCTION COMPANY (626) 625-7048- IAA BLDG PERMIT ISSUANCE 27.80 1 I
437 W WELLS ST JAB STATE GREEN BLDG FEE 7000.00 VAL 1.00 ISPECIAL CONDITIONS: 1
SAN GABRIEL CA 91773 AC STRONG MOTION RESID 7000.00 VAL 0.70 J I
1 iD2 PERMIT W/O EN-HC 7000.00 166.20
TOTAL FEES VAL 195.70 J
ICONTRACTOR: TEL. NO: I JA��S���DATE INSPECTOR SIGNATURE INSPECTOR SIGNATURE J
IFUNG S CONSTRUCTION CO. (626) 625-7043- 1_
1439 W. WELLS LIC. NO [ ILOCATION AND SETBACKS I I I
[SAN GABRIEL CA 91775 753441 B
1 1 ISOILS ENGINEER APPROVAL I I
1ARCHITECT OR ENGINEER: TEL. NO: - 1 IFOUNDATION/TRENCH FORMS I I I
LIC. NO: I ISLP-1/UNDER FLOOR I I I
I IRAISED FLOOR FRAMING I I
IMAP NO: SEWER MAP BOOK: PAGE: FIRE ZONE: CMP:I JUNDERFLOOR INSULATION I I I
1147H273 3 001 1 [ 1 I
I I IFLOOR SHEATHING
1
INO. OF FAMILIES: DWELLING UNITS: APT/COND: STAT CLASS: I 0 NO 21-1 ROOF SHEATHING
I
1 SCHOOL WITHIN HAZARDOUS I ISHEAR PANELS
(AIR QUALITY: 1000 FEET MATERIALS I
1
1 NO NO NO 1 1FRAMUE INSPECTION 1 I
I I
I 1 IFIRE SPRINKLER HANGERS I I I
I 1 JINSCLiXTION/WEATHER STRI91 I I
JINTERIOR LATH/DRYWALL I I I
I 1EXTERIOR LATH 1 I I
IRATED FLOOR/CEIL ASSEM. I I I
II 1RATED WALL ASSEMBLIES 1 I I
1 1RATED SHAFTS/OPENINGS
I 1 1T-BAk CEILINGS
I I I
I 1 1LOT DRAINAGE 1 I I
I IREPORT ID: DPR261 ROUTE TO: BS0508